Dental health and hygiene

• The information details the management of patients with ingestive disorders.

Ingestion

• The process of taking food into the body via the mouth, or simply eating.

Dental Disorder

Dental Plaque

• Dental plaque is a soft, sticky mass containing proliferating bacteria, leukocytes, macrophages, and epithelial cells.
• The bacteria and cells reside in a sticky polysaccharide protein matrix that adheres to the teeth.
• Dental plaque is transparent and colorless.
• Carbohydrates contribute to plaque formation.

Dental Caries/ Tooth Decay

• Tooth decay is an erosive process causing progressive demineralization and destruction of the outer enamel.
• Acid production from bacteria and dietary carbohydrates leads to the dental caries.

Management of Dental Caries

• Consistent brushing and flossing.
• Following a diet low in simple carbohydrates.
• Fluoridation introduces about one part per million of fluorides into public water supply, protecting against tooth decay.
• Routine dentist visits, biannually or as prescribed.
• Treatment options consist of cleaning, caries treatment, fillings, extractions, and root canal treatment (pulpectomy).

Periodontal Diseases

Gingivitis

• Gingivitis is the inflammation of the gums, resulting in gum bleeding, reddening, swelling, and ulceration.

Periodontitis/ pyorrhea

• Periodontitis is the progression of inflammation from the gums into the alveolar bone, destroying the periodontal attachments.
• The supporting structures of the teeth get eroded, and teeth may loosen and fall out.

Management of Periodontal Diseases

• Maintain good oral hygiene
• Reduce meal frequency
• Reduce snacks
• Pain relief

Malocclusion

• Malocclusion is the misalignment of teeth that usually involves orthodontic treatment.

Impacted Third Molar

• An impacted third molar calls for the need for surgical removal.

Oral Disorder

• Stomatitis

Aphthous stomatitis (canker sores)

• Aphthous stomatitis is characterized by small, recurrent, ulcerated lesions on the soft tissues of the mouth, like the lips, tongue, or inside the cheek.
• Causes include mechanical or chemical trauma, stress, vitamin deficiency, food or drug allergies, along with endocrine imbalances and viral infections.
• Signs and symptoms include well-circumscribed erythematous macules that undergo necrosis, forming pseudomembranous ulcers with erythematous borders, and typically heal within 1-2 weeks.
• Collaborative management includes corticosteroids, avoiding tomatoes, chocolate, eggs, shellfish, milk products, nuts, and citrus fruits known to irritate lesions.

Herpes Simplex (HSV)

• Herpes Simplex Type I causes fever blisters, also known as Herpes Labialis or "cold sores."
• Herpes simplex is a viral infection that causes blisters in the mouth, lips, and tongue, characteristically appearing coated and is contagious, typically lasting about one week.
• Collaborative management includes analgesics, antimicrobials, local anesthetics, mouthwash, and Acyclovir (Zovirax).

Vincents Angina (Necrotizing Ulcerative Gingivitis, Trench mouth)

• Vincent's Angina is an acute bacterial infection of the gingival tissues.
• Common causes are fusiform bacteria, spirochetes, poor oral hygiene, nutritional deficiency, lack of rest/sleep, local tissue damage, systematic infections, blood dyscrasias, and diabetes mellitus.
• Signs and symptoms include ulcers overlaid with pseudomembranes, elevated WBC, foul taste, pain, choking sensation, fever, thick secretions, anorexia, and lymphadenopathy.

Oral Candidiasis

Also called oral thrush, it is caused by Candida albicans. Risk factors include immunosuppression and prolonged antibiotic therapy. Signs and symptoms are white patches on the tongue, palate, and buccal mucosa ("milk curds"). Management for oral Candidiasis require interprofessional collaboration.

