Dental Sciences & Prev Dentistry- Ch 13/14-Test-COMPLETE

Dental Health in the United States

Oral health is essential to overall health

Improvement in preventive care and treatment = significant improvement in oral health

Components of Dental Public Health:

Government

Education

Workforce

Importance of Dental Public Health

Primary function of dental public health specialist:

Oral health assessment

Oral health assurance

Oral health policy development and implementation

Preventing Dental Disease

Most common dental diseases:

• Dental caries

• Periodontal disease

Components of preventive care:

• Patient education

• Nutrition and dietary counseling

• Plaque control

• Fluoride therapy

• Sealants

Types of floss

Floss Picks: Removes plague and food particles between teeth and below the gum line

Satin Tape: Covers more area than standard floss for cleaning wider gaps between teeth

Super Floss: Features varying widths for cleaning between braces, bridges, and around implants

Ribbon Floss: Slides easily in tight spaces for a superior clean at and below the gum line

How to Prevention Dental Issues

Listen carefully

• Each patient will have different needs

Assess the patient’s motivations and needs

• Combine motivating factors with needs

Select the home care aids

• Select a toothbrush, brushing method, interproximal cleaning aids such as dental floss, and a toothpaste

Keep the instruction simple

• Comment positively on the patient’s efforts

Reinforce home care during return visits

Early Preventive Dental Care

Pregnancy and dental care

• The American Academy of Pediatric Dentistry (AAPD) guidelines advise all pregnant women to receive counseling and oral healthcare during pregnancy and that infants undergo oral health assessment by their first birthday

• Many women are not aware of these guidelines, and do not seek dental care during their pregnancy because they believe that they do not have any dental problems

Dental Care: 0 to 5 Years

Even before the baby has teeth, the parent should wipe the gums gently with a clean, wet cloth after each feeding

Visit the dentist by first birthday

As soon as the first tooth appears, the parent can begin brushing the baby’s teeth in the morning and before bedtime

• Toothpaste is not necessary but can be used

• A pea-sized dab of toothpaste until age 6

Oral Health and Aging

Enamel becomes darker in color

Enamel surface develops numerous cracks

Vitality of dentin is greatly decreased

Cementum has compositional changes

Pulpal blood supply decreases

Size of the pulp chamber is reduced

Abrasion and attrition occur in the crowns of the teeth

Age-Related Pathology-Related Conditions

Both coronal and root caries

Alveolar bone becomes more porous

Increase of gingival recession

Systemic disease and medications causing dry mouth

Salivary gland changes causing reduced saliva flow

Older adults frequently have anemia caused by iron deficiencies resulting in red and burning tongue

Fluoride

Has been our primary weapon with which to combat dental caries since the 1950s

Slows demineralization and enhances remineralization of tooth surfaces

Is a mineral that occurs naturally in food and water

Systemic fluoride: ingested by mouth through water, food, beverages, or supplements

Topical fluoride: applied in direct contact with teeth

How Fluoride Works

Preeruptive development

• Before a tooth erupts, systemic fluoride in a fluid-filled sac surrounds it strengthening its enamel

Posteruptive development

• After eruption, fluoride continues to enter the enamel and alters the structure of the enamel crystals

• These fluoride-enriched crystals are less acid soluble than the original structure of the enamel

Safe and Toxic Levels of Fluoride

The fluorides used in the dental office have been proved safe and effective when used as recommended

Chronic overexposure to fluoride, even at low concentrations, can result in dental fluorosis in children younger than 6 years with developing teeth

Acute overdosage of fluoride can result in poisoning or even death

Acute overdosage is very rare

Fluoride Precautions and Needs Assessment

To prevent patients from receiving too much fluoride, evaluate the patient’s current fluoride intake

Fluoride needs assessment

• Saves time by identifying risk factors

• Opens communication between the dental professional and the patient

• Helps “individualize” patient fluoride therapies

• Allows the dentist to more accurately select the appropriate fluoride therapy

Sources of Fluoride

Fluoridated water

Bottled water

Foods and Beverages

Prescribed Dietary Supplements

Topical Fluoride

Plaque Control Program

Plaque can be kept under control with the use of brushing, flossing, interdental cleaning aids, and antimicrobial solutions

