1. STATISTICS 42% adults 65 and older visit a dentist annually 68% of teenagers have experienced tooth decay average adult has 21.5 decayed or filled tooth surfaces 50% of all Americans need dental treatment 80% of all Americans have some degree of periodontal disease 44% of all Americans 75 years and up have lost all natural teeth

2. CARIES (a.k.a. – cavities)

3. WHAT CAUSES CARIES?  orthodontic appliances  xerostomia (dry mouth)  gum tissue recession  radiation therapy  smokeless tobacco  excessive alcohol consumption (xerostomia)  Patients with poor oral hygiene = BACTERIA! Bacteria acid = elevated pH = demineralization = cavities

4. HOW DO YOU PREVENT CARIES? DIET: cariogenic foods - >15% sugar (sucrose, fructose, lactose) - clings less cariogenic foods - high water content - stimulate saliva - high in protein PLAQUE REMOVAL/PREVENTION: - mechanical methods - brush and floss (twice daily) -chemical methods - disrupts components of plaque to aid in mechanical removal - specialty aids - Stim-U-Dent - rubber stimulator tips - miniature bottle brushes - denture brushes….etc… - oral irrigating devices - high pressure stream to tooth surface - contraindicated in patients predisposed to bacterial endocarditis - removal by dentist

5. DENTRIFICES: abrasive ingredients - essential for removing stains from teeth - baking soda (not shown to be effective) - high abrasive formulations not for long- term use whitening agents - titanium dioxide = temporary brightening - not a tooth bleaching agent chemotherapeutic ingredients - fluoride (preventing/treating caries) - potassium nitrate (hypersensitive dentin) - triclosan (antibacterial/antigingivitis) - stannous fluoride (antigingivitis/anticaries) - >2-3 months = temporary staining - zinc chloride & citrate (prevent/retard calculus) - soluble pyrophosphates (inhibit crystal growth) - can cause contact dermatitis

6. OTHER ANTIPLAQUE PRODUCTS: Mouthrinses and Gels: - adjunct to proper flossing and toothbrushing Cosmetic Mouthrinses - alcohol (antibacterial & cleansing action) - surfactants (aid in removal of debris) - fluoride - astringents - demulcents Therapeutic Mouthrinses: - aromatic oils (antibacterial & anesthetic activity) - thymol - eucalyptol - menthol - methyl salicylate - agents with antimicrobial activity - cetylpyridinium chloride - domiphen bromide - phenol = anesthetic, antiseptic & bacteriocidal agent Gum and Lozenges: - increases saliva flow = buffer effect against acids - baking soda chewing gum (plaque reduction) - lozenge by Aquafresh (increase saliva flow) (chew or suck after eating…) Discontinue use if irritation occurs and persists. Caution parents of use in children when alcohol is an ingredient.

7. NOTE: IF ORAL ODOR PERSISTS AFTER BRUSHING AND FLOSSING DO NOT RECOMMEND MOUTHWASH/RINSE TO MASK SMELL. REFER PATIENT TO DENTIST.

8. FLUORIDE: - believed to help prevent cavities - facilitates remineralization of early carious lesions - may interfere with plaque adherence - may inhibit glycolysis (sugar to acid) - found in water of 50% of communities in US (web: seattle public utilities) Rinses and Gels: - used daily = significant reduction in caries Who benefits from use? - orthodontic appliances - decreased salivary flow - at risk for developing root caries - poor oral hygiene Fluorosis resulting from too much systemic fluoride.

9. HALITOSIS …OFFENSIVE ODOR EMANATING FROM THE ORAL CAVITY… …MAY BY SYMPTOMATIC OF ORAL PATHOLOGY…

10. What causes halitosis? - poor oral hygiene - cancer - odiferous decaying food particles - hepatic failure - cellular & nutritional debris - plaque coated tongue - caries - bleeding gums - periodontal disease - xerostoma - postsurgical states - purulent infections - improperly cleaned dentures - pulmonary disease - renal failure Tobacco, smoked and smokeless, can cause halitosis. PREVENTION OF HALITOSIS: - removal of plaque - prevention of calculus formation - brushing and flossing regularly - 8 ounces of water each day