Treatment of Oral Candidiasis

• Assess for pain, tenderness, and bleeding in the oral cavity and fever.
• Check for history of infections, use of antibiotics, treatments with radiation or chemotherapy.
• Use prescribed analgesics like ASA or acetaminophen.
• Topical agents/swishes
• Liquid/ pureed diet
• Avoid spicy foods, citrus juices, and extremely hot liquids to prevent irritation of lesions.
• Good oral hygiene is recommended, including warm water rinses mixed with half-strength hydrogen peroxide.
• Avoid astringent mouthwash due to its alcohol content.

Tumors of the Oral Cavity

Benign Tumors

• Fibromas, lipomas, neurofibromas, and hemangiomas are all considered benign tumors

Premalignant Tumors

• Leukoplakia buccalis
• Precancerous condition presenting as white or gray lesions.
• These lesions might be due to chronic irritation of the mucosa from sources such as physical or chemical irritants, or from smoking, spicy food, etc.
• Erythroplakia appears a red velvety patch, often indicative of early squamous cell carcinoma.

Malignant Tumors

Squamous Cell Carcinoma

• Squamous cell carcinoma stems from tiny flat squamous cells of the mucous membrane, and is the most common type of oral cancer.
• Predisposing factors include chronic irritation of the mucous lining of the mouth and oral cavity by agents like alcohol or tobacco, poor oral hygiene, jagged teeth, and poorly fitted dentures.
• Other contributing factors include hot, spicy foods and drinks, malnutrition, syphilis due to leukoplakia, liver cirrhosis due to alcohol, and a positive family history.
• Cancer may occur on the lips, buccal mucosa, tongue, floor of the mouth, and tonsils.
• Collaborative management may include surgery, radiation therapy, and/or Chemotherapy.

Surgical Treatment

• Surgical interventions include hemiglossectomy (partial removal of the tongue), glossectomy (total removal), radical neck dissection, mandibulectomy, commando operation (combined mandibulectomy), tracheostomy, and feeding method based on NGT feelings.

Salivary Gland Disorders

Parotitis

• Parotitis is caused by prolonged NPO, diuretic therapy, AtSO4 administration, enabling oral bacteria to multiply and invade the parotid/salivary glands.
• Parotitis occuring among postop clients gets considered "surgical parotitis.”
• Manage with frequent oral hygiene, address inadequate hygiene, and offer sugarless hard gums.

Sialolithiasis

• Sialolithiasis is characterized by the presence of stones or calculi in the salivary glands, due to inactive glands, metabolic conditions, and/ or precipitation of salts.
• Sialolithiasis presents with swelling and pain.
• Treatment includes local Excision.

Tumors

• Can be either benign or malignant carcinoma

Lip Disorders

Actinic Cheilitis

• This presents as whitish keratosis.
• Actinic cheilitis might lead to Cancer.
• Actinic cheilitis is associated with too much sun exposure
• Prevention and treatment involves using lip gloss during hot weather

Contact Dermatitis

• Contact dermatitis of the lips occurs due to allergy to cosmetics, toothpaste, powder, or anything that comes in contact with the lips, and its characterized by itching and erythema. Prevention is to identify and avoid the causative agent.

Lip Cancer

• Lip Cancer is usually squamous cell cancer and tends to occur at a higher incidence in men.
• Risk factors include excessive sun exposure, tobacco smoking, alcohol consumption, and constant irritation.

Disorder of the Esophagus

Dysphagia

• Difficulty in swallowing.

Odynophagia

• This entails painful swallowing, which is usually both severe and long lasting.
• Odynophagia is generally accompanied by diffuse esophageal spasm, and can be triggered by cold, carbonated beverages, or solid food.

Regurgitation

• Regurgitation is the ejection of a small amount of chyme or gastric juice from the mouth preceded by nausea.
• Its caused by an incompetent lower esophageal sphincter (LES)/cardiac sphincter of the stomach.

Heartburns/Pyrosis/Indigestion/ Dyspepsia

• Results in a painful sensation described as warmth and burning in the lower retrosternal midline area.
• Triggered by gastroesophageal reflux.

