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Clinical Theory > Oral Malodor and Nicotine Use > Flashcards

Oral Malodor and Nicotine Use Flashcards

1
Q

types of halitosis

A

genuine halitosis: physiologic and pathologic
pseudo-halitosis
halitophobia

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2
Q

genuine halitosis: physiologic

A

morning breath: due to hyposalivation during the night
diet: garlic, onion, eating disorders, special diets
tobacco/cannabis use
can be aggravated by menstrual cycle

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3
Q

pathologic halitosis: intra oral

A

caused by bacteria: porphyromonas gingivalis is most common
hyposalivation: bacteria accumulate
periodontal disease

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4
Q

pathologic halitosis: extra oral

A

gastrointestinal: acid reflux, H.Pylori and ulcers
respiratory: infections such as tonsillitis or bronchitis, sinus issues, sepsis from foreign bodies inserted into nose

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5
Q

metabolic halitosis

A

blood-borne halitosis
diabetes
renal failure
liver disease - trimetylaminuria

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6
Q

pseudo-halitosis

A

when a patient is under the impression they regularly suffer from halitosis

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7
Q

halitophobia

A

classified as monosymptomatic hypochondriasis (a form of psychosis)
cannot be treated by the dental professional
requires referral for psychological evaluation/support

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8
Q

chemical origin of halitosis

A

degradation of: peptides in saliva, epithelial cells, biofilm buildup, food debris, blood cells, gingival crevicular fluid

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9
Q

volatile sulphur compounds (VSC)

A

main cause of oral malodor
caused by anaerobic bacteria metabolizing amino acids which contain sulfur
intra oral and extra oral

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10
Q

the tongue and its environment

A

covered in papillae which create small grooves where bacteria, dead cells, and food can gather
accumulation creates a white plaque on the tongue that reduces oxygen for anaerobic bacteria to grow

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11
Q

the posterior dorsum of the tongue

A

the most common area for tongue related halitosis
where most bacteria and food debris will collect

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12
Q

tongue brushing

A

specialized tongue brush, or a toothbrush
done from terminal sulcus to tip of tongue in smooth strokes

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13
Q

most effective to least effective mouth rinses

A

CHX: chlorhexidine
listerine
cetylpyridinium chloride: CPC
hydrogen peroxide

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14
Q

chlorhexidine

A

effective at treating VSC creating bacteria
side effects: staining, tissue sloughing, altered taste

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15
Q

listerine

A

contains essential oils known to kill bacteria
flavoring masks the scent of halitosis
many contain alcohol which can dry out the tissues and lead to more malodor in the long run

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16
Q

cetylpyridinium chloride (CPC)

A

found in Crest Pro-Health and Colgate Total mouthwash
reduces bacterial growth
known to stain teeth (black line stain)
least effective against VSCs than other rinses
not generally recommended for long-term use

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17
Q

hydrogen peroxide

A

effective but use caution
has been suggested as a pre-procedural rinse to reduce viral load and potentially reduce the spread of covid

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18
Q

toothpaste

A

not as effective at reducing VSCs as mouth rinse
most effective pasts involve baking soda and/or zinc
most effective when combined with other methods

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19
Q

chewing gum

A

stimulates salivary flow and helps cleanse oral cavity
sugar free gum leads to more malodor
gum with sugar alters the pH of the oral cavity reducing the VSCs created
mostly just masks the smell
improves self rated oral malodor

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20
Q

probiotics

A

influence the physiologic flora of the oral environment

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21
Q

more treatments

A

tobacco cessation education
avoiding foods like garlic, onions
regular eating schedule and eating high fiber fruits and vegetables
referrals to other health care practitioners to treat underlying medical conditions

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22
Q

components of tobacco products

A

nicotine
cancer causing
respiratory toxin
cardiovascular toxin

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23
Q

varieties of nicotine

A

smoking tobacco: cigarettes, cigars, pipes
chewing tobacco: spit, chaw, quid
poppers
vapes and e-cigs

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24
Q

extra chemicals in vapes

A

contain some chemicals found in lead paint, gasoline, embalming fluid and cigarettes

