Adult Oral Health Flashcards
(36 cards)
Risk Factors for Adult Caries
- High bacterial counts
- Family history of caries
- Frequent consumption of sugar-containing foods and beverages
- Inadequate fluoride
- Poor oral hygiene practices and behaviors
- Low socioeconomic status
- Physical Disabilities (make brushing/oral hygiene more difficulty)
- existing resorations or applicances
- decreased salivary flow/meds
Root Caries Etiologies/Preventive Measures/Treatment
Etiology
* In the presence of caries-causing bacteria and a diet high in sugars, caries can develop easily and progress rapidly.
* Roots do not have protective enamel like crowns of teeth, so caries progresses rapidly in the roots.
Preventive Measures & Treatment
* Regular dental visits to remove plaque accumulation and reinforce appropriate home care.
* Lesions can be prevented or arrested using fluoride containing toothpaste, fluoride gels, varnish, or silver diamine fluoride.
* Chlorhexidine-Thymol varnish 1:1 mixture of may be efficacious in prevention of root caries.
* Sucrose-free chewing gum containing xylitol only or xylitol lozenges may be used as adjunctive therapy for adults at higher risk of caries.
* Advanced lesions require restoration or extraction.
Gingivitis Sx/Etiology/Preventive Measures/Tx
Gingivitis is characterized by inflammation of the gingiva without destruction of the periodontal ligament or bone, which distinguishes it from periodontitis.
Symptoms
* Mild gum swelling
* Tenderness
* Erythema
* Bleeding gums when brushing
* Bad breath or bad taste in the mouth
Etiology
* Bacteria and food residue (plaque) stick to teeth near the gumline and cause irritation and inflammation of the gums
* Changes in hormone levels as a result of puberty, pregnancy, and diabetes can modify the gingival response to plaque, resulting in increased gingivitis
* Oral foreign bodies such as popcorn kernels are a frequent culprit in acute gum inflammation
Preventive Measures & Treatment
* Effective brushing and flossing
* Regular dental visits to remove plaque accumulation and reinforce appropriate home care
Periodontitis Etiology/Preventive Measures/Tx
Periodontitis is the leading cause of tooth loss in adults. 45% of all adults are affected to some degree.
Etiology
Chronic exposure of the periodontal tissues to bacterial plaque causes a chronic inflammation leading to:
* Destruction of the periodontal ligament, loss of supporting bone, tooth loosening, and eventual tooth loss. Bone loss can be halted, but not reversed.
* Smoking, diabetes, HIV, pregnancy, and poor oral hygiene all contribute to the development of periodontitis.
* Some forms of periodontitis are genetic. Individual risk is affected by many factors.
Preventive Measures & Treatment
* Effective brushing and flossing, possible referral to periodontist.
* Cessation of tobacco use.
* Dental referral for deep root scaling (cleaning below the gum surface).
* Initial dental therapy may be nonsurgical, such as deep root scaling (cleaning below the gum surface) and application of local chemotherapeutic agents (e.g. chlorhexidine).
* Moderate to severe periodontitis treatment may include surgical procedures.
Teeth Changes with Age
With age, teeth become more yellow due to thinning enamel and dentin showing through.
Teeth also become stained and begin to wear down, a process known as attrition.
Losing teeth is not a normal part of aging. With access to dental care, older adults can keep their teeth throughout their lives.
