Oral Health for Medical students Dr. Zahra Saied - PDF document

2/25/2013 Oral Health for Medical students رﺗﮐد ﯽﻣﻠﻌﻣ دﯾﺳ ارھز Dr. Zahra Saied Moallemi ﯽﺻﺻﺧﺗ یارﺗﮐد ،ﮏﺷزﭘ نادﻧد DDS, PhD, Head of department تﻼﯾﺻﺣﺗ تﺳرﭘرﺳ و هورﮔ رﯾدﻣ Oral Public Health Dept., Dentistry ﯽﻠﯾﻣﮑﺗ Inst., IUMS ﯽﮑﺷزﭘ نادﻧد و نﺎھد تﻣﻼﺳ هورﮔ 1391 رﮕﻧ ﮫﻌﻣﺎﺟ • a fever of unknown origin that got all sorts of Why we should know about workup because it never occurred to the oral health? physician team that it might be a dental issue. • an elevated white blood cells in a patient indicating an infection: an abscess in the mouth Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi 1

2/25/2013 Dental caries • What is the most prevalent infectious disease worldwide? • Everybody – Influenza? • Gender – HIV? • Age – ….? • Race • Everywhere • Every time Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi • Your recommendations for a pregnant woman with vomiting? • Which are threatening the oral health of pregnant mother during pregnancy? – Dental erosion – Dental caries – Gingivitis – Periodontitis – Pregnant tumor Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi 2

2/25/2013 Why we should know about oral Oral disorders due to systemic diseases health? Oral disorders from diabetes: – General diseases with oral origin • Gingivitis and periodontitis – General diseases with signs in oral cavity • Neuro-sensory disorders, burnt mouth, taste – Common risk factor approach disorders • Fungal infectious, unhealed wounds – YOU are the HEAD. You are RESPONSIBLE for the • Halitosis, dry mouth: dental caries OVERALL health of individuals – For your personal health Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi • Respiratory dis., inhalers may make fungal dis. Uncontrolled diabetes Uncontrolled Periodontitis or dry mouth • Systemic diseases or medication: – Low saliva flow xerostomia (anti-colinergic • Type 2 diabetes: increased incidence of medicine) – Change in taste or smell periodontitis – Oro-facial pain • Periodontitis: increase two fold risk of – Gingival fibrosis – Bone loss developing diabetes – Tooth mobility Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi 3

2/25/2013 – Arthritis rheumatoid (increased systemic • Poor oral hygiene is a risk factor for some systemic inflammation) diseases. – Pneumonia, especially in high risk groups like • Periodontal diseases in linked to: elderly people: pneumonia was 3.9 times higher in – Diabetes patients with periodontal infection than healthy mouth – COPD: 3 times more in perio. dis. – Cardiovascular diseases (due to increased systemic – an improvement in oral health can lead to a inflammation)  fragments of periodontal bacteria found at reduction in respiratory infection. – Pancreatic cancer: increased risk in perio. dis. atherosclerotic blood vessels.  aggressive treatment of gum disease reduces the (systemic inflammation or increased levels of carcinogenic compounds) incidence of atherosclerosis within six months (type 2 diabetes points to damage to the pancreas) Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi Oral cancer • Pregnancy: – Prevalence? – fluctuating hormone levels – neglected oral care • The 8 th most common cancer in the world. (Petersen et al, 2005) • Pregnant mother with periodontal dis.: • sixth most common cancer in men (Parkin et al, 2005)  Premature delivery : (inflammation in the mouth • 40% of head and neck cancers occur in the oral cavity. possibly triggers an increase in prostaglandin) – pregnant women with gum disease between • 700,000 death annually (Moore et al, 2000) weeks 21 and 24: 4-7 times more likely to give • Oro-pharyngeal cancers = 3% of all diagnosed cancer in birth before week 37.  LBW baby Iran (MOHME,2003) and in the U.S. (Day et al, 2003) Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi 4

2/25/2013 60% of oral cancers are in an advanced stage by the time of detection In Iran, most of diagnosed cancer were in advanced stage (Sargeran et al, 2006) • Oral cavity (i.e., lip, tongue, floor of the mouth, gums, and soft palate). – Diagnostic delay [ time elapsed between the onset of • The most common sites for oral cancer are the symptoms and diagnosis ]: 7.2 months tongue and floor of the mouth. – Treatment delay [time from diagnosis to the beginning of treatment ]: 1.3 months [Sargeran et al, 2006] – 60% five-year-survival rate, increase with early detection Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi 5

