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145 Cards in this Set
- Front
- Back
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First dental visit should be at what age? |
1 year old or when first few teeth start erupting note: must kids don't start coming until 2-3 and Pediatricians will see kids as babies so they should refer them to a pediatricdentist early on |
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________ ________ is the most chronic childhood disease |
dental caries |
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Most children ages _____ have has cavities already |
5-9 |
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_______ ______ can result from a cavity in a primary tooth |
Facial cellulitis note: In Maryland a 12 year old boy died from a dental bacteria that spread to hisbrain |
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Approx what percent of children ages 2-5 had dental caries on their primary teeth? |
a quarter |
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what method is under utilized in children? |
dental sealants |
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what is ECC and how is it defined? |
early childhood caries Presence of 1 or more decayed, missing (due to caries) or filled toothsurfaces in a child <6 years of age |
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______ ______ lesions are early stages of a carious lesion – tooth isdemineralized – can be treated in this early stage with________ (it isreversible) |
white spot fluoride |
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Consequences of ECC |
o Higher risk of new carious lesions in primary and permanentdentition o Risk for delayed physical growth and development o Becomes difficult to eat nutritious food when teeth are decayed o Loss of school days and increase in days with restricted activity o Quality of life diminished o Hospitalizations o Increased cost of treatment |
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Current paradigm in patient care |
early intervention, risk assessment, anticipatory guidance,individualized prevention and disease management |
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Important to do what on a pregnant mother? |
pre-natal visit |
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Tell them babies teeth are forming already in ___ week of pregnancy |
6th |
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what can be a risk factor for pre-term low birth weight baby? |
gum disease |
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Caries Risk Assessment (CAT) Tool for 0-5 year olds |
biological protective clinical findings |
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biological |
o Primary caretaker with caries o Low socio economic status o Frequency of snacking o Child put to bed with bottle o Special needs o Recent immigrant |
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Protective |
o Fluoride (in tap water where they live?) o Home care o Child receives fluoride from health professional o Dental home |
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clinical findings |
o 1 or more dmfs (decayed/missing/filled surfaces – lower case forprimary teeth and upper case for permanent teeth) o White spot lesions o Elevated SM (streptococcus mutans) o Plaque |
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knee to knee exam |
o Oral examination o Soon after a few teeth erupt, no later than age 1 o Two chairs facing each other with kid laying on lap of mother withhead in dentist’s lap |
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What is healthy in a child? |
o Coral pink gums o Stippled o Knifelike margins o Firm consistency |
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Anticipatory guidance |
Proactive counseling of parents by health providers about developmentalchanges |
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why primary teeth are important |
- Provide space for the permanent teeth and guide them into correct position - normal development of the jaw and bones and muscles - If teeth are lost too soon some of their permanent teeth will not grow inuntil a lot later – will affect permanent teeth |
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Risk Factors for ECC |
• Frequency of eating • Sleep time habits • Disruption of tooth development (enamel hypoplasia) • Bacterial transmission from caregiver to child o Streptococcus mutant o “Window of infectivity” • Oral habits o Bottle feeding: should be weaned at 12-14 months to sip cup o Thumb sucking – normal for infants, not for when you have permanent teeth |
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Begin cleaning _____ before teeth come in |
gums |
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what to use for oral hygiene in infants |
• Finger tender • Gauze • Clean washcloth • Infant toothbrush |
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positioning for oral hygiene in infants |
child’s head in lap of dentist or caregiver doing the cleaning |
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how to and how often to clean for infant |
• Cleaning: wipe ridge of upper and lower jaws, wipe teeth • Clean the mouth at least two times daily |