A goal of the program is to remove plaque at least once daily

The techniques that are selected must be based on the needs and abilities of the individual patient

Toothbrushes and Toothbrushing

The two basic types of toothbrushes are:

• Manual

• Automatic

Used properly, both types are effective in the removal of dental plaque

Infant Toothbrushes

Very small and soft; should be used as soon as the baby’s first tooth appears in the mouth

Finger brush can also be used

Manual Toothbrushes

Come in many styles of head size, tuft shape, and angle and shape of handle

In general, dental professionals recommend soft-bristled brushes because these bristles are gentler to the soft tissues and to any exposed cementum and dentin

Nylon bristles are preferred

Toothbrushes should be replaced as soon as the bristles show signs of wear or begin to splay outward

Electric Toothbrushes

Have larger handles that contain a rechargeable battery

The larger handle also makes them useful for patients with physical disabilities

Automatic toothbrushes use one of several motions, including back and forth, up and down, or circular

Some models feature pulsating and ultrasonic action

Toothbrushing Methods

Bass method most recommended

The dental professional will recommend the method best suited to the patient’s needs

Teach the patient to clean the mouth and tongue thoroughly using a systematic approach and to understand the importance of controlling plaque and inflammation

Too vigorous brushing can cause wear of tooth structure, gingival recession, exposure of root

Toothbrushing for Unusual Conditions

Acute oral inflammation or a traumatic lesion

After periodontal surgery

After dental extractions

After dental restorations

Dental Floss or Tape

Removes bacterial plaque and thus reduces interproximal bleeding

Dental floss is circular in shape; dental tape is flat

No difference in the effectiveness of waxed and unwaxed floss in removing plaque

Patients should be encouraged to floss before brushing

Interdental Aids

End-tuft brushes

• Soft nylon filaments formed into a narrow cone shape

Bridge threaders

• Used to pass dental floss under the pontic

Automatic flossers

• Have one-use, replaceable, thin rubber filament tips

Perio-Aid

• A handle with holes in the end designed to hold a toothpick

Toothpaste

Toothpaste contains ingredients designed to remove food residue and includes abrasives to remove stains

Highly polished tooth surfaces will stain less readily and remain clean longer

In addition, most brands of toothpaste now contain fluoride

Some toothpastes now contain a compound that reduces calculus formation when they are used regularly after dental prophylaxis

Mouth Rinses

Many patients like the feeling of freshness provided by a mouth rinse

A wide variety of mouth rinses are available today, and some contain fluoride

Recovering alcoholics should select a mouth rinse that does not contain alcohol

Rinsing the mouth with water is recommended after meals and snacks when toothbrushing and interdental cleaning are not possible

Oral Irrigation Devices

Oral irrigators deliver a pulsating stream of water or chemical agent through a nozzle to the teeth and gingiva

Can be applied at home by the patient or in the dental office

Helps keep levels of subgingival bacteria to a minimum

In selected patients, oral irrigation can be used to supplement other oral hygiene techniques

Disclosing Agent

coloring agent used to make plague visible when applied to teeth

Fluoride Varnishing

concentrated form of topical fluoride applied to teeth that are at high risk for developing caries (cavities)

Preventative Dentistry

practice for caring your teeth to keep them healthy; this can include the use of fluorides, application of dental sealants, proper nutrient, and plague control

Systemic Fluoride

fluoride that is ingested, such as in the drinking water

Topical Fluoride

Fluoride applied directly to the tooth surface to aid in remineralization and prevent decay.

Amino Acids

compounds in proteins used by the body to build and repair tissue

antioxidants

substance that protects our body to prevent or slow damage to cells

Anorexia Nervosa

eating disorder caused by an altered self image leading to extreme weight loss and an intense fear of gaining weight.

bulimia

an eating disorder characterized by recurrent episodes of binge eating followed by purging (forcing yourself to throw up), starvation, and/or excessive exercise.

cariogenic

substance causing tooth decay

cholesterol

waxy fat like substance found in all of the cells in the body

fats

also known as lipids; are compounds of carbon, hydrogen, and oxygen and are a major class of energy rich foods

