Preventive Dentistry & Nutrition

Diagnosis of caries

Visual exam, explorer, radiographs, indicator dyes and laser caries detector

Materia Alba

White material Mass that can collect over dental biofilm on teeth, composed of food debris, mucin and bacteria. Visible w/o the use of disclosing agent. Usually associated w very poor oral hygiene.

Steps for the application of fluoride

Clean teeth (remove calculus) Dry and isolate teeth with cotton rolls Seat the patient upright and insert trays with the fluoride Place cotton rolls between the trays and place saliva ejector in the middle After 1-2 minutes, remove trays and use saliva ejector and HVE to remove excess fluoride and saliva Instruct patient not to eat, drink or rinse for 30 minutes If patient has upset stomach, advise them to take Tums or have glass of milk

What are the 2 major infectious dental diseases dental plaque is responsible for?

Dental caries and periodontal disease

If left undisturbed dental plaque can cause?

Destruction of epithelial attachment Pocket formation: red, swollen gingiva Bone destruction: loose/separating teeth

Chronic Fluoride Poisoning

During pre-eruption stage the tooth is surrounded by a fluidfilled sac and excessive amounts of fluoride in it can disturb the normal pattern of development 91.8-2.0ppm). The porosity of the enamel is increased and the mineral content is decreased (fluorosis/mottled enamel)

How can bacteremia be created?

During the use of power-driven stain removal instruments Rotation of rubber cup can force microorganisms into the tissue, bacteria gain access to the bloodstream

Role of the RDA

Educate and motivate pt to maintain a good oral health Listen to learn how pt perceive their dental healthcare needs Instruct pt on how to effectively remove plaque Asses the pt's motivation and needs Select home care aids Keep instruction simple Reinforce home care during return visits

Goals of Preventive Dentistry

Educate the patient Components Help individual to achieve and maintain an optimal oral health throughout their lives

What are the types of dental stains?

Endogenous & Exogenous

Flouride

Essential to the formation of healthy bones and teeth

Acute fluoride poisoning

Extremely rare. Occurs when large amounts of fluoride ar eingested or inhaled into body.

True or False: Calculus can be easily removed by brushing

False. Calculus is rough a porous, it's the perfect surface for even more plaque to adhere to and cannot be removed by brushing.

True or False: Sealants do not release fluoride.

False. Some types do. The theory is that the fluoride released from the sealant may create a fluoride-rich layer at the base of the sealed groove.

Sources of Systematic Fluoride

Fluoridated water (sodium fluoride) Foods (tea, fish, meat, vegetables) and beverages Tablets and drops (supplements)

What's the new structure formed when fluoride reached the tooth?

Fluoroapatite crystal. Much harder than original crystal.

Sources of Topical Fluoride

Gels, mouth rinses, foams, liquids, varnish Toothpastes Fluoridated water (not as effective)

Dental Sealants

Highly effective in preventing dental caries in the pit and fissure areas of the teeth. Made of a resin material.

What part of the tooth does fluoride replace?

Hydroxyl ion, found on surface of the apatite crystal in enamel

What's the optimum level of fluoride?

1 parts per million (1ppm)

What are the 3 activies that can achieve effective caries control?

1. By removing plaque completely, carefully and effectively at least once a day. 2. Restricting the frequency of eating and drinking sugary foods/drinks 3. Increasing defense of enamel eg. using fluorides in toothpastes or mouth rinses

Stages of caries

1. No caries, intact tooth 2. Incipient, white spot/fleck first sign of demineralization, not yet a cavity 3. Cavity. Enamel surface is demineralized and broken down 4. Resto required, demineralization poceeds and undermines tooth 5. Filling is done but demineralization has not stopped & lesion is surronding filling (secondary/recurrent carries) 6. Tooth is fractured. An effective progressive demineralization process

What are the 3 basic steps in the formation of bacterial plaque?

1. Pellicle formation 2. Bacterial colonization 3. Plaque maturation

What are the 3 basic ways stains occur?

1. Stain adheres directly to the surface of the tooth. 2. Stain can be embedded in calculus and plaque deposits. 3. Stain is incorporated within the tooth structure.

What are 2 ways fluoride is incorporated into the tooth?

1. Systemically 2. Topically

How long does it take for plaque to form again?

