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103 Cards in this Set
- Front
- Back
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Categories of Oral Disease |
• Dental Caries • Periodontal Disease • Acquired oral conditions, like oral cancer • Craniofacial disorders – ranging from congenital to accidents |
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Dental Caries |
• The localized chemical dissolution of a tooth surface by acidproduced by bacteria as a by-product of fermentation of dietarycarbohydrates • Tooth surfaces: enamel, dentin, cementum • Factors involved in developmental of caries: environmental,behavioral, etc. - risk factor? plaque |
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Periodontal Disease |
A variety of inflammatory and degenerative diseases that affectthe supporting structures of the teeth |
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Two types of periodontal disease |
gingivitis (reversible) & periodontitis (irreversible) |
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Where does plaque accumulate most? |
gum line and inter proximally |
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Risk factors for oral cancer |
smoking and drinking (worse when doing both) |
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Percent of american visit dentist each year.. |
60% vs 40% for physician |
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limits of dentistry |
cannot giveadvice/diagnose outside our area of expertise |
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3 types of disease prevention |
• Primary prevention: preventing the disease before it occurs o Ex: sealants to prevent caries • Secondary Prevention: limiting the extent of the disease, once ithas occurred (treatment) o Ex: screening, perio scaling, restoration • Tertiary Prevention: rehabilitation after extensive disease hasleft functional disabilities o Ex: extraction, fixed/removable prostheses |
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Health Promotion |
Science and art of helping people change their lifestyle to movetoward a state of optimal health Focuses on the person and health, not the disease |
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Paradigm Shift in Patient Care |
Focus of the health care profession is changing from diagnosisand treatment to disease prevention, health maintenance andhealth promotion |
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Framingham Study (1948-present) |
o Collected clinical, behavioral, and demographic datafrom 6507 males, ages 30-60 years o Monitored health status and looked for commonalities among those suffering from heart attacks o Identified risk factors: smoking, hypertension, obesity,diabetes, sedentary, cholesterol, triglycerides • Significance: o Chronic diseases are behavioral basedo Agents of chronic disease redefined as risk factors o Discoveries translated into prevention programs |
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Surgeon General’s Report of Smoking and Health |
o 1964 o Casuses cancer, heart disease, etc o Human behavior as a target for health promotion |
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key to further reduction in the burden ofdiseases and disorders that affect the face, mouth and teeth |
Scientific research |
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Health People 2010 Final Report |
o 21 categories o Didn’t achieve percent of kids with sealants – targetswere maybe a little too high |
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Best way to approach HP |
common risk factor approach By directing action on one risk factor you are affectingmultiple conditions and other risk factors |
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the most common chronic diseasein both children and adults and second most common disease |
dental caries |
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how dental caries are formed |
• Step 1: Bacteria/germs + food/drink/sugars = acid produced • Step 2: Healthy tooth + acid = cavity |
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Primary etiological factors of dental caries |
o Cariogenic bacteria o Fermentable carbohydrate diet o Susceptible tooth |
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True or false: Biofilms express properties not exhibited by the sameorganisms in individual cultures |
true, they are more than the sum of their parts |
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Cariogenic features of dental biofilm bacteria |
o The ability to rapidly convert sugars to acid (acidogenic) o The ability to maintain sugar metabolism (aciduric) under extremeenvironmental conditions, such as at a low pH (acidic) o The ability to produce extracellular and intracellularpolysaccharides which contribute to the biofilm matrix |
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Remineralization by which ions |
calcium and phosphate |
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Effect of pH on Caries |
• The higher the acid, the more the demineralization • The lower the acid, the more the remineralization |
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The Stephan Curve |
represents the fall and subsequent rise inplaque pH which occurs after exposure of dental plaque to fermentable carbohydrates Plots pH of dental plaque against time When pH drops below 5.5, teeth start to demineralize |
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pH of dental plaque prior to exposure |
6.5-7.0 o It can fall <5.5 within 2-5 minutes with exposure tosucrose o Slow recovery – usually 30-60 minutes |