MyPlate

nutrition guide published by the USDA using a visual representation of the five food groups to promote a balanced diet.

nutrients

organic and inorganic food that provides nourishment essential for growth and maintenance of life

organic 

describes food products that have been grown without the use of chemical pesticides, herbicides, or fertilizers

triglycerides

type of fat found in your blood that gives energy to your body

xylitol

is a natural sugar substitute thought to prevent tooth decay

Nutrition and how it effects your oral/bodily health

You are what you eat”

It is true because food is used to build and repair the body

Food choices must therefore be based on sound information and knowledge

Malnutrition during crucial periods may result in physical or mental disabilities

Well-nourished persons are usually better able to heal and ward off infections than are poorly nourished individuals

Healthy People 2020 Report

Issued by the U.S. Department of Human and Health Services (USDHHS)

Healthy People Reports issued every 10 years to describe national goals, and objectives for improved health throughout the population.

Healthy People 2020 has a renewed focus on identifying, measuring, tracking, and reducing health disparities through a “determinants of health” approach

Essential Nutrients

Macronutrients:

• Carbohydrates

• Proteins

• Fats

• Water

Micronutrients:

• Vitamins

• Minerals

Carbohydrates

Simple sugars

• Absorbed first

Complex carbohydrates

• Must be processed before they can be absorbed into the intestinal tract

Dietary fiber

• Indigestible and passes through the intestinal tract unchanged

Sources of Carbohydrates

Cereal grains

• Wheat, corn, oat, rice, barley, and buckwheat

Sweets

• Table sugar, honey, and maple and corn syrups

Vegetables

• Green leafy vegetables, dried beans, and peas

Proteins

Composed of amino acids

Only nutrient that can build and repair body tissues

There are 20 amino acids; eight are essential in the adult for normal growth and maintenance of tissues

• These eight essential amino acids must come from food

A complete protein is one that contains a well-balanced mixture of all eight essential amino acids

Sources of Protein

Complete proteins

• Meat, fish, poultry, eggs, and dairy products

Partially complete proteins

• Grains and vegetables

Incomplete proteins

• Corn and gelatin

Fats (Lipids)

Important source of energy

Provide essential fatty acids

Transport vitamins

Provide heat insulation

Components of cell membranes and myelin, the covering of nerve fibers

Form protective cushions around the organs

Cholesterol

A fat commonly found in saturated fats (from animal sources)

Fat in the body is divided into two categories

• High-density lipoprotein (HDL) is good fat

• Low-density lipoprotein (LDL) is bad fat

Cholesterol should be limited to less than 250 mg per day

differences between unsaturated fats and saturated fats

Saturated and unsaturated fats differ primarily in their chemical structure, which affects their physical state and health impacts.

Saturated fats: Have single carbon-carbon bonds, are saturated with hydrogen, are typically solid at room temperature (like butter), and can raise "bad" LDL (low-density lipoprotein) cholesterol levels.

Unsaturated fats: Have one or more double bonds, are liquid at room temperature (like olive oil), and are generally considered healthier as they can help lower bad cholesterol.

Antioxidants

Antioxidant vitamins E and C and beta-carotene can prevent cholesterol from oxidizing and damaging arteries

Many fruits, vegetables, and certain seasonings contain naturally occurring antioxidants

Water

Approximately two thirds of the body’s weight is water

Often called the forgotten nutrient, water helps in:

• Building tissue

• Regulating body temperature

• Lubricating joints and mucous membranes

Vitamins

Organic substances that occur in plant and animal tissues

Essential in minute amounts for the human body to maintain growth and good health

Do not supply energy, but needed to release energy from carbohydrates, fats, and proteins

To date, 13 vitamins have been discovered

• Four are fat-soluble

• Nine are water-soluble

Minerals

Inorganic substances that make up about 4% of the body’s weight

14 essential minerals

Minerals present in the largest quantities are sodium, potassium, calcium, chlorine, phosphorus, and magnesium

Trace elements include iron, zinc, copper, selenium, chromium, manganese, iodine, and fluorine

MyPlate

MyPlate replaced MyPyramid as the USDA’s familiar guide to primary food groups

Visual cue to help consumers adopt healthy eating habits

Emphasizes the fruit, vegetable, grains, protein, and dairy food groups

Canada’s Food Guide

Canada has also developed a pictorial food guide to assist Canadians to choose food wisely