24 hours

Refractory Periodontitis

A progressive inflammatory destruction of the periodontal attachment that resists conventional mechanical treatment. It's unresponsive to any treatment provided

Plaque

A soft, sticky, colorless deposit on teeth that consist of bacteria and bacterial byproducts. Formed by colonizing bacteria trying to attach itself to rough/smooth tooth surface

Factors of dental caries to occur

A susceptible tooth, bacterial plaque and fermentable carbohydrates

Acquired Pellicle

A thin, acellular, colorless, transparent, bacteria-free film that forms on teeth within minutes after cleaning Composed of glycoproteins from saliva; aka mucin

Precautions of Coronal Polishing

Bacteremia Aerosol production & spatter Removal of Enamel Coarse abrasives Heat production

Bacterial Colonization

Bacteria multiply in # and form colonies. As colonies increase in size they form a continuous bacterial mass. Takes about 24 hours for the plaque (buofilm) to form.

Materials needed for polishing

Basic kit Prophy paste Slow speed prophy handpiece Prophy cup Oral evacuation Dental floss Disclosing solution

Why are tinted/opaque sealant more popular?

Because they are easier to see than clear sealants when applying, and when checking for sealant retention on subsequent office visits.

Calculus in Subgingivally

Below ging margin Reddish/green/black, commonly occurs on prox subgingivial surface

Effects of Materia Alba

Can contribute to gingival inflammation Tooth surface deminerilzation and dental caries are seen frequently under materia alba

Intrinsic Stains

Caused by an environmental source but cannot be removed because the stain has become incorporated into the structure of the tooth.

Antibacterial Action

Certain substances in saliva work against bacteria (immunoglobulins).

Indications for Dental Sealants

Children with newly erupted teeth and people living in a non fluoridated area. Deep pits and fissures Preferably in recently erupted teeth (less than 4 years)

What role does calculus in periodontal disease?

In the development, promotion and recurrence of periodontal disease

What does a good disclosing agent have?

Intensity of color Duration of intensity Taste should not be unpleasant No irritation to mucosa Diffusibility (not too thick or too thin!) Can have antiseptic properties (dual purpose!)

Disclosing Agents

Is a liquid, tablet or lozenge form that contains a dye or other coloring agent

Systemic Fluoride

It is ingested and then circulated throughout the body to the developing teeth. Fluoride is absorbed almost entirely through the bloodstream from the gastrointestinal tract It is deposited in the bones and teeth

Contraindications for Dental Sealants

Lack of pits and fissures Apparent occlusal decay Interproximal decay Insufficient eruption of tooth Soon to be lost primary tooth Poor patient cooperation in dental chair

What's the biggest barrier between RDA and patient?

Language

What are barriers to patient learning

Language, lack of motivation, lack of knowledge/skills, mental/physical disability, age

Advanced Periodontitis

Loss of attachment over 5mm Periodontal probing depths 7mm and more

Moderate Periodontitis

Loss of attachment up to 4mm Periodontal probing depths 5-7mm

Early periodontitis

Loss of attachment: 1-2mm Periodontal probing depths 3-4mm

Plaque Maturation

Mass will grow in # and thickness if left undistrubed

Self-cured

Materials are supplied as a two-part system (base and catalyst). When these pastes are mixed together, they quickly polymerize (harden).

What are the colors of sealant material?

May be clear, tinted, or opaque (white).

Factors in Sealants Retentio

Moisture control Isolation and access to area Tooth sufficiently erupted Proper etching No contamination from time of acid removal to curing of sealant Must remain intact Need periodic check and maintenance Patient must maintain good oral hygiene

Rubber cup polishing

Most common technique Uses rubber cup or bristle brush (for deep pits on the occlusal) and an abrasive polishing agent

Topical Fluoride

Most effective if tooth is cleaned before application

NUG

Necrotizing Ulcerative Gingivitis aka Trench mouth Severe pain, profuse bleeding, fetid breath, decaying of tips of gingival papillae

NUP

Necrotizing Ulcerative Periodontitis Necrosis of gingical tissue, periodontal ligament and alveolar bone. Associated with immune disorders such as HIV infection.

Contraindications for Coronal Polishing

No stain is present Demineralized areas on the enamel present Patients at high risk for dental caries (ECC, xerostomia) Patients with respiratory problems (aerosols produced by handpiece) Tooth sensitivity For people at risk for transient bacteremia unless they were given antibiotic before prophylaxis Newly erupted teeth (incomplete mineralization)

Flouride content in the bones and teeth

Normal: Contains 0.01-0.3% Dental Enamel: 0.01-0.02% Carious teeth: Little as 0.0069%

Which teeth is most benefited by fluoride?

Ones that are still developing and the newly erupted ones that are still calcifying

Purpose of Disclosing Agents

Personalized patient instruction Self-assessment by patient

3 main roles of saliva in caries prevention

Physical, chemical and antibacterial protection

When should fluoride not be applied? And why?

Placement of orthodontic bands Placement of sealants Seating of cosmetic dentistry Because it may inhibit adhesion.

Dental Abraisives

Polishing materials. Used to remove stain and to polish natural teeth, prosthetic appliances, restorations, and castings.

