NYUCD Health Promo - everything for midterm

Categories of oral disease

1. dental caries
2. periodontal disease
3. oral cancer/oralpharyngeal cancer

dental caries

localized chemical dissolution of a
surface by acid produced by
as a by product of fermentation of dietary
-need all three for caries!
-best prevention - work on all three together
-dental caries is complex: personal factors,

periodontal disease

A variety of inflammatory and degenerative diseases that affect the supporting structures of the teeth
-Gingivitis - inflammation of the gums
-Periodontitis - irreversible disease that involves more of tooth structure, including the bone; gum level recede

oral cancer/oralpharyngeal cancer

75% of oral cancers are attributed to tobacco and heavy alcohol use
-Our role as dentists and health care providers is in the health of our patients - linking systemic and oral health - holistic approach - dentists are gatekeepers as the mouth is connecte


focuses on the determinants of disease. It covers measures not only to prevent the occurrence of disease, such as risk factor reduction, but also to arrest its progress and reduce its consequences once established

Primary Prevention

preventing occurrence of the disease ***Goal
a. Caries - sealants, fluoride, diet and plaque control
b. CV diseases - exercise, low fat diet
c. Accidental Injuries - helmets, mouth guards
d. Oral/Lung Cancer - avoid smoking

Secondary Prevention

limiting the extent of the disease, once it has occurred (treatment)
a. Oral Cancer - screening/early detection, chemo/surgical intervention
b. Periodontal Disease - scaling, periodontal surgery, tooth extraction
c. Caries - re-mineralization, restoration

Tertiary Prevention

rehabilitation after extensive disease has left
functional disabilities
a. Caries - fix/remove prostheses
b. Periodontal Disease - grafts, fix/remove prostheses
c. Stroke - rehabilitating individual to reach highest level of
functioning and teaching lifes

health promotion is _____

The science and art of helping people change their lifestyle to move toward a state
of optimal health


-a community of bacterial microorganisms (in plaque) growing on a surface
-express properties not exhibited by the same organisms in individual cultures. The properties are more than the sum of their parts


inflammation in the gums


irreversible disease that involves more of tooth structure, including the bone; gum level recedes with plaque/calculus deposits
-in pregnant woman, can affect the fetus by causing premature birth, etc

75% of oral cancers are attributed to

tobacco and heavy alcohol use


high blood pressure

dentist's role in pre-disease control

-Pre-diabetes- diabetes (gum disease, dry mouth)
-Prehypertension- hypertension (dry mouth)
-Overweight- obesity (talk about caries and diet change)

Optimal Health

a balance of physical, emotional, social, spiritual and intellectual health

Lifestyle Change -

can be facilitated through enhancing awareness,
change behavior, or creating an environment that supports good health practices


focus on patient instead of disease, focus on empowering people to take greater control over conditions affecting their health, build on existing strengths and positive factors

focus of the health care profession

changing from diagnosis and treatment to disease prevention, health maintenance and health promotion

Surgeon General's Report on Smoking and Health (1964)

documented the health consequences of smoking on cancer, heart disease and other major illness

Major Findings

-oral diseases and disorders affect health and well-being throughout life
-the mouth mirrors general health and well-being, oral diseases and conditions are associated with other health problems, lifestyle behaviors that affect general health - such as to

The Inner Circle

oral diseases and conditions - prevention and management are the primary responsibility of the dentist
-Dental cares, periodontal disease, oral cancer, facial trauma/injuries (intentional - abuse/violence; unintentional - accidents)

The Middle Circle

diseases with direct impact on the oral cavity - are risk factors, risk indicators or risk markers for oral disease
-Diabetes + periodontal disease, substance abuse, osteoporosis, eating disorders - erosion of teeth due to acid in mouth, HIV and AIDS, str

The Outer Circle

chronic disease conditions related to lifestyle - the dentists responsibility as the primary health care provider and agent for health promotion within the health delivery team
-Obesity, hyperlipidemia, hypertension, CV diseases, cancers

Risk Reduction Activities

Plaque control, use of fluoride, use of sealants, regular exams, screenings, proper diet, tobacco use cessation, physical activities, abuse prevention, accident prevention, use of protective devices, immunizations, sun protection, safe sex behaviors (HPV

Common Risk Factor Approach

recognizes that chronic conditions, such as heart disease, stroke, cancers, diabetes, obesity and oral diseases share a set of common risks - inter-professional practice and reduction

Dental "Caries

from Latin- "rottenness", "decay"
- Dental caries (tooth decay)- the most common chronic disease in both children and adults; one of the most common of all diseases, second only to the common cold
-Major cause of tooth loss in children; contributes to adu

caries formula

cariogenic bacteria + fermentable carbohydrates = acid
acid + susceptible tooth = cavity
fermentable carbohydrates


acidogenic bacteria + fermentable carbohydrates -> acid
teeth + calcium + phosphate ions

dental erosion

Loss of hard dental tissues due to acid on teeth, not from bacteria (Could be from bulimia, gerd, anything that brings consistent acid to the mouth/teeth)


biofilm that forms naturally on the tooth surface. It consists of a mixed community of microbes embedded in an extracellular matrix of bacteria and salivary polymers

Cariogenic features of dental biofilm bacteria

-The ability to rapidly convert sugars to acid (acidogenic)
-The ability to maintain sugar metabolism under extreme environmental conditions, such as at a low pH (aciduric)
-The ability to produce extracellular and intra cellular polysaccharides which con


increasing the likelihood that dental caries will develop


the ability to convert sugars rapidly to acid


the ability to maintain sugar metabolism and thrive under extreme environmental conditions, such as at a low pH

