Presentation on theme: "Oral health and Prevention in Dentistry"— Presentation transcript:
1Oral health and Prevention in Dentistry In The Name Of GodOral health and Prevention in DentistryMojtaba SedaghatAssistant Professor of Community and Preventive MedicineTehran University of Medical Sciences
2WHAT IS ORAL HEALTH? Being free of : Chronic mouth and facial pain, Oral and throat cancer,Oral sores,Birth defects such as cleft lip and palate,Periodontal (gum) disease,Tooth decay and tooth loss,
3WHAT ARE COMMON CAUSES OF ORAL DISEASE? Share common risk factors with the four leadingchronic diseases -- cardiovascular diseases,cancer, chronic respiratory diseases and diabetes :Unhealthy diet,Tobacco use, andHarmful alcohol usePoor oral hygiene
4HOW CAN THE BURDEN OF ORAL DISEASES BE REDUCED? Addressing common risk factors such as tobacco use and unhealthy diet:Decreased intake of sugars and well-balanced nutrition prevent tooth decay andpremature tooth loss.Tobacco cessation and decreased alcohol consumption reduce risk for oralcancers, periodontal disease, and tooth loss.Fruit and vegetable consumption is protective against oral cancer.Effective use of protective sports and motor vehicle equipment reduces facialinjuriesDental cavities : prevented by a low level of fluoride constantly maintained in theoral cavity. Fluoride can be obtained from :Fluoridated drinking water, salt, milk,Mouth rinse or toothpaste,Professionally-applied fluorides.
5INTEGRATED PREVENTION OF ORAL DISEASE AND HEALTH PROMOTIONMost effective when they are integrated with other chronic diseases and withnational public health programsAdvocacy for a common risk factor approach to prevent oral and other chronicdiseases simultaneously .The focus is on modifiable risk behaviors related todiet, nutrition, use of tobacco and excessive consumption of alcohol, and hygieneFluoridation programs to improve fluoride access in low-income countries
71- Development and implementation of community-oriented demonstration projects for oral health promotion and preventionof oral diseases with focus on disadvantaged and poorpopulation groups in developed and developing countries2- Encourage national health authorities to implement effectivefluoride programmesautomatic fluoride administration (e.g. water or salt fluoridation)use of affordable fluoridated toothpastes.Self-care practices in relation to oral hygiene3- Effective control of diet and nutrition risk factors for dentaldiseases, oral cancer, and cranio-facial development diseasesthrough the WHO Global Strategy on Diet, Physical Activity andHealth.4- Tobacco use (smoking and smokeless tobacco) - risk factor toconditions such as oral cancer, oral mucosal lesions andperiodontal disease.5- Community programs for improved oral health of the elderly and of children : high priority
8Community Prevention Infants and young children rarely visit a dentist Professionals who have frequent contact with infants andchildren be able to help prevent or reduce the risk of tooth decayand to provide appropriate referralsSteps to prevent or reduce the risk of tooth decay:Perform an oral health risk assessment.If qualified, conduct a basic oral health screening and initiateappropriate preventive interventions.Record oral health information.Refer infants and children to a dentist.Provide anticipatory guidance.
9What is an Oral Health Risk Assessment Oral health risk assessment involves identifying an infant’s or child’s risk or protective factors that may impact oral healthAll infants and children are not equally likely to develop oral health problemsChecks more than one of the boxes (the next slide)Refer the infant or child to a dentist for an oral health examination and/or possible treatment.