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Toddlers: begin supervised brushing ____ a day for _____ minutes |
twice two |
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Begin fluoridated toothpaste at ___ - ___ years old |
2-3 or as soon as teeth erupt |
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scrub technique for toddlers |
brush placed horizontally on buccal and lingual surfacesand moved back and forth with a scrubbing motion easy bc they have poor manual dexterity at that age --> Modified Bass Technique when older |
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toothbrushes specialized for braces |
middle row of bristles isshorter to accommodate brackets |
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different types of fluoride |
Fluoride toothpaste, professionally applied fluoride, water fluoridation, overthe counter fluoride products |
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amount of fluoride toothpaste for age |
Smear/grain of rice sized for 1<3 (or whenever teeth erupt pea sized >3 |
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bottled water vs NYC water and fluoride content |
bottled water is usually around .1-.2 ppm NYC is about 1 ppm note CDC says we can go as low as .7 for the same health benefits |
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fluoride varnish |
alternative form of topical fluoride o Easy to apply o Can eat and drink after (just no crunchy foods or hot liquids, don’tbrush right away, no alcohol right after) o Ingestion minimal o Teeth do not need a professional prophylaxis |
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age to start flossing? |
3-4 years old o Contacts between posterior teeth close between 3 and 4 years o Open contacts may linger until eruption of permanent first molars o Parents floss for young children until development of manualdexterity |
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when did data show that fluoride reduced caries |
1940's |
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topical fluoride |
– this is the main use currently o Inhibits demineralization o Promotes remineralization o Fluoride acts as a catalyst to move this equilibrium equation towardsthe remineralization side |
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systemic fluoride |
– this is not the focus anymore o Improves enamel crystallinity o Reduces acid solubility o Improves tooth morphology |
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antibacterial fluoride |
o Concentrates in plaque o Disrupts enzyme system |
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3 Anti-CariesMechanisms of Fluoride |
• Inhibits demineralization • Enhances remineralization • Antibacterial effect |
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Inhibits demineralization |
by adsorbing negative fluoride ions to the surfaceof crystals in teeth and acts as a physical barrier against acids. In addition,during remineralization, the newly forming crystal will incorporate fluorideinstead of hydroxyl (fluorapatite). |
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Enhances remineralization |
by neutralizing acids with salivary buffers and, ifcalcium and phosphate is present in solution in the saliva, to allow crystalgrowth. |
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Antibacterial effect |
by diffusing into bacterial cell wall as a neutral HFmolecule, then dissociates into the cytoplasm releasing H+ and F- ions. TheF- inhibits key enzymes that stops glycolysis and also acidifies the cytoplasmby not allowing H+ ions to be removed. |
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amount of fluoride needed insolution in saliva to assist remineralization |
0.04 ppm with an optimum at0.08 ppm or above Most effective in low doses at regularintervals on a daily basis |
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_____ serves as an important fluoride reservoir to facilitateremineralization of decalcified areas |
CaF |
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Fluoride ion fits more perfectly into crystal than _______ _______ |
hydroxyl ion Fluorapatite more compact and stable than hydroxyapatite |
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Role of Saliva – the“Bloodstream of theMouth” |
• Produces salivary pellicle - biofilm • Antimicrobial • Clears bacteria and carbohydrates; buffers acids • Contains calcium / phosphate / fluoride • Lubricates oral mucosa • Mediates taste acuity |
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Fluoride DeliverySystems |
• Drinking water • Salt, milk • Commercial (toothpaste, daily home rinses) • Professional (gels, varnish, supplements) |
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Silver Diamine Fluoride (SDF) |
Very effective at preventing decay and arresting decay for children withlarge cavities simple and low-cost method thatdoes not require the cooperation of the patient or the complex training ofthe health professional |
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first city with fluoridated water and when |
Grand Rapids, Michigan fluoridated its public water supply on January 25,1945 |
