Download Chapter 7 Body Systems

Chapter 15
Preventive Dentistry
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Lesson 15.1
Preventive Dentistry for Lifelong Health
1.
2.
Pronounce, define, and spell the Key Terms.
Discuss preventive dentistry, including:
•
•
•
3.
Explain the goal of preventive dentistry.
Describe the components of a preventive dentistry program.
List the guidelines for preventive patient education.
Discuss the benefits of early dental care, including:
•
•
•
•
Describe why dental care is important for pregnant women.
Describe the method used to clean a baby’s mouth.
Describe when children should first visit the dentist.
Explain the purpose of dental sealants.
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
2
Lesson 15.1
Preventive Dentistry for Lifelong Health
4.
5.
Describe age-related changes in oral health.
Describe the effects of water fluoridation on the
teeth, including:
•
•
•
•
•
Explain how fluoride works.
Discuss safe and toxic levels of fluoride.
Explain the precautions to protect patients from
receiving too much fluoride.
Describe the purpose of a fluoride needs assessment.
Identify sources of systemic and topical fluoride.
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
3
Introduction


The goal of preventive dentistry is to have a
healthy mouth for a lifetime
To achieve this goal, new and recurring
disease must be prevented
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4
Partners in Prevention


To prevent dental disease, a partnership must be
formed between the patient and the dental
healthcare team
Optimum oral health can become a reality when
partners work together in a program that
includes:





Patient education
Fluorides
Dental sealants
Proper nutrition
Plaque control program
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
5
Guides for Patient Education





Listen carefully: Each patient will have different
needs
The initial instruction: Explain the relationship of
plaque to dental disease
Assess the patient’s motivations and needs: Combine
the patient’s motivating factors with the patient’s
needs
Select the home cleaning aids: Select a toothbrush,
toothbrushing method, interproximal cleaning aids
such as dental floss, and a toothpaste
Keep the instruction simple: Comment positively on
the patient’s efforts
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
6
Early Dental Care

Pregnancy and dental care


The American Academy of Pediatric Dentistry
(AAPD) guidelines advise all pregnant women to
receive counseling and oral health care 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
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7
Dental Care: 0-5 Years



Even before the baby has teeth, the parent
should wipe the gums gently with a clean, wet
cloth after each feeding
To avoid spreading bacteria that cause caries,
the parent should not put anything into the baby’s
mouth that has been in his or her own mouth,
including spoons, cups, and so forth
As soon as the first tooth appears, the parent can
begin brushing the baby’s teeth in the morning
and before bedtime

A pea-sized dab of toothpaste can be used
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
8
Oral Health in Infants
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9
Dental Sealants





Used as a means of protecting the difficult-toclean occlusal surfaces of the teeth from decay
A plastic-like coating that is applied over the
occlusal pits and grooves of the teeth
Sealants cover the occlusal pits and fissures
where decay-causing bacteria can live
They are an important component in preventive
dentistry
In several states, the application of dental
sealants is delegated to the dental assistant as
an expanded function
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
10
Dental Sealant on Tooth
Courtesy 3M Espe Co, St Paul, MN.
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
11
Age-Related Pathology-Related
Conditions



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

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
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12
Fluoride




Has been our primary weapon with which to
combat dental caries for more than 40 years
Slows demineralization and enhances
remineralization of tooth surfaces
Is a mineral that occurs naturally in food and
water
A supply of both systemic and topical fluoride
must be available throughout life to achieve
the maximum cavity prevention benefits
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13
Ways of Receiving Fluoride



Prescription-strength fluorides are applied in
the dental office
Non–prescription-strength fluorides are sold
over the counter for at-home use
Fluoridated water is available bottled or
through the community
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14
Systemic and Topical Fluoride

Systemic fluoride is ingested in food,
beverages, or supplements



The required amount of fluoride is absorbed
through the intestine into the bloodstream and
transported to the tissues where it is needed
Excess systemic fluoride is excreted by the body
through the skin and kidneys and in the feces
Topical fluoride is applied directly to the teeth
through the use of fluoridated toothpastes
and mouth rinses and topical applications of
rinses, gels, foams, and varnishes
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
15
Topical Fluoride
From Darby ML, Walsh MM: Dental hygiene: theory and practice, ed 3, St Louis, 2010, Saunders.
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
16
How Fluoride Works

Preeruptive development



Before a tooth erupts, a fluid-filled sac surrounds it
Systemic fluoride present in this fluid strengthens
the enamel of the developing tooth and makes it
more resistant to acid
Posteruptive development