10RISK FACTORS FOR ORAL DIISEASE FACTORS THAT PROMOTE ORAL HEALTH ORAL HEALTH HISTORY❏ Active untreated dental decay❏ Previous dental decay experience❏ Deep pits & fissures in teeth❏ Severely crowded teeth❏ Poor oral hygiene❏ Reduced saliva flow / dry mouth❏ Inadequate fluoride❏ Poor family oral health❏ No family dentist❏ Last visit to dentist over one year❏ No active decay / all teeth restored❏ No or minimal history of dental decay❏ Sealants on back teeth❏ Properly aligned and positioned teeth❏ Good oral hygiene❏ Mouth lining moist with clear saliva❏ Optimal fluoride❏ Good family oral health❏ Visits dentist for routine periodic exams❏ Visits dentist at least once a year
11MEDICAL HISTORY❏ Healthy balanced diet❏ Medical condition managed and stable❏ Alternative medication if possible❏ Occasional snacks: fruits & vegetables
12❏ Bottles only for routine feeding ❏ Poor diet❏ Metabolic disease (e.g., diabetes)❏ Infectious disease❏ Neoplastic disease (e.g., leukemia)❏ Gastric reflux❏ Frequent snacks❏ Baby bottle at night for sleep, or at will❏ Income higher than 400% of poverty❏ Good dental insurance coverage❏ Parents’ education beyond 12th grade❏ No tobacco or alcohol use❏ Poverty, low income❏ No or inadequate dental insurance❏ Parents’ education up to 12th grade❏ Tobacco or alcohol useCULTURAL / SOCIAL / FINANCIAL STATUS❏ Medications that affect the mouth(e.g., Dilantin, sugary liquid medications)
14Oral Health Risk Assessment Results (check one) At high risk for tooth decay (refer immediately to a dentist)At low risk for tooth decay (refer to a dentist)Oral Health Screening Clinical Findings (circle “present” or “absent”)1. Pain and/or infection related to oral problems: present ORabsent (If present, refer immediately to a dentist)2. Developmental problems: present OR absent3. Dental restorations or fillings: present OR absent4. Untreated tooth decay: present OR absent (If present, refer assoon as possible to a dentist)5. Dental sealants: present OR absent6. Trauma: present OR absent
15Trained professionals, can perform an oral health screening of the lips,tongue,teeth,gums,inside of the cheeks, androof of the mouth to identify oral disease, especially tooth decay, or other oral conditions (for example, delayed tooth eruption or premature tooth loss, abscesses, or trauma)An oral health screening takes only 2 or 3 minutes to complete.Screenings are not examinations and do not involve makingDiagnoses that lead to treatment plansA dental chair is not needed
16For infants and children under age 3, the professional and the parent should sit face to face with their knees touching, with the child placed in the professional’s and the parent’s lap. The child’s head should be nestled securely against the health professional’s abdomen with the child facing the parent
17With a gloved hand, the professional lifts the lips,feels the soft tissues,views the health of the teeth, andlooks throughout the mouthAny type of lighting, such as a flashlight, a portable gooseneck lamp, an examination light, or a headlamp, will work for an oral health screening.A tongue depressor or child-sized toothbrush can be used to move the lips to view the teeth.A dental mirror or other similar-sized mirror can make it easier for the professional to see behind the teeth and may make it possible to perform a more thorough screening, but such a mirror is not necessary
18When performing the oral health screening, the professional should note whether the infant or child is currently in pain or has a dental abscess on the gums above/below the teeth. An abscess may look like a “gum boil” and may or may not have localized or generalized swelling with or without pus draining from the area. If the infant or child is in pain or has an abscess, refer the infant or child to a dentist immediately.Check whether tooth eruption and loss are proceeding according to schedule (see tooth eruption chart).Check the teeth for plaque and food debris.If the parent is present, demonstrate how to remove plaque and food debris from teeth using the appropriate-sized toothbrush
21Photographs of tooth development, past history of tooth decay, tooth decay, and dental sealants can help professionals screen infants and children.Note whether any teeth appear to have developmental problems.Note whether any teeth have untreated decay. Tooth decay may occur on any tooth surface. Tooth decay initially appears as a chalky white area on the enamel. More advanced tooth decay appears as cavities or stains. When decay is observed, refer the infant or child to a dentist.Discolored teeth may be difficult to distinguish from stains associated with tooth decay. When in doubt, refer the infant or child to a dentist.Note whether any dental trauma has occurred. If the teeth are prematurely missing, refer the infant or child to a dentist for possible space management. If trauma may be the result of physical abuse, record observations and call the local social service agency.
26What is Oral Health Anticipatory Guidance? Helps families understand what to expect during their infant’s or child’s current and approaching stage of development.Primary care professionals, other health professionals, and early childhood professionals.Prevent or reduce tooth decay in their infants and children.For parents of infants and children, anticipatory guidance topics :includeoral development, tooth eruption, gum/tooth cleaning, appropriate use of fluoride, bottle use, and feeding and eating practices.Bacteria (Streptococcus mutans [S. mutans]) can be transmitted from a parent, especially the mother or another intimate caregiver, to an infant or child through contact, anticipatory guidance should also be provided to pregnant women, new mothers, and other intimate caregivers
27Can a Parent “Infect” an Infant or Child with Streptococcus Mutans? Transmitted from a parent or another intimate caregiver to an infant or child via saliva, for example, by allowing infants or children to put their fingers in the parent’s mouth and then into their own mouths, testing the temperature of a bottle with the mouth, sharing forks and spoons, and “cleaning” a pacifier or a bottle nipple that has fallen by sucking on it before giving it back to the infant or child.Even if an infant or child is already infected with S. mutans, transmission can increase the concentration of bacteria in the infant’s or child’s mouth, increasing the likelihood of tooth decay or resulting in more severe decay. Therefore, it is important that parents and other intimate caregivers practice good oral hygiene and avoid behaviors that could transmit S. mutans to an infant or child.