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____ sources of drinking water in the U.S. contain some fluoride |
All Fluoridation is merely an upward adjustment of existing fluoride levels tothat which is optimum for health |
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2010 stats show increase in US residents receiving fluoridated drinking water– shows that community water fluoridation prevents at least ___% of toothdecay in children and adults throughout the lifespan |
25 |
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New York City: ___% fluoridated (1ppm) |
100 |
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40-50% caries reduction in theprimary dentition, 50-60% for the permanent teeth |
n/a |
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Halo Effect |
increasing amounts of foodsand beverages are being prepared with fluoridated water and beingconsumed in non-fluoridated communities |
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Salt Fluoridation |
• Vehicles - domestic salt, meals at school, large kitchens, bread • Concentrations from 90mg/kg – 350mg/kg, optimal 250mg/kg • Concern: may contradict PH efforts to reduce salt intake to fighthypertension • People eat too much salt – not the best way to deliver fluoride • Solution: balance intake and Fl- dosage |
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Milk Fluoridation |
• Switzerland, Scotland, Hungary (as early as 1962) • Distributed in schools, national feeding programs • Start in early childhood, to maximize effect on primary dentition; maintainconsumption for at least 180 days/year • One study in China sent milk home Fridays to increase consumption toinclude weekends and get 300+ days of exposure (2003) |
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Topically AppliedFluoride Products |
• OTC Daily Rinses = 225 ppmF = 0.23mg/cc • Weekly Rx Rinse (NaF) = 900ppmF = 0.9mg/cc • FluorProtector varnish = 1000ppmF = 1.0mg/cc• OTC toothpastes = 1000-1500ppmF = 1.5mg/cc• 1.23% APF gel = 2,300 ppmF = 2.3 mg/cc • Rx toothpaste (Prevident) = 5,000ppmF = 5mg/cc • 2% NaF gel = 9,040 ppmF = 9 mg/cc • 5% NaF varnish = 22,500 ppmF = 22.5 mg/cc |
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Fluoride Dentifrices |
• First successful clinical trial in 1954 (Crest SnF2)• Na Fluoride (Crest, Colgate Total) • Na MFP (Aim, Aqua Fresh, Macleans, Colgate) • Most contain about 1,000 ppm fluoride • Estimated caries reduction due to fluoride containing toothpastes alone is inthe 30% range • Big problem: ingestion of excess fluoride by swallowing – implicated inincreased prevalence of fluorosis • F ion in 0.1% = 1000ppm • Use pea-sized portion or a “smear” (0.25 mg) to minimize amount swallowed • 0.2-0.3 mg of F can be swallowed by pre-school children when brushingtwice a day |
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Daily Home Rinses |
• Most commonly used – daily rinses – 0.05% NaF (ACT, Fluoriguard) • Weekly rinses – 0.2% NaF (Prevident) Rx • Indicated for children who do not drink water, drink bottled water, wearorthodontic appliances, or are high risk for dental caries • Many school-based rinse studies – reductions in caries of 20-25% over 4years (50% fewer interproximal) |
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The use of supplementsduring the first six years of life, especially during the first three years, isassociated with a significant increase in __________ |
fluorosis |
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Fluoride Content ofCommercial InfantFormulas |
• Range from 0.1-0.3 ppm • This is considered a very low level of fluoride, not much to be concernedabout • Amount of fluoride recommended increases as weight increases, but only upto a certain amount that does not put them at risk for fluorosis |
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Topical Fluoride in the dental office |
• Acidulated fluoride gels and solutions introduced – this led to a remarkabledecrease in future caries formation • Used since the early 1940’s • 4 applications of 2% NaF in a 2 week period – as much as 40% cariesreduction • 1950’s, 60’s – Stannous fluoride – claimed superior caries reduction – up to65% reduction – unstable, inconvenient to use • APF – 1.23% F – increased Fl content at enamel surface – 1 four-minuteapplication, now one-minute application • Advantages – stable, does not discolor teeth, non-irritating to gingiva,acceptable taste, easy to apply |
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Fluoride varnish |
• Tested in Europe since 1964 • Particularly recommended for preschool and younger children – ease ofapplication and equal efficacy to APF gels • No need for prophylaxis before application • Sets under moisture/saliva • Minimizes ingestion – very little gets swallowed• Best material for remineralization or arresting caries • Advantages:o Easy to applyo Can eat and drink aftero Ingestion minimalo Teeth do not need a professional prophylaxis |
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Fluoride Toxicity |
• Probable Toxic Dose = 5 mgF/kg • Certain Lethal Dose = 15-71 mg/kg |
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Fluoride Compound/IonConcentrationConversions |
