Oral Health

Aka: Oral Health, Oral Hygiene, Dental Health, Dental Hygiene, Tooth Brush, ToothBrush, Medications Affecting Oral Health, Drug-Induced Dental Conditions

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II. Epidemiology

  1. Adults over age 17: Average 8 caries in US
  2. Adults over age 64: 41% edentulous
  3. No dental insurance in U.S. for 74 Million (2016)
  4. Emergency Department visits in U.S. for Dental Pain (2010): 2 Million Vists/year

III. Risk Factors: Habits Adversely Affecting Oral Health

  1. Frequent sugar intake
  2. Inadequate oral care (Tooth Brushing, flossing, dental visits)
  3. Inadequate fluoride exposure
  4. Substance Abuse
    1. Tobacco Use
    2. Alcohol Use Disorder
    3. Methamphetamine use

IV. Risk Factors: Conditions Associated with Oral Disease

  1. Risks for oral neoplasms
    1. Tobacco Abuse
    2. Alcohol Abuse
  2. Poor Dental Hygiene due to Inhibited self care
    1. Neurologic disease
    2. Mental illness
    3. Physical Handicaps
  3. Xerostomia causes
    1. See Xerostomia
    2. See Medication Causes of Xerostomia
    3. Diabetes Mellitus
    4. Sjogren's Syndrome
  4. Local dental injury
    1. Bulimia or Recurrent Vomiting
    2. Chemotherapy
    3. Radiation Therapy to head and neck
  5. Other conditions affecting Oral Health
    1. AIDS or other Immunodeficiency
    2. Blood dyscrasia

V. Risk Factors: Medications Affecting Oral Health

  1. Medication Causes of Xerostomia (Dry Mouth)
  2. Gingival Hyperplasia (esp. Calcium Channel Blockers and anticonvulsants)
  3. Oral Mucosa Hyperpigmentation
  4. Allergic Contact Stomatitis
  5. Jaw Osteonecrosis
  6. Drug-Induced Tooth Staining
  7. Stevens Johnson Syndrome
  8. Altered Host resistance
    1. Antibiotics
    2. Systemic Corticosteroids or Inhaled Corticosteroids

VI. Management: General Recommendations

  1. See Oral Health in Children
  2. Floss daily
  3. Brush for 2 minutes at least twice daily (with fluoride toothpaste)
    1. Use a soft bristled ToothBrush to avoid tooth or gum damage
    2. Replace the brush every 3-4 months
    3. Brush up and down, not side to side
  4. Toothpaste
    1. Fluoride toothpaste
    2. Sensidine toothpaste for tooth sensitivity
  5. ToothBrush
    1. Standard ToothBrush
      1. Effective if used properly for 2 minutes per time
    2. Electric ToothBrush (Oral-B, Sonicare, Spinbrush)
      1. Indicated for decreased manual dexterity or poor brushing technique
      2. May reduce Plaque and Gingivitis more than a standard brush
        1. But no evidence for reduced cavities or Periodontal Disease
      3. Most electric ToothBrushes have a 2 minute timer which may promote adequate brushing times
      4. No significant superiority of one brush over another
        1. Although Oral B rotary brush may have more evidence in support
      5. Deacon (2010) Cochrane Database Syst Rev (12):CD004971 [PubMed]
      6. Robinson (2005) Cochrane Database Syst Rev (2):CD002281 [PubMed]
  6. Fluoride
    1. Consider fluoride rinse (e.g. Act)
  7. Other measures
    1. Tobacco Cessation

VII. Complications: Poor Dentition

  1. Oral complications
    1. Tooth Pain
    2. Gingivitis
    3. Periodontitis
    4. Tooth Loss
  2. Systemic complications
    1. Heart disease
    2. Diabetes Mellitus
    3. Osteoporosis

VIII. References

  1. Stephens (2018) Am Fam Physician 98(11): 654-60 [PubMed]

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