Dental Team's Role In Disease Prevention

• The dental team includes:

  • Dentists
  • Dental nurses
  • Dental therapists
  • Dental hygienists
  • Orthodontic therapists
  • Dental technicians
  • Clinical dental technicians
• Prevention is:

  • Specific, population-based and individual-based interventions
  • Aims to minimise the burden of disease and associated risk factors
  • Primary prevention - preventing disease before it occurs
  • Secondary prevention - early detection of disease
• The dental team and prevention:

  • Habit change relies on rapport - conversational, establish trust, awareness of non-verbal cues, engage and actively listen, summarise back to the patient
  • Non-judgemental approach
  • Provide leaflets/written information
  • Reassure them that they can ask questions
  • Signpost them to resources
• The Common Risk Factor Approach:

  • Preventing oral disease by modifying risk factors
  • Many of these risk factors are common to other major diseases - cardiovascular disease, cancer, diabetes
  • Link oral health and general health - consistent messages

  
• Diet and general health:

  • Unbalanced diet can cause variety of oral health and general health related problems
  • Dietary advice should routinely be given to patients to promote good oral and general health
  • Delivering Better Oral Health toolkit
  • Eat less, move more
  • Eatwell plate

  
• Diet and dental caries:

  • Most prevalent non-communicable disease worldwide
  • Completely preventable
  • Prevented by limiting frequency of sugar intake
  • Tailored advice
  • Disproportionately affects low income families
• Bulimia Nervosa:

  • Eating disorder and mental health condition
  • Cycle of binge-eating and compensatory behaviours such as self-induced vomiting
  • Potentially life-threatening
  • Can be associated with alcohol misuse, depression and self-harm
  • Can lead to erosive tooth wear
  • Dental exam - erosion
  • Smooth glassy surfaces - exposed dentine
  • Relationship between severity of wear and degree of vomiting (+ oral health regime)

  
• Dental management of Bulimia Nervosa:

  • Dental professionals may be the first to notice
  • Many patients won't disclose
  • Non-judgemental sympathetic approach
  • Advice - rinse after vomiting and do not brush immediately
  • Signpost to available services for Eating Disorders
  • Monitor wear - photos, study models
  • Manage sensitivity
  • Restorative care - in severe wear cases treatment may be complex
• Other dietary-related oral conditions:

  • Periodontal disease (diabetes, CVD [cardiovascular disease])
  • Angular cheilitis (vitamin B2 deficiency)
  • Glossitis (iron deficiency)
• Substance use disorders:

  • Group of chronic and progressive psychological illnesses
  • Results in a person losing control over a substance despite the negative physical, mental and social implications

  
• Smoking:

  • Patients should be asked about smoking status routinely, as part of taking their history
  • Pack years = cigarettes smoked a day / number of years smoked
  • DBOH recommends Very Brief Advice (VBA) is given to patients who smoke
  • Every member of the dental team
  • National Centre for Smoking Cessation and Training

  
• Alcohol misuse:

  • Alcohol use (socially acceptable) -> harmful alcohol use (early stages of dependence) -> alcohol dependence (physiological phenomenon & psychological)
  • Lower risk = not regularly exceeding >= 14 units per week
  • Increasing risk = regularly drinking >14 units per week
  • Higher risk = regularly drinking >35 units per week (women) or >50 units per week (men)

  
• Alcohol units:

  • Pint of beer = 3 units (half pint = 1.5 units)
  • Red wine = 1.6 units
  • White wine = 2.3 units
  • Shot = 1 unit
  • Bottle of lager = 1.7 units
  • Pint of lager = 3 units
  • Champagne = 2 units
  • Bottle of wine = 10 units

  
• Alcohol advice:

  • Adults:
  • Do not regularly exceed 14 units per wee
  • Best to spread evenly over >= 3 days
  • Young people:
  • Those <18 should normally drink < adult men and women
  • Pregnant people:
  • If pregnant or planning pregnancy it's safer not to drink alcohol

  
• Alcohol prevention:

  • Screen: determine patient risk
  • Brief advice: raise awareness of drinking guidelines and provide brief information of the effects of adverse drinking habits on oral and general health
  • Signpost/referral

  
• Drugs - methamphetamines:

  • A powerful synthetic stimulant which is highly addictive
  • Also known as Speed, Chalk or Crystal Meth (concentrated version)
  • Meth can be taken orally, nasally or intravenously
  • Can cause memory loss, aggression and paranoia
  • Meth burns up the body's resources which can lead to extreme weight loss
  • Rampant caries and perio disease in pictures thought to be caused by xerostomia, poor diet and poor OH

  
• Drugs - heroin:

  • An opiate which can be smoked, snorted or injected
  • Users have high levels of caries - often they crave sugary foods and have poor oral hygiene
  • IV use has increased risk of blood borne viruses ie HIV, hepatitis C
  • Often treated with methadone - an opioid which itself is addictive
  • Methadone - recovery - can induce caries
• Drugs - cocaine:

  • Usually inhaled
  • Use is increasing - 4.1% of London's population are said to use cocaine
  • Dental implications: gingival lesions, temporomandibular disorders, bruxism, increased rate of periodontal disease, erosive lichen planus
  • Risks associated with local anaesthetic administration
• Drugs - cannabis:

  • The most commonly used illegal drug (aka Marijuana)
  • Causes dry mouth, often combined with poor oral hygiene and diet therefore increased risk of caries and periodontal disease
  • Issues with local anaesthetic
  • Increased carcinogenicity compared to tobacco?
  • Psychosis, hyperemesis
  • Can advise patients using the same principles as for smoking