Oral Health Flashcards
Dental Caries - Etiology and Pathophysiology
• Plaque: complex microbial community which adheres to tooth surface, readily removed by brushing/flossing
- Source of microbes causing caries and periodontal disease
- Calculus (tartar) – hardened deposit due to calcium salts in saliva; removable only by professional
- Plaque bacteria generate acid - acid demineralizes tooth enamel/dentin - dental plaque attracts more bacteria, promoting decay
- Prevalent in children!!
Symptoms of Dental Caries
- Enamel: No SX
- Dentin: Tooth pain/sensitivity
- Pulp: Pain
- Systemic: Inflammation/pus
Risk Factors for Caries
- Poor oral hygiene
- Diet
- Xerostomia (dry mouth)
- Heredity
- Gum tissue recession
- Limited access to dental care
- Orthodontic appliances
- Tobacco
- Medications and medical disorders (anticholinergic meds; diabetes)
- Radiation therapy to head/neck
- Baby bottle tooth decay
Prevention of Caries*
- Key to preventing caries is controlling dental plaque
Non-Pharm:
- Dietary measures
- Plaque removal devices (toothbrushes, dental floss, oral irrigators)
Pharm:
- Fluoride
- Dentifrices (toothpastes)
- Mouth rinses
Dietary Measures (Prevention)
HIGH
- water content
- fibrous foods
- fluids
- saliva production (sugar free gum)
LOW
- highly cariogenic food (>15% sugar/clings to teeth/remains in mouth)
- acidic foods/beverages
Plaque Removal Devices (Prevention)
• Toothbrush
- No standardization (soft bristles less likely to cause damage)
- Has ADA Seal of Acceptance
- Replace about every 3mo or when sick/worn out
- Worn out toothbrush may injure gums
- Manual vs electric (Orthodontic appliances, manual dexterity)
• Floss
- Failing to floss leaves up to 35% of tooth surface un- cleaned
- Considerations: manual dexterity, elderly, tightness of teeth
- ADA Seal of Acceptance
• Oral Irrigators
- High-pressure stream of water
- Not a substitute for toothbrush, floss
- Useful with orthodontic appliances
Proper Oral Hygiene
- Brush with toothpaste (after each meal or at least 2x/day)
- Floss (at least 1x per day)
- Proper selection and timely replacement of toothbrushes
- Use tongue scrapers
- Visit dentist at a minimum 2x/year
Dentifrice - Toothpaste (Prevention)
• Enhances removal of dental plaque/stains
• Decreases incidence of dental caries/gum disease
• Reduces mouth odors
• Enhances personal appearance
• Commonly contain abrasive, surfactant, humectants, binder, sweetener, flavoring, therapeutic ingredient
- Abrasive (silica, Ca/Al salts) essential in cleaning teeth
- Surfactant (Na lauryl sulfate) causes foaming
• Sweetener (saccharin)
- Available as powders, pastes and gels
Therapeutic Ingredients in Dentifrices
- Fluoride: preventing AND treating carious lesions
- Facilitates remineralization of early caries
- May interfere with bacterial process (decrease plaque adherence and/or inhibit glycolysis) - Triclosan: antigingivitis/antibacterial
- Still in some toothpastes, although in 2016 the FDA banned
them in antiseptic hand and body wash products - Potassium nitrate: sensitive teeth
- Titanium dioxide, hydrogen peroxide: antistain, whitening
- Plain baking soda also effective at stain removal
Fluoride
• Indicated for both prevention and treating carious lesions
• Maintain overall oral health
• Topical effects facilitate remineralization of early carious lesions
• Three forms effective for anticaries/anticavity effect
- Sodium fluoride
- Sodium monofluorophosphate
- Stannous fluoride*
*May cause slight tooth discoloration (not permanent)
Mouth Rinses
- Adjunct to proper flossing and brushing
• Fluoridated mouthwashes (0.05% sodium fluoride daily or 0.2% weekly)
- Effective anticaries agents
- Use after brushing; DO NOT swallow