2/25/2013 • Mouth Rinses: Ethyl alcohol insufficient clinical evidence Risk Factors • Ultraviolet Light: Excessive exposure to solar radiation • Cigarette Smoking: risk for 75% of oral cavity and (sunlight) especially at a young age pharyngeal cancers, six times more than non-smokers – Pipe smokers have an especially high risk for lip cancer • Smokeless Tobacco (Chewing Tobacco): 50 times • Irritation: chronic irritation- complete dentures more likely to develop cancers of the cheek, gums, and lining of the lips. • Human Papillomavirus Infection: Infection with human • Marijuana papillomavirus (HPV) = increased oral squamous cell • Alcohol Abuse: six times more carcinoma (still in question) • Age: older than 40, average age 63 year (Viruses cause proto-oncogenes to become oncogenic, which can cause altered expression of their products and lead to cancer) • Gender: Men have twice the risk of oral cancer as women • Poor Nutrition Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi Do “90-second oral cancer examination” • Symptoms of Mouth Cancer (Oral Cancer) • Family history of cancer • no early symptoms • an ulcer in the mouth or on the lip that won’t heal • constant pain or soreness • A weakened immune system: HIV/AIDS , or • red or white patches in the mouth who are taking medicines that suppress the • a lump on the lip, tongue or in the neck immune system • bad breath • unexplained bleeding in the mouth • numbness in the mouth • loose teeth • Difficulty swallowing or speaking Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi 6

2/25/2013 Extra-oral assessment Lip • Face, head, and neck, ears, – Asymmetry • Observing the lips – changes on the skin such as crusts, fissuring, growths, – closed and open patient's mouth and/or color change. – Note: • bilaterally palpated on regional lymph node • the color, • enlarged nodes • If enlargement is detected, should determine the mobility and • Texture consistency of the nodes. • surface abnormalities • A recommended order of examination: • Pre-auricular, • Sub-mandibular, • Anterior cervical, • Posterior auricular, • Posterior cervical regions Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi Labial mucosa and sulcus Buccal mucosa • Retract and Examine right then left buccal • With the patient's mouth partially open, mucosa (from the labial commissure and back visually examine the of the maxillary vestibule to the anterior tonsillar pillar) and frenum and the mandibular vestibule. • Note: • Observe – change in pigmentation, – color, – color, – texture, – texture, – any swelling – mobility, – other abnormalities – other abnormalities Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi 7

2/25/2013 Gingiva and alveolar ridges Tongue • the dorsum and tip of the tongue (patient's • First, examine the buccal and labial aspects tongue at rest, and mouth partially open) • inspect: • Second, examine the palatal and lingual – swelling, aspects – ulceration, – coating, – variation in size, color, or texture. – change in the pattern of the papillae covering the surface of the tongue and examine the. – The patient should then protrude the tongue, and note any abnormality of mobility or positioning Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi Tongue Tongue • lateral margins of tongue (with mouth mirror) • more posterior aspects of the tongue's lateral borders (grasping the tip of the tongue with a piece of gauze) Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi 8

2/25/2013 Tongue Floor • Examine the ventral surface • floor of the mouth (with tongue elevated) • Palpate the tongue to detect growth • Inspect changes in: – color, – texture, – swellings, – Other abnormalities. Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi Palate Soft palate and oropharyngeal tissues • hard and soft palate (with the mouth wide • Examine all soft palate and oropharyngeal tissues open and the patient's head tilted back, gently depress the base of the tongue with a mouth mirror Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi 9

2/25/2013 Palpation Overall … • Bimanually palpate the floor of the mouth for any abnormalities. • All mucosal or facial tissues that seem to be abnormal should be palpated. • http://www.nidcr.nih.gov/imagegallery/oralhealth/O ralCancerExam.htm Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi Elderly people Root caries • Periodontitis and receding gums, • Root caries Dr . Z. Saied-Moallemi Dr . Z. Saied-Moallemi 10