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Prevention of oral disease for adults. Aim Provide an overview of evidence-based practical prevention for adults.

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Presentation on theme: "Prevention of oral disease for adults. Aim Provide an overview of evidence-based practical prevention for adults."— Presentation transcript:

1 Prevention of oral disease for adults

2 Aim Provide an overview of evidence-based practical prevention for adults

3 Hierarchy of evidence Level I – Systematic review of RCTs Level II – At least 1 RCT Level III– Evidence from non- randomised trials Level IV – Well designed observational studies from >1 centre Level V - Expert opinion, traditional reviews Strong Moderate Caution

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5 Oral diseases to prevent Caries Erosion Periodontal diseases Oral cancer Trauma

6 Oral diseases to prevent Caries Erosion Periodontal diseases Oral cancer Trauma

7 Caries and its prevention

8 Risk factors Frequent sugars A cidogenic bacteria Sub-normal saliva Caries progression

9 Protective factors Saliva Fluoride Antibacterials Caries and its prevention Risk factors Frequent sugars A cidogenic bacteria Sub-normal saliva Equilibrium!

10 Protective factors Saliva Fluoride Antibacterials Caries and its prevention Remineralisation

11 Prevention of caries – Fluoride (1) Fluoride toothpaste Most cost-effective topical fluoride agent Main reason for the decline in caries in the last 30 yrs – 24% reduction of caries (I) Fluoride concentration of toothpaste more important than plaque removal (I)

12 Prevention of caries – Fluoride (2) Fluoride toothpaste Fluoride conc. Preventive effect

13 Prevention of caries – Fluoride (2) How often should adults brush? –Al least twice daily (I) – and always at night (V) What conc. of fluoride toothpaste should be recommended? –At least 1350ppm (I) –Higher conc. (>2000ppm) available for adults (II)

14 ppm F ALDI – Dentitex, whitening, freshmint total care Aquafresh – Extreme Clean & Intense Rush, Complete Care, Fresh & Minty, Mild & Minty, Big Teeth, Multi-active ASDA – Total care, Sensitive, whitening Boots – Sensitive Colgate – Sensitive Fresh stripe, Sensitive Whitening, Sensitive Multi Protection Total, Total Advanced Fresh, Total Plus Whitening, Total Professional Weekly CleanGreat Regular, Bicarb paste, Triple cool, Fresh stripe, Ultra cavity protection, Time control, Sensation Deep clean, whitening, Sensitive multi-protection Crest – Freshmint, mildmint, tartar control, 5Complete Janina Opale Whitening Paste LIDL – Salvamed, whitening, sensitive and mature; Dentalux, herb and freshmint Macleans - Total Health, Total Health Whitening, Freshmint, Coolmint Marks & Spencer – Protect Mentadent SR Morrisons – Total care, Whitening, sensitive Sainsburys – Total care, Sensitive, Whitening Sensodyne – Total Care Gentle Whitening, Total Care Gel, Total Care F, Total Care Extra Fresh, Pronamel Signal Tesco – Total care: Freshmint, Coolmint stripe Correct in 2007!

15 >1500ppm F Prescription only

16 Prevention of caries – Fluoride (3) How should the mouth be rinsed after brushing? –Discourage rinsing, just spit (IV) How long should brushing take – what technique is best? –No clear evidence for either –2 minutes!

17 Prevention of caries – Fluoride (4) What type of toothbrush is best? –Some powered toothbrushes are more effective than manual brushes (Oral B range) (I) –Sonic toothbrushes no better (I) –Normal brushes – small heads, with soft, variable length and round ended filaments (V)

18 Prevention of caries – Fluoride (5) Fluoride Mouthrinses 2 types –Daily (0.05% F) –Weekly (0.2% F) Both give 26% reduction in caries (I) Recommended for high risk patients – Active decay –Poor quantity or poor quality of saliva

19 Prevention of caries – Fluoride (6) Fluoride varnishes 46% reduction in caries in permanent teeth (I) Good for patients high risk of caries Apply 6 mthly in high risk Professional application - expensive ppm F, some higher

20 Protective factors Saliva Fluoride Antibacterials Caries and its prevention Risk factors Frequent sugars A cidogenic bacteria Sub-normal saliva Equilibrium!