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Cariostatic Foods |
aka protective foods |
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Role of Saliva in CariesPrevention |
• Buffering Effect: o Saliva contains calcium and phosphate ions in a state ofsupersaturated with respect to the hydroxyapatitecrystals in the tooth o Saliva reduces the dissolution (demineralization) oftooth minerals in caries by replacing minerals(remineralization of the crystals) in early caries lesions |
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What affects yourStephen curve? |
• How often you eat and drink (frequency) • How long you eat and drink for (duration) • What you eat and drink (sugar vs. sugarless) • Consistency of the food • What you eat or drink after the sugar intake • The amount and quality of your saliva • The amount of bacteria (plaque) • Fluoride |
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Major Caries RiskFactors |
• Plaque from poor oral hygiene • Lack of fluoride • Frequent sugared beverages consumption • Frequent fermentable carbs consumption • Exposed roots • Restorations with overhangs • Dental appliances (prostheses) • Orthodontic appliances • Saliva reducing factors • Severe xerostomia • Substance abuse (e.g. methamphetamine) |
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Caries PreventiveStrategies |
• Plaque control • Fluoride • Sealants • Diet modification o Diet risk assessment o Diet counseling |
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Limiting cariogenic effect |
• Eat protective foods with dangerous foods • Apple (acidic) with peanut butter (protective) • Raisins and nuts • Chew xylitol gum – promotes remineralization |
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Experimental Gingivitisin Man (article to read) |
• Withdrawal of oral hygiene led to accumulation of l=plaque andgingivitis • Plaque increased quantitatively and qualitatively during periodof no cleaning • 3 distinct phases microbiologically o 1st: Biofilm consisting of gram positive bacteria(streptococci and short rods surrounding fusobacterium– good oral bacteria)# “Strep” bacteria is good for oral hygiene o 2nd: Rods, filamentous o 3rd: Gram negative anaerobes • Gingivitis developed between 10 and 21 days (gingivitis isreversible) • Reinstitution of oral hygiene measures resulted in gingivalhealth • Things that they tracked: type and amount of bacteria in themouth, age of the plaque (the longer left in the mouth the moreit ages and changes into bad gram negative bacteria) |
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Gram pos vs gram neg in oral health |
• In health there is a lot of gram positive, which is aerobicbacteria, and only a little bit of anaerobic gram negative • In gingivitis there is a lot more gram negative - must be professionally removed |
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effects of plaque |
inflammation, redness, swelling |
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The Periodontium |
• Fibers and bone holding onto cementum of the root, which is allcovered by gums • As the bone level decreases and the attachment of the bone tothe tooth decreases, you get periodontitis • Pockets around tooth is normally 1-3mm, but when the pocketdepth gets deeper you have periodontitis because of bone loss |
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According to National Health and Nutrition Examination Survey in 1999, US adults 30 years or older, estimated that ___% havegingival bleeding, ___% have calculus, and ___% havesubgingival calculus |
50, 92, 55 |
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Study in 2009-10: over ___% had periodontitis |
47 with mostly moderate cases (30-60% of bone lost) |
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Total periodontitis ranged from ___% in adults 30-34 years oldto ___% in adults aged 65 years and older |
25, 70 |
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Specific plaque hypothesis (current theory) |
bacteria changesin character as time goes on |
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Mechanical plaque control |
using a toothbrush andfloss |
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Plaque growth occurs within hours and must be completelyremoved at the very least every ___ hours in periodontally |
48 |
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Most people on average only clean about ___% of the plaque |
40 |
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Recommend toothpastes with the ________ |
ADA label |
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Recommend everyone uses _______ BRISTLES |
soft |
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difference in plaque removalin hard vs. soft bristles |
none... soft bristles are best because theywill not aggravate the gums |
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Amount of abrasive toothpaste the brush holds is alsoimportant – only need a _____ amount |
pea sized |
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recommend changing toothbrushevery ____ months |
3-4 |
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how often to floss and brush a day |
brush twice; floss once |
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Electronic toothbrushes: remove __% more plaque and reducegingivitis by __% more than a regular toothbrush |
11, 6 |
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Electronic toothbrushes shown toimprove oral health for: |
