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Oral Health session 1

Evening class delivery
by

louise Rooke

on 15 March 2016

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Transcript of Oral Health session 1

Oral Health

Session 1

Caries - Tooth decay

In groups, list different methods for controlling plaque

FOOD GLORIOUS FOOD!!

Oral conditions

Saliva plays a large part in plaque formation
‘Salivary Pellicle’ is the film that coats the teeth and is sticky (mucous)
Thin, transparent, protein containing, soft film that stick in stagnation areas.
Contains micro-organisms, food and tissue debris
Continually forming on our teeth in pits and fissures, Cervical margins, perio pockets
Colonised by millions of microorganisms (streptoccocus and lactobacilli) which constitutes early plaque
Poor plaque removal leads to mature plaque





Composition of plaque

Mouth cancer presenting as an ulcer on the tongue


A sore or ulcer in the mouth that does not heal within three weeks A lump or overgrowth of tissue anywhere in the mouth A white or red patch on the gums, tongue, or lining of the mouth Difficulty in swallowing, chewing, jaw movement Numbness of the tongue or other area of the mouth A feeling that something is caught in the throat
A chronic sore throat or hoarseness that  persists more than six weeks, particularly smokers over 50 years old and heavy drinkers Swelling of the jaw that causes dentures to fit poorly or become uncomfortable Neck swelling present for more than three weeks

Symptoms and Signs

CAUSES

Oral cancer

Smoking

Chewing tobacco (Betel Nut)

Drinking( Alcohol)

Excessive exposure to sun can cause cancer of the lips

Oral cancer appears as a growth or sore that does not go away. Oral cancer — which includes cancers of the lips,
tongue, cheek, floor of the mouth, hard and soft palate, sinuses, and pharynx (throat) — can be life-threatening if not diagnosed and treated early.

Oral thrush
Caused by Candida Albicans (Fungi)
Oral thrush- a white film with underlying white/ red patches. Associated with general ill health, or other illness such as AIDS, HIV, Low immune system

Denture Stomatitis- Also known as ‘denture sore mouth’. Can be caused by poor oral hygiene around appliances.

Treated with anti-fungal agents, taken as a pastille and oral hygiene to be reinforced.

CAUSES

Redness
Swelling
Heat
Pain






Loss of function is the final stage of inflammation

5 Stages of inflammation

Gingivitis

Gum Disease

STEPHANS CURVE

In groups of 2, write down what causes
disease

Caries
Gingivitis
Periodontitis
Oral cancer

ORAL DISEASES

Caries
“Bacterial infection of the mineralised tissues of the teeth”
Gingivitis
“Inflammation of the epithelium and connective tissue (gingivae) at the neck of the tooth”
Periodontitis
“Inflammation of the supporting structures of the teeth”
Oral Thrush
Oral thrush, also known as oral candidiasis, is a yeast infection in the mouth caused by a type of fungus called Candida Albicans.
Oral Cancer
Cancer is defined as the uncontrollable growth of cells that invade and cause damage to surrounding tissue. Causes around 1700 deaths a year


Split into groups of 2
To prepare a talk, no longer than 5 minutes, on how to advise a particular group on dental care.

Find leaflets, items for demonstrating and other methods to get the advice over

Complete a witness statement for the person you observe.

HOMEWORK

DENTAL FLUOROSIS

Proportions

Proteins
Carbohydrates
Fats
Vitamins
Mineral salts
Roughage
Water

Nutritional substances

AIDS- Acquired immune deficiency syndrome
(Gingivitis, NUG, Oral thrush, Herpes,)
Recreational drugs- (Regular users cannabis or heroin) May present with recurrent ANUG, Candida or herpetic infections due to lowered immunity.

Diabetes- (Type 1 and 2.) Increase of periodontal disease due to the blood vessel degeneration, blood supply not as good. White blood cells are less attracted to sites of infection, diabetics are less able to fight infection. (Poor wound healing).
Crohn’s Disease- Signs of severe ulceration and gingivitis as it can affect the whole digestive system.

