Management Of Dental Procedures And Oral Health Diseases

Causes of dental caries and periodontal diseases

Discuss about the Management of Dental Procedures and Oral Health Diseases.

Dental caries are majorly caused by Streptococcus mutans which produce an acid that results in the irremediable solubilisation of minerals of the teeth. Lactobacilli can aggravate the lesion progression. Periodontal diseases are mixed and are mostly caused by anaerobes like Porphyromonas gingivalis and Trepanoma denticola, again, juvenile periodontitis is caused by Actinobacillus actinomycetemcomitans. Gingivitis is caused by poor oral hygiene that causes adherence of bacteria to the teeth in a colony called plaque. It precedes periodontal disease (de Silva et al., 2016).

Caries are caused by acid-producing bacteria from sugars and other foods. Demineralisation of the teeth surface may occur. If the damage is insignificant, salivary protective abilities can halt the process and remineralisation may begin. Proper oral hygiene reduces its progression. If not managed, the enamel and the entire tooth will be lost, and infections like tooth abscess and periodontitis set in.

Periodontal disease is caused by anaerobic bacteria due to the progression of other diseases like gingivitis and caries. Treatment of these infections prevents the onset of periodontitis, however, if untreated, it leads to mucogingival problems, furcation lesions, and loss of teeth as well as the bone. It may lead to systemic bacterial infections (Kapellas et al., 2014).

Due to poor oral hygiene, pellicle forms on tooth thus providing a surface for bacterial attachment. This process is called association. In a few hours, bacteria bind to the surface, a process called adhesion. Then the bacteria proliferates throughout the oral cavity. They form microcolonies where the Streptococci create slime layer, a protective film. Having metabolic benefits, the microcolonies form groups (complex). Finally, the film matures by setting up a circulatory system that is primitive. Around 90% of the plaque’s weight is water and dry weight of around 70% consists of bacteria and then 30% is glycoproteins and polysaccharides (The causation of gingivitis. 2015).

Redness, swelling, and pain in the gums, tongue, and the teeth. The oral cavity may also be hyperthermic, which can be confirmed by an oral thermometer. There is function loss, where there is difficulty in chewing, swallowing and even ingestion of food and fluids.

Family backgrounds like a minority and low-income families have problems like shortage of dental workforce, poor community water fluoridation, and inadequate access to dental insurance and high costs of care. Wealthy family backgrounds have minor dental and general health problems. Cultural influences are related to health seeking behaviours and prevention of disease, practice of oral hygiene, utilisation of folk therapies and beliefs about oral hygiene and the teeth. For example, the appearance of teeth in China proves good health even if there are bleeding, painful chewing, and other symptoms. In some African American families, use of cotton balls soaked in aspirin is the remedy instead of seeking hospital care.

Symptoms of dental caries and periodontal diseases

In environments like cold areas and war zones, people do not often adhere to oral hygiene guidelines and general health practice. Habits like alcoholism and cigarette smoking aggravate health problems. Diets such as sugars, carbonated, and uncarbonated acidic drinks also affect oral and general health. Utilising sugary foods like biscuits, soft drinks, and candy more than four times in a day predisposes one to dental diseases, even if oral hygiene is upheld. Furthermore, the soft drinks have sugars and acids that possess cariogenic and acidogenic potentials that lead to caries and other diseases. Too many sugars also cause diabetes mellitus, lowered immunity among other health concerns (Silva, Hopcraft, and Morgan, 2014).

Oral health messages can be delivered through various methods like the use of mass media, face-to-face advice and education, legislation, social media, action research, community development, sharing skills and training, lobbying and others. Giving information through the television, radio, magazines, and the newspapers covers a wide geographic area. Many people also use social media such as Facebook and Twitter, therefore, posting the health messages on these platforms ensures broad coverage and adherence. Research can be done and communicated to organisations like WHO and World Food Program (WFP) who then spread the news to masses and governments. Face-to-face communication in clinical areas and public places helps propagate the oral health message. Sharing skills and training among different parties like in continuous medical education (CMEs) help advance health workers proficiency in managing oral conditions.

