Oral Hygiene Flashcards
What is the total population affected by oral health across the world
3.9B (34% of world pop)
Inequities in oral health in canada
- lower income more likely to have dental problems/worst outcomes
- Inuit
What is enamel
hard outer coating protecting crown
What is dentin
hard substance beneath enamel; makes up bulk of tooth
transports nutrients from pulp
what is pulp
soft tissue in middle of the tooth
consists of vascular and neural tissue
if exposed to decay, infection can occur
what is cementum
hard tissue covering root & attaches it to jawbone
What is biofilm
Sticky, mat-like microbial communities
• Organisms cooperate (synergistic)
• Teamwork ensures their mutual survival
• 700 oral microbial species contribute to dental plaque biofilm
How does biofilm form
- Initial adherence
- tooth surface covered by acquired pellicle (protects tooth from lactic acid)
- primary bacteria (mainly G+) bind to pellicle - Lag phase
- shift in genetic expression, lag in bacterial growth - Rapid growth
- other types of bacterial bind
- primary: G+ cocci (streptococcal)
- secondary: fusobacterium species
- final: pathogenic G- - Steady state/detachment
- some bacteria disperse to colonize other areas of the mouth
How does biofilm cause oral disease?
- accumulation on tooth surfaces often leads to caries
- Accumulation along & under the gingival margin often leads to gingivitis
• Chronic gingivitis -> periodontitis
What bacteria is involved in endocarditis, brain abscesses, artery plaque, aneurysmal wall and tissues
A. actinomycetemcomitans
What bacteria is involved in diabetes, heart attack, artery plaque, aneurysmal wall and tissues
T. forsythia
What bacteria is involved in oral cancers, oral abscesses, ASVD, CVD, CVA
T. denticola
What bacteria is involved in diabetes, rheumatoid arthritis, kidney disease, MS, atheromatosis, atherosclerosis
P. gingivalis
What is the keystone pathogen of many systemic diseases
P. gingivalis
• Translocates during normal oral hygiene activities
• Deposits in the tissues of the heart, liver, placenta
• Systemic spread happens quickly and gradually -> chronic & pathologic inflammatory response
• Highest proteolytic activity; induces dysbiosis; produces endotoxins (e.g., LPS) -> pro-inflammatory cytokine release
What is the relationship between cardiovascular health and PD
- association (not causative)
What is the relationship of diabetes and PD
Diabetes: have a higher prevalence of PD as diabetes is a risk factor, poor blood glucose control is associated with PD
PD: increases systemic inflammation which reduces ability to use insulin - contributes to blood glucose control problems
Relationship between gastrointestinal health and PD
- GI = highway from oral cavity
- Pancreatic cancer associated with H. pylori and P. gingivalis
Relationship between pulmonary health and PD
Pulmonary diseases characterized by:
• Inflammatory mediators found in saliva & gingival crevicular fluid
• Oropharyngeal structures serve as reservoirs that harbour bacteria
*no evidence that PD CAUSES disease
Liver disease and PD
- contain large number of oral microbes like P. gingivalis
- cirrhosis
Systemic Lupus Erythematosis and PD
Characterized by persistent inflammation -> organ damage
• Linked to microbial dysbiosis
Rheumatoid arthritis and PD
- Characterized by chronic inflammation
- Linked to microbial dysbiosis
- Oral antiseptic treatment for PD has been shown to be protective against RA-induced bone loss
Dementia and PD
- strong association
- P. gingivalis (and proteases called gingipains) found in brain of Alzheimer’s patients
Bi-directional relationship
• Cytokines from oral cavity -> bloodstream/brain
• Alzheimer’s patients -> poorer oral hygiene, inability to report pain
Pregnancy and PD
Hormonal changes can cause: Pregnancy gingivitis, Gestational diabetes, Gingival hypertrophy, Gastric reflux
PD increases risk of • Preeclampsia • Low-birth weight • Preterm birth • Stillbirth • Spontaneous abortions
What are risk factors for caries and PD
- poor oral hygiene
- age
- poor nutrition
- diabetes
- xerostomia
- frequent alcohol use
- tobacco use
- medications
- gum tissue recession
- orthodontic appliances
- pregnancy
What info to assess (from patients)
- Medical, medication, and social history
- State of dentition and other considerations for oral care
- Current oral care regimen
- Visible changes to teeth or oral cavity, or other dental/oral-related complaints
What are non-pharm prevention measures
- Tooth brushing 2x per day with an CDA-accepted fluoride toothpaste + floss everyday +/- mouthwash
- Limit alcohol & avoid smoking
- Dietary Modifications
- Visit a dental professional regularly for professional cleanings and examination
When and how long to brush teeth
Should be done after every meal and at bedtime (or at least twice daily)
• Minimum time required to effectively remove plaque is 2 minutes
What type of toothbrush should be used
- soft/ultra soft
- round bristles
- should reach back teeth
- replaced every 3 months
- powered brushed > manual
When to floss
- every 24 h (before bed)
- before brushing teeth
Who should use waxed vs unwaxed floss
Unwaxed floss is suitable for most people, but if it does not slide easily between the teeth, a waxed floss can be used
• However, hypersensitivity to waxed floss has been reported
Who would benefit from interdental brushes
Useful for patients with braces, dental implants, etc
May be helpful for removing plaque from areas difficult to
reach with a toothbrush and regular floss
Who would benefit from irrigating devices
Might be useful for patients with orthodontic appliances, after oral surgery, or patients with manual dexterity issues
• Removes food debris and possibly some plaque from teeth
What is a stimulator
Removes plaque by applying contouring pressure to hyperplastic gingival papillae
What are the 2 types of mouthwashes
- Cosmetic - May temporarily control bad breath and leave behind a pleasant taste (does not address cause)
- Therapeutic - Have active ingredients intended to help control or reduce conditions like bad breath, gingivitis, plaque, and tooth decay
Chlorhexidine gluconate
Schedule 1
plaque reduction
binds to dental surfaces and releases over time (“timed release of antimicrobial”)
cannot be used long-term
interacts with stannous fluoride (wait 30 mins between if using both)
Cetylpyridinium chloride (CPC)
moderate plaque reduction
Releases from dental surfaces at a much faster rate than chlorhexidine, resulting in lower effectiveness
concentration as active ingredient is 0.07%, in cosmetic mouthwash <0.045%
Essential Oils
thymol, menthol, eucalyptol, methyl salicylate
High plaque reduction
some products have a high alcohol content; may cause burning sensation, bitter taste, or mucosal drying
not recommended for children
Sodium Fluoride
Treats and prevents caries
• 0.2% rinse once weekly is recommended as nonrestorative treatment for caries
• Lower concentrations (0.05%) are used to prevent caries in high-risk individuals
not for <6 years of age oxygenating agents (e.g., 1.5% hydrogen peroxide (Peroxyl®)) are not recommended because of lack of efficacy and potential adverse effects
Common inactive ingredients in therapeutic mouthwashes
Water: vehicle for carrying ingredients to site of action
Alcohol: Acts as a solvent, vehicle, and preservative
Flavouring agent: Adds a freshening or cooling quality; improve breath aroma
Humectant: Adds “body” to the liquid; provides a feeling of cleanliness
Surfactant: Solubilizes the flavor oils; stabilizes the mouthwash formula
What mouthwash does the CDA recommend for daily use
essential oil