General health on Oral health

ORAL CONDITIONS- Tooth surface loss

Dental Erosion-
Also known acid erosion, is the irreversible loss of tooth structure due to a chemical process. (Diet, stomach acids)
Abrasion - Mechanical factors such as tooth brushing, piercings, Occupational (hair grips) Pipe smokers.
Attrition - Tooth to tooth contact. Incisal surfaces. Main cause - Bruxism
Abfraction- Wedge-shaped areas at the cervical margins. Main cause can be misalignment of teeth or occlusal restorations which alter the bite.

Carcinoma of the Lip



Oral Thrush
“Candidasis”
caused by candida
Albicans
Periodontal Disease

Caries
5 stages







[1] Early stages : acids dissolve the enamel in the crown of the tooth
[2] Moderate tooth decay : here the dentine is attacked by acids and bacteria invade the cavity. (ADJ is breached)Amelodentinal junction.
[3] Advanced tooth decay : inflammation of the pulp.
[4] Necrosis (death) of the pulp tissue.
[5] Periapical abscess forms at the apex of the root

When we eat sugar and starch, plaque produces acid
which attacks teeth.
Cavity (hole) develops and the acid attacks the dentine.
Bacteria attacks nerves and blood vessels from soft pulp.
Root and socket become infected.

Decay

DENTAL CARIES


Acid caused by sugar in the mouth
By-product of the bacteria eating the sugar
Acid level falls to 5.5 this is the CRITICAL level
This level can last 20mins – 2hours (Stephan's Curve)



CAUSES



Bacterial activity
Diet (amount/frequency of sugar and acid consumption.)
Demineralisation of enamel due to acid attack.
Direct demineralisation by acidic drinks.

Four factors for caries to develop


REVIEW OF OBJECTIVES
Can You……..
Describe the main types and causes of Oral Disease
Explain the different oral hygiene techniques used to prevent oral disease
Describe how diet and social factors can affect oral health
Explain the different forms of fluoride and its optimal levels
Explain and demonstrate the methods of communicating information about the prevention of oral diseases.


SOCIAL FACTORS


Family background
Cultural
Environmental



BARRIERS TO COMMUNICATION


Noise
Disturbance/distractions
Poor body language
The language
Not listening
Irrelevant topic
Ethnic background
Age/sex
Mental health problems
Negativity to dentistry
Contradictions



HOW TO GET THE MESSAGE OVER


Discuss face to face
Show pictures
Demonstrate
Videos
Posters



ORAL HYGIENE


Brushing
Flossing
Inter-dental brushes
Mouthwash
Disclosing tablets
Fluoride
Diet advice
Regular dental visits
Remove plaque retentive areas



PREVENTION OF CARIES


Modification of diet
Control of plaque and Calculus
Increase tooth resistance
Regular dental checks

FLUORIDE- compound of the element fluorine



Found naturally in water, soil, rock, air and plants
Added to toothpastes at (
1500ppm
)
Sodium fluoride added to water (
1ppm
)
Calcium Hydroxyapatite can be replaced with calcium fluorapatite in developing tooth (PH 4.5)
Fluoride inhibits the growth of bacteria
Fluoride can help remineralise the early caries when used topically
Desensitise the tooth by blocking the dentinal tubules
Dental fluorosis is caused by having too much fluoride when the teeth are developing.

FOOD CATEGORIES- MINERALS, ROUGHAGE AND WATER.

Calcium, Phosphorus, Potassium, Sodium, magnesium, Iron, Chloride, Iodine and Fluoride
Vital for function of organs, strength for teeth and bones and muscle and nerve function
WATER- 70% of our body weight.
We need 3 litres a day, 1 litre from food stuff
ROUGHAGE- Dietary fibre. Has no nutritional value but essential for healthy digestion and protects against disorders of the colon and intestines.



FOOD CATEGORIES VITAMINS

“B” Cereals and liver
(Formation of red blood cells)
Deficiency causes anaemia, bleeding gums, '
glossitis'
“C” Fresh fruit and veg
(Formation of capillary blood vessels)
Deficiency causes bleeding gums and damage the periodontal ligament
“D” Meat, fish, dairy products
Deficiency may effect structure of bone and tooth formation.