29Food Interactions with Streptococcus Mutans? Foods containing fermentable carbohydrates, which include all sugars and cooked starches, interact with S. mutans, producingacids that can cause mineral loss from teeth.Sucrose, which is highly concentrated in candy, cookies, cake, and sweetened beverages (for example, fruit drinks and soda), is a major contributor to tooth decay.Fructose, the naturally occurring sugar contained in fruit, contributes to tooth decay, although fruit is more nutritious than candy, cookies, and cake.Lactose, the sugar contained in milk, contributes to tooth decay, although milk is more nutritious than candy, cookies, and cake.Starch, contained in processed foods such as bread, crackers, pasta, potato chips, pretzels, sweetened cereal, and French fries breaks down into simpler sugars. Processed foods containing starch produce as much acid in plaque as sucrose alone, but at a slower rate.
30Frequent consumption of foods high in sugar (for example, candy, cookies, cake, sweetened beverages, and fruit juice) increases the risk for tooth decay. Even very small amounts of these foods consumed frequently over the course of a day will create an acid environment lasting many hours.Even though they contain sugar (fermentable carbohydrates), healthy foods like fruit, vegetables, grain products (especially whole grain), and dairy products should not be avoided.Snacking is important for infants and children; because their stomachs are small, they need to eat small amounts frequently to meet their nutritional requirements. However, it is important to limit snacking on foods high in sugar,
31Can Tooth Decay Lead to Other Problems? Painful, Destruction of teeth, Difficulty chewing, under nutritionimpaired physical development.Speech problems.Inability to concentrate, difficulty with learning, and impairedperformance in school.Psychological problems such as low self-esteem and poorsocial interaction.Tooth decay in primary teeth most often means that there will betooth decay in permanent teeth.
32Proper speech development Development of the facial structureDon’t assume that tooth decay will occur no matter what.Any effort to save teeth, including primary teeth, will helppromote healthy development and reduce or eliminate the painassociated with tooth decay
33Module 1: Tooth DecayKey PointsTooth decay is an active process of tooth destruction resulting from interactions between teeth, food, and bacteria.The bacterium S. mutans is the main contributor to tooth decay.S. mutans is found mostly on tooth surfaces. It is most concentrated in the crevices, pits, and fissures that are a normal part of the teeth and surrounding structures.Bacteria can be transmitted from a parent or other intimate caregiver to an infant or child via saliva. Therefore, it is important that parents and other intimate caregivers practice good oral hygiene and avoid behaviors that could transmit S. mutans to an infant or child.Foods containing fermentable carbohydrates, which include all sugars and cooked starches, interact with S. mutans and produce acids that cause mineral loss from teeth. Each time such foods are consumed, the acid attacks the enamel of the teeth. This mineral loss results in cavities when the attack is prolonged and exceeds an individual’s resistance and the ability of the teeth to heal.Tooth decay can spread and be extremely painful.Tooth decay in primary teeth most often means that there will be tooth decay in permanent teeth.
34Educational Module : Prevention of Tooth Decay / Feeding and Eating Practices Do not put the infant or child to sleep with a bottle or sippy cup or allow frequent and prolonged bottle feedings or use of a sippy cup containing beverages high in sugar (for example, fruit drinks, soda, or fruit juice), milk, or formula during the day or at night.Do not use a bottle to calm an infant or to put an infant to bed. Instead of a bottle try:Giving the infant a favorite blanket or toyOffering the infant a clean pacifierHolding, patting, or rocking the infantReading to the infantSoftly talking or singing to the infantIf an infant is accustomed to being put to bed with a bottle, offer a bottle filled with plain water. If the infant does not adapt initially to the plain water, it may be necessary to fill the bottle with a mixture of juice and water, reducing the amount of juice slightly each night until only water is used.Hold the infant or child while feeding. Never prop a bottle (that is, use pillows or any other objects to hold a bottle in the infant’s mouth).
35Never add cereal to a bottle Never add cereal to a bottle. This causes sugary fluids to pool around the teeth and can also cause choking if the infant is unable to swallow the extra food. Instead, always feed infants and children solid foods with a spoon or fork, or, if the infant or child is coordinated enough, encourage self-feeding.Introduce a small cup when the infant can sit up without support.As the infant begins to eat more solid foods and drink from a cup, the infant can be weaned from the bottle. Begin to wean the infant gradually, at about 9 to 10 months. By 12 to 14 months, most infants can drink from a cup.Do not dip pacifiers in sweetened foods like sugar or honey.
