DENT 1111 Section 2 Notes PDF

ORAL HEALTH & PREVENTION OF DENTAL DISEASE Chapter 15 - Dental Caries Dental caries - tooth decay worldwide health concern, affecting humans of all ages common chronic disease among children, teenagers, and adults over 65 cariology = causes of caries. process of decay and science and practice of car...

ORAL HEALTH & PREVENTION OF DENTAL DISEASE Chapter 15 - Dental Caries Dental caries - tooth decay worldwide health concern, affecting humans of all ages common chronic disease among children, teenagers, and adults over 65 cariology = causes of caries. process of decay and science and practice of caries prevention/ management Historical view Bacterial infection mutans streptococci - new borns do not have, transmitted by mothers usually from kissing or sharing food lactobacilli - present when high intake of sugar Oral biofilm - Dental plaque biofilm colourless, soft, sticky coating made of communities of microorganism, adhering to tooth surfaces dental caries and gingival and periodontal infections are caused by microorganisms from a person's dental plaque Enamel structure - most mineralized tissue in body Caries process 3 factors in caries development ◦ susceptible tooth ◦ diet rich in fermentable carbohydrates ◦ specific bacteria within 5 min of eating or drinking, bacteria begin to produce acid as a by-product of digestion if acid attacks are infrequent and short in duration saliva can help repair the damage by neutralizing acids and supplying minerals and fluoride to replace what was stolen frequent acid attacks causes more acid in mouth producing a high risk of dental decay carious lesions primarily occur on 4 general areas ◦ pit and fissure caries - primarily on occlusal surfaces, buccal and lingual grooves of posterior teeth and lingual pits of maxillary incisors ◦ smooth surface caries - mesial, distal, facial, and lingual surfaces of enamel ◦ root surface caries - on any surface of exposed root ◦ secondary caries - recurrent caries - occurs on tooth with restoration Stages of caries development - can take any where from months to years for a carious lesion to develop. depending on demineralization vs remineralization occuring in mouth Dental caries is not simply a continual, cumulative loss of minerals carious lesion have 2 distinct periods ◦ first stage incipient caries or lesion - occurs when caries begin to demineralize the enamel ◦ second stage, overt lesion or frank lesion - characterized by cavitation development of a cavity or lesion Secondary (recurrent) caries form in tiny spaces between tooth and margins of a restoration difficult to diagnose because not easy to see on radiographs, and cannot be detected with explorer materials that bond to tooth structure limit recurrent caries Root caries occur at any age, as Pts age risk increases occurs on teeth with exposed cementum from gingival recession cementum more susceptible than enamel Early Childhood Caries (ECC) - infectious disease that affects children with constant pain de decayed teeth and swollen gums Risk factors low-income families particular ethnic groups limited access to care lack of fluoridated water Importance of Saliva 'miracle fluid' provides chemical, physical and antibacterial protection to teeth dependent on water content in saliva and flow rate fluid dilutes and removes acid components from dental plaque thick saliva is less effective contains calcium, phosphate, & fluoride saliva keeps calcium in mouth, ready to use during remineralization good saliva = lower risk of caries Caries diagnosis Dental explorer - sharp tip pressed into a suspected area. if 'stuck' indicated of enamel weakening Radiographic images - useful for interproximal and reccurent caries but not early caries Visual appearance - caries can range in colour from white, brown, black spouts. colouring can mimic stains in pits and grooves from plaque or calculus, coffee, tea, smoking, medications or vitamins Caries detection dyes - visual location of carious dentin. diseased area of tooth will take on colour of dye. research shown to have high rate of false positives Caries detection devices laser caries detector optical coherence tomography Caries assessment systems Caries management by risk assessment CAMBRA - evidence based strategy for preventive and reparative care for ECC determines risk of caries factors and protective factors, then develops plan molded to Pts needs Caries risk tests saliva flow test - chew wax