Oral Health and Dental Care

By

Hanan Moussa

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Outline
Dental plaque and dental calculous
Methods of controlling dental plaque and calculus
Role of fluoride in the prevention of dental caries
Nonpharmacologic methods for the prevention of dental caries
Bruxism and Mouth Guard
Denture Care
Common outpatient dental procedures
 Post-dental procedure (root canal, extraction) pharmacologic management
 Post-dental procedure complications and prevention strategies
Role of the pharmacist in providing oral health and dental care.
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Dental plaque
Is a specific but highly variable structural entity, resulting from sequential colonization of microorganisms
on tooth surfaces, restorations & other parts of oral cavity, composed of salivary components like mucin,
desquamated epithelial cells, debris & microorganisms, all embedded in extracellular gelatinous matrix.

Composition of dental Plaque

Intercellular Matrix Microorganisms

20-30% 70-80%
More than 500 distinct microbial species
Host cells: macrophage, leukocyte
found in dental plaque.
and epithelial cells
Organic: Polysaccharide, Protein, Nonbacterial organisms are:
lipid Mycoplasma, Yeast, Protozoa and Viruses
Inorganic: Ca, P major
Na, K, F - trace 3
Dental calculous
is a mineralized plaque that accumulates at the deepest layers of a living plaque deposit and
adheres to tooth surfaces. It may develop above the gum (supragingival) or below it (subgingival)

Composition of dental Calculous

Mineralised inorganic Components Organic Components

70-80% 20%
calcium phosphate Proteins,
Carbohydrates
Minor lipid fraction

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 Dental plaque formation

1 2 3
Initial Colonization
Formation
attachment and and plaque
of adhesion
dental maturation
pellicle

Dental Pellicle is a homogenous membranous acellular film that covers the tooth surface
between the tooth and dental plaque and calculous.

A fully established pellicle is found within 30 min. In 24hr, the pellicle thickness is 0.1-0.8 µm.

Derived from components of saliva and crevicular fluid as well as bacterial and host tissue cell
products and food debris.

Dental plaque may be readily visualized on teeth after 1-2 days of no oral hygiene
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 Consequences of dental plaque

Dental
Caries

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 Consequences of dental plaque

Gingivitis periodontitis

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 Plaque Control
Plaque control means the regular removal and prevention of accumulations of the dental plaque on
the teeth and adjacent gingival surfaces. It is also deals with the prevention of calculous formation

Chemical Mechanical

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 Methods of controlling dental plaque
Mechanical Method
Tooth brush

Manual toothbrush Electric toothbrush

Hard, medium, and soft

Should be changed every 3-4 months
Brushing your teeth for 2 minutes, twice a day is the most effective step you can take for your oral health
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 Methods of controlling dental plaque
Mechanical Method
Interdental Aids

Dental Floss

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Types of Dental Floss
Unwaxed floss is thin nylon floss. It fits into tight spaces if the teeth are close together, but it can be prone to shredding or
breaking.

Waxed floss is a standard nylon floss with a light wax coating. It is less likely to break, but the wax coating may make it harder
to use in tight spots.

Dental tape is broader and flatter than standard floss and comes in waxed or unwaxed versions. People with more space
between their teeth often find dental tape more comfortable to use than standard floss.

Polytetrafluorethylene floss (PTFE) is the same material used in high-tech Gore-Tex fabric. The material slides between the
teeth easily and is less likely to shred compared to standard floss.

Super flosses are made from yarn-like material that has stiffer sections on each end that can be used to clean around braces or
dental bridges.

Flavored & Unflavored Floss

Available in various flavors, such as Fluoride, Mint, Cinnamon, Chocolate,

Floss Sticks
If you can use string floss, you should always choose it over floss picks.
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 Methods of controlling dental plaque
Mechanical Method
Interdental Aids

Interdental brush

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 Methods of controlling dental plaque
Mechanical Method
Interdental Aids

Unitufted brush

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 Methods of controlling dental plaque
Chemical Method

Detection of dental Plaque

Disclosing agents
A material which when applied on natural teeth makes biofilm visible, focusing
on areas that have been missed out during daily toothbrushing. I is a
preparation in liquid, tablet or lozenge which contains a dye or other coloring
agent.

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 Chemical plaque control

Antimicrobial Ingredient
First generation Second generation Third generation

Reduce the plaque to 20-50%. Reduce the plaque to 70-90%. They block microorganisms’ binding
They have low mouth retention. They demonstrated improved oral on the tooth.
tissue retention and slow release they have low retention capability.
E.g., Antibiotics, quaternary
ammonium, and sanguanarine. E.g.,. Chlorhexidine (0.12%) E.g., Delmopinol.

