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

CARIES (a.k.a. – cavities)

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

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

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

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.

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

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.

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

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