The food guide rainbow encourages consumers to determine their own healthy lifestyle

Reading Food Labels

Every food label must contain the following information:

• Individual serving size

• Number of servings per container

• Total calories

• Calories derived from fat content

• Percentage of daily value (RDA)

Product Label Information

Begin with the serving size

• It is uniform across product lines so that you can easily compare similar foods

The amount of each nutrient in the food is expressed in two ways:

• As a percentage of the RDA

• By weight of the serving size

By using the percentage of daily values, you can easily determine whether a food contributes a large or small amount of a particular nutrient

Labeling Ingredients

Almost all foods are required to have the ingredients listed on the package

Ingredients are listed in descending order of weight to indicate the proportion of any ingredient

Artificial coloring must also be named in the list of ingredients

Label Claims

Examples of nutrient claims include:

• “Low fat”

• “High fiber”

• “Reduced calories”

• “Cholesterol free”

Organic Foods

Foods with the “organic” label must have been grown without the use of any chemical pesticides, herbicides, or fertilizers

The use of hormones in seed preparation is prohibited

Organic milk must have no added vitamins or chemicals, and preparation is closely monitored

Foods That Cause Tooth Decay

Cariogenic

• Foods that produce or promote dental decay

Refined carbohydrates, such as candy and other sweets, are cariogenic because their sugars are readily available

A major factor in the cariogenicity of a carbohydrate is how long the food stays in the mouth

Foods That Cause Tooth Decay

Sugary liquids, such as soft drinks, leave the mouth quickly and are not as cariogenic as sticky foods such as raisins and caramels

Foods such as crackers, although they are not sweet, are cariogenic because they stick to the teeth and remain in the mouth long enough to be broken down into sugars

Another important factor in cariogenicity is whether the food stimulates the flow of saliva

Role of the Dental Team in Patient Nutrition

Counseling patients about the prevention of tooth decay

Counseling patients regarding their diet before and after a surgical procedure

Counseling patients that have a removable prosthesis

Counseling patients who have orthodontic fixed and removable appliances regarding food choices

Dietary Analysis

Can be used to help a patient understand the role of nutrition in his or her dental and general health

Patient must keep a diet diary for either 24-hours or a full week

Patient must record every food eaten, including the amount, how the food was prepared, and when it was eaten

Dental team then reviews the completed diary with the patient, using a dietary-analysis form

Diet Modification

Diet modification provided by members of the dental team is usually focused on dental health and is not intended to replace the services of a registered dietitian

The patient’s lifestyle and background must be considered when one is making recommendations

Always suggest modifications in a positive manner

If your dietary recommendations are compatible with the patient’s normal diet, the patient is more likely to comply

Eating Disorders

Influences of the media, food industry, and society have led to a preoccupation with being thin

Such influences have contributed to a society of weight-conscious adolescents and adults and an increase in eating disorders

Eating disorders have serious medical, oral, and psychological implications and can be life threatening

Eating disorders commonly occur during adolescence and adulthood and include:

• Anorexia nervosa, bulimia, binge eating, compulsive overeating, female athlete triad, and chronic-dieting syndrome

Most of those who suffer from eating disorders are 14 to 25 years old, white, and affluent

Occurrence of eating disorders is more common in females; the ratio of females to males is 10:1

food eating disorders

Bulimia

• Often referred to as a binging and purging disorder

Anorexia nervosa

• Characterized by self-starvation

Binge eating

• Eating large amounts of food regardless of hunger

Female athlete triad

• Restrictive dieting, overexercise, weight loss, lack of body fat

Chronic dieting

• Over-focus on dieting without a psychological drive

Management of Eating Disorders

Anorexia nervosa and bulimia are considered psychiatric diseases with serious medical, dental, and nutritional complications

Dental professionals are often the first healthcare providers to diagnose an eating disorder

In addition to providing dental care and education, the dentist is obligated to assist the patient in obtaining psychotherapy and medical care

Successful management of these disorders requires a team approach including psychiatrists, psychologists, physicians, nurses, dietitians, social workers, and dentists