Toothbrushes are the most commonly used and recommended aids. They need to have a seal of approval and electric and ultrasonic abilities because they break down bacteria and plaque so well. Using the appropriate toothpaste, place the brush at 45 degrees angle towards the gums and teeth to ensure all food remains are removed. Brush in a circular motion from up downwards along the line of gums (Wynne, 2011). Do not apply excessive pressure, be gentle enough by gauging how your teeth respond. Cover all parts of the mouth, including tongue and soft tissues. Rinse well using dentist prescribed mouthwash or clean water (Balabaskaran, 2013).

Disclosing tablets help in removal of plaque. After obtaining the recommended tablet, chew and mix it with your saliva. Afterward, swish the saliva in your mouth covering all locations for around 30 to 40 seconds and spit it out. Mouthwashes also help in removing plaque and lethal bacteria. Pour the required amount based on the manufacturer’s guidelines into to the mouth. Vigorously swish and rinse in the mouth for around 30 seconds to one minute and then spit it out. Then gargle using a new solution in your mouth. Interdental aids like knitting yam, toothpick, gauze strip, dental tape, and floss help remove substances in between teeth. As directed by the manufacturer, gently place the aid between the teeth and in a soft back and forth motion, remove the substances as you spit and clean the support. Do this for around a minute between all the teeth and rinse the mouth with fresh water or mouthwash.

Factors affecting oral health

(Wynne, 2012)

Delivery of fluoride can be achieved topically or systemically. Systemic delivery is made through the artificial introduction in milk, water, supplements or salt. Fluoride is introduced at the water treatment plant, for consumption in households. Fluoridating table salt has also been used in Costa Rica and parts of Europe, and it is spreading to other areas of the world. This method has reduced caries in children by 50% in Costa Rica. Also, powdered, long-life and liquid milk has been fluoridated in China, Eastern Europe, South America and other parts of the world. It is easy to target a given population like children and to control fluoride amounts. Fluoride supplements are only recommended for high-risk children. This method is effective as well (Optimised fluoride delivery, 2013).

Topical delivery of fluoride can be professionally-applied or self-applied. The professionally applied include aqueous solution and gel, prophylactic pastes, foam among others. They are mostly high fluoridated products that may range from 5,000 to 18,000 ppm. For instance, the gel’s adhesiveness to teeth prevents continuous wetting of the surface of the enamel needed when solutions are utilised. On the other hand, self-applied products include mouth rinses and fluoride dentifrices. They have low concentrations of fluoride ranging from 200 to 1000ppm.

Delivering fluoride improves dental and general oral health. The American Dental Association (ADA) reports that fluoridation lowers, reverses and prevents teeth decay by 20-40 %. It is because fluoride strengthens the enamel. Furthermore, delivering fluoride reduces expenses due to dental problems. According to Virginia Community Colleges, a dollar spent on fluoridation helps reduce dental expenses of $50 per individual. Centre for Disease Control and Prevention (CDC) identified that 50-54% of costs are reduced in Scotland among children due to fluoridation (Optimised fluoride delivery, 2013).  

There is increased potential for fluorosis. It is characterised by mottling and staining that is brown on teeth surface. It is irreversible without cosmetics. An aim of keeping fluoride levels below 1ppm by all municipalities is vital. It can lead to skeletal fluorosis as well. It can cause stiffening, pain, and calcification that severely affects mobility which is common in India, Asia, and the Middle East. Hyperthyroidism may be exacerbated if fluoridation is excessive especially in table salt. This finding is because of fluoride limits activity of the thyroid hormones (Neil, 2012).

For children below six months, fluoride therapy is not recommended. For those between six months and three years, 0.25mg, which is below 0.3ppm F is recommended. Between 3 and 6 years, they can get 0.5mg of

Oral health messages and education

Helps in examination, healing, sterilisation and anaesthesia.

Curation, removal of debris and infected areas.

ermanent teeth; stage I-obtain the tooth outline, retention and resistance form.

Stage II-Carious dentin removal, protection of pulp, getting secondary retention and resistance form. Then finish the walls of the margins and enamel.

Deciduous teeth- Give anaesthesia, do isolation of Rubber Dam, excavation of remaining caries, induration, and placement of amalgam, do the condensation, confirmation of any occlusion, do polishing and finishing.

