Prevention of oral disease for adults

1
Prevention of oral disease for adults
2
Prevention of oral disease for adults

• Aim
• Provide an overview of evidence-based practical
  prevention for adults

3
Hierarchy of evidence

• Level I Systematic review of RCTs
• Level II At least 1 RCT
• Level III Evidence from non-randomised trials
• Level IV Well designed
• observational studies from gt1 centre
• Level V - Expert opinion, traditional reviews

Strong
Moderate
Caution
4
www.dh.gov.uk/en/Publicationsandstatistics/Publica
tions/PublicationsPolicyAndGuidance/DH_078742
5
Oral diseases to prevent

• Caries
• Erosion
• Periodontal diseases
• Oral cancer
• Trauma

6
Oral diseases to prevent

• Caries
• Erosion
• Periodontal diseases
• Oral cancer
• Trauma

7
Caries and its prevention
8
Caries and its prevention
Risk factors Frequent sugars Acidogenic
bacteria Sub-normal saliva
Caries progression
9
Caries and its prevention
Protective factors Saliva Fluoride Antibacterials
Risk factors Frequent sugars Acidogenic
bacteria Sub-normal saliva
Equilibrium!
10
Caries and its prevention
Protective factors Saliva Fluoride Antibacterials
Remineralisation
11
Prevention of caries Fluoride (1)

• Fluoride toothpaste
• Most cost-effective topical fluoride agent
• Main reason for the decline in caries in the last
  30 yrs 24 reduction of caries (I)
• Fluoride concentration of toothpaste more
  important than plaque removal (I)

12
Prevention of caries Fluoride (2)

• Fluoride toothpaste

Fluoride conc.
Preventive effect
13
Prevention of caries Fluoride (2)

• How often should adults brush?
• Al least twice daily (I) and always at night
  (V)
• What conc. of fluoride toothpaste should be
  recommended?
• At least 1350ppm (I)
• Higher conc. (gt2000ppm) available for adults (II)

14
1350-1500ppm F
Correct in 2007!

• Crest Freshmint, mildmint, tartar
• control, 5Complete
• Janina Opale Whitening Paste
• LIDL Salvamed, whitening, sensitive
• and mature Dentalux, herb and freshmint
• Macleans- Total Health, Total Health
• Whitening, Freshmint, Coolmint
• Marks Spencer Protect
• Mentadent SR
• Morrisons Total care, Whitening,
• sensitive
• Sainsburys Total care, Sensitive,
• Whitening
• Sensodyne Total Care Gentle
• Whitening, Total Care Gel, Total Care F,
• Total Care Extra Fresh, Pronamel
• Signal
• Tesco Total care Freshmint, Coolmint

• ALDI Dentitex, whitening, freshmint
• total care
• Aquafresh Extreme Clean Intense
• Rush, Complete Care, Fresh Minty,
• Mild Minty, Big Teeth, Multi-active
• ASDA Total care, Sensitive, whitening
• Boots Sensitive
• Colgate Sensitive Fresh stripe,
• Sensitive Whitening, Sensitive Multi
• Protection Total, Total Advanced
• Fresh, Total Plus Whitening,
• Total Professional Weekly CleanGreat
• Regular, Bicarb paste, Triple cool,
• Fresh stripe, Ultra cavity protection,
• Time control, Sensation Deep clean,
• whitening, Sensitive multi-protection

15
gt1500ppm F
Prescription only
16
Prevention of caries Fluoride (3)

• How should the mouth be rinsed after brushing?
• Discourage rinsing, just spit (IV)
• How long should brushing take what technique is
  best?
• No clear evidence for either
• 2 minutes!

17
Prevention of caries Fluoride (4)

• What type of toothbrush is best?
• Some powered toothbrushes are more effective than
  manual brushes (Oral B range) (I)
• Sonic toothbrushes no better (I)
• Normal brushes small heads, with soft, variable
  length and round ended filaments
• (V)

18
Prevention of caries Fluoride (5)

• Fluoride Mouthrinses
• 2 types
• Daily (0.05 F)
• Weekly (0.2 F)
• Both give 26 reduction in caries (I)
• Recommended for high risk patients
• Active decay
• Poor quantity or poor quality of saliva

19
Prevention of caries Fluoride (6)

• Fluoride varnishes
• 46 reduction in caries in permanent teeth (I)
• Good for patients high risk of caries
• Apply 6 mthly in high risk
• Professional application - expensive
• 22600 ppm F, some higher

20
Caries and its prevention
Protective factors Saliva Fluoride Antibacterials
Risk factors Frequent sugars Acidogenic
bacteria Sub-normal saliva
Equilibrium!
21
Prevention of caries dietary counselling (1)
22
Prevention of caries dietary counselling (1)

• Evidence for Fgtgtgtdietary advice
• Providing information WILL NOT achieve sustained
  changes in behaviour (I)