- Nothing PO for 30 min after use
- Not recommended for kids under 6 yo or those with difficulty rinsing
• Gels (stannous fluoride 0.4%)
- Use after brushing, daily at night
- Brush 1 minute, swish before expectorating
- Do not rinse
- Available via dental professional
Other Ingredients in Mouth Rinses
Antigingivitis/Antiplaque effects
• Aromatic oils (eucalyptol, menthol, methyl salicylate, thymol) (eg – Listerine)
- Antibacterial, local anesthetic effect
• Quaternary ammonium compounds (cetylpyridinium) (eg – Crest Pro- Health)
- Antimicrobial
• Phenol oils, methyl salicylate, and alcohol
- Sloughing of the oral epithelium may occur
- Burning sensation
- Disulfiram reaction/alcohol disorders
• Caution in children < 12 yo
- Labeling includes warning not to swallow
- Seek care or contact poison control center
Cautions in Children
• < 3 yo – begin brushing teeth as soon as they come into mouth using fluoride toothpaste
- Use small amount or ”smear” (size of grain of rice)
• 3 to 6 yo –use small amount (size of a pea)
• Do not use high fluoride concentrated toothpaste in children <6 yo
• Children need supervision with brushing until age 8-9
• Important to provide instruction on proper technique/habits
• All fluoride dentifrice products must contain warning label
Periodontal Disease
- Affects ~46% of U.S. adults 30 yrs and older
- Main cause of tooth loss in adults > 45 years
- Inflammation of supporting structures of the teeth
- Associated with oral hygiene status, not with age
• Types of Periodontal Disease
1. Gingivitis (mildest form, early stages)
• Common, reversible
• Inflammation of the gingiva without loss of epithelial attachment to the tooth
2. Periodontitis (involves bone loss)
• Significant, irreversible
• Periodontal ligament attachment and bone support of tooth have been compromised/lost
Periodontal Disease: Treatment
• Refer for:
- Oral hygiene improvement (same measures as prevention of caries)
- Debridement
- Scaling and root planing by dentist/hygienist
- Chlorhexidine gluconate rinse
- Gum surgery
Tooth Hypersensitivity
• Potential Etiologies
- Gum recession exposing sensitive portions of teeth
~ Extrinsic acid (acidic/soda/wine/sour)
~ Intrinsic acid (GERD/vomit)
~ Xerostomia
~ Incorrect tooth brushing
~ Occupation
• Teeth clenching (can result in referred pain)
• Dental work (may be temporary)
• Damage to pulp/tooth
• Infection (gum, bone)
• Pain from hot, cold, sweet, or sour solutions
• Individual pain thresholds vary
• Self-treatable if due to abrasion or erosion
REFER patient to dentist if: • Toothache • Fracture • Faulty restoration • Gingival recession
Management of Tooth Hypersensitivity
• Identify and eliminate predisposing factors
- Extrinsic/intrinsic acid exposure, improper brushing
• Brush and floss carefully and completely
• Do not brush within 30-60 min. after consuming acidic foods/drinks
• Avoid whitening or stain removal toothpastes
• Ice may provide temporary relief
• Toothpaste for sensitive teeth
- Containing potassium nitrate 5%
- Use for 2-4 weeks to relieve symptoms
- Long-term treatment needed in ~25% of adults
• Referral to dentist if no relief after 2-3 weeks
Tooth Hypersensitivity: Exclusions for Self-Treatment
- Toothache
- Mouth soreness associated with poor-fitting dentures
- Presence of fever or swelling
- Loose teeth
- Bleeding gums w/o trauma
- Broken teeth
- Severe tooth pain
- Trauma to the mouth
Eruption Cysts
• Bluish, soft and round swellings over emerging incisors and molars during teething process
• Not the result of infection
• No treatment is typically needed (resolve spontaneously)
• Nonpharmacologic
- Massaging gum
- Cold teething ring