VITAMINS: A (fish oils), E (Nuts), K (Liver)

FOOD CATEGORIES FATS


Meat Wholegrains
Fish Nuts
Dairy products
Vegetable oils
Necessary for energy and insulation

FOOD CATEGORIES CARBOHYDRATES


Sugar Bread
Flour Pasta
Potatoes Cereals
Necessary for energy
Digestion of fermentable carbohydrates begins in the mouth when Ptyalin begins the breakdown of certain carbs to sugars (Caries)

Oral thrush and Cancer

OBJECTIVES

Describe the main types and causes of Oral Disease
Explain the different oral hygiene techniques used to prevent oral disease
Describe how diet and social factors can affect oral health
Explain the different forms of fluoride and its optimal levels
Explain and demonstrate the methods of communicating information about the
prevention of oral diseases.


Plaque and Oral Conditions

ORAL CARE

Toothpaste
Rinses
Varnishes
Gels
Floss

Topically- Applied to

Water
Milk
Salt
Tablets
Drops
Swallowed toothpastes
Acidulated phosphate fluoride (APF) gel.
(rarely used in U.K- placed into trays)
Systemically- Ingested

Application of fluoride

Non-milk extrinsic sugars
Known as NME’s
Added sucrose, fructose, glucose, dextrose and maltose
Found in confectionery, soft drinks, biscuits, cakes


Milk extrinsic sugars include lactose
Less cariogenic due to benefits, Calcium.




Extrinsic

Natural sugars
Found in the cells of food like fruit and veg
Fructose, glucose and sucrose break down in the stomach
Less cariogenic than extrinsic sugars

Intrinsic

Sugars

                                                                                

BODY BUILDERS


Broken down into amino acids during digestion







Cell growth and repair

FOOD CATEGORIES PROTEIN

("inflammation of the gum tissue") is a non-destructive periodontal disease
Caused by poor oral hygiene
Existence of stagnation areas allowing dental plaque to accumulate around the margin of the teeth
Gingivitis is superficial
Red, swollen, shiny gingivae that bleed easily




Disease of the supporting structures
Bad breath that won’t go away
Red or swollen gums
Painful chewing
Loose teeth
Smokers are about 4 times more likely to have Periodontitis as tobacco reduces
blood flow to the gums
Untreated chronic gingivitis can lead to periodontitis

Periodontal abscess Torus Mandibularis
Mouth ulcers Torus Palatinus
Cold sores (herpes Simplex) Epulis
ANUG Geographic tongue
Angular Cheilitis
Leukoplakia(White patches) and Erythroplakia
Risk of cancer
Lichen Planus (inflammation/ skin condition)
Xerostomia
Acute Herpetic gingivostomatitis
(simplex virus) Babies and children
Bell's palsy- Paralysis of the muscles of the face
Colgate Duraphat fluoride varnish contains 22,600 ppm fluoride (Duraphat 2800 and 5000)
Water has 1 PPM
Toothpastes contain 1,350 to 1,500ppm
225ppm in daily mouthrinses
Sodium Fluoride


Stannous fluoride
Sodium monofluorophosphate

Dental fluorosis, also called mottling of tooth enamel, is a developmental disturbance of dental enamel caused by excessive exposure to high concentrations of fluoride during tooth development

COMMUNICATION
WARMTH
EMPATHY
RESPECT
ONLY ATTEND WHEN IN PAIN
PREVIOUS BAD EXPERIENCE
CONFLICTING VIEWS
FROM FAMILY
UNABLE TO SPEAK
THE LANGUAGE
MALE DENTIST TREATING
WOMEN (ORTHODOX MUSLIMS)
UNABLE TO GET TO DENTIST
HOMELESS PEOPLE
NO PRACTICES CLOSE BY
p.H is neutral
at 7 (resting)
Critical level
is 5.5
Most common disease
of our time
Caries is the latin word
for decay
DMF- index survey carried out
every 10yrs
Gradual reduction in
caries in children 5 -12 yrs
Fluoride, regular dental
visits & OH education
smooth surface caries
Pits & fissures
Root caries
Streptococcus mutans
(initiates it)
Lactobacilli
(joins in)
Lactic Acid
Calcium hydroxyapatite begins to dissolve
Epulis
Angular Cheilitis
Torus Palatinus
Plaque
99.5% water
Proteins or Glycoproteins, are in Saliva
and the origin of the Salivary Pellicle
Enzymes- Ptyalin. Starts to break down starches before being swallowed (salivary amylase)
Lysozyme- antibacterial, to aid in the defence against disease
Acute Necrotising Ulcerative
Gingivitis (ANUG)
Smoking Cessation
Educate and encourage to stop smoking
Effects of smoking:
Chronic bronchitis
Heart disease
Infertility
Cancers
Reduced saliva
Sticker plaque
Stained teeth
Halitosis
Xerostomia
destroy periodontium
loss of taste