Selective Polishing

Procedure in which only those teeth or surfaces with stain and/or plaque are polished. To avoid removing even small amounts of the surface enamel unnecessarily

Fluoridation

Process of adding fluoride to the water supply

What's the benefits of fluoride?

Promotes remineralization, makes tooth more resistant to decay, inhibit oral bacteria's growth and ability to create acids

Pros vs. Cons of Acquired Pellicle

Pros: Helps to keep surface moist and acts as a barrier against acids produced by plaque Cons: Tho film does not produce disease, it does participate in plaque formation

Physical Protection

Provides a cleansing effect. Dilutes and removes acid.

How can you remove Materia Alba?

Removed with a water spray or oral irrigator

Chemical Protection

Saliva contains calcium, phosphorus and fluoide ready to be used during remineralization. Include bicarbonate, phosphate and small proteins that act as buffers and neutralize the acids.

Light-cured

Sealants do not require mixing. After the material has been placed, it hardens during exposure to a curing light.

Types of polymerization

Self-cured & light-cured

Common Abrasives

Silex (Silicon Dioxide) - fairly abrasive Super-fine Silex - still for heavy stains Fine pumice - mildly abrasive - for minimal staining Zirconium silicate - effectively cleans with minimal abrasion Commercial premixed preparations Fluoride prophylaxis pastes - should not be used before acid etching of enamel

Exogenous

Stains originate outside the tooth from environmental agents. Caused by an environmental source. They are subdivided into extrinsic or intrinsic.

Endogenous

Stains originate within the tooth from developmental and systemic disturbances.

Extrinsic Stains

Stains that are on the exterior of the tooth and can be removed. External source and stain may be removed

Characteristics of Acquired Pellicle

Sticky and colorless (invisible to naked eye). Only be seen with extrinsically stained or stained w a disclosing solution

What bacteria cause caries?

Streptococcus mutans and Lactobacilli

Plaques can be formed where?

Subgingivally: Apical (below) gingival margin. Composted of anaerobic bacteria. Supraginivally: Above gingival margin. Composed of anaerobic and aerobic. Gingival: Plaque forms on the external surfaces of the oral epithelium and attached gingiva Pits & Fissures

Calculus

Tartar, refers to calcified deposits on the teeth formed by the mineralization of dental plaque by salts from saliva and diet

Coronal Polishing

Technique used to remove plaque and extrinsic stain from the coronal surfaces of the teeth

Flouride Therapy

Use of flouride in dentistry is based on knowledge that when fluoride content of the teeth is increased to the "optimum level"

Caries risk assessment ests

Use to identify the factors that contribute to an increased risk for dental caries. Based on mutan streptococci and lacobacilli

Air-powder polishing

Uses a specially designed hand piece with a nozzle delivering a high-pressure stream of water and sodium bicarbonate

Prevention

Any measures taken to prevent a disease from occuring or progressing further to a mature or even worse condition

Precaution for Sealant Materials

To reduce the risk of an allergic response, minimize the exposure to these materials. Use protective gloves and a no-touch technique. If skin contact occurs, wash skin with soap and water. Acrylates may penetrate gloves. If the sealant contacts the gloves, remove and discard the glove, wash hands immediately with soap and water, and then re-glove. Eye flush if accidental eye contact.

Indications for Coronal Polishing

To remove extrinsic stains not otherwise removed during toothbrushing and scaling To prepare teeth for caries-preventive procedures (e.g. placement of pit and fissure sealants, application of fluoride solutions) To contribute to patient motivation Before placement of dental sealants, dental dam, orthodontic bands, acid etch, crowns & bridges.

Dental Caries

Tooth decay, a cavity or hole in the tooth. Diease where bacterial processes damage hard tooth structure.

Susceptible Tooth

Tooth that does not have an optimum flouride content is more prone to the caries process

True or False: Caries can start with the first erupted tooth

True

True or False: Do not use sealants on patients with known acrylate allergies

True

True or False: Microorganism present in dental plaque are all naturally present in the oral cavity and are normally harmless

True.

True or False: Plaque is soft and can be easily removed by brushing and flossing

True.

True or False: Calculus is not the cause of periodontal disease

True. It contributes to periodontal diseases

Calculus in Surpragingivally

Above the ging margin Yellow in collor, frequently occurs on lingual on mand. ant and buccal surface of max molars

What's the first stage in biofilm formation?

Acquired Pellicle

Phrophylaxis

Action taken to guard or prevent disease, rather than treat or cure a disease

What's the lethal does for fluoride?

Adults: 2.5-10g Infants: 0.25

What are the methods of removing stains?

Air-powder polishing Rubber cup polishing