Mouth rinsing-The limited area rinses are meant to remove debris, and the complete rinsing is done after completion of the procedure.

Saliva ejectors- It is meant for removal of small amounts of water and saliva.

High volume oral evacuation- It utilises the vacuum principle to increase pressure and ensure that the water and saliva are removed (Oral health surveys, 2013).

Cotton rolls- They are meant to absorb the saliva and water where they are placed in between the gums and the cheeks.

Dental Dam- It is a barrier that is placed between the teeth and it is made of latex.

Moisture control helps exclude sulcular fluid, saliva, and blood from the site of operation.

Prevention of debris inspiration by the patient.

Protects the surgeon from getting in contact with the oral fluids.

Ensures a clearly visible site of operation.

Prevention of bacterial localisation at the site.

Protective materials- Some of the advantages include restoration of the tooth function, it is for cosmetics, and promotion of mastication. Some of the disadvantages are a predisposition to cancer, discomfort and having a metallic feeling.

Lining materials- Some advantages include protection from irritants like chemicals, and some foods, and promotion of good looks. Disadvantages include the reduced strength to protect the teeth; prolonged use is uncomfortable, predisposition to cancer among others.

Etchants- They help expose the porous layer of the teeth for attachment of restoratives, they are efficient and cheap, and they are readily available. Some of the disadvantages are corrosion of the teeth if used for long, and they promote thinning of the enamel thus susceptibility to infections (Melo, 2014).

Bonding agents- They help the filling materials to adhere to dentin and enamel, the shaping of the teeth to feel and look attractive, it is easy and accessible. Disadvantages include being expensive, and mixed types corrode the teeth (Restorative methods and materials, 2013).

Curing lights- Advantages include promotion of curing light resin, and very effective.

Disadvantages include a danger to the mucosa of the mouth, predisposition to cancer if used for long.

Prevention techniques for maintaining good oral hygiene

Amalgam- Advantages include being a strong filling, cheap, and saving time as it can be finished in just one visit. Some of the disadvantages are tarnishing over time, does not bond with the teeth, it involves a tedious process of cavity preparation and the inability to match with the colour of the teeth.

Open the windows for ventilation, put on the protective gear (PPE), use a scoop in collecting the mercury or syringes for the smaller spillages, open the container with calcium hydroxide and sulphur and tip out the area of spillage then close. Additionally, mix the powders with the mercury and finally put the mixture in a container of wastes for collection by relevant organisations (Khwaja and Abbasi, 2014).

Matrix systems are placed between the teeth that are being restored and the adjacent ones in creating a surface the material of restoration, and hence it increases the coverage of the damaged section of the tooth.

The intrapupal, blocks and infiltration methods include complete controlled local anaesthetic delivery where a computer controls the fluid flow rate through the needle. Jet injectors use the mechanical energy principle where the small orifices in the bone and teeth are accessed.  The intraosseous anaesthesia devices inject through the cancellous bone, and they include Stabident and X-tip. Safety dental syringes like ultrasafe are designed to lower prick risks. Vibraject is a high-frequency vibration machine that delivers anaesthetic fluid. The topical paste can be applied to an open oral site or wound.

Implants- They are posts surgically placed in jaws to anchor the replacements. They are usually made from titanium. They are stable and secure and inadvisable for patients with diabetes and leukaemia because there is slowed healing. Also, they last long.

Bridges- They are restorations that involve filling a toothless space. They are made from metal, glass ceramics or their combinations. They function, feel and look like real teeth. Again, they are cheap. However, they may affect the next real tooth.

Dentures- They are meant for partial use. Also, they have a plastic base whose colour matches with that of the user’s gums and can be removed for cleaning purposes. Some disadvantages include poor stability, breakage, and discomfort.

Tissue conditioners- They are meant to realign dentures after a prolonged use thus helping in final fitting.

Reduces infections after prosthetic surgery and also smoothening of the surgical procedure. Again, eliminates the dangers that may arise from poor aseptic techniques (Agrawal, 2015).

They are dental restorations that can be removed when not in use. Examples are the partial dentures. They promote patient’s comfort, cleaning, and flexibility if needed to change.

