Oral Health (Lec. #16)

Dental caries: Cariostatic foods These foods do what? How is it metabolized? This leads to? What are some examples (6)

•Foods that DO NOT promote formation of caries •Food that is not metabolized by microorganisms in plaque leading to a drop in salivary pH •Examples: protein foods, eggs, fish, meat, most vegetables, fats

Dental caries: Cariogenic foods What do these foods promote? Fermentable carbohydrates - why are they fermentable? - What can they be broken down by? - This leads to? - What are some examples? (6)

•Foods that promote formation of caries Fermentable carbohydrates oFermentable because the bacteria in mouth can break down carbs into acids oFoods that can be broken down by salivary amylase oLeads to a lower pH in mouth oExamples: crackers, chips, pretzels, cereals, breads, sweets

Oral Biofilms (Plaque) What is it composed of? What are they responsible for?

•Highly ordered, surface-associated assemblages of microorganisms (bacteria, protozoa, fungi and viruses) •These surface-attached microbial communities are responsible for many oral diseases such as dental caries and periodontitis

Health Care providers promoting dental health: Nondental health professional What should you perform? Ask two simple and straightforward questions

•Nondental health professional o Perform an oral exam oAsk two simple and straightforward questions: 1."Do you have any pain or discomfort in your mouth?" 2."Do you have any trouble biting or chewing your food?"

Complementary and integrative medicine: 3 examples

•Oil pulling •Baking soda •Increase vitamin C intake

Oral Health Dz: At-risk populations What 4 populations are at risk?

•Pregnant women •Pediatric •Geriatric •Lower socioeconomic status - Often seek dental care on an emergency-only basis and seek the least expensive treatment (tooth extraction)

Predictors of poor oral health: What are 8 of these? People who smoke are ___ times more likely to lose all their teeth.

•Tobacco use •Excessive alcohol use •Drug abusers - Methamphetamine ("meth mouth") •Hygiene •Poor nutrition •Poor dentition •Sugar in diet •Human papilloma virus (HPV) - Associated with poor oral health; linked to 40-80% of oropharyngeal cancers

Oral Health across the lifespan: Older adults Older americans with poor oral health tend to be (5)

◦Economically disadvantaged ◦Disabled ◦Homebound ◦Institutionalized ◦Without dental insurance

What does oral health refer to?

According to the Centers for Disease Control (CDC), oral health refers to the health of teeth, gums, and entire oral-facial system

Oral Health & Systemic Health: An increasingly recognized role in the oral-systemic interaction is __________________. What is the theory behind this? (5)

An increasingly recognized role in the oral-systemic interaction is inflammation Theory oDental plaque is made up of a polymicrobial biofilm oNeutrophils attack bacteria oMacrophages secrete inflammatory mediators oInflammatory cascade oHarmful strains of bacteria in biofilm can enter bloodstream during inflammatory response and travel to other areas

Dental caries pathophysiology: Dental caries (tri-step process) Periodontal disease is the result of?

Dental caries (tri-step process) 1.Bacteria (Streptococcus mutans) colonize biofilm (plaque) on tooth surface and metabolize 2.Sugars (dietary carbohydrates) into acids 3.Teeth are demineralized leading to enamel breakdown and cavity formation Periodontal disease oResult of infection and inflammation of gums and bone that surround and support teeth

Dental prophylaxis: Recommendation (6) Antibiotics one hr prior to procedure (3 examples)

Dental prophylaxis controversy exists Recommendation oPrevious episode infective endocarditis (IE) oUnderlying cardiac conditions associated with high risk of poor outcome from IE oProsthetic valves/materials oCongenital heart disease oCardiac transplant oTotal joint replacement for one year (many ortho surgeons recommend lifelong prophylaxis) Antibiotics one hour prior to procedure oExamples: Amoxicillin, cephalexin, azithromycin oClindamycin not recommended due to increased risk of C. difficile

Oral health: Restorative dentistry Dentures: - What function is not fully restored? What can lead to ill fitting dentures? - this leads to (2) What is common (65%) with denture wearers?

Dentures - Even when properly made and well fitting, masticatory function is not fully restored Remodeling of alveolar bone may lead to ill fitting dentures §Leads to disruption of normal flora §Difficulty eating Oral candidiasis §Common (65%) in denture wearers

Health Care providers promoting dental health: •Educate parents and children that oral health is a key to overall health •Provide nutrition counseling to prevent caries in children and adults ___________ and ____________ of food consumption impacts oral health

Diet and frequency of food consumption impacts oral health

Oral Health dz: High risk medication use Drug preparations and nutritional supplements containing sugar promote? (1) Chemotherapy and radiation therapy can cause? (2) Steroids increase susceptibility to? (1)

Drug preparations and nutritional supplements containing sugar promote dental caries Chemotherapy and radiation therapy can cause oral mucositis and stomatitis Steroids increase susceptibility to candidiasis infections

Oral Health across the lifespan: Pediatric early childhood caries (ECC) - What was it previously known as? (2) This includes the presence of (3) in any primary tooth in a child 71 months of age or younger?

