PHA 336 - Oral Health L18

Caries (Cavities)

An infectious disease of the teeth caused by acid-producing bacteria leading to demineralization of enamel

Etiology of Caries

Plaque bacteria metabolize carbohydrates producing acid that damages enamel

Risk Factors for Caries

Orthodontic appliances, xerostomia, gum recession, poor oral hygiene

Pathophysiology of Caries

Demineralization of enamel exceeds remineralization due to acid from plaque bacteria

Clinical Presentation of Caries

Plaque buildup, tooth decay, calculus formation if plaque not removed

Exclusions for Self-Treatment (Caries)

Toothache, mottled teeth, bleeding/swollen gums, persistent bad breath

Preventative Strategies for Caries

Fluoride use, limit sugar intake, brushing and flossing, chewing sugarless gum

Plaque

Sticky bacterial biofilm that leads to caries and periodontal disease

Plaque Removal (Adults)

Toothbrush, dental floss, oral irrigating devices

Plaque Removal (Babies)

Wipe gums with wet gauze after feeding

Fluoride Mechanism

Promotes remineralization and strengthens enamel

Dentifrices (Toothpaste)

Used with toothbrush to remove plaque and may contain fluoride or tartar control agents

Mouth Rinses

Cosmetic (freshen breath) or therapeutic (reduce plaque and gingivitis)

Gingivitis

Inflammation of gums due to plaque accumulation

Etiology of Gingivitis

Plaque buildup, medications (amlodipine, phenytoin, cyclosporine), smoking, reduced saliva

Pathophysiology of Gingivitis

Plaque accumulates leading to bacterial invasion and inflammation of gingiva

Clinical Presentation of Gingivitis

Red, swollen gums, bleeding when brushing, erythema

Complication of Gingivitis

Progression to periodontitis if untreated

Exclusion for Self-Treatment (Gingivitis)

Bleeding gums requires referral to dentist

Prevention of Gingivitis

Brushing, flossing, antiplaque agents like triclosan or cetylpyridinium chloride

Halitosis

Bad breath caused primarily by oral bacteria

Etiology of Halitosis

Poor hygiene, caries, infections, dry mouth, foods, tobacco

Pathophysiology of Halitosis

Volatile sulfur compounds produced by oral bacteria

Clinical Presentation of Halitosis

Unpleasant oral odor

Exclusion for Self-Treatment (Halitosis)

Persistent odor without identifiable cause

Prevention of Halitosis

Brush teeth and tongue, remove plaque, use zinc salts

Tooth Hypersensitivity

Pain due to exposed dentin from enamel loss or gum recession

Pathophysiology of Hypersensitivity

Open dentin tubules allow stimuli to reach nerves

Clinical Presentation (Hypersensitivity)

Pain with hot, cold, sweet, sour, or air exposure

Treatment of Hypersensitivity

Potassium nitrate toothpaste, soft-bristle brushing

Xerostomia (Dry Mouth)

Reduced or absent saliva production

Etiology of Xerostomia

Sjogren syndrome, diabetes, depression, medications

Clinical Presentation (Xerostomia)

Dry mouth, difficulty swallowing, burning tongue, halitosis

Treatment of Xerostomia

Artificial saliva, lozenges, hydration, avoid alcohol and caffeine

Exclusions for Self-Treatment (Xerostomia)

Sjogren syndrome, infection, fever, loose teeth, severe pain

Cold Sores (Herpes Simplex Labialis)

Viral infection caused by HSV-1

Transmission of Cold Sores

Direct contact such as kissing

Pathophysiology of Cold Sores

Virus enters cells and replicates causing lesions

Clinical Presentation (Cold Sores)

Tingling, burning, blister formation, pain, fever, swollen lymph nodes

Treatment Approach (Cold Sores)

Early use of docosanol 10 percent, keep area clean, avoid triggers

Exclusions for Self-Treatment (Cold Sores)

Lesions longer than 14 days, frequent outbreaks, immunocompromised, systemic symptoms, no prior diagnosis

Docosanol (Abreva)

Only FDA approved OTC for cold sores

Mechanism of Docosanol

Inhibits viral fusion with host cells

Canker Sores (Aphthous Ulcers)

Painful ulcers on non keratinized oral mucosa

Etiology of Canker Sores

Local trauma, irritation, stress

Clinical Presentation (Canker Sores)

Ulcers on tongue, lips, cheeks, or soft palate

Treatment of Canker Sores

Hydrogen peroxide, benzocaine, topical protectants

Exclusions for Self-Treatment (Canker Sores)

Lesions longer than 14 days, recurrence, systemic illness

Denture Stomatitis

Inflammation caused by poor denture hygiene

Etiology of Denture Problems

Plaque buildup and fungal growth

Prevention of Denture Problems

Soak dentures and clean regularly, avoid abrasive toothpaste

Medications that Exacerbate Oral Disorders

Amlodipine, phenytoin, cyclosporine, anticholinergics, antidepressants

Goals of Therapy (Oral Disorders)

Relieve symptoms, reduce plaque, prevent progression, restore oral health

Top OTC Agents (Oral Disorders)

Fluoride, potassium nitrate, benzocaine, hydrogen peroxide, docosanol, artificial saliva

Mechanism (Fluoride)

Promotes enamel remineralization

Mechanism (Potassium Nitrate)

Blocks nerve transmission in dentin

Mechanism (Benzocaine)

Local anesthetic that blocks sodium channels to numb pain

Mechanism (Hydrogen Peroxide)

Releases oxygen to clean wounds and debris

Mechanism (Artificial Saliva)

Lubricates oral mucosa to mimic natural saliva

Onset (Docosanol)

Shortens healing time if used early

Onset (Benzocaine)

Rapid within minutes

Onset (Fluoride)

Works over time for prevention

Onset (Artificial Saliva)

Immediate symptom relief

Common ADRs (Oral Products)

Burning, stinging, irritation, altered taste

Less Common ADRs

Nausea, dryness, altered swallowing

Serious ADRs

Hypersensitivity reactions

Special Populations (Pediatrics)

Use small amounts of fluoride toothpaste and supervise brushing

Special Populations (Geriatrics)

May require artificial saliva due to dry mouth

Special Populations (Infants)

Wipe gums with wet gauze

Special Populations (Orthodontics)

Use oral irrigators and fluoride rinses

Product Selection (Bleeding Gums)

Refer to dentist, not appropriate for self treatment

Product Selection (Cold Sores)

Docosanol 10 percent

Product Selection (Hypersensitivity)

Potassium nitrate toothpaste

Product Selection (Dry Mouth)

Artificial saliva products

Product Selection (Canker Sores)

Benzocaine or hydrogen peroxide

Counseling (Docosanol)

Apply five times daily, wash hands before and after, avoid sharing

Counseling (Fluoride)

Do not swallow especially in children

Counseling (Benzocaine)

Use only as needed and avoid overuse

Counseling (Artificial Saliva)

Check label before swallowing

Lifestyle Modifications

Brush twice daily, floss daily, reduce sugar intake, avoid tobacco, stay hydrated

Tooth Hypersensitivity Definition

Pain from exposed dentin triggered by stimuli

Halitosis Definition

Bad breath caused by bacterial activity

Gingivitis Definition

Inflammation of gums due to plaque accumulation