0.05% fluoride
Treatment for periodontal disease
Root surface planning
regular scale, polish and debridement (sub and supra)
Chlorhexidine mouthwashes
Reinforced OH care
No smoking
I.D brushes, woodsticks, floss
Perio chip
FMD- antibiotics
Gingivectomy
Objectives
Identify the components of the tooth
List 3 structures of the periodontium
List the different food groups and their benefits to general health
Identify the composition of plaque
List the 8 functions of saliva
Discuss which sugars can cause decay
List 2 different food groups
List 3 cleaning methods
What are they for?
Incisors
They're the sharpest teeth, built to cut food and shaped to shovel the food inward.
Canines
Because they're meant for grasping and tearing food, they have very long roots
Premolars
Molars
Premolars have a more flat chewing surface because they're meant for crushing food
Molars are much bigger than the Premolars and have bigger, flatter chewing surfaces because their job is to chew and grind the food into smaller pieces.
Periodontium
The periodontium is the part that supports your teeth.

It is comprised of 4 different hard or soft tissues:
. gum
. cementum
. periodontal ligament
. alveolar bone

Periodontal ligament
Good snacks include:
non-citrus fruits like apples, pears and peaches
Raw veg like carrots and celery
unflavoured crisps
low fat cheese
unsweetened yoghurt
Bad snacks include:
Sweets
Biscuits and cakes
carbonated drinks
pure citrus fruit juices
Hot drinks with sugar

GOOD SNACKS
BAD SNACKS
Attached gingiva
Free gingiva
What is in our saliva?
Produced by three Saliva Glands. Parotid, sublingual and the submandibular


Two types of saliva
Serous and Mucous
Inorganic ions and minerals - sodium, calcium, potassium which help to neutralise acids and act as a buffer to maintain PH
Leucocytes- white blood cells - defend against disease
Antibodies- immunoglobulins- fight infections like periodontal disease.
Xerostomia- Excessive dry mouth

Age
Hormone levels
Mouth breathing
irradiation treatment
Medication- some antidepressants
Sjogren's Syndrome (Show-grin's)
Ptyalism- Excessive salivation

A symptom of an underlying disease
Periodontal disease
Parkinson's disease

1) Mastication and deglutition- creates a food bolus
2) Lysozyme (Enzyme) controls bacterial growth
3) Speech
4) Taste
5) Helps maintain water balance in the body
6) Excreation- Uric and urea acid
7) Digestion- Salivary amylase (Ptyalin) starts to break down starches
8) Buffering action- maintains the PH level (bicarbonate ion)
Eight main functions of saliva
Mature plaque is 70% micro-organisms and 30% matirx
Enzymes and toxins- produce by bacteria
proteins and carbohydrates
red and white blood cells
Lactic acid
Antigens- immune response
Demineralisation
- ( Inorganic ions) Calcium and phosphate ions leave the tooth. Start of decay.

Remineralisation
- return of calcium and phosphate ions. (30 mins to 1hr )
Ionic Seesaw
Detergent foods
225ppm
White mottling
opaque lines and flecks
Enamel is made up of calcium hydroxyapatite crystals
Enamel is 96%
Inorganic
Hardest substance in the human body
Enamel
Not sensitive to temperatures
Calcium and phosphate ions
DECAY
Tooth
Bacterial plaque
Fermentable
carbohydrates
Time
Shows the development of an
acid attack
Progression of periodontal
disease
Plaque that is not removed by brushing accumulates
Plaque thickens as more bacteria flourish
Toxins produced by the bacteria enter the periodontal tissues and an immune response is activated
The continued immune response leads to the destruction of the periodontium
Should fluoride be added to our water supply??
Roughage - dietary fibre (aids digestion)
Burka
Full transcript