Tooth Loss
Negative Impacts of Tooth Loss
* Difficulty eating
* Inadequate nutritional intake
* Dissatisfaction with facial appearance
Dentures, while not nearly as good as original teeth, can significantly improve quality of life by:
* Providing support and increasing the vertical dimension of the mouth
* Improving appearance
* Making eating easier
Tooth loss is very common in the elderly:
* 30% of elderly have untreated caries
* 25% have lost tooth-supporting structures due to periodontal disease
* Adults over age 65 have an average of 18 remaining teeth
* 25% are completely edentulous
* Medicare does not offer a dental benefit
Preventive Steps
Preventive Steps
* Brush and floss regularly
* Avoid frequent snacking on sugary foods, as this increases the acidity of the mouth and accelerates decay
* Use fluoride toothpaste
* Avoid alcohol and tobacco
* Minimize medications with oral effects
* Visit dentist regularly
Brushing & Flossing Techniques
* Brush at least twice a day
* Use a soft toothbrush and focus on the area where the tooth meets the gingiva
* Manual and electric toothbrushes produce comparable oral hygiene results, so the choice should be based on personal preference
* Flossing helps disrupt the formation of plaque below the gum line and between the teeth
* Water flossers and Super Floss(R) are as effective as regular floss for plaque removal. They can be used as an alternative for people with dental appliances, or people with dexterity issues
Oral Effects of Meds
- Gingival Hyperplasia: anticonvulsants, methotrexate, cyclosporin, CCBs
- Dental Erosions (due to GERD): progesterone, nitrates, BBs, CCBs
- Dental Caries: sugar containing preps, xerostomia
- Osteonecrosis: bisphosphonates (jaw pain, swelling, infection, loose teeth, pathologic fxs)
Gingival Hyperplasia sx/etiology/preventive measures/ tx
Gingival hyperplasia can be associated with poor oral hygiene, underlying systemic disease, or as a medication side effect. Oral hygiene may be impaired by developmental disability or poor manual dexterity as a result of stroke, osteoarthritis of the hands, or Alzheimer’s disease or other dementia.
Symptoms
* Gums or teeth have unsightly gingival enlargement.
* Teeth become hard to clean which puts patients at risk for periodontal disease.
* Periodontitis may occur particularly where there is concurrent gingival inflammation, untreated dental plaque, and poor oral hygiene.
Etiology
* Poor oral hygiene practices
* Drug induced (Phenytoin, Methotrexate, Cyclosporin, Calcium channel blockers)
* Underlying systemic disease (e.g. leukemia) and conditions (e.g. pregnancy)
Preventive Measures & Treatment
* Meticulous oral hygiene
* Regular professional cleanings
* May require gum resection surgery
* Alternative medications may need to be consider
Dental Erosion Sx/Etiology/Preventives
Dental erosion occurs when gastric acid erodes dentin and enamel. Patients with bulimia and severe GERD are at great risk for enamel erosions, even at very young ages.
Symptoms
* Teeth become smooth and glassy.
* Pulp exposure causes hot and cold sensitivity.
Etiology
* Bulimia
* Severe gastroesophageal reflux (GERD)
* Acidic drinks
* Medication effects
Preventive Measures
* Rinse with water after reflux or vomiting.
* Do not brush teeth immediately after reflux or vomiting as this may further hasten enamel erosion.
Xerostomia Sx/Etiology/Preventives
Symptoms
* Dry mouth
* Changes in taste
* Burning sensation
* Difficulty swallowing and speaking
* Increased caries risk
Etiology
* Medications that can cause xerostomia include: Antihypertensives, Protease inhibitors, Antidepressants, Diuretics, Antihistamines, Others
* Polypharmacy (multiple medication regimen) heightens risk for xerostomia more than a single drug effect.
* Systemic disease and treatment consequences that can lead to this condition include: Sjögren’s syndrome, Head and neck radiation therapy
* Although geriatric patients are likely to have xerostomia, this is not due to aging per se, but instead medications and disease.
Preventive Measures & Treatment
* Change or eliminate medications known to decrease salivary flow.
* Encourage patients to drink water, and avoid alcohol as well as caffeinated or sugary drinks.
* Promote chewing of sugarless gums or candies to induce salivation.
* Recommend use of high concentration topical fluoride products to reduce caries.
* Encourage excellent oral hygiene.
* Ensure regular dental care.
* Recommend use of over-the-counter salivary substitutes for temporary relief. (Be aware they require frequent reapplication.)
* Suggest medications such as pilocarpine hydrochloride (Salagen) and cevimeline hydrochloride (Evoxac). These may be particularly helpful in patients with Sjögren’s syndrome, although side effects are common
Illicit Drugs
Alcohol, tobacco, and cannabis use cause oral problems through direct contact, altered immune response, poor blood flow, carcinogenesis, teratogenesis, and accidental trauma. In the case of oral cancers, the effects may be additive when more than one substance is used.
