Oral care Flashcards
What is the most common childhood condition
dental caries
When do wisdom teeth appear
between ages 17 - 21
What is the order of the teeth in the permanent dentition
central incisor (4) lateral incisor (4) cuspids/canines (4) premolars/bicuspids (8) molars (12)
What is the most common site of dental caries
molars
pits and fissures harbor cariogenic bacteria
how many teeth do adults have
28 +/- 4 wisdom teeth (third molars)
What is the function of incisors
bite off pieces of food
function of cuspids
sharp - cut food when you bite
functions of premolars
large and strong - crush and grind food
function of molars
grinding and chewing food
What is the anatomy of a tooth
Crown (above gums) and root (below)
Enamel -> Dentin -> pulp
What is saliva
alkaline, slightly viscous, clear secretion containing enzymes, albumin, epithelial mucin, immunoglobulin, leukocytes, and minerals (Ca+, phosphate, fluoride ions)
what are the 3 salivary glands
parotid
sublingual
submandibular
what is the function of saliva
- Maintain neutral oral pH
- Tooth remineralization, cleansing and shielding
- Mouth lubrication
- Local antimicrobial activity
- Assists in taste, speech, chewing, swallowing, digestion and nutrition
What happens without saliva
- risk of bacterial/fungal infections
- certain medications will not work
- gum disease more common
- dry mouth
how much saliva is produced per day
500 mL
What is dental plaque (“biofilm”)
- gelatinous deposit (aerobic & anaerobic bacteria) adherent to the tooth surfaces, fillings or dental prostheses
- begins to calcify if not removed within 24 hours
- Buildup is directly related to incidence of oral disease
What are the 2 types of dental plaques
Supragingival - white to yellow, can remove at home within 48 hours
Subgingival - can only be removed by professional cleaning
What is dental calculus (“tartar”)
- The calcification of existing plaque deposits on the teeth or any other hard surface in the mouth
- Dental plaque presence is a prerequisite for calculus
What are the types of dental calculus
supragingival - Yellowish colour that may be darkened by dietary or exogenous pigmentation (coffee, tea, red wine, nicotine)
subgingival - dark colour and is very adherent to the cementum of the tooth
How do bacteria lead to dental caries
- bacteria metabolize carbs from diet to produce lactic acid
- acid demineralizes tooth surface (due to lower pH)
- saliva remineralizes
- over time, saliva cannot keep up
What is the process of dental caries formation
- enamel demineralization
- extension of demineralized zone into dentin (+ bacterial invasion)
- collapse of surface layer to form cavity
- spread of caries lesion causing pulpits - (requires filling)
- extension of pulpits into apex (apical abscess) - (requires surgery)
What are risk factors for dental caries
Patients with:
- Poor oral hygiene
- Orthodontic appliances
- Xerostomia
- Gum tissue recession that exposes root surfaces
Other Predisposing Factors:
- Tobacco products
- Alcohol
- Certain medications
- Head and neck radiation
- Consumption of cariogenic foods
Goals of treatment
- Protect & strengthen tooth structure
- Reduce the amount of substrate available to the bacteria (by modification of diet)
- Remove plaque and calculus regularly
How to modify diet to prevent plaque
- Avoidance of cariogenic foods (>15% sugar)
- Limiting sucrose
- Sugarless gum (stimulates salivary flow)
- Limit carbs that can be metabolized by bacteria
How to prevent oral bacteria
Plaque removal through brushing, flossing, and other devices
How to prevent host resistance
Antiplaque products
Pharm therapy: fluoride
Product: Prevident 5000 Plus
Ingredients: Sodium Fluoride (NaF), Stannous Fluoride, Sodium Monofluorophosphate (MFP)
*Caries protection and treatment; Stannous Fluoride may stain teeth- only for >12 years old
Pharm therapy: Tartar-control
Product: Crest Tartar Gel/ Toothpaste
Ingredients: Pyrophosphates, Triclosan, Zinc Citrate
*Prevents supragingival calculus (not subgingival or existing tartar)
Pharm Therapy: Antiplaque/antigingivitis
Product: Colgate total
Ingredients: Triclosan + Fluoride
*Antibacterial and promoter of substantivity
Pharm Therapy: Whitening/antistain
Product: Colgate optic white
Ingredients: Peroxides, Sodium tripolyphosphate (STP),
Titanium dioxide (makes toothpaste white)
*May work by breaking down pigments that accumulate on or in the tooth enamel. Some stains can’t be removed by them.
