Dental Public Health- Introduction to the Prevention of Oral Diseases

• prevention of dental trauma

  mouth guard in contact sports (prevention at an individual

  level)
• epidemiology of dental trauma

  • Around 1 in 10 children had sustained dental trauma to their

  incisors (12% at age 12 and 10% at age 15)

  • Compared to the 2003, the proportion of children observed with traumatic damage to permanent incisors has remained similar overall
• aetiology of dental trauma

  • Increased overjet (>5mm) with inadequate lip coverage

  ( overjet: overlap of teeth in thehorizontall dimensions)

  • Risk taking

  • Failure to use protective gear when participating in contact

  sports

  • Violence and bullying

  • Falls, traffic and bicycle accidents
• what is dental trauma?


  injury in the mouth
• Prevention of tooth wear

  Abrasion:

  • Identify and correct aetiological factors (e.g.

  good oral hygiene technique)

  
  

  Attrition:

  • Prevent further tooth loss ( eg- use occlusal splint (night guard))

  
  

  Erosion:

  • Dietary assessment and counselling: reduce

  frequency of acidic foods and drinks intake, keep

  them to mealtime

  • Avoid frequent swishing of acidic drinks

  • Use a straw

  • Do not clean teeth immediately after

  eating/drinking acidic products or vomiting (??

  up to one hour)

  • Use fluoride toothpaste 1450 ppm low abrasive
• epidemiology of tooth wear

  Children:

  • 14% of 5-year old and 4% of 15-year old have wear into the

  dentine affecting at least two incisor teeth

  
  

  Adults:

  • 15% of adults had moderate tooth wear

  • 2% of adults had severe tooth wear

  • Increasing prevalence of moderate tooth wear in adults, from 11% in 1998 to 15% in 2009

  ----> moderate tooth wear is on the rise among UK adults
• aetiology of tooth wear

  • Abrasion:

  loss of tooth surface because of friction of a foreign

  body (e.g. toothbrush, pipe smoking)

  • Attrition:

  loss of tooth surface because of tooth to tooth contact

  (e.g. bruxism)

  • Erosion:

  loss of tooth surface because of extrinsic and intrinsic

  acids (acidic foods and drinks, vomiting)
• what is Tooth wear

  loss of tooth surface
• Prevention of oral cancer

  - stopping tobacco use

  - sensible alcohol consumption

  - increase intake of non-starchy vegetables

  and fruits
• Epidemiology of oral cancer

  • The annual age-standardised incidence rate of head and

  neck cancers has increased in both male and female

  London residents

  • Oral and oropharyngeal cancers showed the most

  significant rise among UK adults
• Aetiology of oral cancer

  • Tobacco use (smoking tobacco, chewing tobacco/oral snuff, chewing betel quid (pan) with tobacco)

  • Excessive alcohol consumption

  • Diet (e.g. low intake of non-starchy vegetables and fruits)

  • Human papillomavirus (HPV) infection

  • low social economic status

  
  

  Predisposing factors:

  • Sunlight (lip cancer)

  • Genetic disposition

  • low social economic status

  • pollution
• what is oral cancer?

  - Iincludes cancers of the lip, tongue, mouth and pharynx

  - Majority of malignancies are squamous cell carcinomas
• prevention of periodontal disease

  - plaque control (tooth brushing and interdental cleaning), -- correcting factors that impede good plaque control

  - controlling risk factors such as tobacco use and diabetes
• Epidemiology of periodontal disease

  in children:

  The proportion of 8-year-old children with some

  gum inflammation reduced from 64% in 2003 to 46% in 2013

  
  

  in adults:

  (in 2009)

  • 17% had very healthy periodontal tissues

  • 45% had periodontal pocketing ≥4mm

  • 8% had periodontal pocketing ≥6mm

  • Severe periodontitis is on the rise among UK adults
• Aetiology of periodontal disease

  • Poor oral hygiene

  • Plaque

  • Smoking- increased smoking leads to increased risk of the disease

  • Systemic diseases e.g. diabetes.

  • Stress (it affects the immune system) and other psychosocial factors

  • Genetic disorders

  
  

  Predisposing factors ( makes someone susceptible to the disease) to plaque accumulation:

  • Overhanging restorations

  • Removable partial dentures

  • Calculus ( calcified dental plaque)

  • Tooth malalignment

  • Social conditions - poor housing and environment ( studies have shown that decreased social class= increased chance of periodontal disease)

  • Economic conditions- lower income, worse education, job insecurity
• what are the two types of Periodontal disease?

  Gingivitis: (mild)

  - inflammation of the marginal gingival tissues due to

  the accumulation of dental plaque

  - characterised by redness, swelling and bleeding of

  the tissues

  
  

  Periodontitis: ( advanced)

  - plaque-induced inflammation of the periodontal

  tissues

  - leads to loss of attachment, bone destruction and

  eventually loss of teeth
• what is Periodontal disease?


  gum disease
• prevention of dental caries

  Diet (diet including Free sugars)

  • Reduce daily free sugar intake (<5% of total energy intake)

  
  

  Microorganisms

  • Physical plaque removal (tooth brushing and

  interdental cleaning)

  • Chemical plaque removal - mouthwash (chlorhexidine)

  
  

  Tooth

  • Strengthen tooth with fluoride ( makes teeth more resistant to bacteria)

  
  

  Time

  • Reduce frequency of (and night-time) sugar intake

  • Increase frequency of (and night-time) plaque removal

  and mouth fluoridation
• epidemiology of dental caries

  The percentage of adults with dental caries in England,

  from 1998 to 2009, shows a decline. This is mainly due to the use of fluoride toothpaste.

  
  

  However, it is still a dental public health problem.
• Aetiology of dental caries

  -micro-organisms

  -diet ( level free sugars)

  -teeth ( morphology of the tooth and level of fluoride exposure)

  -happens over time

  
  

  - saliva is able to flush microorganisms and substrates and maintain oral cleanliness so it can influence dental caries
• what are dental caries?

  the process involving periods of demineralisation and

  remineralisation of the hard tissues of the tooth
• Define epidemiology

  The study of the distribution, patterns and determinants of diseases in a defined population
• Define aetiology


  cause of disease
• what is the 'delivering better oral health tool kit'?

  - simplified approach to prevention for the dental team

  
  

  -provides practical based prevention advice and professional interventions.

  -------> The advice has its level of evidence (EB) shown =

  I, II, III, IV, V (with I having the highest level of evidence and V having the lowest level of evidence). Some advice will have GP next to it- this means general good practice by observation.

  
  

  -has summary tables for each oral disease structured according to age and risk level