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DS2102 Anatomy > W9: Prevention of Oral Diseases > Flashcards

W9: Prevention of Oral Diseases Flashcards

1
Q

Define how sugar and Streptococcus mutans initiate dental caries

A

Mono and disaccharides are readily fermentable by cariogenic bacteria including those that cause dental caries (Streptococcus mutans) ie. acidogenic = lactic acid (low pH) = demineralisation (loss of inorganic (white spot) and organic content)

Strep mutans and Strep sobrinus are implicated in dental caries formation
* Thrive in an acid environment
* Thrive on fermentable carbohydrates (sugar)
* Produce lactic acid as a metabolite creating an acidic environment
* Produce extracellular polysaccharides that promote adhesion to tooth structure
* The lactic acid production may tip the mineralization/demineralization balance within the oral environment to promote cavitation of tooth structure
Lactic acid pH = 2.4 compared to hydrochloric acid pH = 2.0

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2
Q

What is ‘sugar’?

A

Sugar = sucrose = glucose + fructose
Disaccharide

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3
Q

Describe some methods of enhancing remineralisation and decreasing demineralisation

A
  • plaque control (brushing, F, flossing, mouthrinse)
  • diet (low sugar/acid)
  • Tooth mouse (CPP-ACP) enhancing remineralisation
  • pit and fissure sealants (tooth related factor)
  • increase saliva production
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4
Q

What does CPP-ACP stand for

A

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP

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5
Q

List the categories of sugar substitutes

A

Sugar substitutes – two groups

Non-nutritive
* Low or no calories
* Minimal nutrition

Nutritive
* Contain calories
* Minimal nutrition

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6
Q

Elaborate on the types of the Artificial Non-nutritive sugar substitutes

Advantages, disadvantages, properties

A

Artificial non-nutritive sweeteners
* Saccharin - 300x sweeter than sugar, bitter aftertaste - increased risk of side-effects including cancer formation
* Aspartame (Nutrasweet/Equal) - 160-220x – increased risk all multiple cancers in animals and brain tumors in humans
* Neotame (Nutrasweet) – 7000x, safer than aspartame, approved food additives, GRAS (generally recognised as safe by US FDA) TEST
* Sucralose (Splenda) – 600x
* Acesulfame Potassium (ACE-K) – 200x
* Cyclamate – 30x – increased cancer risk

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7
Q

Elaborate on the types of the Natural Non-nutritive sugar substitutes

A

Natural non-nutritive sweeteners
Stevia
* Herbal extract – Stevia rebaudiana
* General purpose sweetener
* 200x
* Non-cariogenic (not fermented by bacteria)
* Mild to moderate aftertaste
Monkfruit
* Small, subtropical melon from Southern China* 20-200x
* Anti-cariogenic

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8
Q

List the Nutritive sugar substitutes, including the overall advantages and disadvantages

A

Sugar alcohols - Occur naturally in certain fruits and vegetables
* Sorbitol
* Maltitol
* Mannitol
* Erythritol
* Xylitol

Classified as nutritive sweeteners with 1/3 to 2/3 the caloric content of sucrose

Advantages: Poorly fermented by oral acidogenic bacteria, low or non-cariogenic, no after-taste
Disadvantages: Most are not well absorbed in the GIT - excessive consumption = GI symptoms

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9
Q

Describe the sugar alcohol, Sorbitol, its advantages and disadvantages, and explain how it reacts with Strepmutans

A

Naturally occurring, mostly sourced from corn syrup
* Chewing gum, diabetic lollies, toothpaste and mouthwash
* Half as sweet as sugar
* Low/Non-cariogenic – ferments slowly
* Not easily digested or absorbed
* Diarrhea if consumed in large quantities

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10
Q

Describe the sugar alcohol, Erythritol, its advantages and disadvantages, and explain how it reacts with Strepmutans

A

Occurs naturally
* 70% as sweet as sugar, but used 1:1 ratio in cooking
* Heat stable – used in baking
* Lollies, soft drink, chewing gum…
* Absorbed in GIT but excreted unmetabolized in urine with minimal effect on insulin levels
* Used as sugar substitute in ketogenic diets
* Reduces oral Strep mutans levels