Early Childhood Caries (ECC) o Previously known as "nursing caries" or "baby bottle tooth decay" o Presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger

Tooth anatomy: Describe enamel (2) Describe cementum (2)

Enamel oHardest and most highly mineralized substance in body oMade up mostly of minerals, primarily hydroxyapatite (mineralized form of calcium) Cementum oLayer of bonelike, mineralized tissue covering dentin of root and neck of tooth; anchors fibers of periodontal ligament

Oral cavity anatomy: Major functions (3)

Major Functions oDigestion oCommunication oBreathing

Oral Health & Systemic Health: Heart Dz & Cerebrovascular Dz: Studies support an association between periodontitis and? - What is involved with both of these conditions? Obesity: - What does adipose tissue produce? - This promotes? (2)

Heart Disease and Cerebrovascular Disease oStudies support an association between periodontitis and atherosclerotic vascular disease oInflammatory cytokines involved in atherogenesis are also involved in periodontitis Obesity oAdipose tissue produces cytokines (tumor necrosis factor alpha [TNF] and interleukin 6) that promote bone breakdown and inflammation which potentiates periodontal disease

Oral Health & Systemic Health: Helicobacter pylori & Peptic ulcer disease: - Bacteria has been found in? - What has shown to decrease prevalence of? Artificial joints: - Studies showed direct _____ links between bacteria in joint synovial fluid and plaque from the mouth. - What can reduce joint infection during surgical healing?

Helicobacter pylori and Peptic Ulcer Disease oBacteria has been found in dental plaque oControl of dental plaque shown to decrease prevalence of H. pylori Artificial Joints oStudy showed direct DNA links between bacteria in joint synovial fluid and plaque from mouth oTreating periodontal disease prior to joint replacement can reduce joint infection during surgical healing

Oral Health & Systemic Health: Infertility: Compare ferility rates between women with or without gum disease. - Periodontitis causes systemic? - Could interfere with infertility by (3) Menopause: - Decrease in hormones leads to? - Associated with an increase in? - What has shown to be protective?

Infertility oWomen with gum disease took, on average, two months longer to conceive than women without gum disease (7 vs 5) oPeriodontitis causes systemic inflammation oCould interfere with infertility by preventing ovulation, preventing implantation, or not sustaining implantation Menopause oDecrease in hormones leads to atrophy of gums oAssociated with an increase in periodontitis oHRT shown to be protective

Medicare ___________ ___________ most dental care. What are some examples (6)

Medicare doesn't cover most dental care (including procedures and supplies like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices)

Oral Health Dz: At-risk populations Minority pts (4) Individuals with physical or mental health barriers (3)

Minority Patients oFinancial constraints, language barriers, fear of jeopardizing immigration status, lack of minority providers Individuals with Physical or Mental Health Barriers oResidents in nursing homes/chronic care facilities have limited access to care oPhysically impairing conditions (quadriplegic patients, Parkinson disease, multiple sclerosis) lead to difficulty brushing/flossing oMental health disorders (anxiety/panic attacks, depression, eating disorders, OCD)

Dental diseases: Overview What are the most common oral diseases? (4) By age 8, over 50% of children have had a ________ in a primary (baby) tooth.

Most common oral diseases oDental cavities, periodontal disease, oral cancer, oral infectious diseases By age 8, over 50% of children have had a cavity in a primary (baby) tooth oTooth decay is number one chronic childhood illness

Oral Health across the lifespan: Pediatric Diet & feeding recommendations (5)

oBreast feeding is encouraged oBottles should not be given at bedtime/naptime oBest to hold infant during bottle feeding oAvoid juice for the first year of life oNo added sugar in snacks

Oral Health across the lifespan: Older adults Older americans are at a significant risk for dental dz - Why is that (4)

oCumulative effect oChronic disease oMedications oPhysically unable to maintain oral care (ex. arthritis)

Oral Health across the lifespan: Pregnancy American college of obstetricians & gynecologists recommendations (3)

oFirst prenatal visit should include an oral health assessment oProvide reassurance to women that oral care is safe during pregnancy and should not be postponed oAll pregnant and post-partum patients should be educated on oral health

Oral Health & Systemic Health: Aspiration pneumonia Major reason for hospital admission from nursing homes - what is the mortality rate? What causes an increase in bacterial load in the oral cavity? What actions can reduce the risk? (5)

oMajor reason for hospital admission from nursing homes and has a mortality rate of 20% to 50% oPoor oral health increases bacteria load in oral cavity oReduced risk: Daily oral hygiene, proper positioning, extra time for feeding assistance, feeding smaller quantities per bite, and instructing patients to chew longer prior to swallowing reduces aspiration pneumonia risk

Oral Health & Systemic Health: Oral cancer More than 70,000 oral cancers diagnosed every year - this diagnosis is usually _______. Leads to 14,000 deaths. High risk with _____________ and ____________ use. What two things should be biopsied?

