Unit 311 Flashcards
What are the 4 main oral diseases that raise concern for the dental team?
- dental caries
-gingivitis - periodontitis
-oral cancer
what is dental caries?
bacterial infection of the tooth
what is gingivitis?
inflammation of the gingival tissues
what is periodontitis?
inflammation of the surrounding structures of the tooth.
what is oral cancer?
squamous cell carcinoma
What is a good way to promote communication?
advice delievered in a way the patient understands.
Communication:what are the 3 age groups?
style of communication and advice given will vary between age groups
adults, young people, children
patient motivation:
regardless of the help of the dental team, some patients are not interested in their own OH and are unwilling to follow advice
mental capacity:
as people get older health conditions will affect the mental functions e.g. dementia so the understanding and retention of info being given may be forgotten
In regards to patients general health, how may this affect oral hygiene?
some medical and physical conditions will cause oral disease development in some patients, while other conditions affect the patients ability to carry out effective OH
what are the causing factors of dental caries?
- high sugar diet NMES
- poor oral hygiene
- stagnation areas e.g. overhangs, occlusal fissues, abutments (dentures).
- bacteria within the plaque biofilm + sugars = acid
What are the causing factors of gingivitis and periodontitis?
- poor OH
- stagnation areas e.g. gingival crevice
-failure to treat and eradicate the ginigvitis allowing the inflammation to progress to periodontitis
dental plaque biofilm is..
plaque
What is plaque
thin transparent layer of saliva, oral debris and normal mouth bacteria that sticks to the tooth surface it can only be removed by cleaning.
What causes plaque to grow thicker?
food debris
If plaque is in contact with a tooth surface caries will develop unless the plaque is removed.
If plaque is in contact with the gingiva, gingivitis and then periodontitis will develop unless the plaque is removed.
caries is mainly a disease for those of what age groups?
children and young adults
periodontal disease develops at what stage in life?
Later in life
It can be found in younger patients but this is uncommon
In regards to sugars what age group is more likely to eat more?
young children - their teeth are more vulnerable to caries
what is saliva?
the watery secretion from the salivary glands that bathes the oral cavity to keep the tissues moist.
What does saliva protect our oral cavity against?
- caries by promoting remineralisation of early enamel caries due to its MINERAL CONTENT and BUFFERING effects
- Periodontal disease by its cleansing and antibacterial properties due to its ANTIBODY and WHITE BLOOD CELL content and ANTIBACTERIAL ENZYMES.
How does saliva promote overall health of the mouth?
lubricating and cleansing effects
what is xerostomia?
dry mouth
Patient who have xerostomia are at more risk of getting what oral diseases?
caries and periodontal disease
what do acids cause?
enamel demineralisation
What are the 3 examples of advice we will give to a patient in relation to caries prevention?
- increase the tooth resistance to acid attack - fluoride
- modify the diet - fewer cariogenic foods and drinks and reduce frequency intake
- control the build up of bacterial plaque - good OH routine
what is the main cause of periodontal disease?
poor oral hygiene
What are the 3 examples of advice we will give to a patient in relation to periodontal disease?
- control the build up of bacterial plaque - good OH
- modify the contributory factors - smoking
- control the host response - frequent dental attendance for monitoring and evaluation and intervention - 3 months.
Plaque forms within what time frame?
hours
Oral hygiene techniques that are given to a patient to carry out at home:
- toothbrushing - effective technique and recommended toothpaste
- interdental cleaning - brushes or floss
- suitable mouthwashes
Toothbrushing is the method used to remove..
surpagingival plaque + food debris on the tooth surface
Should the patient be told to rinse after brushing?
No - the patient should spit not rinse as it removes the residual toothpaste and prevents chemical constituents from continuing to act in the mouth e.g. flouride
What is the recommended age that parents should brush their childs teeth up until?
