Fundamentals of Oral Health

=Objectives=

Epidemiology & Importance of Oral Health

 * Described as a silent epidemic that effects the country's most vulnerable
 * 90% of dental costs are paid out of pocket by patient
 * 168 million people in the United States lack dental insurance.
 * Poor oral health is associated with general measures of health
 * gastrointestinal: for example, people with dentures eat less ruffage --> higher rates of colon cancer?
 * airway & ventilation --> sleep apnea, chronic pulmonary aspiration
 * psychosocial: smiling, speech, etc
 * nerve injury
 * oral inflammation --> systemic inflammation --> cardiovascular disease (poor health is equivalent to smoking).
 * movement disorders in the elderly: oral mandibular dystonia (lip smacking)
 * Oral cancer: 30k/year, 40% 5 year survival

Demonstrate taking an oral health history.

 * systematic examination to occur for all primary care patients
 * Observation: visualize all mucosal surfaces: buccal mucosa, labial mucosa, floor of mouth**, palate, tonsilar pilars**, and the lateral base of the tongue** (**hot spots)
 * look for leukoplakias, ulcers, erythroplasia, which can be sign of cancer
 * sun damage to lower lip --> actinic changes (precancer) --> squamous cell carcinoma
 * examine tooth patterns in pediatrics
 * Palpation: lymphatic examination of the neck - palpate nodes - see PCM1: Head & Neck Exam

Assess fluoride status

 * low fluoride is associated with osteoporosis and dental decay
 * aluminum tailings can displace fluoride leading to soft bones
 * Bones are weakened by excessive (image below) or insufficient fluoridation

Habits

 * Bad things: use of mouthwash with alcohols, toxins, EToH, mouthwash.
 * Good: Tom's of Maine

Normal salivary duct anatomy

 * The parotid duct, or Stensen duct, courses anteriorly from the parotid gland over the masseter muscle and pierces the buccinator muscle to enter through the buccal mucosa, usually opposite the second maxillary molar'.

Dental caries

 * 50% of preschoolers, and 280 million americans
 * an infectious disease: Strep Mutans, sticky, communicable
 * Smooth surface caries: results from xerostomia, high plaque levels, immunosuppression, autoimmunity
 * associated with "meth mouth" & "milk bottle mouth"
 * Pit and Fissure
 * anaerobic
 * associated conditions (risks and complications), physical appearance

Dental Abscesses

 * Pathogenesis: spread can lead to orbital cellulitis, necrotizing fasciitis

Periodontium (Gums)

 * most common oral disease
 * systemic causes or peridontitis: HIV, scurvy, leukemia, betel nuts, kwashikor, etc.
 * PD associated with systemic disease: low birth weights, senile dementia, heart disease
 * Associated with systemic inflammation

TMJ Syndrome

 * TMJ syndrome is characterized by chronic or acute musculoskeletal pain with dysfunction of the masticatory system. It is aggravated by movements of the jaw but is distinct from dental disease. Myofascial pain of the masticatory muscles presumably occurs due to persistent, unconscious, repetitive use of the involved muscles
 * 30-40% people have problems
 * tempromandibular joint has a interposition disc. torn disc is associated with pain, clicking, arthritis, inflammation.

Oral Cancer

 * The only way to improve outcomes is early diagnosis
 * Non-symptom driven diagnosis (ie incidental discovery on examination) almost never identified by physicians
 * Treatment: radical ablative surgical intervention

Oropharyngeal complications

 * lymphoma: extranodal tumors go to mouth mucosa
 * methamphetamine abuse: smooth surface caries
 * osteoarthritis, osteoporosis treatment: increased in low fluoride water. bone health is associated with tooth health
 * Parkinson’s disease: Forward tilt of trunk, head forward posture, poor oral hygiene
 * chronic organophosphate exposure: temporal wasting

List a differential for the diagnosis of oral-facial pain

 * Locations tend to be temporalis, sternocleidomastoid
 * botox is a common treatment for spasm, pain

Demonstrate the ability to number the teeth appropriately.

 * Start in the top right.
 * Just memorize the pattern of counting and one of the incisors.

Describe pitfalls in diagnosing oral cancer, and expected physical findings of oral cancer

 * The main pitfall is not looking.
 * Most oral cancers are discovered by an oral hygienist.

=Quotable=
 * Assael, "How do you know an alcoholic or meth user is lying? Their lips are moving."
 * "The mouth is a mirror", a wealth of information can be derived from information derived from examination of the mouth (hypovitaminosis, palate bruising, kaposi's sarcoma, lymphoma)
 * "How to bridge the interdisciplinary divide? PCM is the answer."

=Links=
 * American Dental Association
 * Healthy People 2010
 * Institute of Dental and Craniofacial Research