W9: Prevention of Oral Diseases Flashcards
Define how sugar and Streptococcus mutans initiate dental caries
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
What is ‘sugar’?
Sugar = sucrose = glucose + fructose
Disaccharide
Describe some methods of enhancing remineralisation and decreasing demineralisation
- 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
What does CPP-ACP stand for
Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP
List the categories of sugar substitutes
Sugar substitutes – two groups
Non-nutritive
* Low or no calories
* Minimal nutrition
Nutritive
* Contain calories
* Minimal nutrition
Elaborate on the types of the Artificial Non-nutritive sugar substitutes
Advantages, disadvantages, properties
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
Elaborate on the types of the Natural Non-nutritive sugar substitutes
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
List the Nutritive sugar substitutes, including the overall advantages and disadvantages
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
Describe the sugar alcohol, Sorbitol, its advantages and disadvantages, and explain how it reacts with Strepmutans
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
Describe the sugar alcohol, Erythritol, its advantages and disadvantages, and explain how it reacts with Strepmutans
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
Describe the sugar alcohol, Xylitol, its advantages and disadvantages, and explain how it reacts with Strepmutans
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
What is the role of xylitol in remineralisation?
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.
Elaborate on xylitol and erythritol and the evidence for their use in oral health prevention
- 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
What is the minimum dose and frequency for xylitol to reduce salivary Strepmutans
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
Wha does DMFS stand for
DMFS=Decayed,Missing, Filled Surfaces
How does chewing gum cause remineralisation?
Chewing stimulates saliva flow and raises Saliva pH = acid buffering and promotes remineralisation
Why do dentists need to know about sugar substitutes?
- 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
What is the responsibility of a Dental practitioners with patients with a history of consuming large quantities of sugar and gaining excess weight
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
What is happening in this photo? Diagnosis.
PLAQUE INDUCED GINGIVITIS
Explain plaque-induced gingivitis
The signs, symptoms and methods of diagnosis
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
Elaborate on the differences between gingivitis and periodontitis
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
Describe the different causes of potential plaque retention
Discuss strategies for the prevention and treatment of gingivitis and periodontitis
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)
WHY REMOVE CALCULUS?
- 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