Effects of Tobacco Use
* Tooth stains
* Altered taste and smell
* Periodontitis
* Xerostomia
* Caries
* Oral, head, and neck cancers
* Congenital anomalies in offspring, such as cleft lip and palate
Effects of Alcohol Use
* Periodontitis
* Xerostomia
* Caries
* Oral and throat cancers
* Fetal alcohol syndrome and effects in offspring.
* Congenital anomalies in offspring, such as cleft lip and palate
Effects of Cannabis Use
* Dental caries
* Increased oral infections
* Xerostomia
* Dysplastic changes and premalignant oral lesions (literature is unclear if cannabis has a direct carcinogenic effect)
* Increase in oral infections (possibly from mild immune suppression effect of marijuana)
Substance Use Disorders
Substance use can result in severe oral consequences, some of which are depicted below.
Rapid onset oral devastation is mainly a problem of teens and young adults. Up to 5% of the 12-to-40-year old population report having used methamphetamines.
Research has shown that behavioral factors, such as smoking, consuming sugary beverages, and poor oral hygiene, are more important than direct drug effects.
Symptoms
* Rampant caries, gingival recession, and dental erosion in a young person
* Involves the buccal smooth surfaces, anterior teeth, and gums
* Often accompanied by behavioral changes and sometimes weight loss
Substance use leads to:
* Drug induced xerostomia
* Poor hygiene
* Increased carbohydrate and carbonated beverage consumption
* Teeth grinding
* Direct acid effect of the drug
Treatment
* Dental/oral surgery referral and behavioral health referral
Herpes Labialis
Herpes labialis, also known as cold sores, is caused by a reactivation of a latent viral infection.
Symptoms
* Burning, itching, or pain 12–36 hours before eruption
* Vesicles rupture, ulcerate, and crust within 48 hours
Treatment
* Administer topical or systemic antiviral agents, either prophylactically, abortively, or for a full course of treatment.
* Topical 1% pencyclovir cream may help speed healing and reduce pain even if started after the prodrome.
* Oral medications should be initiated during the prodrome to be effective.
* Consider prophylactic antiviral prescription for recurrent outbreaks.
Pyogenic Granuloma
Pyogenic granuloma is a rapidly growing, tumor-like lesion that develops as a response to local irritation (e.g., poor hygiene or overhanging restorations) or trauma. Altered hormonal levels in pregnancy increase the incidence and severity of this condition.
Symptoms
* An erythematous, nonpainful, smooth, or lobulated mass that often bleeds when touched
* Usually develops on the gingiva, but less common locations include the lip, tongue, or buccal mucosa
* May be a few millimeters to several centimeters in diameter
Treatment
* Observation and conservative surgical excision are both options
* Recurrence is uncommon unless the lesion is incompletely removed or the source of irritation remains.
* Lesions excised during pregnancy recur more frequently.
Oral Ulcerations
Oral ulcerations may be of unknown etiology (aphthous), or associated with a variety of viral or bacterial infections, or in rare instances, drug reactions. In this module, we will address only aphthous ulcers in detail.
Aphthous Stomatitis
- Recurrent aphthous stomatitis (RAS), also known as “canker sores,” is an oral ulcerative condition. Although a variety of host and environmental factors have been implicated, including trauma, nutritional deficiencies, and autoimmunity, the precise etiology remains unknown.
- 3 Types: minor (< 7 mm diameter; heal in 10-14 days w/out scarring), Major (>7 mm diameter; may take longer to heal w/ scarring), herpetiform
Symptoms
* Recurring, painful, solitary, or multiple ulcers
* Typically covered by a white to yellow pseudomembrane surrounded by an erythematous halo
* Usually involves nonkeratinizing mucosa (e.g., labial mucosa, buccal mucosa, and ventral tongue)
Preventive Measure/Tx
* Most mild aphthae require no treatment.
* Application of benzocaine paste or gel (Orabase (R)), with or without topical steriods can be used for symptomatic relief.
* Topical treatment with corticosteroids, such as fluocinonide gel or dexamethasone elixir, can promote healing and lessen severity.
* Steroid injection of ulcers or systemic therapy with thalidomide, colchicine, pentoxifylline, or azathioprine may be necessary in severe cases of major aphthae.
* Avoiding trigger foods or sodium lauryl sulfate in toothpaste can help reduce recurrences.
