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Oral Health Casey Maidon, MMS, PA-C ME617 Preventive Medicine Franklin Pierce University DENTAL CARIES TREATMENT agenda PEDIATRICS FLUORIDE PREVENTION Dental Caries Dental caries usually begin asymptomatically as a destructive infectious process of the enamel. Bacteria—principally Streptococcus muta...
Oral Health Casey Maidon, MMS, PA-C ME617 Preventive Medicine Franklin Pierce University DENTAL CARIES TREATMENT agenda PEDIATRICS FLUORIDE PREVENTION Dental Caries Dental caries usually begin asymptomatically as a destructive infectious process of the enamel. Bacteria—principally Streptococcus mutans—colonize the organic buffering biofilm (plaque) on the tooth surface. If not removed by brushing or by the natural cleansing and antibacterial action of saliva, bacterial acids can demineralize the enamel. Fissures and pits on the occlusal surfaces are the most frequent sites of early decay. Surfaces between the teeth, adjacent to tooth restorations and exposed roots, are also vulnerable, particularly as individuals age. 3 Dental Caries Over time, dental caries extend to the underlying dentin, leading to cavitation of the enamel. Without management, the caries will penetrate to the tooth pulp, producing acute pulpitis. At this stage, when the pulp infection is limited, the tooth may become sensitive to percussion and to hot or cold, and pain resolves immediately when the irritating stimulus is removed. Should the infection spread throughout the pulp, irreversible pulpitis occurs, leading to pulp necrosis. At this later stage, pain can be severe and has a sharp or throbbing visceral quality that may be worse when the patient lies down. Once pulp necrosis is complete, pain may be constant or intermittent, but cold sensitivity is lost. 4 5 Dental caries Risk factors shared by adults & children include: High bacterial counts Family history of caries Frequent consumption of sugarcontaining foods and beverages Inadequate fluoride Poor oral hygiene practices and behaviors Low socioeconomic status 6 Dental Caries Treatment Treatment of caries involves removal of the softened and infected hard tissue and restoration of the tooth structure with silver amalgam, glass ionomer, composite resin, or gold. Once irreversible pulpitis occurs, root canal therapy becomes necessary; removal of the contents of the pulp chamber and root canal is followed by thorough cleaning and filling with an inert material. Alternatively, the tooth may be extracted. 7 Dental Caries in Children Dental caries is the most common chronic disease of childhood 59% of 12- to 19-year-olds having at least 1 documented cavity Once teeth emerge, they become colonized with cariogenic bacteria. bacteria metabolize carbohydrates and create acid as a byproduct. The acid dissolves the mineral content of enamel (demineralization) and, over time, with repeated acid attacks the enamel surface disintegrates and results in a cavity in the tooth. Protective factors that help to remineralize enamel include exposing the teeth to fluoride, limiting the frequency of carbohydrate consumption (to 3 meals and 2 healthy snacks per day), choosing less cariogenic foods (selecting cheese or raw carrots over candy or crackers; selecting fresh fruit over dried fruit or processed fruit snacks), practicing good oral hygiene (brushing twice a day for 2 minutes and flossing between all teeth that touch), receiving regular dental assessments and care. If carious lesions are identified early, the process can be halted or reversed by modifying the patient’s individual risk and protective factors. 8 Fluoride in Children Fluoride is available from many sources, divided into 3 major categories: tap water (and foods and beverages processed with fluoridated water), home administered professionally applied The widespread decline in dental caries in many developed countries, including the United States, has been largely attributable to the use of fluoride. Fluoride has 3 main mechanisms of action: Fluoride promotes enamel remineralization. Fluoride reduces enamel demineralization. Fluoride inhibits bacterial metabolism and acid production. 9 Fluoride administration 10 Oral Health Prevention Steps can be taken to minimize the impact of oral diseases. Educating patients and encouraging them to follow these steps will help promote oral health and minimize oral disease. Preventive Steps Brush and floss regularly Avoid frequent snacking on sugary foods, as this increases the acidity of the mouth and accelerates decay Use fluoride toothpaste Avoid alcohol and tobacco Minimize medications with oral effects Visit dentist regularly 11 Oral Health Prevention Brushing & Flossing Techniques Brush at least twice a day Use a soft toothbrush and focus on the area where the tooth meets the gingiva Manual and electric toothbrushes produce comparable oral hygiene results, so the choice should be based on personal preference Flossing helps disrupt the formation of plaque below the gum line and between the teeth Water flossers and Super Floss(R) are as effective as regular floss for plaque removal. They can be used as an alternative for people with dental appliances, or people with dexterity issues 12 thank you Casey Maidon, MMS, PA-C [email protected] Please include slide number and time stamp in questions!