for 3-5 mins to measure amount of saliva in mouth cariscreen caries susceptibility test - 1-minute bacterial test for assessing caries risk Chapter 16 - Periodontal Disease Periodontal disease -infectious disease process involving inflammation of structures of periodontium. causes breakdown of periodontium resculting in loss of tissue attachment and destruction of alveolar bone Structures of the periodontium gingiva - 'gums' mucosa covering alveolar process of jaws and surrounds neck of teeth epithelial attachment - tissue at base of sulcus where gingiva attaches to tooth sulcus - space between tooth and free gingiva periodontal ligaments - dense connective fibers that connect the cementum covering root of tooth with alveolar bone of socket walls cementum - covers root of tooth alveolar bone - bone supporting the tooth in its position in the jaw Causes of periodontal disease most common symptoms: red, swollen gingiva bleeding gingiva from brushing or flossing loose or separating teeth pain or pressure chewing pus around teeth or gingival tissue Bacterial plaque calcium deposits ◦ accquired pellicle - thin film of protein that quickly forms on teeth ◦ materia alba - soft mixture of bacteria and salivary proteins, white material - visible without disclosing tablets ◦ food debris - particles of food impacted between teeth after eating, may contribute to dental caries Calculus - calcium and phosphate salts supragingival - found on clinical crown, visible yellowish-white deposits that can darken over time subgingival - forms on root surfaces below gingival margin and can extend into periodontal pockets Systemic connection Cardiovascular disease - Pts with severe periodontal disease 3.6x more likely to to have coronary heart disease Respiratory disease - appears as bacteria that colonize in mouth and alter respiratory epithelium, leaving more susceptible to pneumonia Low birth weight - pre term birth associated with mother with periodontitis Stages of periodontal diseases gingivitis - redness and swelling early periodontitis - bacteria/ plaque beginning to collect - infection, periodontal pockets starting to form moderate periodontitis - inflammation spreading; supporting bone is lost, teeth loosen, receding gums severe periodontitis - inflammation of gingiva and surrounding tissues resulting is severe bone loss including teeth. Gingivitis - inflammation of gingival tissue most common disease and easiest to treat and control redness and swelling characterize gingivitis asscoicated with puberty, pregnancy, and vitamin C deficiencies Periodontitis - inflammation of supporting tissues of teeth periodontal pocket is destroyed as disease progresses periodontitis caused by changes in bacteria in oral cavity Diagnosis of periodontal disease comprehensive periodontal exam part of Pt's check-up charting the depths of periodontal pockets illustrates health of the periodontal tissue radiographs taken to show any bone loss Periodontal staging and grading grade A = slow grade B = moderate grade C = rapid Chapter 13 - Impact of Oral Public Health importance of dental public health oral health assessment oral health assurance components of dental public health government families workforce preventing dental disease = comprehensive dental care Pt education nutrition and dietary counseling plaque control fluoride therapy sealants partners in prevention listen carefully assess the Pts motivations and needs select home care aids keep instructions simple reinforce home care early preventative dental care pregnancy and dental care dental care for 0-5 years oral health and aging Age related oral change ◦ enamel becomes darker ◦ enamel surface develops cracks ◦ vitality of dentin is greatly decreases ◦ cementum composition changes ◦ pulpal blood supply decreases ◦ size of pulp chamber reduced ◦ abrasion and attrition occur in cowns of teeth age related pathology conditions ◦ both coronal and rooth caries ◦ alveolar bone becomes more porous ◦ increase of gingival recession ◦ systematic disease and medications that cause dry mouth ◦ salivary glands change causing reduced saliva flow ◦ frequent anemia caused by iron deficiencies resulting in red and burning tongue fluoride slowing demineralization and enhancing remineralization of tooth surfaces = most important way to control caries process systemic fluoride - ingested by mouth and absorbed into bloodstream topical fluoride - applied in direct contact with teeth how fluoride