• X% NaF = 0.45(X)%F o Ex: 0.5% NaF = 0.225%F = 2250 ppmF • X% SnF2 = 0.25(X)%F o Ex: 2% SnF2 = 0.5%F = 5000 ppmF • ppmF = mg F/L o Ex: NYC water = 1ppmF = 1 milligram of fluoride per liter |
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Preventing AccidentalIngestion of Fluoride |
• Accidental ingestion of fluoride should be followed by administering agentsthat contain calcium such as milk, lime water or antacid preparations – thesecounteract the effect of the fluoride• Induce vomiting with agents such as syrup of ipecac |
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Why use sealants? |
• Fluorides are highly effective in reducing smooth surface caries but are notequally effective in protecting the occlusal pits and fissures, where themajority of all carious lesions occur • Grooves in some teeth are often too deep for the bristles of a brush to reach • Saliva does not penetrate grooves as readily, so recovery from acid attack isslower • Review found that dental sealants reduce more tooth decay in grooves ofpermanent teeth than fluoride varnish – more high quality research neededto clarify how big the difference is |
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How do sealants work? |
• Change the morphology of the tooth and act as a barrier, protecting theenamel from plaque and acid and therefore protecting it from decay |
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What are sealants? |
• Plastic material (resin) that is applied to the chewing surfaces of the backteeth (premolars/molars) • The plastic resin bonds to the depressions and grooves (pits and fissures) ofthe chewing surfaces of back teeth |
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Two categories of sealants – difference is method of polymerization |
o Light-cured sealants (visible blue light) - Photocure, photoactivation, light activation o Self-cured sealants - Chemical activation, autopolymerization, cold cure |
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Types of sealants |
• Opaque, tinted, and clear sealant materials are commercially available • Opaque and tinted have been advocated because of their ease of detectionby the dentist, parents, and child, which allows monitoring of sealantretention • Detection of a clear sealant requires tactile exploration of the sealed surface |
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First successful use when? |
1960's |
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Facts about caries andsealants |
• 78% of 17 year-olds have experienced caries • 90% of caries in children occur in pits & fissures• Only 23% of 8 year-olds and 15% of 14 year-olds had any sealants • In adults, only 5% of 18 to 24-year-olds and 2% of 25 to 39-year-olds hadsealants • The goal for the U.S. Healthy People 2010 was to increase sealant utilizationto 50% - did not reach that goal |
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Why are sealants underutilized? Note: Decay is NOT going toprogress under a SEALED TOOTH |
• Concerns of sealing over carious lesions • Lack of technical skill • Short longevity of sealants • The need for more research • Lack of adequate insurance fee schedule • Dentists are reluctant to explain the advantages of sealants over restorations • State-board restrictions on auxiliary placement of sealants • Lack of public knowledge of the effectiveness of sealants • Lack of demand for sealants by the public |
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Facts about effectiveness of sealants |
• In a 4.5 year follow up, the sealed permanent molars of 5-10 year olds hadover 50% reduction in decay compared to teeth without sealants • In a 9 year follow up, only 27% of sealed tooth surfaces were decayedcompared to 77% of tooth surfaces without sealant • Dental sealants are effective at preventing dental decay (primaryprevention) • Sealants can stop noncavitated (incipient) lesions from progressing(secondary prevention) • Both children and adults can benefit from the use of sealants |
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Review of the evidenceof dental sealants onbacteria levels in carieslesions |
• Results: Sealants reduced the probability of viable bacteria by about 50% • Conclusions: Sealant reduced bacteria in carious lesions, but that in somestudies, low levels of bacteria persisted. These findings do not supportconcerns about poorer outcomes associated with inadvertently sealingcaries • Clinical Implications: Practitioners should not be reluctant to providesealants because of concerns about inadvertently sealing over caries |
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The recommendations stress that in order to be effective, sealants must beapplied properly, monitored and replaced when needed and the evidenceshows that retention of sealants is significantly enhanced when a ___________ placement technique is used |
fourhanded |
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To seal or not to seal? |
• Decision is based on risk assessment • The best predictors: o Prior caries experience of the patient o Tooth morphology (fissure anatomy) o Home care, plaque load |
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Comparing effectivenessbased on application |
