Prevention of Oral Disease II: Diseases of the Hard Tissues
The aim of this chapter is to guide the dental team through the prevention of hard tissue tooth loss.
The team members should have an understanding of the delivery of health messages to prevent dental caries, tooth erosion and abrasion.
Dental hygienists and dental therapists have a role in educating the patient in the prevention of hard tissue tooth loss by dental caries, erosion and abrasion.
Dental caries is a process of demineralisation caused by bacterial metabolism of fermentable carbohydrates. It is estimated that calcium hydroxyapatite will begin to dissolve when pH falls below 5.5. Dietary advice to prevent caries is therefore intended to reduce the duration and frequency of occasions when the pH of microbial plaque falls below the critical level.
In patients presenting for the management of periodontal disease, the emphasis is on prevention of secondary caries and primary root caries. This is because patients with a diagnosis of chronic periodontitis tend to be middle aged at the time of diagnosis and are more likely to present with previously restored dentitions. They may have lost teeth through either periodontal disease or caries and may wear partial dentures. They may have a medical or medication history which predisposes them to xerostomia and have recession of the periodontal tissues, exposing radicular dentine to demineralisation in the interproximal, buccal, lingual and furcation areas. Prevention is therefore aimed at identifying local risk factors, dietary factors and relevant habits.
Identifying plaque and local risk factors
One of the most effective methods is disclosing the plaque and demonstrating to the patient the plaque retained in a specific area. Disclosing the fitting surface of dentures is also useful.
Education subsequently involves selection of the most appropriate cleaning aid specifically to remove the plaque, bearing in mind the patient’s manual dexterity and the availability of the product to be purchased.
Identifying dietary factors and habits
Dietary analysis may be done in two ways:
24-hour analysis – the patient documents everything eaten and drunk in the previous 24 hours.
3-day analysis – the patient documents everything eaten and drunk over a 3-day period. One day, at least, should be during the weekend.
Honesty is the key to success! (Fig 6-1).
The dental hygienist or therapist is then able to analyse the diet by circling in red every occasion when sugar is consumed. The education process can then commence with emphasis on reducing the frequency of non-milk extrinsic sugars and the suggestion of suitable alternatives.
The education process should involve discussion with the patient on the prevention of the loss of “key teeth” through understanding their oral cavity and how it functions as a masticatory unit. The greater the understanding the more likely the personal commitment to preservation. Examples include education regarding abutment teeth for dentures and bridges and the consequences of extraction. A simple explanation of how loss of a bridge abutment may lead to denture provision will help the patient to focus on prevention (Fig 6-2). Education of the patient should focus on the maintenance of occlusal contacts to avoid non-functional teeth and subsequent plaque retention (Fig 6-3) and reinforcement of the importance of regular recall appointments for the early detection of interproximal and furcation caries.