Natvia = combo Stevia + erythritol

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11
Q

Describe the sugar alcohol, Xylitol, its advantages and disadvantages, and explain how it reacts with Strepmutans

A

Occurs naturally in plants and animals, produced commercially from birch and corn
* 60% of the calories and sweetness of sugar
* First used as a sugar replacement for diabetics - sugar shortage during WW2 - mass production
* Anti-cariogenic effect - 100% xylitol had highest caries reduction
* Fatal to dogs and cats
* May aggravate GIT issues (approx. 50g/day)

How reacts with Step Mutans…
* Xylitol is not fermentable by Strep mutans. Strep will metabolise xylitol before sucrose and bacteria expend energy attempting to metabolizing xylitol to no avail = futile cycle
* Decreases replication and adhesion to the teeth (by decreasing amount of polysaccharides produced by bacteria)
* Decreases pathogenic effect of P. Gingivalis

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12
Q

What is the role of xylitol in remineralisation?

A

The use of xylitol can assist remineralisation by interfering with acid production by bacteria. If used in a chewing gum, saliva is stimulated and remineralisation further assisted.

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13
Q

Elaborate on xylitol and erythritol and the evidence for their use in oral health prevention

A
  • Protect against tooth decay by decreasing levels of Strep mutans in saliva and plaque
  • Xylitol is well studied, but the latest research shows that erythritol has the most anti-cariogenic effect compared to xylitol and sorbitol
    Xylitol is fatal to dogs and cats - hypoglycaemia and liver failure
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14
Q

What is the minimum dose and frequency for xylitol to reduce salivary Strepmutans

A

Xylitol dose of 5-10g per day divided into 3 or more doses will have atherapeutic effect on oral Strep mutans IN Gum, Toothpaste, Foods

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15
Q

Wha does DMFS stand for

A

DMFS=Decayed,Missing, Filled Surfaces

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16
Q

How does chewing gum cause remineralisation?

A

Chewing stimulates saliva flow and raises Saliva pH = acid buffering and promotes remineralisation

17
Q

Why do dentists need to know about sugar substitutes?

A
  • Dental professionals are required to provide knowledgeable advice regarding the role of sugars in caries.
  • We must be familiar with the substitutes.
  • Any caries prevention programme must include primarily dietary advice, oral hygiene education and instruction, regular dental care and fluoride exposure
18
Q

What is the responsibility of a Dental practitioners with patients with a history of consuming large quantities of sugar and gaining excess weight

A

Dental practitioners should consider referring patients with a history of consuming large quantities of sugar and gaining excess weight to their medical practitioners for additional investigation and counselling. Practitioners should keep up to date with what alternatives to sugar exist, what’s are being developed and what’s approved for use

19
Q

What is happening in this photo? Diagnosis.

A

PLAQUE INDUCED GINGIVITIS

20
Q

Explain plaque-induced gingivitis
The signs, symptoms and methods of diagnosis

A

Dental plaque = biofilm– microbial exo- and endotoxins –> initiate inflammation of gingival tissue
Classic signs: red, swollen, bleeding on brushing or probing, usually painless. Probing depths = < 3mm

21
Q

Elaborate on the differences between gingivitis and periodontitis

A

GINGIVITIS AND PERIODONTITIS OCCUR TOGETHER BUT…..
* Not all patients with gingivitis will get periodontitis
* Evidence states that preventing gingivitis will prevent periodontitis
* Progression from gingivitis to periodontitis depends on IMMUNE response
* Some individuals progress to periodontitis with minimal gingivitis

22
Q

Describe the different causes of potential plaque retention

A
23
Q

Discuss strategies for the prevention and treatment of gingivitis and periodontitis

A

Oral hygiene instruction
* Educate patient about the disease process (simple words)
* Toothbrushing technique
* Interproximal cleaning
* Hygiene products (chemotherapeutics)

Professional cleaning including:
* Removal of calculus and plaque: supragingival cleaning/scaling, subgingival cleaning/scaling
* Flossing and prophylaxis (polishing)
Using ultrasonic, hand-scaling instruments, prophylaxis paste, flossing (local anesthetic if needed)

Eliminate all plaque retentive elements: restoration overhangs, open contacts

Reviews for active gingivitis: if gingivitis has not resolved, look for other CAUSES…

Address other factors: dental awareness, dental apathy, dental phobia, non-dental priorities, age, manual dexterity, economic limitations, disabilities, personality types, tooth anatomic factors (crowding – mal-aligned teeth are more plaque retentive and morechallenging to clean, recession, surface anatomy, proximity to frenum, position in jaw)

24
Q

WHY REMOVE CALCULUS?