36Serve age-appropriate healthy snacks such as fruit, vegetables, grain products (especially whole grain), and dairy products instead of foods high in sugar such as candy, cookies, or cake.Offer snacks at regular times between meals only. If a child snacks frequently, brush the child’s teeth three times a day.Make sure the child drinks plenty of water throughout the day, especially between meals and snacks.Don’t offer food in return for good behavior. This teaches children that foods are rewards and can lead to the development of unhealthy habits.
37Educational Module : Prevention of Tooth Decay What is Fluoride, and Who Needs It?Enhances tooth and bone health, primarily through topical effects. Groundwater, Foods such as breads and beverages that are made using fluoridated water and in many public fluoridated water supplies.Tooth decay can be reduced by 50 to 70 percent with exposure to the proper amounts of fluoride.Water fluoridation is one of the best examples of a public health preventive intervention at the community level.
38Topical fluoride is probably the most important method of preventing tooth decay. Works best when it is ingested in very small amounts many times a day through water, foods containing fluoride, and fluoridated toothpaste.Unless a dentist or physician advises otherwise, fluoridated toothpaste should be introduced at around age 2.Another form of topical fluoride is professionally applied fluoride (including gels, foams, and varnish), for children at high risk for tooth decay because they lack fluoridated water, have a history of tooth decay, snack frequently on foods high in sugar, or have a medical condition that makes them susceptible to decay.Only a dentist, dental hygienist, physician, or other qualified health professional should apply topical fluoride
39Who Needs Fluoride Supplements, and How Much Fluoride is Enough? Fluoride supplements are recommended only when an infant or child age 6 months or older consumes less than the optimal amount of fluoride (see Table 1. Systemic Fluoride Supplements: Recommended Dosage). Infants or children suspected of drinking mainly water that is not fluoridated should be considered for fluoride supplementation.Table 1. Systemic Fluoride Supplements: Recommended DosageFluoride Ion Level in Drinking Water*Age< 0.3 ppmppm> 0.6 ppmNewborn-6 monthsNone6 months-3 years0.25 mg/day**3-6 years0.50 mg/day0.25 mg/day6-16 years1.0 mg/dayThe dentist or physician should consider the following before prescribing systemic fluoride drops:Is the infant’s or child’s source of water from a well? If it is, the water should be tested to determine how much fluoride it contains.Is the infant’s or child’s source of water bottled or processed? Bottled water often does not contain adequate amounts of fluoride; some water filtration systems filter out fluoride.
40Educational Module : Prevention of Tooth Decay What is Fluorosis?Too much fluoride or use of too much topical fluoride during infancy and childhood, when the teeth are developing.Fluorosis usually appears as small white areas in the enamelCosmetic problem that usually does not affect health.Generally, infants and children will not consume too much fluoride as long as only a pea-sized amount of toothpaste is used for toothbrushing (for children ages 2 and above),only plain water is used for toothbrushing (for infants and children under age 2),an adult brushes the infant’s or child’s teeth or, for older children, supervises toothbrushing.
41Educational Module : Prevention of Tooth Decay What are Dental Sealants?Dental sealants are thin plastic coatings applied to pits and fissures on the chewing surfaces of the teeth to prevent tooth decay by creating a physical barrier against dental plaque.Applying dental sealants to tooth surfaces with pits and fissures shortly after the teeth erupt helps prevent decay.
42Educational Module : Prevention of Tooth Decay Key PointsChildren should visit a dentist within 6 months of the eruption of the first primary tooth, and no later than age 12 months.Parents should begin cleaning an infant’s teeth as the first tooth erupts, usually around age 6 to 10 months.Tooth decay can be reduced by 50 to 70 percent with exposure to proper amounts of fluoride.All infants and children who drink fluoridated water benefit from systemic ingestion by incorporating fluoride into their developing teeth, as well as from important topical effects.Topical fluoride is probably the most important method for preventing tooth decay.
43Dental sealants are thin plastic coatings applied to pits and fissures on the chewing surfaces of the teeth to prevent decay by creating a physical barrier against dental plaque.Fluoride varnish is a topical fluoride-containing lacquer that can be easily “painted” onto the susceptible surfaces of a child’s teeth.Xylitol, a low-calorie sugar substitute used in certain chewing gums and other food products, may reduce the incidence of tooth decay in mothers and children.