After eruption, fluoride continues to enter the
enamel and alter the structure of the enamel
crystals
These fluoride-enriched crystals are less acid
soluble than the original structure of the enamel
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17
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
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18
Mild Fluorosis
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19
Moderate Fluorosis
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20
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
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21
Sources of Fluoride

Fluoridated water



For more than 40 years, fluoride has been safely
added to the communal water supply
Most major cities in the United States have
fluoridated water, and efforts to fluoridate water in
other communities continue
From a public health standpoint, fluoridation of
public water supplies is a good way to deliver
fluoride to lower socioeconomic populations who
may not otherwise have access to topical fluoride
products such as fluoridated toothpaste and
mouth rinses
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
22
Fluoridated Water



Until recently it was believed that water
fluoridation was effective in preventing tooth
decay as a result of systemic uptake and
incorporation of fluoride into the enamel of
developing teeth
It has now been proved that the major effects of
water fluoridation are topical, not systemic
Topical uptake means the fluoride diffuses into
the surface of the enamel of an erupted tooth
rather than being incorporated into unerupted
teeth during development
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
23
Fluoridated Water



Approximately 1 part per million (ppm) of
fluoride in drinking water has been specified
as the safe and recommended concentration
to aid in the control of dental decay
This is approximately equivalent to one drop
of fluoride in a bathtub of water
The levels of fluoride in controlled water
fluoridation are so low that there is no danger
of ingesting an acutely toxic quantity of
fluoride
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
24
Bottled Water

Bottled water may not be equal to tap water
with regard to dental health


Some bottled waters may contain fluoride;
however, most are below the optimal level of
fluoride
The amount of fluoride in bottled water
depends on:



The fluoride content of the source water
The treatment the source water receives before
bottling
Whether fluoride additives were used
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
25
Sources of Systemic Fluoride

Foods and beverages


Many processed foods and beverages are
prepared with fluoridated water
Prescribed dietary supplements


May be prescribed by the dentist for children ages
6 months to 16 years
NOTE: Toothpaste and mouth rinses containing
fluoride should not be used as a source of
systemic fluoride because with proper use any
excess is spit out and never swallowed
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
26
Fluoride in Tablet Form
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27
Sources of Topical Fluoride

Toothpastes


Mouth rinses



Brush-on or reusable custom tray
Varnish


Prescription
Nonprescription
Gels


The primary source of topical fluoride
Painted on the teeth
Professional applications
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28
Examples of Fluoride Gels and
Pastes, and Sodium Toothpaste
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
29
Training Toothpaste for Young
Children
From Darby ML, Walsh MM: Dental hygiene: theory and practice, ed 3, St Louis, 2010,
Saunders; Colgate products courtesy Colgate Oral Pharmaceuticals, New York; Oral-B products
courtesy Procter & Gamble, Cincinnati, OH.
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
30
Varnish
Courtesy OMNI Preventive Care, St Paul, MN.
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31
Lesson 15.2
Nutrition and Oral Hygiene Products
and Techniques
6.
7.
Describe the relationship between nutrition and
dental caries, including the steps involved in
analyzing a food diary.
List the oral hygiene products available to aid in
a plaque control program, including:
•
•
Compare and contrast toothbrushing techniques.
Describe the process required for cleaning a denture.
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32
Nutrition and Dental Caries



Without dietary sugars, dental caries will not
occur
Sucrose has a greater decay-causing potential
than other sugars, but maltose, lactose, glucose,
fructose, and their combinations do have high
caries-producing capabilities
Flour and starches are not usually decaycausing, but when starch is used in conjunction
with sugar (e.g., in cookies), the potential for
caries increases
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33
Sugar Substitutes



Use of less fermentable and noncariogenic
(caries-causing) artificial sweeteners has
increased in recent years
Artificial sweeteners are an alternative to
sucrose: saccharine (“Sweet and Low”),
aspartame (“NutraSweet,” “Equal”), sorbitol,
xylitol, and mannitol
Of these sugar substitutes, saccharine,
aspartame, sorbitol, and mannitol are
noncariogenic, which means that they do not
cause dental caries
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34
Xylitol


The only one of the artificial sweeteners that
actually prevents caries (anticariogenic)
Products that contain xylitol are significantly
better; however, they are also more
expensive than products containing other
types of artificial sweeteners
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35
Sugar-Free Sodium Bicarbonate
Gum Containing Xylitol
From Darby ML, Walsh MM: Dental hygiene: theory and practice, ed 3, St Louis, 2010, Saunders.
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
36
Dietary Analysis




Done to determine the patient’s current food
intake as a means of assessing the need for
dietary counseling
Patient maintains a food diary that includes
everything he or she consumes each day for 1
week
The listing includes all meals, supplements, gum,
snacks, and fluoridated water
Used to reveal any dietary habits that are likely to
have an adverse effect on the patient’s oral
health
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37
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
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38
Plaque Control Program (Cont.)