o Children and adolescents o Children with physical and mental disabilities o Hospitalized patients, including those that need to havetheir teeth cleaned by caregivers o Patients with fixed ortho appliances |
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Dentrifices |
Aids for cleaning and polishing tooth surfaces (toothpaste or powder) |
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Fluoride toothpastes comprise over __% of all dentifricesmarketed in the US |
90 |
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Fluoride works to prevent caries by _________ demineralizationand __________ remineralization, and it inhibits the enzymes thatthe bacteria produce; it helps in both the enamel and the roots |
decreasing, increasing |
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What demineralizes faster than enamel? |
cementum (covering the roots) |
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Fluoride must be _______ ppm to effectively prevent caries(_______ppm for high risk patients) |
1000-1100, 5000 note: ppm is 1mg/1L |
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Ingredients in toothpaste |
• Surfactants (1-2%) • Abrasive systems (20-40%) • Binders (1-2%) • Humectants (20-60%) • Other: water, flavoring coloring |
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Surfactants (1-2%) |
o Foam lowers surface tension for dispersion ofingredients o Loosens and removes debris and plaque bacteria o Ex: sodium lauryl sulfate |
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Abrasive systems (20-40%) |
o Clean, polish, remove stained pellicle o Ex: silica, silicon oxide, aluminum oxide, etc. |
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Binders (1-2%) |
o Thicken o Provide cohesion of ingredients o Ex: xanthan gum, carbomer, carrageenan |
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Humectants (20-60%) |
o Retain moisture o Prevent hardening o Transport other ingredients o Ex: sorbitol, glycerin, polyethylene glycol |
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ACTIVE INGREDIENTS in toothpaste |
o Anticaries benefits: sodium fluoride, sodiummonofluorophosphate, stannous fluoride o Desensitizing agents: potassium nitrate, strontiumchloride o Antigingivitis agent: triclosan (only in Colgate Total) o Anticalculus agents: # Pyrophosphate • Inhibits nucleation of calculus • Holds calcium in solution • Coats crystals – prevents maturation # Zinc • Inhibits nucleation of calculus • Traps phosphate – holds it in • Coats crystals – prevents maturation # Gantrez • Inhibits nucleation of calculus • Holds calcium in solution • Coats crystals – prevents maturation |
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Intrinsic stain |
o Part of tooth structure, like tetracycline stain o Can't be brushed off, can be bleached |
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Extrinsic stain |
can be brushed off |
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Brushing Methods |
• Bass and Modified Bass Technique (most recommended) • Stillman Technique • Charter’s • Tell patient to do “Target Hygiene” method for electrictoothbrushes as well |
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Bass and Modified Bass Technique (most recommended) |
o Target Hygiene o Targets the gumline and interproximal region o Bristles angled at 45 degrees at gumline from toothsurface o Start at the most distal tooth in the arch and use avibrating back and forth motion to brush o Jiggle jiggle jiggle and flick o Bristles stay on the gum and do not move (don’t scrub) o People mostly miss lingual buccal surface in the backbecause coronoid process gets in the way o Brush three teeth at a time |
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Stillman Technique |
o Using the sides of the bristles o Doesn’t target the gingiva because it is meant to preventrecession o Less effective plaque control |
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Charter’s |
o Bristles face the occlusal o This is only for after surgery when you don’t wantpeople to irritate the gums o Targets the interproximalo Doesn’t work very well |
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Interdental CleaningAids |
• Dental floss: floss threaders and floss holders • Interdental brushes (Proxabrxsh) • Single-tufted brushes • Wooden tips: Stim-U-Dent, Perio-Aid • Rubber tip stimulators |
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Dental floss: floss threaders and floss holders |
o There are reusable and disposable floss holders o C shaped holder works better in the posterior teeth o Power flossing tools don’t work any better than regularflossing o Floss threaders are good for under pontics |
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Interdental brushes (Proxabrush) |
Very good when people have periodontal disease because it can clean the root concavities |
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Single-tufted brushes |
o Good for tracing the gum margin o Works well for poetics (dummy tooth) in bridges |
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Wooden tips: Stim-U-Dent, Perio-Aid |
o Smaller than interdental brushes o Only work up to premolar area o Perio aid holds toothpicks so you can access posteriorteeth o Tongue gets in the way of cleaning the lower lingualsurface so this helps o Trace gum margin |
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Teach them to use an interdental brush when they have ______ _________ because they work better and patients tend to liketo use them better; if there is no space teach them to use floss |
large embrasures |