8 years old
95% of Toothpastes in the UK contain fluoride, what is the normal PPM for fluoride for children and adults?
sodium monofluorophosphate and sodium fluoride at 1400PPM
High fluoride toothpastes should contain what PPM?
between 2800 and 5000ppm for use of adult patients with high caries risk
What else does toothpaste contain?
triclosan with zinc this acts as an antiseptic plaque suppressant
what do sensitive toothpastes contain?
arginine, NovaMin and stannous fluoride
what do whitening toothpastes contain?
mild abrasives as micro-crystals - use of biological enzyme systems
toothpastes that contain titanium dioxide and phosphosilicates help to protect the teeth against…
acid erosion + help enamel repair
what is dental floss used to do?
achieve interdental plaque removal
instructions on the usage is important
why are flossettes easier to use than floss?
patients can floss with one hand - makes it easier with posterior teeth
Indental brushes are used to clean:
interdentally around every tooth and they are also used with orthodontic appliances.
What are interspace brushes usually used for?
help the patient to clean in wider interdental spaces as well as fixed ortho appliances
Are woodsticks usually recommended?
No as they can easily become stuck into the gum and cause problems if used incorrectly
The main aim of interdental aids is?
to dislodge food particles and accumulated plaque from the interdental areas of the teeth.
mesial and distal surfaces of teeth
general use mouthwashes contain various ingredients to promote good OH for example…
sodium fluoride - provides TOPICAL fluoride application to teeth
triclosan - chemical that suppresses the formation of plaque
what ingredient does the mouthwash contain that is given to patients with soft tissue inflammation:
hydrogen peroxide
specialist mouthwashses are advised to patients suffering from both acute and chronic periodontal infections they contain:
chlorhexidine - antiseptic plaque suppressant
Can loose food debris be removed by sugar-free chewing gum or finishing a meal with detergent food?
Yes - it is recommended
Examples of detergent foods:
raw, firm, fibrous fruits or vegetables e.g. apples, pears, carrots and celery.
What does having HARD cheese at the end of a meal stimulate?
salivary flow, neutralises acid and enhances remineralisation of enamel = calcium content
Chewing gum should be advised for what time of the day?
after a meal not continuously
after 10 mins should be disposed of
will increase the amount of tooth wear that occurs
fluoride occurs naturally in water and is added artifically to water supplies in other areas during the process of water fluoridation.
fluoride replaces the hydroxyapatite crystals with:
fluorapatite crystals = fluoride protects the teeth from developing caries.
topical fluoride is
application of various oral health products
systemic fluoride is
fluoride that is taken internally with food/drink products
Topical fluoride that patients can use:
- fluoride toothpastes
-Not to rinse after brushing - flouride mouthwash
- dental floss
Children under 3 years old should be using toothpastes containing no less than what PPM?
1000
Topical fluoride that the dental team can provide for a patient:
- fluoride varnish for patients with high caries risk contain 22,600PPM fluoride, reduce the indicience of caries by 30-40%
- Fluoride varnish - duraphat
- high concentration fluoride toothpaste on perscription
What is the risk of perscribed fluoride supplements?
fluorosis
Examples of systemic fluorides:
- fluoridated water supplies 1ppm
- fluoride drops and tablets - for children on perscription to be taken up until the age of 13 years old
What does fissure sealant do?
used to seal the natural stagnation areas of pits and fissures therefore preventing the patient from acid attacks and avoiding onset of dental caries.
What is enamel fluorosis?
Occurs when excessive fluoride is ingested during enamel formation.
dotted white areas in the enamel surface which very in severity.
restorative techniques can disguise this
Reducing which foods will help prevent dental caries:
- free sugars NMES
- dietary acids from daily food and drink intake
After eating the oral cavity will experience an acid attack what level will the PH go to?
5.5
what is the neutral PH level?
7
Free sugar foods should be ate at meal times only what is the reason behind this?
Because the acids involved are neutralised to some extent by the buffering action of saliva and the extent of demineralisation will be reduced.
