Oral hygiene Flashcards
what is oral health
A state of the oral and related tissues and structures that contributes positively to physical, mental and social well-being and to the enjoyment of life’s possibilities, by allowing the individual to speak, eat and socialize unhindered by pain, discomfort or embarrassment
current state of oral health
- 74.5% canadian go to annual dental visit
- most have access to dental care and report good oral health
- 95.9% of adult over 20 have had a cavity
what are the 4 structural components of the tooth
Enamel: hard outer coating protecting the crown
Dentin: hard substance beneath enamel: makes up the bulk of tooth, microscopic tubules that transfer nutrients
Pulp: soft tissue in middle of tooth: lots of nerve endings, if decay reaches it can get infraction, lots of pain -> need root canal
Cementum: hard itssue covering root and attaches it to jaw bone
what is a biofilm
• Sticky, mat-like microbial communities
- > Organisms cooperate (synergistic)
- >Teamwork ensures their mutual survival
- 700 oral microbila special contribute to dental plaque biofilm
- > types: supragingival and subgingival
- > buildup is direcctly related to incidence of oral disease
how does a biofilm form
- initial adherance
- tooth surface covered by acquired pellicle
- primary colonizing bacterial (primarily gram pos cocci and rods) ahdere to pellicle
- Lag phase
- attachment to pellicle leads to shift in genetic expression that causes lag in bacterial growth\
- Rapid growth
- other types of bacteria ahdere to primary colonizers: forms mature dental biofilm
- primaru colonizers: gram pos cocci
- secondary colonizers: fusobacterium
- final biofilm: mostly pathogenic gram neg
- other types of bacteria ahdere to primary colonizers: forms mature dental biofilm
- Steady statte/detachent
- some surface bacteria disperse to colonize other areas of mouth
How does a biofilm cause oral disease
- accumulation on tooth surfaces leads to caries
Accumulation along & under the gingival margin often leads to gingivitis
• Chronic gingivitis -> periodontitis
how are systemic and oral health connected
- systemic conditions have oral manifestations
- treatments for systemic condiions have oral health effects
- oral diseases have impacts on treatments for systemic conditions
*inflammation is pathway that links
what are the main microbial players in oral health
A. actinomycetemcomitans, T. forsynthia, T. denticola, P. gingivalis ( highest risk pathogen)
*P.gingivalis is considered a keystone pathogen in development of many systemic diseases
- > translocated dueing normal oral hygiene activites
- > deposits in tissues of heart, liver and placenta
- systemic spread happens quickly and gradually -> chornic & pathologic inflammation repsonse
- > highest proteolytic activity; induced dysbiosis; produces endotoxins (LPS) -> proinflammatory cytokine release
what systemic diseases are associated with oral pathogens
- alzheimer disease
- cardiovascular disease
- oral colorectal carcinomas and GI diseases
- respiratory tract infection and bacteria pneumonia
- adverse pregnancy outcomes
- diabetes and insulin resistance
link between cardiovascular health and oral health
- oral microbes can enter general circulation
- > people with periodontal disease have 2x higher LDL
- > endotoxins released make BV more permeable & more inner layer of arterial walls stickier (makes it easier to deposit)
*studies support an association between PD and atherosclerotic vascular disease but does not support a causative relationship
connection between PD and diabetes mellitus
- inflammation in oral cavity impairs bodies ability to control blood sugar and utilize insulin
- high blood sugar makes one more prone to infection like PD
- patients with diabetes have higher prevalence of PD as diabetes is a risk factor
- poor blood glucose control is associated with PD
- PD increases systemic inflammation and contrinutes to problems with glycemic control
*PD treatment -> 10-20% improvement in glycemic control
connection between PD and GI health
- GI is a highway from oral cavity to rectum
- > leaky gut syndrome: oral microbes associated with periodontal disease, can impact gut lining