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 Hydrogen peroxide 0.1 % 0.14% Ethyl lauroyl arginate

Sore mouth rinse

+ Fluoride
In Toothpaste 1,350 to 1,500ppm In Mouthwash 8 to 450 ppm
5000 ppm 230 ppm
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 Role of fluoride in the prevention of dental caries

Systemic application Topical application

 Helps to prevent dental caries by strengthening
 Strengthening the developing teeth the enamel
from infancy to adolescence  Reduces the ability of oral bacteria in dental
plaque to produce acid
 Strengthens teeth by the formation  Re-mineralizes existing dental cavities
of harder enamel by converting
hydroxyapatite crystals to
fluorapatite crystals.

Fluorapatite is more resistant to acid

than tooth enamel (hydroxyapatite) and
hence gives greater protection against
acid attack.

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Nonpharmacologic method for the prevention of dental caries
Diet Changes to Reduce Bacteria
General dietary changes can also help to slow the advance of tooth decay.

Establish a Healthy pH Level with Xylitol

Xylitol is a natural sweetener which can help to prevent the spread of bacteria and prevent
tooth decay.

Clove Oil for Pain Relief and Prevention

Cloves are an established natural remedy to treat toothache.

Green Tea as a Natural Fluoride Treatment

Drinking (unsweetened, or at least sugar-free) Green Tea daily can help to eliminate harmful
bacteria buildup in your mouth.

Keep Teeth Healthy with Licorice Root

Chewing on licorice root can help slow tooth decay. Licorice Root is a natural antimicrobial
which inhibits the bacteria that cause cavities to form and grow.
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 Bruxism
Bruxism is a condition in which the patient grinds or clenches their teeth unconsciously when they are awake
or while they are sleeping.
Reasons for bruxism
• Emotional stress (e.g. anger and anxiety),
• Aggressive, competitive, and hyperactive personality
• Abnormal tooth alignment or problems with dental treatment.
• Some people can also get bruxism as a side effect of antidepressants

Signs and symptoms

• Teeth grinding may be loud enough to wake the sleep partner
• Flattened or chipped teeth which result in increased teeth sensitivity
over-the-counter mouthguard
• Jaw pain or jaw muscle tightness.
• Dull morning headache
• Chronic facial pain
• Earache due to strong jaw muscle contraction

Treatment
Mouth Guard or protective dental appliance to prevent tooth damage
Custom-made or over-the-counter mouthguard

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 Denture care
Denture should be removed and rinsed after each meal

Cleaning with denture solution

Don’t use
Household
cleaners/toothpaste, Bleach, or
Alcoholic solutions

Use
Denture paste/gel or mild non-
toxic cleansing solution or
professional Denture solution
*Ultrasonic cleaner

Dentures need to be kept

moist so they don’t dry out or
lose shape 20
Use
 Denture care

Denture Application
• Dentures are clean and moist before applying into the mouth
• Proper amount of adhesive.

• Denture adhesive is a product designed to improve the functionality and

stability of dentures. The 4 types of denture adhesives are: Adhesive Creams,
Powders, Strips, Pads.

Improper Denture Fit

• Ill fitting will need to be re-lined for proper fit, contact the Dentist immediately

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 Common outpatient dental procedures

Root Canal Tooth

Fillings
Tooth
Extractions Teeth
Cleanings

Post dental procedure pharmacologic management

Pain medications are normally required after tooth extraction and root canal treatment.
Ibuprofen (Motrin® or Advil®), take 400–600 mg every 6–8 hours. Ibuprofen will help with pain relief
and as an anti-inflammatory.

Tylenol (1–2 tablets ) should be taken every 4 hours.

Sometimes stronger pain medication such as Lortab (hydrocodone with acetaminophen), or

Percocet
(oxycodone with acetaminophen) to control sever pain 22
Post dental procedure complications and prevention strategies

After Tooth Extraction After root canal treatment

pain or discomfort
Pain
Swelling
Bleeding

Infection

Dry socket

Limited mouth opening

Swelling

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The role of the pharmacist in providing oral health

1. Oral health promotion services.

 Practice good oral hygiene. Brush teeth thoroughly twice a day and floss daily between the
teeth to remove dental plaque.
 Visit your dentist at least once a year
 Do not use any tobacco products. If you smoke, quit.
 Limit alcoholic drinks.
 If you have diabetes, work to maintain control of the disease.
 When acting as a caregiver, help older individuals brush and floss their teeth if they are
not able to perform these activities independently.

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The role of the pharmacist in providing oral health

Provide (advice/recommendation) on oral problems

Toothache Teething Oral

ulcers

Chewy toys

While most mouth sores heal on their own, your provider may prescribe medications to
help ease discomfort. Common mouth ulcer treatments include:
Antiseptic gels or mouth rinses.
Steroid ointments like triamcinolone.
Lidocaine for mouth and throat: Bonjela, Anbesol, Iglu, Calgel, Covonia
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 The role of the pharmacist in providing oral health

Referral to a dental clinic

A long-lasting or recurring mouth ulcers may be a sign of deeper issues, so it is best to

get it checked out by a dentist.

Community pharmacies can play active part in early cancer diagnosis

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 Thank you
[email protected]

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