Foods containing “hidden sugars” can be identified by reading the contents label of each product.
What was the reasoning behind the “Eatwell guide” being made?
help advise the public on what constitutes to a healthy balanced diet by dividing standard food plate into thirds and indicating the amount of products that should come from each group
What are the 4 food groups:
- 1/3 protein
- 1/3 carbohydrate 33%
-diary - 1/3 fruit n veg
Department of health publication: delivering better oral health for adult patients
Dietary advice that should be given to a patient in regards to reducing dental caries:
- healthy balanced diet - foods of low cariogenic
- any high in sugar foods should be ate at meal time
- use of diet sheets to see if any hidden sugars are being taken
- advice to mothers when using cariogenic drinks in bottles
contributing factors of periodontal disease cause the disease to worsen, what are common factors:
-smoking
- stress
- hormonal imbalance
- history of radiotherapy treatment
- medical conditions - diabetes, leukemia, vitamin c deficiency, Aids
- plaque retention factors - crowding, unopposed teeth, overhangs
Patients who are unable to properly fight infection or to heal when attacked by pathogens are called:
immunocompromised
Tissue overgrowth is called:
gingival hyperplasia
What medications can cause gingival hyperplasia?
phenytoin (epilepsy), antihypertensive agents, immunosuppressant drugs
What are the two main contributing factors of periodontal disease?
- masticatory stress
- localised plaque retention
Patients suffering with gingival hyperplasia can undergo what procedure to remove the excess tissue?
gingivectomy
What is the service that can be offered to patients during smoking cessation advice?
NHS stop smoking service
Can periodontal disease be caused by genetics?
patients can develop periodontal disease genetically
require a high level of support and maintenance by the dental team to ensure the disease does not spiral out of control and result in loss of teeth.
Dental treatment that is recommended to help patients who are suffering with genetic periodontal disease:
- scaling
toothpastes containing - triclosan and zinc citrate
mouthwashes containing - chlorhexidine - antibiotic gel if necessary once debrided
- periochip
- periodontal specialist ref
what is periochip used to do?
inserted into the debrided pocket to provide a slow release delivery of chlorhexidine directly into the problem area.
Good communication skills are really important when giving advice to patients regarding oral hygiene.
what does communicating mean?
to give or exchange information
verbally or non - verbally
ways to communicate to a patient correctly:
- talking directly or over the phone
- written explanations
- information leaflets/posters
-body language = friendly and open - eye contact = maintaining eye contact
-facial expressions - body positions - talk face to face
- touching - calm patients down and reassure them
Ethic group: hindus: how could this religion affect a patients oral health?
diets are high in fats
Ethic group: Sikhs : how could this religion affect a patients oral health?
diets are high in diary
Ethic group: muslems: how could this religion affect a patients oral health?
diet is rich in fish
Asian groups tend to breastfeed their children til around 2 years old, is breast milk high in sugar?
yes
The aim of good communication is to identify a patients level of motivation, if a patient is unmotivated we will try and think of ways to help
Risks factors of poor OH tend to be because of:
complex social attitudes and outside pressures
Childrens oral health very much depends on who:
parental guidance + support
Parents who have little interest in their own oral health will influence these behaviours on their children.
Oral health messages to children need to come across in what way?
as fun
use of games, drawings and competitions
Lack of motivation could be because of:
- lack of knowledge
- lack of interest
- presence of known risk factors
As the dental team we have to understand the reasons behind why a patient is not motivated and try to help.
Successful communication with adult patients can be achieved by:
- health leaflets
-one to one discussions
-eye contact maintained
-any queries listened to and answered
Successful communication with young people can be achieved by:
- relevant leaflets
- good patient management
- one to one sessions
Successful communication with children can be achieved by:
- disclosing tablets
- supervise individual attempts at toothbrushing
-relevant games to play
-encourage parental involvement
What factors could be affecting a patients oral health?
social, environmental, economic, patients knowledge and skills
oral health education should aim to..
modify a patients poor behaviour towards their oral health not reverse it
Low socioeconomic groups may have poor OH for what reasons?
