Ch 20 Flashcards
what is the goal of oral hygiene
- to keep biofilms below threshold levels for periodontal disease through
- home care procedures
- mechanical debridement
- supragingival plaque control contributes to preventing or moderating subgingival microbial recolonization
what is oral hygiene self-care
- physical therapy for the mouth or oral cavity
- suppression of harmful microorganisms
- supragingival biofilms
- plaque (biofilm) control prevents potential detrimental effects of pathogens on the periodontium
what are preventive measures
- primary goal of prevention is to achieve the lowest plaque (biofilm) level as possible
- total elimination of oral bacteria is not possible nor desirable
- oral cavity is not sterile
- beneficial (good) bacteria
what is primary prevention
- preventive measures taken to prevent disease from occuring
what is secondary prevention
- preventive measure taken to prevent the disease from progressing further
- or prevent the recurrence of the disease after treatment
what is tertiary prevention/treatment
- restorative (surgery)
what is halitosis and what causes
- common complaint among patients: high percent of population, some over 50%
- etiology: poor oral hygiene, local factors, systemic factors
- majority of cases oral malodor originates from oral cavity: gram-negative, anaerobic bacteria
what are the compounds producing malodor in halitosis
volatile sulfur compounds (VSC) – (hydrogen sulfide, methylmercaptan, dimethyl sulfide)
- arise from bacterial metabolism (degrades) of sulfur containing amino acids
- intensity of malodor is associated with amount of VSC
- as is dorsum of tongue
- VSC also accelerate periodontal tissue destruction
- GI conditions: possible cause, more rare
- sinue/ENT: possible, require referral
oral conditions that may cause bad breath
- periodontal pockets
- xerostomia (dryness of mouth)
- carious lesions
- bacterial biofilms
- interdental areas debris
- spaces between papillae of the tongue
- poor restorations
- calculus
- erupting wisdom teeth (pericoronitis)
- remaining roots
- gangrenous pulps (necrosed pulp tissue)
- NUG
what are the 3 categories of halitosis
- genuine halitosis: physiological halitosis (tongue main origin), pathologic halitosis (subclassified as oral path and extraoral pathologic halitosis)
- pseudo-halitosis: pte thinks they have bad breath. psychosomatic condition
- halitophobia: psychosomatic condition
how can we diagnose and assess oral malodor
- self-assessment: unable to smell ones own malodor
- gas chromatography: specific sulfur detector, gold standard for oral malodor measurement
- halimeter: significantly influenced by other oral gases such as chewing gum, smoking, etc
- simple determination of oral malodor: spoon test
- psychological assessment: halitophobia, psychosomatic condition, questionnaires
- tongue sulfide probe: sulfide level on the dorsum of the tongue, probe applied to different parts of the tongue, voltage proportional to concentration of sulfide ions present
- organoleptic measurement: natural smelling, good for dental practitioners
what are the scores on the organoleptic scoring scale
0: absence of odor: detectable odor is completely absent
1: questionable: odor is detectable, although a judge could not recognize it as malodor. this is defined as the detection threshold
2: slight malodor: odor is deemed to exceed the threshold of malodor recognition. this is defined as the recognition threshold
3: moderate malodor: malodor is definitely detected
4: strong malodor: strong malodor, but examiner can tolerate
5: severe malodor: overwhelming malodor. examiner cannot tolerate malodor at this level (the examiner instinctively averts the nose)
what is a diamond probe
- sensors are integrated into the periodontal probe
- probe is placed into the periodontal pocket or tongue
- electrical control unit and disposable sensor tip that combines a standard michigan 0 styled dental probe with a sulphide sensor which responds to the sulfides present in the periodontal pocket
what are the treatment needs (tn) for breath odor
- tn-1: explanation of halitosis and instruction for oral hygiene. support and reinforcement of the patient’s self-care for further improvement of his or her oral hygiene
- tn-2: oral prophylaxis, professional cleaning, and treatment for oral diseases, especially periodontal disease
- tn-3: referral to a physician or medical specialist
- tn-4: explanation of examination data further professional instruction, education and reassurance for improvement
- tn-5: referral to a clinical psychologist, psychiatrist, or other psychological specialist
- tn-1 is applicable to all ases requiring tn-2 - tn-5
treatment of oral malodor: physiological halitosis
- based on treatment needs (TN):
- tongue cleaning: physiologic halitosis (tn-1), reduces VSCs, brushing preferred over scraping?
- oral hygiene and mouth rinses: mechanical reduction of bacteria, included in tn-1, different options (zinc – breath prescription)
- toothpastes/rinses: triclosan containing pastes (colgate total, arm&hammer), may reduce certain amounts of VSCs
- chewing gum: 70% patients with halitosis use gum (sugar may reduce VSCs), sugarless gum masks halitosis
- periodontal and restorative treatment: periodontal treatment required as tn-2, treat xerostomia, caries may cause malodor
treatment of oral malodor: pseudo-halitosis
- requires tn-3, tn-4 and/or tn-5
- referral to physician
- a treated patient may not believe their halitosis was treated and thinks it still exists
