dental issues. objectives upon completion of this session, you will: understand key components in...

Dental Issues

Objectives

Upon completion of this session, you will:

• Understand key components in preventing dental problems:1. Assess your oral-health needs2. Commit to a daily oral-health routine3. Use fluoride4. Brush and floss regularly to remove plaque5. Eat smart6. If you use tobacco in any form, quit7. Examine your mouth regularly8. Visit your dentist regularly

• Understand how to minimize some of the risks of dental treatment

What percentage of adults have untreated tooth decay?

a. 10%b. 18%c. 27%

What percentage of adults suffer fromgum disease at some point in their lives?

a. 45%b. 60%c. 90%

What percentage of adults have hada dental visit in the last year?

a. 48%b. 63%c. 81%

Eight Steps to Dental Health


Step 1: Assess your oral-health needs

Oral health depends on:• what you eat• saliva• habits• overall health• oral hygiene routine


Step 2: Commit to a daily oral health routine

Talk to your dentist or dental hygienist. Discuss:• proper brushing and flossing technique• medications you are taking• special circumstances (e.g., asthma, diabetes, braces, pregnancy)

Rule of thumb…how long does it take for a new habit to become second nature?


Step 3: Use fluoride

• Everyone can benefit, not just children• Helps prevent decay • Toothpastes and mouthwashes are good sources• Dentist may prescribe stronger concentration if needed


Step 4: Brush and floss regularly to remove plaque

Plaque - a sticky layer of bacteria that forms on teeth,which leads to tooth decay, gingivitis (gum disease) , and other problems.


Brushing TipsBrush…• at least twice a day• for at least two minutes• inside, outside, and on the chewing surface• at a 45 degree angle against gum line

Don’t brush…• too often or too hard


Flossing Tips

• Floss once a day and take your time• Don’t skimp on the floss• Choose the type that works best for you – if you have

limited motion in your elbow, you may prefer a special floss holder

• It is normal for gums to bleed slightly when you start – this will stop within a week if you floss everyday

Remember…..healthy gums do not generally bleed during brushing or flossing

• Bleeding gums are a sign of dental disease

• Treating with factor or other therapies may temporarily stop the bleeding, but not the disease – see your dentist!

• If bleeding continues for more than 20 minutes or starts and stops again, it’s time to call your HTC



Other ways to clean between teeth

• Interdental cleaners – work well for large spaces, braces

• Oral irrigators – electrical device, pumps water• Interdental tip – flexible rubber nib• Mouthwashes and rinses


Step 5: Eat smart• Eat a balanced diet• Think about when and how often you eat snacks• Consume less sugary food and drinks

When it comes to sugary foods, think about:• the number of times a day you eat them• how long it stays in your mouth• the texture (chewy? sticky?)


Step 6: If you use tobacco in any form, quit

Increases risk of:• oral cancer• gingivitis• periodontitis• tooth decay

Resources

• www. smokefree.govA web site dedicated to helping you quit smoking

• 1-800-QUIT-NOW A free, phone-based service with educational materials and coaches that can help you quit smoking or chewing tobacco

• www.heart.org (Getting Healthy – Quit Smoking)Multiple tools & tips from the American Heart Association



Step 7: Examine your mouth regularly

Changes that may be of concern:• swollen gums• chipped teeth• discolored teeth• sores or lesions on your gums, cheeks or tongue


Step 8: Visit your dentist at least every 6 months

Consider more frequent visits if you:• have a history of cavities• have crown or bridge work• wear braces• have diabetes• are a smoker• have a suppressed immune system

Braces• Growing number of adults are getting braces• May be fixed or removable• Placement does not typically cause bleeding – special care should be taken when bands and wires are placed on teeth• May want to use dental wax on wires

Dentures• Improper fit may cause bleeding and places stress on gums and jawbone – have dentist check them at least once a year• Clean thoroughly every night to remove stains and bacteria

Why are regular dental checkups important?

• Identifying and treating small problems early can save time and money

• Early diagnosis of gum disease• Some medical conditions, such as oral cancer, have

symptoms that appear in the mouth• Other benefits?

Why are regular dental checkups especially important for adults with bleeding disorders?

• You are at greater risk for gum disease as you age, which can lead to tooth loss and more bleeding.• Oral disease may affect general health and may cause serious bleeding.• Surgery such as tooth extractions and some local anesthetic injections can cause persistent bleeding for days or weeks and may even be life threatening.

Cavities

• Occur when the acids in plaque dissolve the enamel surface and create holes in teeth.

• New decay around the edges of cavity fillings is common in older adults – fillings may weaken and fracture over the years allowing bacteria to accumulate in crevices.