- AVOID OTC topical medications (ie benzocaine) risks outweigh benefits
Recurrent Aphthous Stomatitis (RAS)
• Commonly known as canker sores or aphthous ulcers
• Onset peaks 10-19 years
• Not contagious
• Cannot be cured
• Causes
- Unknown, stress, local trauma, infectious, nutritional deficiency, systemic conditions (HIV)
Treatment for RAS: Nonpharmacologic
Goal of therapy
- Relieve pain and irritation so lesions can heal
- Prevent complications, such as secondary infections
Diet
- Avoid spicy foods, acidic foods, sharp-textured foods
- Correct nutritional deficiency
Ice
- Applied directly to lesions in 10-minute increments
- Stress removal, relaxation
- Do not use heat (could spread bacteria if present)
Treatment for RAS: Pharmacologic (Refer)
• Systemic analgesics (for pain)
• Oral debriding and wound cleansing agents (carbamide peroxide, hydrogen peroxide, sodium perborate monohydrate, sodium bicarbonate)
- Ex: Cankaid, Orajel Antiseptic Rinse
- Apply after meals, to affected area, up to 4x/day
• Topical oral anesthetics (benzocaine, benzyl alcohol, others)
- Ex: Orajel, Anbesol
- Apply up to 4x/day
• Oral Protectants
- Coat and protect ulcerated area by creating a barrier
- Apply or use as needed
• Oral Rinses
- Can hasten healing process
- Ex: Saline rinses
• REFER
- If no improvement after 7 days of OTC treatment
- Worsens during self-treatment
Herpes Simplex Labialis (HSL) (NonPharm)
- AKA cold sores or fever blister
- Primary herpes: initial viral infection (childhood, latent)
- Herpes labialis: recurrent (reactivated by trigger, lips)
- Generally caused by HSV-1 (contagious, within 1-2wk)
- Usually resolves in 10-14 days
- Triggers: menstruation, sun exposure, illness with fever, stress, immunosuppression
• Nonpharmacologic
- Keep clean
- Hand washing
- Keep moist
- Avoid triggers (stress, sun, fatigue)
Treatment for HSL: Pharmacologic (contra, refer)
• Duration and severity reduction
- Docosanol 10 (Abreva)
- Dose: Apply to affected area 5x/day as soon as sx onset
• Apply until lesion healed, NTE 10 days
• Relief of discomfort only
- Systemic analgesics
- Topical anesthetics
- e.g. benzocaine 5-20%, benzyl alcohol 10% topical gel (Zilactin)
- Secondary bacterial infections: triple antibiotic
- Topical steroids are contraindicated
- REFER if no improvement after 14 days
HSL: Exclusion for Self-Treatment
- Lesions present >14 days
- Increased frequency of outbreaks
- Compromised immunity
- Symptoms of infection (fever, rash, swollen glands)
- No previous diagnosis of cold sore
Halitosis (Treat)
• Pathophysiology
- May be related to systemic and oral conditions (~85% oral)
- Volatile sulfur compounds due to breakdown of food debris
- Foods (garlic, onions, alcohol)
- Medical; sinus infection/ulcers
• Dental; gum disease/xerostomia/oral cancers/dentures
• Smoking
• Prevention
- Good oral hygiene
- Treat underlying disorders
- Zinc salts, chlorine dioxide products (Oxyfresh, CloSys)
Xerostomia
- Commonly known as dry mouth
- Salivary flow is limited or completely stopped
- Etiology: med (antidep/antihis), radiation, nerve damage, nonpharm (alcohol, tobacco, caffeine), mouth breathing, med disorders
- Can increase dental caries and gingivitis
- Cause of halitosis
- Can predispose oral cavity to candidiasis, hypersensitivity
- Can impair speech, swallowing, ability to taste foods
Treatment of Xerostomia
Nonpharmacologic • Sip water • Sugar free candies • Consider change in drug therapy • Avoid substances that reduce saliva (tobacco, alcohol)
Pharmacologic • Artificial saliva • Biotene Rinse • Salivart Spray • Entertainer’s Secret Spray • Xylitol products (e.g. Spry) • Topical fluoride
• Referral
- If condition worsens or complications develop