* Celiac disease should be considered in patients with recurrent aphthous ulcers or stomatitis.
Geographic Tongue
Geographic tongue, also known as Erythema Migrans or benign migratory glossitis, is of uncertain etiology. Areas of erythema with discrete white borders appear due to atrophy of the filiform papillae. Usually seen on the dorsal surface of the tongue, but other oral sites such as the buccal mucosa may be involved. Geographic tongue is associated with fissured tongue.
Symptoms
* pain/burning (esp w/ spicy foods)
* often asx
* waxes/wanes
Tx
* Normal variant, reassurance only
* Typically no treatment is required.
* Topical steroid gels and antihistamine mouth rinses (e.g., diphenhydramine elixir) can reduce tongue sensitivity.
Hairy Tongue
Hairy tongue is an elongation and hypertrophy of filiform papillae. It should not be confused with oral hairy leukoplakia, a viral condition seen in immunocompromised patients. It is associated with tobacco use, poor oral hygiene, and antibiotic use.
Symptoms
* Most patients are asymptomatic.
* Some patients may experience halitosis or altered taste.
Preventive Measures
* Improves with avoidance of tobacco, mouthwashes, and antibiotics.
* Regular tongue brushing with soft toothbrush or tongue scraper may help.
Fissured Tongue
Fissured tongue is considered a variant of normal; however, frequency increases with age and xerostomia. It may develop in association with infection, malnutrition, or spontaneously, and is inherited in an autosomal dominant fashion with incomplete penetrance. It can also be associated with Down syndrome, psoriasis, and Sjögren syndrome.
Symptoms
* Fissured tongue usually causes no symptoms.
* Number, depth, and direction of the fissures varies considerably.
* Food debris may lodge between the fissures leading to halitosis and rarely irritation.
* Ten to twenty percent of people with fissured tongue also have geographic tongue.
Preventive Measures
* Tongue brushing is important to remove food trapped in fissures
Bony Tori
Tori are benign bony protuberances arising from the cortical plate. They are considered developmental anomalies that are present throughout life, but they often increase in size in adulthood. In the United States, the prevalence of palatal tori is 20-35% of the population, compared to 7-10% for mandibular tori.
Treatment
* Surgical removal is required only if a torus: Affects oral function, Interferes with denture fabrication, Is subject to recurrent trauma or surface ulceration
Candidiasis
Oral candidiasis can exhibit a variety of clinical patterns, and is most commonly seen in newborns or the immunocompromised.
- Pseudomembranous Candidiasis: Often referred to as thrush, it is the most common form and may present with a burning sensation.
Other forms of candidiasis:
* Median rhomboid glossitis presents as a well-demarcated, roughly symmetric, red lesion on the midline of the posterior dorsal tongue. It is three times more common in men than women. Causes no symptoms.
* Erythematous candidiasis, also called denture stomatitis, causes localized or generalized red, flat lesions accompanied by a burning sensation. This may result from poor cleansing of dentures and leaving dentures in at bedtime.
* Angular cheilitis, often associated with candidal and staphylococcal infections, is commonly seen in denture wearers.
* Smoking, diabetes, HIV infection, pregnancy, and poor oral hygiene can all contribute to the development of candidiasis.
Treatment:
* Administer topical or systemic antifungal agents.
* If dentures are involved, ensure they are removed at night, properly cleaned, and soaked in liquid antifungal medication.
* New dentures may be needed to improve fit or increase the vertical dimension of the mouth to prevent recurrence.
* In cases of angular cheilitis unresponsive to topical antifungals, topical antibiotics may be needed to cover for staph.
Denture Complications
People with dentures often have problems with fit and comfort. Dentures should be replaced every 7-10 years due to bony changes over time.
Clinicians should:
* Remove dentures when performing oral exams to visualize the tissues beneath.
* Counsel patients on proper denture care to avoid complications such as denture sores, mucositis, and denture stomatitis (erythematous candidiasis).
Denture care:
* Remove dentures at night.
* Brush with denture brush or soft toothbrush to remove debris. Denture paste or mild dish soap can be used.
* Place dentures in denture cleanser soaking solution or in water overnight. Rinse thoroughly before replacing in mouth.
* Be aware that some people will require a caregiver to manage this aspect of their oral hygiene