Impressions; Involves the need and preliminary stages that include the requirements and other materials that may be irritable to the client.

Bites; the patient bites a soft material to create the outline of his/her jaws so that a fitting and exact replacement is made.

Try-in; after the bite, the substance is made and after completion, the client tests it, if it does not fit, adjustments are made again.

Fit; finally, the exact one is made, and the client tests it. Then they are taught the basics of use and storage.

Temporary crowns are used when one is waiting for the permanent ones. Both the permanent and temporary crowns help in preventing compaction of food between teeth, maintenance of the architecture of the gingiva and in aesthetics.

Bridges are used to replace the teeth that are missing thus promoting mastication and finally veneers are used for covering the front of teeth to improve appearance. They change the length, colour, size and shape of teeth.

Permanent and temporary crowns; using the right equipment and environment, do a pre-prosthetic treatment. Then use local anaesthesia to numb the tooth, do thinning and then make a copy of the tooth by taking the impression. Finally, you are good to place the temporary or permanent crown (Nhs.uk, 2016).

Bridges; alleviate anxiety by explaining the procedure to the patient. Then do the pre-prosthetic treatment, application of local anaesthetic and then reshape the tooth.

Veneers; prepare the patient for the procedure, determine the position of the edge and then do the incisor chamfer. Then do butt-joint readying and lingual wrap. Afterward, cementing the veneer can be done (Al-Quran, Al-Ghalayini, and Al-Zu’bi, 2011).

Relines; intraoral camera, dental laser, chair-side camera, compressors, ultrasafe syringe or jet injectors, curing light, endodontic motors, NSK Dental handpiece, handpiece oiler, ultrasonic scalar, apex locators, CCLAD among others (Harnacke et al., 2012).

Additions; gold, amalgam, porcelain, titanium, silicon, ceramic, and other safe metals.

Disinfection; chair-side disinfection as soon as they are removed is advocated. Again, disinfectants that are tuberculocidal and having both lipophilic and hydrophilic viral elimination should be used. Rinsing with tap and running water should be done before main disinfection. Spray disinfection to be avoided because of increased aerosolisation. Contact period with the impression should be equal or above the tuberculocidal activities. Storage; wrap in the damp paper towel then place in a humidor. This storage is done before pouring in stone or plaster.

During the first hour, the client should hold in place the gauzes in her mouth by gently biting. Disturbance of the site should be avoided, for example, do not eat hard foodstuffs like maize or sugarcane. Cigarette smoking is discouraged. Maintain oral hygiene by brushing and being gentle at the site. Bigger activities on the first day should be bed rest and limited heavy exercises. Again, if there are any emergency issues, then the client should report to the dental surgeon. Medications like painkillers should be taken.

Classified based on Robert angle’s proposal: Class I: Neutrocclusion The occlusion of the molar is standard. However, the other teeth have crowding, spacing, under or over eruption among others. Class II; Distocclusion; where upper first molar mesiobuccal cusp is not in alignment with the lower first molar mesiobuccal groove. Subdivided into class II division 1 where the relations of the molars are same as class II, and there is protrusion of anterior teeth. Class II Division 2 is where the relations of molars are same as class II, but there is retroclination of the central ones. Also, the central are overlapped by the lateral. Class III; Messiocclusion; where molars of the upper jaw are placed posterior to mesiobuccal groove.

Consultation; where your individual orthodontic needs are discussed. Cephalometric X-ray is done where the relationship between the jaw and the teeth alignment is determined. Panoramic X-ray is then done to give finer relationships for an exact diagnosis. Orthodontic photos are then taken for reference. Impressions are then taken for making teeth copies. Banding is done to hold the attachments to a tooth. Then bonding where brackets are placed using an adhesive. Orthodontic adjustments are made for assessing progress and finally debanding where the braces are removed (Orthodontic appliances, 2014).

Removal devices; Adams Crisps or Clasps help in retention. Acrylic baseplate for supporting wire constituents and contacts the vault of the palate for anchorage. Springs help divert teeth in a given direction. Screws aid in the labial movement of teeth and expand the arch. Labial bow for retention on the labial surface. Fixed appliances; archwire helps move teeth in required direction. Ligature holds archwire to both brackets. Brackets joined to bands to hold archwire position. The metal band wraps on the tooth and finally rubber bands which help move teeth to their ultimate position (Orthodontic appliances, 2014).