Stephan curve

-Plots pH of dental plaque against time
-represents the fall and subsequent rise in plaque pH which occurs after exposure of dental plaque to fermentable carbohydrates
-Sometimes takes up to an hour after acidic foods to get back to OK pH (5.5+)

Critical pH

typical pH below which enamel will dissolve (demineralize)
pH 5.5 "accepted" as critical pH because no longer is oral environment saturated with enamel minerals

pH of dental plaque


Cariostatic foods

Foods or beverages that cannot be metabolized by dental plaque bacteria and do not cause a drop in pH to the critical level of <5.5, aka protective foods

Role of Saliva in Caries Prevention

Buffering Effect
-Saliva contains calcium and phosphate ions in a state of supersaturation with respect to the hydroxyapatite crystals in the tooth
Saliva reduces the dissolution (demineralization) of tooth minerals in caries by replacing minerals (remine

sugar free gum helps how?

makes you produce more saliva so that excess saliva comes in handy counteracting the FCHs previously in the mouth

What Affects your Stephan Curve?

-How often you eat and drink (frequency)
-How long you eat and drink for (duration)
-What you eat and drink (sugar vs sugarless)
-Consistency of the food
-What you eat or drink after the sugar intake
-The amount and quality of your saliva
-The amount of b

Major Caries Risk Factors

-Plaque from poor oral hygiene
-Lack of fluoride exposure
-Frequent sugared beverages consumption
-Frequent fermentable carbs consumption
-Exposed roots
-Restorations with overhangs
-Dental appliances (prostheses)
-Orthodontic appliances
-Saliva reducing

To demineralize

bacteria biofilm + fermentable carbohydrates -> acid production

To remineralize

calcium, phosphate, fluoride, saliva, control plaque, modify diet

What is dental plaque caused by?

gram-negative bacteria

bacterial plaque is

-the primary etiological factor of periodontal disease
-consists primarily of proliferating microorganisms with a scattering of epithelial cells, leukocytes and macrophages in an adherent intercellular matrix. Bacteria make up 70-80% of plaque - there are


mineralized plaque

What percentage of children in the US are overweight?


Dietary factors that increase oral cancer risk

-Low intake of antioxidants
-High fat intake
-High nitrate intake
-Increased alcohol consumption
-High Red Meat and Processed Meat Consumption

Obesity in children (2-19 yrs)

-31.8% at risk for overweight (over 85th percentile for BMI for age)
-16.9% at risk for obesity (over 95th percentile for BMI for age)

Obesity in adults (20+)

-68.8% Overweight (BMI ? 25)
-35.7% Obese (BMI ? 30)

How to calculate BMI

ABC's of a healthy diet

A = Adequacy
B = Balance
C = Calorie Control
M = Moderation
V = Variety

what should you eat at your meals?

1/4 veggies -
1/4 grains (1 oz) - wheat, rice, oats, cornmeal, barley or another cereal grain
1/4 fruits -
1/4 protein (5-6 oz) - meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds
dairy (3 cups) - milks, yogurts, milk-b


2.5-3 cups/day


1 oz - wheat, rice, oats, cornmeal, barley or another cereal grain


1.5-2 cups/day


5-6 oz - meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds


3 cups/day - milks, yogurts, milk-based desserts, hard and soft cheeses
-have a little with every meal

gram positive bacteria - good or bad?

good, aerobic bacteria

gram-negative bacteria - good or bad?

bad, anaerobic bacteria - larger and filamentous

where does periodontal disease start?

interproximal area

where does plaque start?

near gingival margin and interproximal areas

How to stop gingivitis?

#1 way to stop is PLAQUE CONTROL, as well as periodontal therapy, but it doesn't matter if we don't have plaque control. We do this by brushing.


-(20-40%) helps clean and polish
-Silica, silicon oxide, aluminum oxide, granular polyvinyl chloride, calcium pyrophosphate and calcium carbonate


-prevents demineralization and aids remineralization
-Sodium fluoride, sodium monofluorophosphate and stannous fluoride
-Active ingredient


-(1-2%) Helps remove debris and take away the other ingredients wash away (also in soaps)
-Sodium lauryl sulfate
-Active ingredient


-(1-2%) thickens + causes cohesion of all the ingredients
-Xanthan gum, carbomer and carrageenan
-Active ingredient


-(20-60%) keeps toothpaste moist
-Sorbitol, glycerin and polyethylene glycol
-Active ingredient

Desensitizing agents

Potassium nitrate and strontium chloride


Anti-gingivitis agent

Anticalculus agents

-only prevents new gingival calculus formations, it doesn't work with calculus that has already formed

Intrinsic stain

-part of tooth structure
-Can only be fixed by professional cleaning
-Intrinsic staining also comes with old age (yellowing, etc)

Extrinsic stain

-like coffee stains, etc.
-can be fixed by toothpaste, whitening strips, etc.

Bass and Modified Bass technique

Aim brush at intergingival area and jiggle, jiggle, flick.

Stillman technique

-for people who have recession
-Use the SIDES of the bristles, not the tips, and move it towards the occlusal
-not as effective as Bass technique

Charters technique

-place brush at 90 degree angle from long axis of the teeth, brush in a swirling motion, massaging the gums, but not pressing the bristles into the gums
-for orthodontic patients, place bristle tips parallel to long axis of teeth and go back and forth ins


-great rinse at removing plaque (better than Listerine)
-but can cause brownish staining and change taste sensation