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Primary purpose of flossing is to remove ______ |
plaque |
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Ease floss through the contact to avoid floss cuts and make thefloss into a ___ shape around the tooth the contact theinterproximal surface and go up and down on the sides of eachtooth – go a little below the gumline but not too far becausethat will cause pain |
C note: o Going below the gumline causes the bad subgingvalflora to go away o Bad flora takes 2-3 months to recolonize |
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Have about __ inch(es) between fingers when holding the floss |
1 |
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Oral Irrigation Devices (WaterPik) |
• Works well for fixed prostheses • Flushes out area under bridges • Lowers amount of plaque and gingivitis • Flushes out toxins that bacteria secrete • Hold for 10-15 seconds at interdental papilla • Works even better using listerine or chlorohexidine • Subgingival irrigation tip: use medicament in reservoir and putbrush in the pocket to flush it out (decreases bleeding well) |
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ChemotheraputicAdjunctive Therapy |
• Chemical plaque control • Chlorohexadine (Rx only): o Peridex o PerioGuard o ADA accepted o Can cause black tongue and temporary impairment oftaste sensation |
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Disclosing Agents |
Causes plaque to turn red so patients can see it |
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% plaque = |
total surfaces with plaque/total surfaces |
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True or false: Brushing three times a day doesn’t make much of a different |
true |
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leading chronic causes of deathin the US |
diabetes, heartdisease and obesity |
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Nearly ___% of children in the US are overweight |
20 |
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Children 2-19 years old • ___% at risk for overweight (over 85th percentile for BMI forage) • ___% at risk for obesity (over 95th percentile for BMI for age) |
32, 17 |
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Adults >20 years old • ___% obese • ___% overweight + obese combined |
36, 69 |
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BMI: • Underweight: below ___ • Normal: ___-___ • Overweight: ___-___ • Obesity: ___ and above |
18.5, 18.6-24.9, 25-29.9, 30 |
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BMI calculation |
(weight/height in inches squared) x 703 |
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Weight in ________ is most dangerous |
midsection |
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processed foods |
no fiber and less nutrients |
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How infants learn foodpreferences |
• Based on experiences with foods • Flavor begins to develop in utero (taste buds and neurons) • Flavor of breast mild influenced by mother’s diet • Genetic predisposition to sweet taste• Food preference from infancy sets stage for lifelong food habits • People love sweets because lactose in breastmilk makes itsweet so we learn to love it from a young age High Fructose CornSyrup• SO many added sugars come from sweet drinks/juice kids drink |
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High Fructose CornSyrup |
• Cheap to make from corn • It is in soda, juice, cough syrup, dessert, frozen food, candy,sauces, lunch meats, jelly, bread, yogurt, infant formula • 80% of 600,000 tested food items in the US had added sugars |
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PROPOSED NEW FOOD LABEL |
will differentiate between addedsugar and natural sugar |
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MyPlate musts... |
fruit, grains, veggies, protein, dairy to have abalanced meal |
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Added sugars no more than ___% of total calories |
10; about 10 tsps |
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Sodium less than ____mg or ____mg for those at risk |
2300, 1500 |
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Cap on cholesterol? |
none now, recently removed (300mg/dy previously) |
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veggies per day |
2.5-3 cups Half your plate should be fruits and vegetables |
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fruit per day |
1.5-2 cups Half your plate should be fruits and vegetables |
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protein per day |
5-6 oz 1/4 of your plate |
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grains per day |
Make at least half your grains whole grains An ounce of grain is one slice of bread, one half cup of cookedcereal/rice/pasta, one cup of dry cereal |
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dairy per day |
3 cups with every meal |
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portion sizes |
see image |
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Caries ProtectiveFactors |
• Proteins: buffering agents, increase in plaque pH, includesmeats and nuts • Casein – inhibits adhesion of plaque to surface, includes milk,cheese, calcium, phosphorus – protects tooth enamel, increasesplaque pH • Fat accelerates oral clearance • Chewy foods like fibrous crunchy veggies, whole grainsstimulate salivary flow • Water – clearance • Xylitol gum helps prevent decay • Chew sugar free gum or drink water after eating a banana |
