Dental Care and Health An Update Dr. Ranjini Pillai, DDS, MPH, FAGD, FICOI
WHO s Definition of Health? Health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity (Preamble to the constitution of the WHO, 1946. Signed July 22, 1946. Enforced on April 7, 1948)
Oral Health Is a state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and plate, periodontal (gum) disease, tooth decay and tooth loss, and other disease that affect the oral cavity (World Health Organization definition)
ADA Policy Definition of Oral Health Oral health is a functional, structural, aesthetic, physiological and psychological state of well-being and is essential to an individuals general health and quality of life (Adopted by the 2014 ADA House of Delegates)
Bacteria on teeth Immunoinflammatory response in the tissue Connective tissue and bone destruction Clinical signs of disease initiation and progression
Cellular Events in Acute Inflammation
Guidelines for Oral Health Care and Pregnancy Dental care is safe and essential during pregnancy Pregnancy is not a reason to defer routine dental care of treatment Diagnostic measures, including needed dental x-rays, can be undertaken safely Scaling and root planing to control periodontal disease can be undertaken safely; avoid using metronidazole during the first trimester (Oregon Oral Health Coalition)
Guidelines for Oral Health Care and Pregnancy Treatment for acute infection or sources of sepsis should be provided at any stage of pregnancy. A number of antibiotics are safe to use. Treatment, including root-canal therapy and tooth extraction, can be undertaken safely Needed diagnoses, preventative care, and treatment can be provided throughout pregnancy; if doubt, coordinate with the woman s prenatal medical provider (Oregon Oral Health Coalition)
Guidelines for Oral Health Care and Pregnancy Emergency care should be provided at any time during pregnancy Delay in necessary treatment could cause unforeseen harm to the mother and possibly the fetus For many women, treatment of oral disease during pregnancy is particularly important because health and dental health insurance may be available only during pregnancy or up to two months post-partum (Oregon Oral Health Coalition)
Recommendations for Parental Oral Health Oral health education: All primary health care professionals who serve parents and infants should provide education on the etiology and prevention of Early Childhood Caries. Comprehensive oral examining: Referral for a comprehensive oral examination and treatment during pregnancy is especially important for the mother Professional oral health care: Routine professional dental care for the parent can help optimize oral health Xylitol chewing gum: Evidence suggests that the use of this gum has an impact on mother-child transmission of streptococcus mutans and decreasing the child s caries rate. (American Academy of Pediatric Dentistry)
Recommendations for Parental Oral Health Oral hygiene: Brushing with fluoridated toothpaste and flossing by the parent are important to help dislodge food and reduce bacterial plaque levels Diet: Dietary education for the parents includes the cariogenicity of certain foods and beverages, role of frequency of consumption of these substances, and the demineralization/remineralization process Fluoride: Using a fluoridated toothpaste and rinsing with an alcohol-free, over-the-counter mouth rinse containing 0.05% sodium fluoride once a day or 0.02% sodium fluoride rinse twice a day may help reduce plaque levels and promote enamel remineralization (American Academy of Pediatric Dentistry)
Recommendations for Infant Oral Health Oral health risk assessment: Every infant should receive an oral health risk assessment from his/her primary health care provider or qualified health care professional by six months of age. This initial assessment should evaluate the patient s risks. Establishment of a dental home: Parents should establish a dental home for infants by 12 months of age. Infants should be referred to the appropriate health professional if specialized intervention is necessary. Teething: Teething can lead to intermittent localized discomfort in the area of erupting primary teeth, irritability, and excessive salivation; however, many children have no apparent difficulties (American Academy of Pediatric Dentistry)
Recommendations for Infant Oral Health Oral hygiene: Oral hygiene measures should be implemented no later than the time of eruption of the first primary tooth. Tooth-brushing should be performed for children by a parent twice daily, using a soft toothbrush of age-appropriate size and the correct amount of fluoridated toothpaste. Diet: Human breast milk is uniquely superior in providing the best possible nutrients to infants and has not been epidemiologically associated with caries. Frequent night time bottle feeding and frequent in between meal consumption of sugar-containing snacks or drinks increase the risk of caries. (American Academy of Pediatric Dentistry)
Recommendations for Infant Oral Health Fluoride: Optimal exposure to fluoride is important to all dentate infants and children. Decisions concerning the administration of fluoride are based on the unique needs of each patient. The use of fluoride for the prevention and control of caries is documented to be both safe and effective. No more than a smear or rice-sized amount, of fluoridated toothpaste should be used for children under age three; no more than a pea-sized amount should be used for children ages three to six. Professionally-applied topical fluoride, such as fluoride varnish, should be considered for children at risk for caries. Systemically-administered fluoride should be considered for all children at caries risk who drink fluoride deficient water after determining all other dietary sources of fluoride exposure. (American Academy of Pediatric Dentistry)
Recommendations for Infant Oral Health Injury prevention: Practitioners should provide ageappropriate injury prevention counseling for orofacial trauma. Non-nutritive oral habits (e.g. digit or pacifier sucking, bruxism, abnormal tongue thrust) may apply forces to teeth and dentoalveolar structures. (American Academy of Pediatric Dentistry)
Common Oral Conditions in Older People Dental caries Coronal or root: painful brownish discoloration with cavitation Gingivitis Red, swollen, bleeding gums Periodontitis Gingivitis, gingiva recession, loose or shifting teeth (American Family Physician)
Common Oral Conditions in Older People Xerostomia Swollen, dry, red tongue; burning sensation; difficulty with speech and swallowing, change in taste Candidiasis White plaques, red macular lesions, erythematous Oral cancer Nonhealing ulcer or mass (American Family Physician)
Oral Manifestations of Common Systemic Disease Mucosal pallor and atrophy Anemia Oral lesions (ulcerative, erosive, or white lesions; swelling; erythema) Lichen planus Lupus erythermatosus Benign mucus membrane pemphigoid Pemphigus vulgaris Crohn disease Behçet syndrome Addison disease
Oral Manifestations of Common Systemic Disease Periodontal bleeding and inflammation Diabetes mellitus HIV-associated periodontal disease Thrombocytopenia Leukemia Dental erosion Gastroesophageal reflux disease Bulimia Anorexia
Oral Cancer Constitutes 12% of all cancers in men and 8% in women. In the US, 3.1% of all new cases ADA recommendation: Oral cancer screening at every periodic oral exam (typically once every 6 months) Normal exam: Done by visual, tactile screening For high risk patients: Advanced technology oral cancer screening methods Vizilite-Chemiluminescent light source system Velscope natural tissue fluorescence visualization
Oral Cancer Risk Factors Tobacco use Excessive alcohol consumption (More than 15 alcoholic beverages per week) The combined use of tobacco and alcohol Excessive unprotected exposure to sun Low intake of fruits and vegetables Use of betel nut and bedis
Oral Cancer Risk Factors Age HPV viral infection Race, ethnicity, and economics Recurrence Gender
Clinical Scenarios
Aesthetic Family Dentistry Durham, North Carolina ranjini.pillai@gmail.com (919) 802-1137