• When you have a cavity, the tooth surface feels soft when probed by your dentist with a dental instrument.

Importance of Regular Checkups


Gum Disease• leading cause is plaque• untreated plaque becomes tartar – harder, more

substantial

Two stages of gum disease:1. Gingivitis – tenderness and bleeding when you brush2. Periodontitis – sore, swollen gums that pull away from

teeth


Gum DiseaseSymptoms:• Gums that are red, puffy, swollen, tender• Gums that bleed• Teeth that look longer because gums have receded• Gums that have pulled away from teeth• Changes in the way your teeth fit together• Pus coming from between your teeth and gums• Constant bad breath or bad taste in your mouth

If you are HIV-positive…• greater risk of developing gum disease, mouth lesions and oral infections• be extra conscientious – brush and floss after every meal, rinse twice a day with antiseptic mouthwash, avoid sweets• get regular check ups; if prone to plaque build up, consider getting cleanings more than twice a year• be sure to tell dentist or hygienist that you are HIV-positive

Dental TreatmentsMinimizing Risks

Two primary concerns:excessive bleeding

infection

Bleeding

Make sure your dentist knows….

• your bleeding disorder type and severity• any complications such as inhibitors, HIV, hepatitis• all medications you are currently taking• name and phone number for HTC contact

Minimizing Treatment Risks


Bleeding• Talk with your HTC about pre-treating with factor for any of the

following:– fillings– deep scaling (removing tartar below the gum line)– extractions– block anesthesia– any oral surgery

• Routine exams and cleanings typically do not need pre-treatment• Minor oozing - apply pressure with gauze, washcloth or moist tea bag

(anyone know why?)

BleedingFillings…• dentist should protect the mucosa - x-ray films and impression molds should be placed carefully• matrix bands and wooden wedges risk bleeding

Extractions…• first 24 hours – no mouth rinsing, no smoking, soft foods• salt water mouthwashes• cool liquids for several days to stabilize clot• no sucking on straws or vigorous swishing


BleedingAnesthesia…• no restrictions on types of local agents• some may have the added benefit of being

vasoconstrictors, which means they cause blood vessels to tighten thus decreasing the flow of blood

• be careful of trauma before anesthesia wears off (i.e., cheek biting)

• mandibular molar teeth treated with inferior nerve block – risk of bleeding into muscles – infuse first!



InfectionMay occur when bacteria enter the bloodstream due to manipulation of

gum tissue or perforation of mucous membranes in the mouth

Joint concerns:• patients with joint replacement are at risk• once bacteria find implanted joints, it’s difficult for the

immune system to fight the infection• prophylactic antibiotics recommended for all invasive

dental work


InfectionHeart concerns:• endocarditis – infection of thin membrane that lines

chambers and valves inside the heart• preventive antibiotics recommended for people with

– history of infective endocarditis– artificial heart valves– certain forms of congenital heart disease– valve abnormalities following transplant

* IMPORTANT NOTE *

Some mouth bleeding can block the airway. Call your HTC or go the emergency room if….

• bleeding on tongue, cheek or floor of mouth doesn’t stop• you notice any swelling or bruising of tongue, throat or neck• you have trouble breathing or swallowing

Questions?

References

1. “Dental Management for Patients with Hereditary Bleeding Disorders” Melissa A. Kennell, D.D.S. and Alan F. Kennell, D.D.S., M.S.

2. Living With Hemophilia: The Importance of Dental Care. Baxter Bioscience website. http://www.thereforyou.com/managing-hemophilia/dental-care.

3. Dental Care: What You Need to Know – For Adults with Bleeding Disorders. King of Prussia, PA: CSL Behring LLC; 2010.

4. Guidelines for Dental Treatment of Patients with Inherited Bleeding Disorders. Montreal, Quebec, Canada: World Federation of Hemophilia; 2006.

5. The Basics of Good Dental Hygiene. Colgate-Palmolive Company website. http://www.colgate.com/app/Colgate/US/OC/Information/OralHealthBasics/GoodOralHygiene.cvsp

6. Dental Health. U.S. National Library of Medicine, National Institutes of Health website. http://www.nlm.nih.gov/medlineplus/dentalhealth.html

7. FastStats: Oral and Dental Health. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/fastats/dental.htm

8. Getting Healthy – Quit Smoking. American Heart Association website. http://www.heart.org/HEARTORG/GettingHealthy/QuitSmoking/Quit-Smoking_UCM_001085_SubHomePage.jsp

9. Smoking & Tobacco Use: How to Quit. Government Resources. Centers for Disease Control and Prevention website.http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/index.htm

THANK YOU!

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