oMore than 70,000 oral cancers diagnosed every year oDiagnosis usually late oLeads to 14,000 deaths oHigh risk with tobacco and alcohol use oLeukoplakia and erythroplakia should be biopsied

Oral Health across the lifespan: Older adults 80% have one or more chronic diseases - what are some examples (5)

oObesity oCoronary artery disease oDiabetes oProsthetic device infection oInfective endocarditis

Oral Health & Systemic Health: Alzheimer's Dz Research clearly showing an association between oral bacteria and Alzheimer's Dz What is the bacteria that produces enzymes called gingipains? What is the significance of gingipains?

oPorphyromonas gingivalis is a bacteria that produces enzymes called gingipains oGingipains found in 90% of brains of Alzheimer patients

Oral Health across the lifespan: Pediatric early childhood caries (ECC continued) - Describe the transmission route - What happens after transmission? - What does this progress to?

oVertical transmission from primary caregiver (usually the mother) oAfter transmission of cariogenic bacteria, a substrate (sucrose) is applied (sugary drink in bottle, sugary foods) oProgresses rapidly if occurs at night without tooth brushing

Oral Health & Systemic Health: Diabetes Associated with a vicious cycle of? (2) Reduced risk: A 10-20% improvement in __________ __________ occurs with treatment of?

oVicious cycle: §Poor glycemic control is associated with periodontal disease §In turn, periodontal disease leads to poor glycemic control oReduced risk: A 10-20% improvement in glycemic control occurs with treatment of periodontal disease

Oral Health across the lifespan: Pediatric Early childhood caries (ECC continued) - Risk is decreased when (4)

§Caregivers receive regular dental care §Limit sugar in the diet §Maintain good oral hygiene §Use toothpaste with fluoride

Oral Health across the lifespan: Pregnancy Adverse pregnancy outcomes: What are two associated risks with periodontitis? What is twice as likely is periodontitis is present?

•Adverse pregnancy outcomes oPreterm birth (PTB) and low birth weight (LBW) risk associated with periodontitis oPreeclampsia twice as likely if periodontitis present (inflammatory mediators proposed mechanism)

Oral Health dz: High risk medication use - What meds? Bleeding (2) Gingival hyperplasia (3) Gastric reflux (3)

•Bleeding oAspirin and anticoagulant use •Gingival hyperplasia oPhenytoin, methotrexate and calcium channel blockers •Gastric reflux oProgesterone, nitrates, beta blockers

Dental diseases: definitions dental caries (tooth decay) Gingivitis (early stage) Periodontitis (advanced dz)

•Dental caries (tooth decay) oCavity formation in teeth due to bacteria that attach to teeth and forms acid in the presence of sucrose •Gingivitis oEarly stage; gums swollen and erythematous with friable tissues (bleeds easily) •Periodontitis oAdvanced disease; gums pull away from tooth; loss of bone; teeth may fall out

Health Care providers promoting dental health: Encourage _________ and ___________ as caries-preventative measures. Reach out to underserved groups and incorporate dental screenings into medical examinations. Talk to __________ users and those who abuse ___________ about quitting and the need to be screened for oral disease

•Encourage fluoride and sealants as caries-preventive measures •Reach out to underserved groups and incorporate dental screenings into medical examinations •Talk to tobacco users and those who abuse alcohol about quitting and the need to be screened for oral disease

Oral health care: barriers (8)

•Financial resources •Lack of dental insurance coverage •Lack of perceived need •Fewer visits to dental providers •Low socioeconomic status •Lack access to dental care •Dental provider shortage •Fear of dental procedures

Oral Health across the lifespan: Pediatric When should their first dental exam be? _________ use has significantly reduced dental caries rates. - What does it do? (3)

•First dental exam by 12 months old Fluoride use has significantly reduced dental caries rates oInhibits tooth demineralization oEnhances remineralization oInhibits bacterial metabolism

Oral Health across the lifespan: Pediatric ________ ________ is the most chronic infectious, transmissible, and preventable childhood disease. Dental caries are four times more common than? What do healthy baby teeth assist in? (5)

•Tooth decay is the most chronic infectious, transmissible, and preventable childhood disease oCDC: dental caries is the most prevalent chronic disease in children in US •Dental caries is four times more common than asthma •Healthy baby teeth assist in development of permanent dentition, proper placement of permanent teeth, speech, chewing of food and nourishment, and self-esteem

Tooth development: When does tooth formation begin? It continues on to what age? Normally, all 20 deciduous teeth have erupted by age __ and shed by age ____. How many permanent adult teeth

•Tooth formation begins ~ 6 weeks of embryonic life and continues until ~ 18 years of age •Normally, all 20 deciduous teeth have erupted by age 3 and shed by age 13 •32 permanent adult teeth

Oral Health Across the lifespan: Pregnancy Approximately 40% of pregnant women have some form of? What % of pregnant pts visit the dentist & even then they may confront? Even among pts with dental insurance, dental care may decline during pregnancy.

◦Approximately 40% of pregnant women have some form of periodontal disease ◦Only 26-34% of all pregnant women visit the dentist - Those who do may confront a dentist unwilling to provide care