Final Exam Flashcards
what percent of the US population currently smokes cigarettes?
14% (34 million)
how many people die per year as a result of DIRECT tobacco use? what about INDIRECT tobacco use?
direct - 8 million
indirect - 1.2 million
what is the most common form of tobacco use worldwide? what are other forms of tobacco use?
most common - cigarette smoking
other - smokeless tobacco, cigars, pipe, bidis, and roll-your-own tobacco
disparity in tobacco use remains across groups defined by:
race, ethnicity, educational level/socioeconomic status, and regions of the country
8.2% of Hispanic adults in the US smoke cigarettes. Who are more likely to smoke cigarettes?
those born in the US
in the hospitality industry, who is the most exposed to secondhand smoke?
hispanics
who has the highest prevalence of cigarette smoking compared to other racial/ethnic groups in the US
american indians/alaskans
deaths attributed to smoking
pulmonary disease, cancer, or cardiovascular disease
what are the primary effects of smoking due to?
toxins and chemicals produced by burning of tobacco
what is the most effective mechanism to deliver nicotine to the brain?
inhalation thru the lungs
what are the nicotine addiction mechanisms?
- rewarding experience of smoking (dopamine release)
- increased tolerance and dependence of nicotine (leading to withdrawal symptoms)
- learnt experience of responding to situational and emotional triggers with smoking
what is the tobacco mechanism of action?
nicotine acts on dopaminergic receptors in ventral tegmental area, causing burst firing of dopamine neurons leading to drug reinforcement
increasing dopamine release from ventral tegmental area neurons contribute to addiction
what receptor does nicotine work thru? what part of brain works for drug reinforcement?
- works thru dopamine receptor
- midbrain plays pivotal role in drug reinforcement
dopamine reward pathway
nicotine enters brain > stim nicotine receptors > ventral ttegmental area > nucleus accumbens > prefrontal cortex
how can you approach tobacco cessation?
behavioral intervention or pharmacologic strategies
what is behavioral intervention?
- only 3-5% of smokers who quit on their own succeed
- intervention by HC professional combined with appropriate medication increases success of maintaining abstinent by 30%
- dentists can have significant impact on tobacco quit rates
how do pharmacological agents aid with tobacco cessation?
provides nicotine in various forms to lessen or relieve cravings
examples of pharmacological agents for tobacco cessation
- nicotine replacement therapy (NRT) - gum, lozenge, nicotine patch, inhaler, spray
- varenicline - decreases craving and withdrawal syndrome
- bupropion - antidepressant
how does NRT work
pure nicotine is administered, removes exposure to nitrosamines and toxins while behavior changes are made
by self-dosing, the user has control over amount of nicotine needed for cessation
OTC nicotine gum
doubles odds of successful cessation attempt
can lead to toxicity as many users use it like reg gum
OTC transdermal nicotine patch
- diffuse steady dose nicotine thru skin
- peaks about 4-8 hours, maintains for 15-24 hours
- milk skin irritation experienced
- insomnia may be side effect, so lower dose
prescription nicotine inhaler
- nicotine puffed into mouth where held and diffuse thru oral mucosa
- mimics smoking and meets smokers emotional need
- benefits highly addicted users, results in immediate dose of nicotine
- can cause local irritation and congestion
prescription varenicline - chantix
pill form stimulates nicotine receptors
12 weeks of therapy
prescription bupropion - wellbuttrin
antidepressant pill form
safe, doubles chances of quitting
contraindicated in seizure disorders, alcoholics, and eating disorders
adverse effects of pharmacological agents
agitation, depressed mood, and suicidal tendencies
smoking vs. vaping
smoking: created by open flame, very high temp, tobacco destroyed, produces harmful toxins, tar causes smell to linger, causes secondhand smoking
vaping: does not involve open flame, temp is much lower, liquid is vaporized, devoid of toxins, smell greatly reduced, no secondhand smoking
has any e-cigarette been approved as a cessation device or authorized to make a modified risk claim?
NO!
what is public health?
winslow: science and art of preventing disease, prolonging life, and promoting physical health and efficiency thru organized community efforts
IOM: fulfilling society’s interest in assuring conditions in which people can be healthy
three core PH functions
- assessment
- policy development
- assurance
what are 10 essential PH services?