21 Prevention of caries – dietary counselling (1)

22 Evidence for F>>>dietary advice Providing information WILL NOT achieve sustained changes in behaviour (I)

23 Changing behaviour Previously assumed that: Providing knowledge Change in attitudes Change in behaviour

24 The KAB approach KnowledgeAttitudesBehaviour Behaviour change ?

25 KnowledgeAttitudesBehaviour Eating 5 portions of fruit & veg per day reduces risk of cancer & CHD Fruit & veg are good for my health I will eat 5 portions of fruit & veg per day Behaviour change The KAB approach

26 Prevention of caries – dietary counselling (1) Evidence for F>>>dietary advice Providing information WILL NOT achieve sustained changes in behaviour (I)

27 Prevention of caries – dietary counselling (1) Evidence for F>>>dietary advice Providing information WILL NOT achieve sustained changes in behaviour (I) BUT important role for dental team – caries, erosion and oral cancer

28 Prevention of caries – dietary counselling (3) Recommendations (III): Reduce frequency & amount consumption of non-milk extrinsic sugars eg sucrose/glucose/glucose syrup – max 4 x per day

29 Oral diseases to prevent Caries Erosion Periodontal diseases Oral cancer Trauma

30 Oral diseases to prevent Caries Erosion Periodontal diseases Oral cancer Trauma

31 Prevention of erosion– dietary counselling (1) Tooth erosion: Tooth erosion is a gradual loss of the normally hard surface of the tooth due to chemical, not bacterial, processes.

32 Prevention of erosion– dietary counselling (1) Recommendations (V) Limit frequency of acidic drinks and foods If do, cheese and milk afterwards Use a straw Dont hold or swish acidic drinks Dont brush for 1 hr after exposure or vomitting Fluoride usage!

33 Oral diseases to prevent Caries Erosion Periodontal diseases Oral cancer Trauma

34 Oral diseases to prevent Caries Erosion Periodontal diseases Oral cancer Trauma

35 Prevention of periodontal disease (1) Quick revision! Key aetiological factors –plaque –smoking

36 Prevention of periodontal disease (2) All toothbrushing advice applies – removal of plaque ++ important Stopping patients smoking – next week! Interdental cleaning aids (floss/sticks) can be effective – but few people master Minibrushes probably best (V) Triclosan with copolymer or zinc citrate in toothpaste effective in reducing plaque and improving gingival health (I)

37 Prevention of periodontal disease (2) Zinc Citrate Triclosan with copolymer

38 Prevention of periodontal disease (2) Mouthrinses Chlorhexidine reduces plaque and improves gingival health – 0.12% and 0.2% (II) Others probably effective at reducing plaque (II) Plax % Triclosan with sodium fluoride (225 ppm fluoride)

39 Prevention of oral cancer Some more revision!

40 Oral cancer kills one person every 2 1 / 2 mins (210,000 deaths pa) World Wide 481,000 new cases of oral cancer pa

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43 UK epidemiology of oral cancer Incidence – approx 5000 new cases per year (2005) 15 th most common cancer – 1.7% of all cancers In UK, similar incidence to brain, liver and cervical cancers and melanoma (IV) Cancer Research UK, 2008

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45 UK epidemiology of oral cancer Incidence increasing in younger people Survival rates changed little in 3 decades – approx 55% at 5 years (IV) Cancer Research UK, 2008 Incidence is increasing in men and women

46 Oral cancer worldwide Cancer Research UK, 2008

47 Alcohol (oz / day) Cigarettes / day Relative Risk Oral Cancer – risk factors Smoking/tobacco use Alcohol Betel quid / paan

48 Oral Cancer – other risk factors Sunlight Diet Human papilloma virus Previous cancer

49 Prevention of oral cancer Record smoking/tobacco use status Help patients to stop smoking/using tobacco (III) – again, more next week Advise moderation of alcohol (IV) Record alcohol consumption 21 units for men (no more than 4 units/day) 14 units for women (no more than 3 units/day) Advise diet high in fruit and vegetables, low in fat (III) Early referral of suspicious lesions

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53 Oral diseases to prevent Caries Erosion Periodontal diseases Oral cancer Trauma

54 Prevention of trauma Sport related – recommend mouthguards (IV) Maxillofacial injuries – alcohol related – advise to moderate consumption – research underway

55 Take home messages Fluoride, in all forms, works Changing (dietary) behaviour is difficult Helping patients to stop smoking is very important Some electric toothbrushes are better than manual Some toothpastes and mouthwashes will reduce plaque and improve gingival health

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