works strengthens enamel making it more acid resistant safe and toxic levels overexposure to fluoride , even at low doses can risk dental fluorosis in children under the age of 6 with developing teeth ingestion of a concentrated fluoride preparation can lead to a toxic reaction fluoride needs assessment sources of fluoride fluoridated water bottled water foods and beverages prescribed dietary supplements topical fluoride fluoride varnish application of fluorides professional application of fluoride may be recommended for children soon after eruption of permanent teeth and for high risk Pts plaque control program - keep plaque controlled by brushing, flossing, using interdental aids, and antimicrobial solutions use the best hygiene strategy for you to stay consistent toothbrushes and toothbrushing toothbrushing infant toothbrushes manual toothbrushes electric toothbrushes methods of tooth brushing bass method - most common stillman's fone's Charter's rolling stroke horizontal dental floss or tape floss = circular in shape tape is flat both come waxed and unwaxed - personal preference floss before brushing teeth interdental aids - special devices recommended for cleaning between large or open interdental spaces end-tuft brushes bridge threaders automatic flossers perio-aid prosthetic brush toothpaste - key to daily oral routine. comes in gel, paste or powder mild abrasive helps remove stains humectant helps prevent from drying out flavouring agent to give fresh and cleaning feel thickening agent detergent causes foaming action mouth rinses cosmetic - designed to refreshen mouth and control bad breath, but does not kill bacteria associated with bad breath therapeutic - come over the counter or prescribed and contains active ingredients: cetylprindinium cholride = bad breath, chlorhexidine= control plaque and gingivitis, flouride = prevent decay, peroxide = whitening, control plaque, gingivitis, bad breath, and tooth decay. oral irrigation devices helps reduce bacteria levels in subgingiva and interproximal areas benefits those with gingivitis, implants, orthodontic appliances, or diabetes and those unable to floss Chapter 14 - Nutrition Nutrition and oral health Healthy people 2020 report Essential nutrients Carbohydrates simple - sugars break down quickly to be used as energy complex - convert glucose for energy fiber - important for weight loss, lowerin blood sugar, and fighting constipation ◦ soluble - dissolves in water helps lower cholesterol ◦ non soluble - promotes movement of material through digestive system, helps prevent colon cancer and reduces risk of heart attack proteins = amino acids complete proteins = has all 9 amino acids incomplete proteins = does not incorporate all 9 amino acids fats (lipids) triglycerides or natural fats occur in both plant and animal products. function of fats is to: build new cells, form blood clots, mineral and vitamin absorption, muscular movement, balance blood sugars cholesterol - waxy fat substance in cells, needed to make hormone, vitamin D and aid in digestion ◦ HDL = good ◦ LDL = bad antioxidants - compounds that help prevent or slow damage to cells that cause cancer, heart disease, ect. Water forgotten nutrient essential to regulating body temp. moistening tissues, carries nutrients and oxygen to cells, lubricates joints, flushes out water waste, and dissolves minerals and vitamins to be easily accessible to our body daily requirement of water is 91 oz total water for females and 125oz for males vitamins essential nutrient that comes mainly from food fat soluble = stored in body fat, are not destroyed by cooking (A, D, E, K) water soluble = naturally present in food, easily destroyed during food prep. Not stored by body therefore must be ingested every day (B &C) minerals components of bones and teeth that make them rigid play an important role in maintaining body's water-electrolyte balance minerals that are needed in large amounts (100mg/day or more) are Sodium, potassium, calcium, chloride, phosphorus, magnesium trace elements needed in smaller amounts- iron, zinc, copper, selenium, chromium, manganese, iodine, and fluoride Nutrient recommendations Canada's food guide "eating well with Canada's food guide plenty fruits and veggies eat protein choose whole grains make water primary drink choice Reading food labels requirements: individual serving size number servings per package total calories calories divided %RDA product label information - provides information about food eating serving size amount of each nutrient ingredients claims organic foods nutrition and dental caries - Dental caries cannot without dietary sugars. simple carbohydrates = caries causing foods that cause tooth decay - cariogenic = sugary, sticky sweets Role of the dental team in patient nutrition counselling Pt about prevention of tooth decay counselling Pt diet before and post surgical procedure counselling Pt that have removable prosthesis counselling Pt who have orthodontic or removable appliances regarding food choices Dietary analysis - help Pt understand role nutrition has on dental and general health Eating disorders - compulsive disorders bulimia - pattern of binging and purging anorexia nervosa - self- starvation management of eating disorders - dentist obligated to assist Pt in obtaining psychotherapy and medical care Chapter 17 - Oral Pathology Oral pathology Making a diagnosis Historical diagnosis - family history for genetic disorders and medical history for information on medications that may affect oral tissues Clinical diagnosis - based on what appears in the lesions shape, colour, size, and location during exam radiographic diagnosis - imaging can supplement diagnosis by assessing soft and hard tissues and reveal abnormalities Microscopic diagnosis - suspicious lesion removed and sent to pathology to be evaluated Laboratory diagnosis - diagnosis made from clinical specimen obtained from a secretion, discharge, blood, or tissue Therapeutic diagnosis - diagnosis made providing a certain drug or treatment and seeing how the condition responds Surgical diagnosis - diagnosis made on basis of findings from surgical procedure Differential diagnosis - list of possible conditions that share same symptoms Acute and Chronic inflammation acute = occurs from injury to tissue is minimal and short-lasting chronic = occurs from injury or irritation to tissue continues Oral lesions - lesions = abnormal tissues in oral cavity Lesions below mucosa surface ulcer - break in mucosa that looks like a punched out area erosion - soft tissue is shallow injury in mucosa caused by trauma or chewing abscess - collection of pus in specific area, found on apex of tooth cyst - fluid or semi solid fluid filled sac Lesions above mucosa surface blister - 'vesicles' filled wiht water pustule - looks like blister but contains pus hematoma - similar to blister but contains blood plaque - any patch or flat area that is slightly raised from the surface (not dental plaque) Lesions with mucosa surface patch - lesion flat or even with oral mucosa, with well defined areas of discolouration ecchymosis - 'bruising' petechiae - small pinpoint, round spots appear due to bleeding Rasied or flat lesions nodules - feel like pea beanth the surface granuloma - nodule containing granulation tissue tumours - 'neoplasms' any mass of tissue that grows beyond normal size. Diseases of oral soft tissue - conditions found in oral cavity may require further observation, medications, follow-up or removal Leukoplakia - 'white patch,' very little pain associated unless ulceration and secondary infect present Lichen planus - benign, chronic disease that affects skin and oral mucosa Candidiasis - superficial infection caused by yeast like fungus 'candida albicans' Pseudomembranous Candidiasis - "thrush" = creamy white plaque, burning sensation, unpleasant taste, feeling of blisters in mouth hyperplastic candidiasis - white plaque that cannot be removed by scrapping. most common on HIV + Pts atrophic candidiasis - "erthematous" smooth red patches appear on dorsal area of tongue and palate Aphthous Ulcers "cancker sores" - recurrent aphthous ulcer (RAU) = disease of recurring outbreaks of blister like sores inside mouth and on the lips minor RAU - mildest heal within 7-10 days, experience reccurance less than 6x/year major RAU - more frequent outbreaks of larger, deeper ulcers taking longer to heal. most often found with Pts of compromised immune systems Cellulitis condition of uncontrollable inflammation within a localized area. swelling develops rapidly. associated with oral infections like abscessed teeth. cellulitis is dangerous because it can travel quickly to sensitive tissues like eyes and brain. Conditions of tongue Black hairy tongue - caused by oral flora imbalance after administration of antibiotics geographic tongue - women affect 2x as often as men, tongue loses areas of papillea filiform