23
Changing behaviour

• Previously assumed that

Providing knowledge
Change in attitudes
Change in behaviour
24
Behaviour change
The KAB approach
?
Knowledge
Attitudes
Behaviour
25
Behaviour change
The KAB approach
Knowledge
Attitudes
Behaviour
Eating 5 portions of fruit veg per day
reduces risk of cancer CHD
Fruit veg are good for my health
I will eat 5 portions of fruit veg per day
26
Prevention of caries dietary counselling (1)

• Evidence for Fgtgtgtdietary advice
• Providing information WILL NOT achieve sustained
  changes in behaviour (I)

27
Prevention of caries dietary counselling (1)

• Evidence for Fgtgtgtdietary advice
• Providing information WILL NOT achieve sustained
  changes in behaviour (I)
• BUT important role for dental team caries,
  erosion and oral cancer

28
Prevention of caries dietary counselling (3)

• Recommendations (III)
• Reduce frequency amount consumption of non-milk
  extrinsic sugars eg sucrose/glucose/glucose syrup
  max 4 x per day
• www.eatwell.gov.uk/agesandstages/

29
Oral diseases to prevent

• Caries
• Erosion
• Periodontal diseases
• Oral cancer
• Trauma

30
Oral diseases to prevent

• Caries
• Erosion
• Periodontal diseases
• Oral cancer
• Trauma

31
Prevention of erosion dietary counselling (1)

• Tooth erosion
• Tooth erosion is a gradual loss of the normally
  hard surface of the tooth due to chemical, not
  bacterial, processes.

32
Prevention of erosion dietary counselling (1)

• Recommendations (V)
• Limit frequency of acidic drinks and foods
• If do, cheese and milk afterwards
• Use a straw
• Dont hold or swish acidic drinks
• Dont brush for 1 hr after exposure or vomitting
• Fluoride usage!

33
Oral diseases to prevent

• Caries
• Erosion
• Periodontal diseases
• Oral cancer
• Trauma

34
Oral diseases to prevent

• Caries
• Erosion
• Periodontal diseases
• Oral cancer
• Trauma

35
Prevention of periodontal disease (1)

• Quick revision!
• Key aetiological factors
• plaque
• smoking

36
Prevention of periodontal disease (2)

• All toothbrushing advice applies removal of
  plaque important
• Stopping patients smoking next week!
• Interdental cleaning aids (floss/sticks) can be
  effective but few people master
• Minibrushes probably best (V)
• Triclosan with copolymer or zinc citrate in
  toothpaste effective in reducing plaque and
  improving gingival health (I)

37
Prevention of periodontal disease (2)
Triclosan with copolymer
Zinc Citrate
38
Prevention of periodontal disease (2)

• Mouthrinses
• Chlorhexidine reduces plaque and improves
  gingival health 0.12 and 0.2 (II)
• Others probably effective at reducing plaque (II)
• Plax - 0.03 Triclosan with sodium fluoride
  (225 ppm fluoride)

39
Prevention of oral cancer

• Some more revision!

40
World Wide 481,000 new cases of oral cancer pa
Oral cancer kills one person every 21/2
mins (210,000 deaths pa)
41
(No Transcript)
42
(No Transcript)
43
UK epidemiology of oral cancer

• Incidence approx 5000 new cases per year (2005)
• 15th most common cancer 1.7 of all cancers
• In UK, similar incidence to brain, liver and
  cervical cancers and melanoma
• (IV)

Cancer Research UK, 2008
44
Cancer Research UK, 2008
45
UK epidemiology of oral cancer

• Incidence is increasing in men and women

• Incidence increasing in younger people
• Survival rates changed little in 3 decades
  approx 55 at 5 years
• (IV)

Cancer Research UK, 2008
46
Oral cancer worldwide
Cancer Research UK, 2008
47
Oral Cancer risk factors

• Smoking/tobacco use
• Alcohol
• Betel quid / paan

48
Oral Cancer other risk factors

• Sunlight
• Diet
• Human papilloma virus
• Previous cancer

49
Prevention of oral cancer

• Record smoking/tobacco use status
• Help patients to stop smoking/using tobacco (III)
  again, more next week
• Advise moderation of alcohol (IV)
• Record alcohol consumption
• 21 units for men (no more than 4 units/day)
• 14 units for women (no more than 3 units/day)
• Advise diet high in fruit and vegetables, low in
  fat (III)
• Early referral of suspicious lesions

50
(No Transcript)
51
(No Transcript)
52
(No Transcript)
53
Oral diseases to prevent

• Caries
• Erosion
• Periodontal diseases
• Oral cancer
• Trauma

54
Prevention of trauma

• Sport related recommend mouthguards (IV)
• Maxillofacial injuries alcohol related advise
  to moderate consumption research underway

55
Take home messages

• Fluoride, in all forms, works
• Changing (dietary) behaviour is difficult
• Helping patients to stop smoking is very
  important
• Some electric toothbrushes are better than manual
• Some toothpastes and mouthwashes will reduce
  plaque and improve gingival health

56
www.dh.gov.uk/en/Publicationsandstatistics/Publica
tions/PublicationsPolicyAndGuidance/DH_078742
57
Any questions?