• Dental assistants and dental hygienists were equal to or better than thedentists in long-term effectiveness • This study supports delegation of sealant delivery to auxiliaries • Cost of sealant placement increases directly with the level ofprofessional education of the operator |
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Long-term success:depends on vigilantrecall and repair |
• Failure rate – 5 - 10% each year • Studies that incorporated routine recall and maintenance report success rateof 80 – 90% after a decade or more • Partial loss of sealant leads to surface equally at risk for caries than onenever sealed |
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Enhancing effect ofsealants |
• Incorporate the use of sealants along with other primary preventivedentistry procedures, such as: plaque control, fluoride therapy, anddietary/sugar discipline • If at all possible, a sealant placement should be followed with a topicalfluoride application • 3-mo recall after placement to determine retention |
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Ripa & Colleagues Study (1987) |
• 2-year study of 2nd and 3rd graders assessing the effectiveness of 0.2%fluoride rinse used alone compared with a rinse plus sealants • Results: • 24 occlusal lesions developed in the 51 rinse subjects • 3 occlusal lesions developed in the 84 subjects receiving the rinse plussealants |
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Placement of sealants |
The 4 commandments for successful sealant placement, the tooth must: o Have a maximum surface area o Have deep, irregular pits and fissures o Be clean o For most sealant materials, be absolutely dry and uncontaminatedwith saliva residue |
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Summary of sealants |
• The majority of carious lesions occur on the occlusal surfaces • Which teeth will become carious cannot be predicted, however, if the pit orfissure is sealed, no caries will develop as long as the sealant is retained • Studies indicate 90% retention rate of sealants 1-year after placement • Research data indicate that many incipient and small covert lesions arearrested when sealed • Sealants are easy to apply, but the application is technique-sensitive • Sealants are comparable to amalgam restorations for longevity and do notrequire cutting of tooth structure • Sealants do not cost as much to place as amalgam • Despite their advantages, the use of sealants has not been embraced by alldentists, even though endorsed by the ADA and the U.S. Public HealthService |
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Geriatric Dentistry |
The portion of the curriculum that deals with the special knowledge,attitudes and technical skills required in the provision of oral health care toolder adults |
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Older adult |
o The term has no specific chronological boundaries o It refers to adults who are affected by physical, social, psychologicaland/or biological changes associated with aging, with or withoutassociated disease o Functionally independent or dependent o Frail |
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Older adult population |
generally over than 65 yrs old o Young old: 65-74 o Old: 75-84 o Old old: >85 |
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significance/importance of geriatrics |
o Increased number of older adults o Increased number of retained natural teeth o Increased utilization of dental services |
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Reasons for increased percentage of older adults |
o Increased life expectancy o Decreased birth rate o The baby boom phenomenon |
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Task of health promotion |
extension of active life expectancy |
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Life expectancy in the US now |
80 |
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Causes of improvement in life expectancy |
o Phase I: Decline in infant mortality and death rates in children - Better prenatal and perinatal care - Development and improvement of public health system • Immunization • Better housing and sanitation • Cleaner water and food supply! Discovery of antibiotics o Phase II: Decline in death rates among middle-aged and older people - Advances in medical care - Improvement in personal habits |
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life span |
the greatest age reached by any member of a species, under idealconditions and in the absence of disease in humans 120 yrs life span stays the same but life expectancy has increased |
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baby boomers |
o Baby boom: born 1946-1964 o They are turning 65 from 2011-2030 |
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Goals for HealthPromotion for OlderPersons |
• Reducing premature mortality caused by chronic and acute illnesses • Maintaining the person’s functional independence for as long as possible • Extending active life expectancy • Enhancing quality of life |
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Leading causes of mortality for geriatrics |
heart disease and cancer |
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Leading causes of morbidity in geriatrics |