- assess and monitor population health
- investigate, diagnose, and address health hazards and root causes
- comm. effectively to inform and educate
- strengthen, support, and mobilize communities and partnerships
- create, champion, and implement policies, plans and laws
- utilize legal and regulatory actions
- enable equitable access
- build a diverse and skilled workforce
- improve and innovate thru evaluation, research, and quality improvement
- build and maintain a strong organizational infrastructure for PH
what is dental public health
science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis”
what is a dental public health specialist (DPH)
- 1 of 9 dental specialties of ADA
- contributes to new knowledge, research, education and services that directly benefit different aspects of clinical pt care
what is clinical care
prevention, tx, and management of illness and preservation of mental and physical well being thru health care services
what is a determinant
factor that contributes to generation of a trait
what is a health outcome
result of a medical condition that directly affects the length or quality of person’s life
what is population health
approach to health that aims to improve health of entire population
what is prevention
action to avoid, forestall, or circumvent a happening, conclusion or phenomenon (e.g. disease)
what is intervention
action or ministration that produces an effect or is intended to alter course of pathological process
what is a target population
group of individuals that the intervention intends to conduct research in and draw conclusions from
why is oral health important
oral health is a key indicator of overall health, well-being and quality of life
what are the core elements of oral health
- disease and condition status
- physiological function
- psycho-social function
core element: disease and condition status
refers to threshold of severity or level of progression of disease which also includes pain and discomfort
core element: physiological function
refers to capacity to reform a set of actions (e.g. speak, smile, chew, and swallow)
core element: psychosocial function
relationship btwn oral health and mental state (e.g. capacity to speak, smile, and interact in social and work situations w/o feeling uncomfortable or embarrassed)
definition moderating factors for oral health
elements that determine or affect how a person scores their oral health
5 main factors that affect oral health
- genetic and biological factors
- social environment
- physical environment
- health behaviors
- access to care
what are SDOH
conditions in the environments where people are born, live, learn, work, play, worship and age that affect wide range of health, functioning, and quality of life outcomes and risks
Social determinants of health
5 domains of SDOH
- economic stability
- education access and quality
- health care access and quality
- neighborhood and built environment
- social and community context
what percent of caries is pit and fissure caries
85%
where are sealants mostly underused
among those at high risk of experiencing caries; children in lower-income and certain racial and ethnic groups
unsealed molars are ___ more likely than sealed molars to receive a caries related service
3x
what group of people should you consider sealants for prevention where there is non lesion but tooth or individual is at risk? which teeth?
children - permanent teeth
adolescents - permanent teeth
what group of people should you consider sealants to limit progression in early non-cavitated lesions? which teeth?
children - all teeth
adolescents - all teeth
young adults - all teeth
sealant indications
- occlusal fissures, pits, and fossa
- lingual pit on incisors and molars
- buccal pits of molars
- anywhere a pit of fissure is deep
when in doubt, seal and monitor
dental sealant placement step by step
- tooth is cleaned and dried
- etching solution applied
- liquid sealant applied
- curing light hardens
where do majority of carious of lesions occur
pits and fissures
what is highly effective when placed over pits and fissures of occlusal, buccal and lingual pits and grooves?
sealants in both primary and permanent teeth
sealants reduce caries up to __%
90%
fluorides are highly effective in reducing number of carious lesions where?
on smooth surfaces of enamel and cementum are arrested and remineralized with fluoride
e.g. proximal surfaces (not equally effective in protecting the occlusal pits and fissures like sealants)
what is a sealant
- liquid resin commonly placed over occlusal surface of the tooth with a pit or fissure that cannot be cleaned with toothbrush
- hard resin is a barrier between tooth and bacteria
- sealing reduces Streptococcus mutans because their habitat is drastically reduced
a one time dental sealant program will decrease caries by __% after 4 years
59%
sealants thru school-based programs are effective and saves more than $11 in tx costs for each tooth
what is an enameloplasty? goals of treatment?
modifying enamel with a bur, more of a treatment procedure than a preventative approach
goals: limit outline form of prep and limit cutting enamel
prophylactic odontomy
early insertion of small restorations in deep pits and fissures before carious lesions had the opportunity to develop
not used anymore- sealants used instead
the do nothing or wait and watch approach violates what principle?
ethical principle of non maleficence, which means to do no harm
sealants more used with what?
with the development of Bis-GMA, UDMA, and TEGDMA
Bis-GMA resin
resin that is the most frequently applied sealant
mixture of Bis-GMA and methyl methacrylate
BPA may be a biproduct
BPA
Bisphenol A - a plastic found in many products that mimic estrogen
blamed for low sperm counts in males and cancer in females
however, amounts of BPA that could be ingested within 24-hour period do not exceed established human exposure limits
filled vs. unfilled sealants
filled - contain microscopic glass beads, quartz particles, and other fillers used in composite resins. coated with products such as silane to facilitate combination with Bis-GMA. more resistant to abrasion and wear
unfilled - more quickly to wear but usually do not need occlusal adjustment
resin matrix + filler (coated with silane) = ?
resin composite/filled sealant
sealants methods of polymerization
light cured with used of visible blue light OR chemical cured (monomer and catalyst are mixed together to induce polymerization without use of light source)
polymerization catalysts
light cured: camphoroquinone
self cured: benzoyl peroxide
which generation of sealants first used visible blue light?
3rd generation
atraumatic restorative technique aka interim therapeutic restoration
removal of soft/demineralized tooth tissue using a hand instrument alone
sealant retention
- resin sealants are retained better on recently erupted teeth than on teeth with a more mature surface
- retained better on first molars than on second molars and on mandibular than maxillary
criteria for selecting teeth for sealant placement
well isolated on fully erupted fossa
teeth on opposite sides of the arches
incipient lesions exist in pit and fissure area