There are a wide variety of oral hygiene
products on the market today
It is important for dental assistants to remain
current on the newest products on the market
so that they can:



Advise patients
Make recommendations
Answer questions
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39
Toothbrushes and Toothbrushing

The two basic types of toothbrushes are:



Manual
Automatic
Used properly, both types are effective in the
removal of dental plaque
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40
Baby 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
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41
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
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42
Automatic 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
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43
Examples of Manual Toothbrushes
From Newman M, Takei T, Klokkevold P et al, editors: Carranza’s clinical periodontology, ed 11, St Louis, 2012, Saunders.
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
44
Positioning the Toothbrush
From Newman M, Takei T, Klokkevold P et al, editors: Carranza’s clinical periodontology, ed 11, St Louis, 2012, Saunders.
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
45
Toothbrushing Methods



Bass method
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
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46
Observing Toothbrushing Technique
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47
Toothbrushing Precautions


The patient should be cautioned about
damage that may be caused by vigorously
scrubbing the teeth with any toothbrush
Over time this practice may cause abnormal
abrasion (wear) of the tooth structure,
gingival recession, and exposure of the root
surface
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48
Improper Brushing
Courtesy Dr. Robert Meckstroth, Santa Rosa, CA.
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49
Toothbrushing for Unusual
Conditions

Acute oral inflammation or a traumatic lesion


After periodontal surgery


Patients may be instructed to brush only the occlusal
surfaces and to use very light strokes over the dressing
After dental extractions


Patients should be instructed to brush all areas of the
mouth that are not affected and to resume regular oral
hygiene practices as soon as possible
Patients are usually instructed to avoid the surgical site
but to brush the other teeth as usual
After dental restorations

Most often, patients are instructed to brush all areas of
their mouth normally
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50
Dental Floss or Tape





Removes bacterial plaque and thus reduces
interproximal bleeding
Dental floss is circular in shape; dental tape is
flat
Both can be purchased in various colors and
flavors
Floss and tape are available in waxed and
unwaxed varieties
No difference in the effectiveness of waxed
and unwaxed floss in removing plaque
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51
Dental Floss or Tape (Cont.)

Dental floss should be used before
toothbrushing for the following reasons:


When plaque has been removed from proximal
surfaces, the fluoride in the dentifrice used during
brushing is able to reach the proximal surfaces for
prevention of dental caries.
When brushing is done first, the mouth may feel
“clean.” Thus, the patient may see no need to floss
or may not want to take the additional time to
floss.
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52
Flossing
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53
Interdental Aids

End-tuft brushes


Bridge threaders


Used to pass dental floss under the pontic
Automatic flossers


Soft nylon filaments formed into a narrow cone shape
Have one-use, replaceable, thin rubber filament tips
Perio-Aid

A handle with holes in the end designed to hold a
toothpick
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54
An Interdental Hygienic Aid
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55
A Bridge Threader
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56
Perlo-Aid
From Newman M, Takei T, Klokkevold P et al, editors: Carranza’s clinical periodontology, ed 11, St Louis, 2012, Saunders.
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
57
Dentures



Patients who have full or partial dentures will
need to use a denture brush to clean all
areas of the denture
A nonabrasive cleanser such as a
commercial denture cleanser, a mild soap,
dishwashing liquid, or a mild toothpaste
should be used on the brush
It is always a good idea to put water or a
towel in the sink so that the dentures will not
break if they are dropped
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58
Denture and Denture Brush
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59
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
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60
Toothpaste for Children
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61
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
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62
Mouth Rinses
Courtesy Dr. W.B. Stilley II, Brandon, MS; from Daniel SJ, Harfst SA: Mosby’s dental hygiene: concepts, cases, and competencies—2004 update, St Louis, 2004, Mosby.
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved.
63
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
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64
Irrigator (or Dental Water Jet)
Courtesy Water Pik, Inc., Fort Collins, CO.
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65
General Guidelines for Home Care
Products



The ADA Council on Dental Therapeutics
conducts an independent review of the scientific
evidence of the research claims and evaluation
of home care products.
When a product meets the appropriate
standards, it is given the ADA Seal of
Acceptance. The Seal of Acceptance provides a
quality-assurance guarantee for consumers and
professionals.
Check the ADA's Web site, www.ada.org, for
current information on toothbrushes, dentifrices,
interproximal aids, and products for the
prevention of gingivitis and caries.
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66
The American Dental Association’s
(ADA’s) Seal of Acceptance
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67
Questions?
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68