fissured tongue - normal variations of tongue and cause is unknown pernicious anemia - condition where body cannot absorb B12 Oral cancer - most frequently occuring cancers early stages are not painful, therefore are missed. Risk factors tobacco use heavy alcohol use human papillomavirus (HPV) infection Leukemia - cancer of blood forming oragans. characterized by rapid growth of immature leukocytes initial oral symtoms may be hemmorage, ulceration, enlargement, spongy texture and red/purple colouration of gingiva Therapy of Oral Cancer oral cancers treated by surgery, radiation, or chemothreapy. often used as a trifecta Dental implications of radiation therapy xerostomia - no saliva radiation caries - result due to lack of saliva induced by radiation causing a tooth to be hospitable to caries. also causes extreme sensitivity osteoadionercrosis - radiation caused decreased blood supply to bones in jaw. Pts should not have tooth extractions after radiation due to possibility of jaw fracturing therefore should have teeth extracted before commencing treatment Dental implications of chemotherapy mucositis apothous ulcers transient reactions xerostomia delayed healing deninal malformation Human immunodeficiency virus (HIV) and Acquired immunodeficiency syndrome (AIDS) Oral manifestations Human papillomavirus (HPVs) - responsible for warts such as oral papilloma, most often in inmunocompromised individuals Herpes Zoster -immunocompromised Pt, latent herpes zoster virus (shingles) may cause intraoral manifestations in the form of blisters Herpes simplex - commonly occur on the lip in immunocompromised Pts, lesions may be throughout mouth. causes ulcer like lesions Kapsoi sarcoma - an opportunistic infection that occurs in HIV Pts. oral lesions appear as multiple blusih, blackish, reddish blotches. No effective treament for Kapsoi sarcoma Hairy Leukoplakia - +for HIV and can be an important symptom of early AIDS status Lymphoma - used to describe malignant disorders. Immunocompromised Pts can occur as solitary lump/ nodule, swelling or non-healing ulcer anywhere in oral cavity Candidiasis - an inital sign of the progression from HIV to AIDS Cervical lymphadenopathy - enlargement of cervical (neck) nodes. swelling of the lymph nodes indicates systemic problem, often associated with AIDS HIV periodontitis - HIV lesions, resembles those observed in acute necrotizing gingivitis superimposed rampant progressive periodontitis HIV gingivitis - HIV Pts develop gum disease more easily because of low immunity Developmental disturbances Disturbances in oral facial development Macrognathia - abnormally large jaws, common in mandible and results in Class III malocclusion Micrognathia - abnormally small jaws, common in mandible and results of Class II malocclusion Exostosis - bengin bony growth that projects outward from surface of a bone ◦ Torus palatinus - bony overgrowth at the midline of the hard palate, not painful but can cause issues with insertion of dental appliances ◦ Torus mandibularis - bony over growth on lingual surface of mandible near permolars Ankyloglossia - tongue tide due to short lingual frenum extending to apex of tongue Miscellaneous conditions - atypical conditions that occur on primary or permanent teeth Habits affecting teeth Abrasion - abnormal wearing away of tooth surface, caused by repetitive habits, improper tooth brushing Attrition - normal wearing away of tooth surface, occurs with age on I, O and proximal surfaces of teeth Bruxism - abnormal wearing, involuntary gnashing , grinding and clenching of teeth, usually occurs during sleep, stress. impacts TMJ Erosion - abnormal wearing, caused by stomach acid in Pt's with bulimia due to self induced vomiting Meth mouth methamphetamine is potent CNS stimulant that can damage brain and severe oral health effects meth mouth = pattern of rampant caries often seen on buccal surface and inter-proximal surface of anterior teeth xerostomia, poor OHI, clenching and/or grinding Oral piercings Oral facial piercing of part of face and oral cavity followed by insertion of various objects Pt's should be made aware of the risks they are exposing themsleves with getting such a piercing ◦ oral cavity contains millions of bacteria ◦ bacteria can migrate through piercing wounds into bloodstream with many consequences ‣ chipped or broken tooth ‣ choking ‣ gum recession ‣ nerve damage ‣ serious infection at site of piercing - can spread throughout head and neck