- not likely to attend for regular examinations
- poor diet
-high rate of smoking and drinking - dental ignorance - low self esteem
Aids to help stop smoking:
nicotine patches or chewing gum
NHS stop smoking service
When progress has been made the patient should be congratulated, how would we show this with children?
stickers, badges, certificates
Current guidelines regarding oral health assessment recall intervals are issued by whom?
NICE
High risk patients should be viewed every:
3 months
mod risk patients should be viewed every:
6 months
low risk patients should be viewed every:
12 months
What affects does smoking have on general and oral health?
general = heart and respiratory disease
oral = periodontal disease, oral cancer
What affects does diet (free sugars) have on general and oral health?
general = obesity, risk of heart disease
oral = dental caries
What affects does excessive alcohol have on general and oral health?
general = liver disease
oral = periodontal disease, dental trauma, oral cancer
What affects does eating disorders have on general and oral health?
general = anorexia, bulimia
oral = acid erosion of enamel
What affects does diabetes have on general and oral health?
general = poor wound healing
oral = poor wound healing and prone to infections including periodontal infections
what medical condition can reduce salivary flow:
sjogrens syndrome
Disabilities can be:
mental or physical
Mentally disabled patients should have:
minor learning disabilities, elderly suffering with dementia such as alzheimers disease, down syndrome
Severe cases of disability patients will be referred for specialist care in community special needs clinics.
Those with some learning disabilities may present themselves in what way to the dental team:
- short attention span
- poor memory retention
-reduced level of understanding
Patients who have physical disabilites may present themselves in what way to the dental team:
- hearing impaired patients - lip reading
- visually impaired patients - touch n feel or listen to the sound of dental equipment before use
- downstairs surgeries
- stroke victims - struggle with speech, rely on family members
What effective oral hygiene can be advised to patients who are disabled?
- adapting a toothbrush handle
- oral health may be of responsibility to a career - important they understand in great detail
-angled toothbrushes
-several floss holders
The dental team may be the first people to notice a change in a patients behaviour - onset dementia what can we do to help?
- the dentist can write a letter to the patients GP describing their concerns
For patient consent with a patient who has dementia what protocol must be followed?
GDC standards for the dental team
code of practice set out in the mental capacity act
In regards to dementia what does cognitively impaired mean?
their disease worsens
Patients with dementia should be perscribed high fluoride toothpastes.
What is bruxism?
teeth grinding - gum shield
Bruxism can occur in patients with dementia
What is the correct word for difficulty in swallowing?
dsyphagia
What is gerodontology?
dentistry for the elderly
Elderly patients: possible changes to the skin with age?
- less underlying fat, increased risk of tissue fragility and soft tissue trauma and bruising.
Elderly patients: possible changes to the bone with age?
- more brittle, jaw bones increased risk of fracture during xla
Female elderly patients with osteoporosis who are taking bisphosphonates are likely to be referred for extractions, what is the reason behind this?
risk of postoperative bone necrosis
Elderly patients: possible changes to the oral mucosa with age?
- thinner less elastic - easy to trauma during routine treatment
ridge areas less tolerant to bearing dentures - discomfort and ulceration
-gingival recession - root caries
Elderly patients: possible changes to the salivary glands with age?
- suffer from dry mouth Xerostomia - increase in caries rate
swallowing, speech dentures
Elderly patients: possible changes to the teeth with age?
- gradual darkening colour
-narrowing and sclerosis of the pulp chamber = difficulty RCT - reduced sensitivity
Elderly patients may experience difficulty in accessing dental care due to:
- poor mobility - unable to attend, downstairs surgeries
-complicated medical problems - limit treatments - dementia, visual or hearing impairment