A
  • Calculus deposits contain and retain plaque (bacterial biofilm)
  • Deposits prevent the patient from accessing the dento-gingival area which results in more deposits and calculus formation
    Prevention is easier than treatment
25
Q

What Denture Hygiene advice should be given to a patient with a RPD

A
  • cleaned twice a day to remove food particles and plaque - remove dentures, clean with warm water mild soap and toothbrush/denture brush
  • clean gums and remaining teeth with a soft toothbrush and toothpaste
  • place dentures in dry environment overnight
  • if plaque build up, soak overnight in solution of white vinegar then clean as usual
26
Q

What is iatrogenic dental disease?

A

injury either on the tooth or the Periodontium or both. Trauma that has been induced by the dentist’s activity, manner, or therapy, and this term is generally used for an infection or other complications of treatment.
Ex. overhangs, open contacts, over/undercontouring

27
Q

Which populations are the most susceptible to periodontitis

A

DIABETES – Both Type I and II are MAJOR risk factors for the development of periodontal disease
SMOKERS - the most important controllable environmental risk factor in periodontitis

28
Q

What should a dentist and patient look out for in “Recall and surveillance of gingivitis and periodontitis”

A
29
Q

Explain how to gather Information when history taking.

5 Steps

A
30
Q

Define and give examples of supervised neglect

A

PREVENTION first and foremost If you find a disease process occurring, ADDRESS THE CAUSE!
If you dont…SUPERVISED NEGLECT
EXAMPLES
* Restoring a carious tooth, but not addressing the periodontal disease
* Restoring a tooth, but not addressing the cause of the caries

31
Q

Describe the correct toothbrushing technique, including the toothpaste…

A

EFFECTIVE and REGULAR toothbrushing: Soft bristles, correct size and shape to fit tight areas, Bristles at 45 degrees, circular motion twice daily for 2 minutes, electric toothbrush is best (Rotational oscillation)
Modified Bass technique
Fluoride + Low abrasion - Spit don’t rinse

32
Q

What would you use to clean interproximally for a patient with tight contacts

A

tight contacts = floss string or sticks

33
Q

Describe the correct flossing technique

A

Hold the floss between the thumbs and forefingers and gently guide and rub it back and forth between the teeth until it goes through the contact point.
* Curve the floss down into the crevice of the tooth in front and behind
* Rub gently up and down against the tooth. Repeat with eachtooth, including the distal of the back teeth.

Be careful not to push down too hard and hurt the gum. If the floss becomes shredded or stuck between the teeth,find out WHY and fix it!!

34
Q

What would you use for interproximal cleaning with orthodontic retainer, brackets or bridges

A

Superfloss (blue and green), interdental brushes, waterpik

35
Q

Describe the guidelines and purpose of chlorohexadine

A
  • Reduces plaque (anti-microbial)
  • Bacteriostatic at low concentration (0.02-0.06%)
  • Bacteriocidal at high concentrations (0.12-0.2%)
    Stains teeth, but stains can be removed with ultrasonic scaler
36
Q

Describe the ingredients found in other anti-microbial mouth rinses (not Chx) and the advantages

A
37
Q

What are the 3 essential steps of the Treatment Plan Sequence

A

Essential parts:
1. Information gathering
2. Diagnosis
3. Treatment list

38
Q

Explain what is required during the information gathering phase of Treatment Plan Sequence

A
39
Q

Explain what is required during the diagnosis and treatment plan/list phases of Treatment Plan Sequence

A

DS2102 Anatomy (17 decks)

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