hypertension, arthritis, heart disease |
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Compression of morbidity |
o Delaying the onset of chronic disease and maximizing functiondespite that disease o Postponing disability and dependency |
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Primary Prevention forOlder Adults |
• Effective oral hygiene • Healthy diet • Alcohol moderation • Smoking cessation • Regular dental attendance |
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Oral hygiene for patients with arthritis |
• Use of electronic toothbrushes might help older patients with arthritic handsbrush effectively• There are also toothbrush handles available to make it easier to hold thetoothbrush • Tongue scrapers • Interdental devices – there are battery operated flossers • Fluoride |
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Modified MyPlate for Older Adults |
o Graphic format: forms of foods that could best meet the uniqueneeds of older adults, nutrient-dense/fiber-dense food choices o Importance of fluid balance o Importance of regular physical activity o Majority, if not all, of nutrients should come from food rather thansupplements |
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Alcohol moderation &Substance safety |
Older patients on many medications (which may cause dry mouth) need tobe careful about alcohol consumption and the possible negative side effectsof mixing their medications with alcohol |
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Smoking Cessation |
• Quitting smoking in the elderly has been shown to: o Extend both years of life and years of active life o Yield benefits for those who already have a smoking-related disease o Reduce the risk of periodontal and respiratory infectionso Improve cerebral perfusion • Journal article: smoking as a risk factor for dementia and cognitive decline o Concluded that elderly smokers have increased risks of dementia andcognitive decline |
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Regular dentalattendance in geriatrics |
• Oral cancer screenings (even if they only have dentures) • Older adults need frequent recalls • Loss of teeth can cause shifting of adjacent teeth |
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Financing Geriatric OralHealth |
Out-of-pocket is the main mode of payment for oral health care |
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Medicare |
• Medicare is a health insurance program, administered by the United StatesGovernment Centers for Medicaid & Medicare Services (CMS) for: o People 65 years of age and older o Some people with disabilities under age 65 o People with End-State Renal Disease • Does not pay for comprehensive dental services • Pays for reconstruction of the jaw following accidental injury, extractionsdone in preparation for radiation treatment, and oral examinations, but nottreatment, preceding kidney transplantation or heart valve replacement |
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Medicaid |
• Medicaid is the United States health program for eligible individuals andfamilies with low income and resources – it is a means-tested program • It is jointly funded by the states and federal government, and is managed bythe states • Comprehensive dental coverage varies from state to state |
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Importance of PhysicalActivity in Older Adults |
• As in adults, it reduces risk of cardiovascular disease, stroke, hypertension,type 2 diabetes, osteoporosis, obesity, colon cancer, breast cancer, anxietyand depression • Substantial evidence: it reduces risk of falls and injuries from falls, preventsor mitigates functional limitations, and is effective therapy for many chronicdiseases • Some evidence: it prevents or delays cognitive impairment and disability,and improves sleep |
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Adult Immunizations |
• Hep A • Hep B • Influenza • Measles, mumps, rubella (MMR) • Pneumococcal polysaccharide vaccine • Tetanus, Diphtheria (Td)o “A” recommendationo Primary series then booster every 10 years o Uncommon disease but 60% of cases occur in older adults >60 whooften do not have protective antibodies • Varicella for susceptible individuals • ADDITIONAL: the CDC’s vaccine advisory panel voted on 10/25/2006 to makesingles (herpes zoster) vaccination routine for all Americans 60 and older |
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Older adults are morevulnerable |
• Influenza and pneumonia kill 20,000-40,000 Americans each epidemicseason • More than 90% of these deaths occur among persons over age 65 • 2/3 of older adults receive influenza vaccine each year |
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Screening in older adults |
o Cancers: oral, breast, colorectal, cervical, prostate o In high risk individuals: diabetes, thyroid disease, osteoporosis o Sensory deficits: vision, hearing |
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Remain alert to: |
o Depression symptoms o Abnormal bereavement o Changes in cognitive function o Medications/side-effects o Skin lesions o Signs and symptoms of abuse or neglect |