Meant to correct the malocclusion. They are also supposed to prevent further damage to the oral cavity due to an orthodontic procedure. They help in performing muscle exercises especially the masseters. For modification of the patient’s biting. For the guidance of growth in issues of deformities in the skeleton (Permanent effects of deciduous malocclusion, 2016).

Pre-operative instructions; the patient has to know the intention and requirements of the procedure. Food restrictions for general anaesthesia. Do not remove the appliance immediately after the procedure. The patient to do the pre-procedure oral cleaning to prevent infections. Postoperative instructions; In the case of complications like an arch ache, report directly to the hospital. Do routine oral hygiene after removal of the appliance. Avoid straining the jaws with hard foods like nuts (Oshima and Tsuji, 2014).

It saves time and resources like medications needed for surgery. Again, evasion of complications of surgery like oral infections is ensured. Also, the operation could destroy the pulp as it is microscopic. It is recommended because the oral canal has mixed strains of bacteria and could easily cause infections if wounds are present (Coulthard, 2013).

Pulpotomy; where a section of the pulp is removed especially when infected so that a healthy portion remains for vitality. Pulpectomy; It is the complete removal of the pulp from the root and the crown. Afterward, cleansing and medication of the canals are done. Pulp capping; Here, the exposed pulp is covered to eliminate micro-organic localisation thus preventing infections. It can be direct or indirectly done.

Rubber dam; prevents contamination of operation field. K-type file; for manipulation of the site. Reamer; for cutting the dentin. Burs; for cutting the cavity to help access the pulp. Barbed broach; meant to remove root canal contents. Chlorhexidine solution for disinfection.  Gutta percha for obturating the prepared canal. Sealer/cement for obturation of root canal that is ready.

There is a risk of aspiration of the saliva and water that may contain procedure contents like cement. There could be the destruction of the entire tooth due to accidental movements by the client. There is a pain due to cleaning and debridement. Undetected root cracks can cause future complications. Defective materials like the seals can erode and cause further infections like abscesses.

Pharmacologic treatment; where medications like analgesics are given either orally or the parenteral route. Non-pharmacologic therapy such as relaxation and use of ice to ease the pain is also helpful. In the case of complications, surgical endodontic treatment may be adopted (Lababidi, 2013).

A crowded mouth can be a reason for extraction.  Meant for proper alignment and dentition. Infections like decay can be severe needing removal. In the case of periodontal disease, an extraction is warranted to prevent further damage. Again, serious injuries due to trauma and other causes can be detrimental hence needing removal. Incorrect mouth position and orthodontic corrections also need minor surgeries like extraction (Banjar and Mealey, 2013).

Unerupted teeth may obscure the development of permanent teeth and hence the removal of their roots. They may cause a repetition of inflammatory processes. In preparation for a prosthesis, they are also removed if they have promoted cyst formation in the cancellous bone. Again, they may pose a risk of mouth deformation.

It is meant to improve the accessibility of the site of operation as opposed to the closed method where a limited surface is exposed. Again, raising the mucoperiosteal flaps does not pose a significant risk because it has its circulation.

Equipment/ Instruments; regional anaesthetic syringes are used to administer anaesthetic fluid to the site. Elevators expose the site of operation. Extraction forceps help grasp a tooth and twist it for removal. Scalpel is used to cut through gums and cartilages to expose a tooth. Periosteal elevator exposes underlining site. Cheek retractor helps adjust the cheek position exposing the gums and teeth. Suture holders help move the stitches through flesh and bone promoting closure of open wounds. Burs help in cavity cutting. Surgical suction tip removes excess saliva during operation. Materials; topical anaesthetic is applied on the site to numb a tooth. A local anaesthetic is injected into the site to eliminate pain during the procedure. Irrigation syringes help use fluid at sight for a better view. Sutures assist in the closure of the wound. Gauze pack absorbs excess fluid and prevents aspiration. Haemostatic medicaments prevent excessive bleeding (Dimova, 2013).

References

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