What are detergents and what do they do
Sodium Lauryl Sulfate, Sodium-N-lauryl sarcosinate (less irritating)
- Foaming action may increase the solubility of plaque during brushing
- not in childrens products
AE’s:
- development of AU
- aggravates dry mouth
- SLS more irritating
What are abrasive agents and what do they do
CaCO3, silicates, phosphate salts, MgCO3, Aluminum trihydrate
- Remove surface stains; whiten/ polish teeth
May cause burning sensation, drying of mucous membranes, taste alteration, gingival abrasion or enamel erosion
What are ingredients that help with tooth densensitization
Potassium Nitrate, Strontium Chloride, Strontium Acetate
Reduce pain from sensitive teeth by physically blocking the tubules in the exposed dentin.
What ingredients prevent tartar formation
Pyrophosphates, Triclosan, Zinc Citrate
- Do not affect subgingival or existing calculus.
- MOA not established
What ingredients prevent gingival inflammation
Stannous fluoride, triclosan, zinc citrate
Reduce plaque accumulation through antibacterial activity.
SF may interact w chlorhexidine
What are examples of humectants and what do they do
glycerol, propylene glycol, sorbitol
- Prevent toothpaste from drying out
Xylitol is an uncommon, but superior humectant, which also boosts fluoride’s cavity-fighting power (stimulates salivary flow, increases pH)
What to look for on dental products
CDA approved
How does fluoride prevent caries
Binding of fluoride to the hydroxyapatite leads to the formation of fluoroapatite, which makes the enamel harder and more resistant to decay.
What are side effects of high intake of fluoride
N/V, abdominal pain, synovitis, GI bleeding
Weight loss
Anemia
Bone development issues
Fluorosis
What is fluorosis
caused by an increased intake of fluoride during permanent tooth formation (irreversible)
- Mild: chalk-like, lacy markings on the enamel.
- Moderate: White opacity can be seen on more than 50% of the tooth
- Severe: brown, pitted, brittle enamel
What schedule are systemic agents of fluoride supplementation in
> 1 mg fluoride: Class I
<1 mg: Class III
What is the optimal concentration of fluoride in drinking water
0.7mg/L (0.7ppm)
Fluoride supplementation recommendations?
- not recommended where community drinking water contains 0.7 ppm or more of Fluoride
- not recommend the use of supplements before the eruption of the first permanent tooth
What is the dosing for fluoride supplementation
appropriate dosing should ensure the total daily intake does not exceed 0.05-0.07 mg/kg body weight to minimize risk of dental fluorosis
When is the most susceptible age for fluorosis
0 to 6 years, especially between the ages of 15 and 30 months.
What are the requirements for taking fluoride supplementation
> 6 mo
fluoride in drinking water is <0.3 ppm
child does not brush teeth at least BID
child is susceptible to high caries activity
Oral health tips for birth - 12 mo
Wipe gums BID Clean baby teeth and gums Avoid bottles in bed ------------------ After 6 mo: Introduce sippy cup Avoid juice Don’t sweeten a soother
Oral health tips for ages 1-2
First dental visit Brush BID Check for signs of tooth decay monthly Switch to regular cup for all drinks Limit soother use
Oral Health tips for ages 3-4
“2 for 2”
• Brush BID x 2 min each time
Start fluoride toothpaste
Pacifier effect on dentition
Potential Complications: dental caries, malocclusion, gingival recession (Only occur with prolonged (>5y) or inappropriate use)
- CDA: pacifiers over thumb sucking
Easier to wean off
Ensure pacifier is clean, unsweetened