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Learning and communication for geriatrics |
• Older people can, and do, learn new things well• Certain kinds of learning are difficult and may not be possible, such as thosethat require: o Perceptual speed o Physical coordination o Muscular strength |
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It is critical that older people... |
o Work at their own pace o Practice new skills – in relative privacy o Avoid embarrassment (appreciate difficulty in accepting role reversal) |
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When giving information, remember: |
o Written information alone is an ineffective way of reaching andencouraging positive health behavior o Verbal information combined with individual demonstration resultsin significantly more successful outcomes |
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Cultural factors, level of acculturation and language competency |
- A study conducted in public hospitals showed that as many as80% of patients older than 60 years have low literacy rates - Another study found a nearly twofold increase in mortalityamong elderly people with limited literacy - Evidence that patients with low literacy likely would havemore oral disease |
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Strategies to improve communication |
o Assess the patient’s baseline understanding o Use plain language o Encourage patients to ask questions o Confirm the patients understanding o Provide written information/instructions |
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When giving information |
o Present information at a slower rate and in small doses o Build on what the patient already knows o Speak in a low tone of voice o Allow plenty of time for the assimilation and integration ofconceptual material o Repeat the information o DO NOT INFANTALIZE OR PATRONIZE |
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Severe ECC |
o Children younger than 3 years of age, any sign of smooth-surfacecaries o Children from ages 3-5: - 1 or more cavitated, missing due to caries, or filled smoothsurfaces in primary maxillary anterior teeth - A dmfs score of >/= 4 (age 3), >/= 5 (age 4) or >/= 6 (age 5) |
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ECC disproportionally high in... |
low income, immigrants, those without accessto health care |
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Maternal attributes toECC etiology |
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Tooth Development |
• Bud • Cap • Bell state • Dentinogenesis • Amelogenesis • Apposition of dentin and enamel • Eruption • Function |
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maternal pregnant effect |
5-7 months in utero |
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Pre-Eruptive Effect |
• Primary incisors can be seen to be forming as early as 6 weeks in utero • Calcification can begin as early as 11 weeks in utero • Formation --> Development --> Eruption --> Maturation • Primary dentition: embryo --> 2 years old• Permanent dentition: fetus --> adolescent • Maternal factors can have pre-eruptive effects on both primary andpermanent teeth that is irreversible, causing the child’s teeth to always bemore susceptible to caries |
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Systemic effects |
• Protein & Calories: affect tooth organic matrix formation and salivary glandsdevelopment • Minerals: o Calcium: is essential for proper development and maintenance ofmineralized tooth issues o Zinc: alters saliva composition and secretion o Fluoride: enhances teeth resistance to caries • Vitamin D: controls mineralization of teeth • Vitamin A: affects number of salivary acinar cells • Vitamin C: is essential for collagen synthesis |
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Malnutrition and ToothEruption/ Dental Caries |
• Delay in tooth eruption in malnourished children • Significantly more caries develop in malnourished children (about 15% more) |
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Clinical Review:Hypoplasia-associatedSevere Early ChildhoodCaries – A ProposedDefinition |
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Cariogenic Oral Bacteria |
• Acidogenic: ability to convert sugars rapidly to acid o Mutans streptococci (MS) - Streptococcus mutans - Streptococcus sobrinus • Aciduric: ability to maintain these activities even under extremeenvironmental conditions o Lactobacillus app • Others: o Non-mutans streptococci o Actinomyces species o Bifidobacterium species o Propoinibacterius species o Scardovia wiggisiae o Veillonella species o Candida albicans |
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Mutans Streptococcus |
• Infants = MS free • 80-90% total prevalence in teenagers • High MS level correlated with more caries • Early MS infection associated with more caries |
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Mutans Streptococcus:Mother and Child |
• Maternal attributes on children’s mutans streptococci colonization – linkbetween maternal salivary levels of MS and primary oral infection of infants o Higher levels of MS levels in maternal saliva correlated with a higherproportion of infant infection o 71% of baby’s MS strains matched the mothero Factors: - Mother’s MS level - Pre-chewing food - Model of delivery - Children’s age - Pre-term born - Children not brushing teeth |