- pancreatic cancer: H. pylori and P. gingivalis are heavily involved (believed to trigger tumour formation on pancreas)
connection between PD and pulmonary health
- abundant evidence that PD affect lung health
- pulmonary disease characterized by:
- > inflammatory mediators found in saliva & gingival crevicular fluid
- > oralpharyngeal structures serve as resevoirs that harbour bacteria (can become pathogenic)
- if fluids are aspirated: triggers inflammatory response -> build up of fluid & lung exudate
*associations are well established does nto establish causation
what other disease are associated with PD
- Liver Disease
- intestinal bacteria of patients with cirrhosis contain large number of oral deried microbes (P. Gingivalis)
- pro-inflammatory mediators can cause cirrhosis
- Systemic Lupus Erythematosis
- characterized by persistent inflammation -> oral damage
- linked to microbial dysbiosis
- Rheumatoid Arthritis
- characterized by chronic inflammation
- linked to microbial dysbiosis
- Oral antiseptic treatment for PD has been shown to be protective against RA-induced bone loss
Associated with PD and dementia
- Research supports a strong association with PD
- bi-directional relationship
- > cytokines form oral cavity -> bloodstream/brain
- > alzheimer’s patients -> poorer oral hygiene, inability to report pain
pregnancy complications associated with PD
PD inc risk of: preeclampsia, low-birth weight, preterm birth, stillbirth, spontaneous abortion
- Hormonal changes may cause: pregnancy gingivitis, gestational diabetes, gingival hypertrophy, gastric reflex
Risk factors for caries & PD development
-poor oral hygiene
- age
- poor nutrition
- diabetes
- xerostomia
- frequent alcohol use
- tobacco use
- medications
- gum tissue recession
- orthodontic appliances
- pregnancy
what are non pharmacologic prevention measures
* goal to control biofilm
- toothbrushing 2x per day with a CDA-accepted fluoride toothpaste + floss everyday +/- mouthwash
- limit alcohol and avoid smoking
- dietary modifications (avoid kerogenic aka above 20% sugar) % food that stays in mouth (dry crackers, gummer candies)
- visit a dental professional regularly for professional cleanings and examination
what devices are used for mechanical removal of supragingival plaque
Toothbrush
Dental floss
Interdental/interproximal brush
Irrigating device (e.g., dental water flosser)
Stimulator
use of toothbrushing for maintaining oral health
Effective method for the removal of plaque (particularly from the gingival area of the tooth and sulcus)
Should be done after every meal and at bedtime (or at least twice daily)
Minimum time to effectively remove plaque = 2 minutes
A toothpaste with fluoride and the CDA seal should be used
- use soft/ultrasoft
- replace every 3 months or sonner
- powered burshes particularly useful when manual brushing has failed patients with limited dexterity -> study found that they are more effective at removing plaque and reducing gingival inflammation
flossing for maintaining oral health
Removes plaque from interproximal surfaces (i.e., between the teeth)
Should be done every 24 hours, preferably before bed
-> For the best result, teeth should be brushed after flossing
Clinical experience and evidence suggests flossing and/or using interdental brushes (along with brushing) reduces plaque and gingivitis
- dental floss, tape either waxed or unwaves are equally effecive
use or irrigating device or stimulator
- irrigating device: might be useful for parits w/ orthodontic appliances, after oral surgery or with dexterity issues. Removes food debris and possible some plaque
*adjuctinve device
stimulator: removed plauqe by applying cotouring pressure to hyperplastic gingival papillae
Chemotherapeutic methods for plaque control
- dentifrices (toothpastes)
- look for ones with Canadian Dental association
- mouthwashes
- can be cosmetic: bad breath and leave behind pleasant taste
- no chemical or biological application beyond temproary benefit
- Therapeutic
- active ingredients intended to help control or reduce condiitons like bad breath, gingivitis, plaque and tooth decay
- can be cosmetic: bad breath and leave behind pleasant taste