Achalasia

• Achalasia entails impaired motility of the lower 2/3 of the esophagus.
• In achalasia, the LES fails to relax with swallowing.
• Treatment comprises bougienage (esophageal dilatation with pneumatic/ hydrostatic balloon into the cardiac sphincter, under fluoroscopy) and esophagomyotomy.

Esophagitis

• Esophagitis is due to to bacteria, trauma, or irritation from food or tobacco.

Gastroesophagael Reflux Disease (GERD/Reflux Esophagitis)

• GERD entails the backward flow of gastric contents into the esophagus, occurring secondary to inappropriate relaxations of the LES.
• Risk factors include nicotine, high fat foods, xanthine derivatives, ganglionic stimulants, and beta adrenergic agents, along with elevated estrogen/ progesterone levels.
• Signs and Symptoms include heartburn, odynophagia, dysphagia, water brash, and acid regurgitation
• Management focuses on interprofessional collaboration, including antacids (1 to 3 hours after meals), histamine blockers, Bethanechol, and Reglan.

Additional non pharmaceutical therapies

• Small frequent feedings
• Fluids with meals
• Eat slowly and chew food thoroughly.
• Avoid very hot or cold foods, spices, fats, alcohol, coffee, chocolates, citrus juices, eating and drinking 3 hours before retiring at night.
• Elevate head of bed 6-8 inches.
• Weight reduction
• Avoid tobacco, salicytates, phenylbutazone.

Surgical Interventions for GERD

• Surgery may involve Nissen's fundoplication, Hill's operation, or Belsey's Repair (Mark IV).

Esophageal Diverticulum

• This involves out pouching of the mucosa.

Esophageal Diverticulum Types:

• Pulsion is weakness through muscle wall of the esophagus
• Traction is pulling outward of esophageal wall due to scarred/ enlarged peri-bronchial lymph node. Signs and symptoms of esophageal diverticulum include dysphagia, fullness in the neck, regurgitation, tracheal irritation, and coughing or belching.

Interprofessional Collaborative Management

• This incorporates a blenderized diet, antacids as ordered, small and frequent feedings, and backrest for several hours after eating, and avoiding irritating foods.
• In more severe cases, surgery might be useful as well and one must be careful about the usage of chest tubes

Cancer of the Esophagus

• The lower 2/3 of the 2/3 is most commonly affected
• Predisposing factors include alcohol, smoking, spicy foods, poor oral hygiene, family history, obesity, and drinking large volume of hot tea
• Management constitutes interprofessional collaboration, potentially calling for surgery (i.e., esophagogastrectomy) and gastrostomy feedings.

Hiatal Hernia (Diaphragmatic Hernia)

• The two types of hiatal hernia are sliding and paraesophageal/rolling hiatal hernia.

Sliding Hiatal Hernia

• A sliding hiatal hernia involves protrusion of the esophagogastric junction into the thoracic cavity that is followed by its return back into the abdomincal cavity
• This is due to position changes (On recumbent position, the stomach slides up; on upright position, the stomach slides down).
• It results due to muscle weakness in esophageal hiatus like due to diaphragm fatigue, congenital issues, obesity etc.
• The other type of hernia involves protrusion of fundus into esophagus, and also causes defect in anatomy

Manifestations

• Heartburns secondary to gastroesophageal reflux.
• Dysphagia(Difficulty swallowing)
• Odynophagia (painfull swallowing) due to compression of the esophagus
• Compression of lungs may cause dyspnea

Gastric Distention

• Abdominal pain due to stimulus of abdominal structures
• Medication management such as proton pump inhibitors or gastric acid.
• Note: The patients with hiatal hernia should avoid drugs that lower LES pressure such as anticholinergics, Xanthine derivatives
• relieve pain by administering anatacids
• high protein diet to enhance LES pressure and reduce reflux

This quiz covers essential aspects of dental health, including the composition of plaque, the formation of dental caries, and preventive measures like dietary modifications and water fluoridation. It also addresses conditions such as oral candidiasis, gingivitis, and periodontitis, along with their risk factors and appropriate management strategies.