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Mother-child general microbial association |
similarity of bacterial populations insaliva in mother-child pairs (94% similarity) - Found a high degree of similarity of bacterial compositionsbetween the children and their biological mothers |
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Songkhla’s Study |
o Mothers:! With >/= decayed teeth - Never received calcium supplements during pregnancy o Children: - Not fed supplementary food at age 3 months - Started sweet-tasting foods at 5 months - Started snacking |
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Studies of acquisition ofMS by infants |
• Longitudinal cohort studies • Caries status of mother-baby pairs • Bacterial levels of mother-baby pairs • MS isolates phenotype • MS chromosomal DNA genotype • PCR/AP-PCR detection • qPCR quantitative analysis • Oral microbiome comparison |
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Etiology of dental caries |
• Specific plaque hypothesis vs. nonspecific plaque hypothesis • Mother can transmit more than just MS – can transmit whole microflora |
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What can we do? |
• Talk to childbearing women about the mouth-body connection o Set up waiting room audit system o Display brochures and posters o Distribute fact sheets o Distribute good quality oral health samples • Provide oral health counseling • Improve oral health of expectant and new mothers • Reducing MS levels in saliva |
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Oral Cancer Prevention |
• Primary prevention: avoids the development of a disease • Secondary prevention: aimed at early disease detection • Tertiary prevention: reduces the negative impact of an already establisheddisease |
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Grover Cleveland |
Had oral cancer removed from maxillary left jaw |
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Oral Cancer Lesions |
• Stage 1: small red/white lesion that is hard to detect • Advanced stage (stage 4): very firm mucosa/gums/lymph nodes o Can take part of fibula bone and skin from leg to make it shape ofmandible and anastemose it in the mouth to recreate the jaw o Also needed radiation and chemotherapy o After treatment he developed a recurrence in neck 6 months laterand died after 1 year • Difference: early detection |
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How dental professionalsplay a role in the fightagainst oral cancer |
• Early detection and screening • “Dentists and dental hygienists in NY State are knowledgeable about oral cancer,but there are gaps in the knowledge of certain risk factors an in the oralcancer examination technique” • Medical providers would benefit fromenhanced oral examination skills to improve their performance in earlydetection” • Routine examination of the mouth by primary care providers as part of aphysical examination would provide the best opportunity for improving thelow oral cancer examination rates in minority populations |
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Health People Report2020 |
• Baseline: 32.5% of oral and pharyngeal cancers were diagnosed at thelocalized stage (stage 1) in 2005-6-7 and pharyngeal cancers were diagnosedat the localized stage (stage 1) in 2005-6 • Target: 35.8% |
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Cancer facts & figures |
• Estimated 48,330 new oral cavity and pharynx cancer cases will be diagnosedan almost 9,570 will die in the US in 2016 • 10.4/100,000 incidence • 2.6/100,000 mortality • 2.5% of all cancers • Progression to malignancy is not linear, not inevitable, and not predictable • Not always: normal --> potentially malignant lesion --> dysplasia --> squamouscell carcinoma • Almost 2/3 or oral/pharyngeal cancers are diagnosed after they have spreadto regional lymph nodes or to distant sites • Overall 5 year survival rate • Survival rate is 62.2% |
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What should dentistsdo? |
• Asses patients for risks of oral cancer • Know clinical history and appearance spectrum or oral precancer and cancer • Perform opportunistic screening to detect early chances • Provide tobacco cessation and other risk fact for modification • Promote healthy lifestyle • Perform available diagnostic tests/adjunctive techniques for early changes • Know how to refer patients with “suspicious” lesions • Keep abreast of changing field through continuing education |
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Risk factors for oral cancer |
Greater Risk • Tobacco • Alcohol • Areca nut• Diet • HPV infection Less Risk • Mouthwase use • Cannabis use • Khat chewing • Mate drinking • Family history • SES status • Gender • Race/ethnicity • Oral hygiene • Immunosuppression |
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Intraoral exam |
• Touch all mucosal surfaces and the tongue and floor of the mouth • Tongue is the most high risk location for oral cancer • Dentists are more likely than physicians to detect early stage diseasebecause of these exams |