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25
metabolism (smoked tobacco)
-passes through the bronchi of lungs to the blood stream -nicotine makes it to the brain in less than 20 seconds -peak plasma concentration at 10 minutes -stays in body for 8-12 hours -metabolized by the liver -excreted in urine
26
metabolism (smokeless)
-nicotine is absorbed through oral mucosa membranes and the gingiva -nicotine concentration reduces over next 2 hours -nicotine absorbed is 2-3X higher compared to a cigarette -most juice byproduct is spit out
27
cardiovascular effects
-increases risk for atherosclerosis and is a major risk factor of coronary heart disease -cardiovascular diseases: atherosclerosis, coronary artery disease, hypertension -aortic aneurysm -arterial thrombosis -stroke
28
increased risk of cardiovascular effects in people who
over age of 50 oral contraceptives family history of heart disease
29
pulmonary effects
increases risk of chronic obstructive pulmonary disease (COPD) -emphysema: irreversible damage to alveoli which results in the bronchial tubes collapsing and air getting stuck in the lungs -chronic bronchitis involves excess mucus in the lungs, results in a chronic cough
30
tobacco and other substances
combining alcohol with smoking increases the risk of developing cancer
31
environmental tobacco smoke (ETS)
consists of a mixture of chemicals created by burning tobacco can last for hours inside, depending on the ventilation of the room people exposed have a risk of developing the same health issues as smokers nonsmokers may have more intense reactions
32
toxicity of ETS compared to mainstream smoke
same chemicals certain chemicals are higher concentrations eye and nasal irritation
33
prenatal smoking
smoking during pregnancy can lead to miscarriage, low birth weight, perinatal mortality, cleft lip/palate, delayed tooth formation
34
infancy smoking
chemicals from smoking pass into breast milk increased risk for lower respiratory tract infections in babies ETS exposure is a cause of sudden infant death syndrome
35
children smoking/ETS
lung development is affected kids are at a higher risk for developing asthma increased change of developing middle ear infections
36
nicotine addiction
creates feeling of pleasure and wellbeing smokers say it helps physical performance, mood or ability to think but in reality has no discernible change in performance or mood after smoking
37
nicotine tolerance
over time tobacco users need to increase their usage as it becomes less effective
38
nicotine dependence
amount and frequency of use needs to be increased to have desired effect dopamine is released in the brain addiction is like cocaine and heroine
39
criteria for nicotine dependency
tolerance withdrawal symptoms when stopped increased use over time wanting to, but having unsuccessful attempts at quitting
40
factors affecting addiction
properties of psychoactive drug family/peer influences social acceptance existing psychiatric conditions cost and avilability advertising
41
withdrawal
maximum symptoms occur within 24 hours relapse is common in first week of quitting and slowly diminish
42
reasons for quitting smoking
general health concerns specific health problems effect on family pregnancy financial reasons social pressure
43
self help interventions
quitting cold turkey lifestyle changes slowly reducing number of cigarettes smoked daily lower nicotine concentration patches, gum, lozenges, nasal spray quitting with friend or family
44
assisted interventions to stop smoking
counseling pharmacotherapies
45
pharmacotherapies
makes it easier to quit smoking by replacing the nicotine helps with withdrawal symptoms by filling cravings casual use should be discouraged
46
pharmacotherapy contraindications
pregnancy nicotine patch: hypertension or allergies to adhesives nicotine gum: hypertension, medications for asthma, depression, diabetes, heart disease, stomach ulcers
47
nicotine replacement therapy
transdermal: nicotine patch transmucosal: nicotine gum, nicotine inhaler, nicotine nasal spray, nicotine lozenge
48
how do oral conditions from smoking vary
vary depending on type of tobacco used and what form frequency and duration of use intra and extra oral exam show patient your findings and use as a motive to quit
49
oral conditions from smoking include
squamous cell carcinoma leukoplakia ANUG nicotine stomatitis smoker's melanosis black hairy tongue staining
50
effects of smoking on periodontal tissues
tobacco is one of the biggest risk factors for periodontal disease higher risk at a younger age with gingivitis, immune inflammatory response to plaque is reduced compared to a nonsmoker
51
periodontitis in smokers
more periodontal destruction deeper pockets recession in anterior teeth lower subgingival temperature tooth loss
52
mechanism of destruction of smoking
lowers immune response: impairs neutrophils and alters antibody production negative effect on bone metabolism, increased risk for osteoporosis impaired healing due to issues with revascularization
53
response to periodontal treatment in smokers
resistant to typical periodontal therapy greater risk of implant failures issues with healing after surgical and nonsurgical therapies pristine home care can reduce effects
54
role of DH patient history
use of tobacco assessed at each appointment
55
role of DH extra oral exam
assess halitosis and electropositive smoke fingers skin lips facial hair
56
role of DH intra oral exam
if a lesion is found show the patient and explain the nature explain the consequences of continued tobacco use record your findings in detail
57
referrals
have patient come back in 2 weeks to reassess the lesion if still present, refer the patient for a biopsy or consult consult pathologist as necessary
58
oral self exam
teach patients with the same techniques you use to do an EO/IO exam
59
the sooner the malignant lesions are found...
-the higher the chance of survival -the better the experience of treatment -reduced treatment morbidity -improved quality of life
60
detect, relate, motivate
detect and show patient the lesions found relate those lesions to tobacco use motivate the patient to quit
61
consult
refer patients to physician if they do not receive routine care discovering underlying medical conditions can alter out treatment plans may be able to receive prescription medication to assist with quitting
62
clinical treatment of smokers
more stain, calculus and perio problems longer appointments and more frequent immaculate home care is priority
63
debridement of smokers
inform patient that healing after a thorough debridement will be compromised tobacco users cannot expect the same treatment outcomes as nonusers use precaution when using powered instruments, patients at a higher risk of pulmonary and cardiovascular complications
64
nutritional counselling
smokers may be malnourished patients may be using smoking as a means for weight loss smokeless tobacco may be sweetened with sugar
65
halitosis of smokers
advise not to use alcohol containing rinses as they may dry out the tissue

Clinical Theory (18 decks)

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