Case Study: Dental Health And Prevention

Mr Brown has been attending the dental surgery regularly every 12 months for the last eight years.  This current recall has shown early demineralisation of the enamel on the buccal surface of his molars, at gingival margins.  He advises that he has had a ‘tickle’ in his throat over the last four months and that to relieve the tickle; he has been eating a packet of smooth menthol lollies a day.

Demineralization is the process of removing minerals ions from HA crystals of hard tissues, such as enamel, dentin, cementum, and bone. The recovery of these mineral ions in HA crystals is called remineralization (Jablonski, Nothelfer, Morawietz, Kiesow, & Korbmacher, 2020).The starting stage of tooth decay is usually painless and can be difficult to see. This is when plaque forms on the surface of the tooth. Plaque is filled with bacteria. This bacterium weakens tooth enamel and begins to break down tooth minerals. The importance of saliva checking out is that it could function each a non-invasive diagnostic device in figuring out a patient`s caries threat fame and a visible aide for teaching patients (Ghazali, Mohammad , Ramli, Yazid , & Ibrahim, 2019).The two tests which is stimulated and unstimulated saliva are used in saliva testing. These two types of saliva have different roles and properties. When both are evaluated, the test results become extremely important diagnostic and communication tools.

The cutting out of sugar and chewing sugarless gum, proper resting, brushing teeth and using fluoride toothpaste are the main elements to recover from demineralization. The saliva test can be undertaken by determine the flow of stimulated saliva i.e. to have the patient spit on the cup while chewing sterile wax for 5 minutes.

The pH level of 14 is the most alkaline, and the pH level of 0 is the most acidic. Mr. Brown’s resting test is highly acidic i.e. the recording of result came as pH level 2 (Khan, et al., 2018). Acidic saliva consequences lead to tooth sensitivity, discoloration, bad breath, and tooth decay. The normal range for the pH of saliva is 6.2 – 7.6. A proper brushing of teeth is required. In order to neutralize the acid, I would suggest rinsing the mouth with fluoride, consuming dairy products, usage of sugar-free chewing gum after meals to promote saliva flow. To get rid of tickle in the throat a gargle with hot water and drinking clear liquids can be done. This symptom can be because of additional mucous in the throat or because of exterior irritant like smoke. In order to motivate the patient, suggestions to eat fruit at meal times instead between meals. Also, eating a balanced diet, avoiding soft drinks or juices, avoid eating or drinking anything acidic. Mr. Brown has to take proper medication for the same. Also, never brush teeth immediately after eating something acidic (Krichauff, Hedges, & Jamieson, 2020).

A 30-year-old male solicitor has attended your practice, and your dentist has observed multiple carious lesions on the interproximal surfaces of the maxillary and mandibular first and second molars.  The patient has discussed his busy lifestyle and long hours at work and told you that he will often eat fast food on the way home late at night.  He believes brushing once a day in the morning is sufficient as this is what he has always done and flosses only occasionally.  He is a heavy smoker and drinks five black coffees each day and appears to have quite a number of questions about his current oral status, including dietary considerations.

The beginning sign of a new caries lesion is the appearance of white chalk spots on the surface of the tooth, indicating an area of ??enamel demineralization. I would highly recommend fluoride as the most effective caries preventative and demineralizing agent. I would suggest the use of fluoridated toothpastes as well. Fluoride has a beneficial effect on oral health by making the teeth more resistant to tooth decay. Fluoride can also halt or even reverse the caries that has begun. I would help the patient in educating the ways through which dental caries can be stopped; four main principles have to be followed by the patient: oral hygiene; healthy eating advice; increasing fluoride availability; and placement of fissure sealants. The questions with the patient may include: how he can substitute fast food at dinner, what is the problem in brushing teeth twice, how can he avoid excessive smoke and drinking habits. Tools like videos, magazines can be used to influence the patient. I would also recommend calcium-rich foods such as low-fat or non-fat milk, yogurt, cheese, and fortified soy milk to promote strong teeth. Phosphorus, a mineral determined in eggs, fish, lean meat, dairy, nuts and beans is right for dental health. I will also ask patient to set reminders on his cell phone to keep a check on himself. A regular follow up will be done to ensure the oral health in every week.

You have been asked by your operator to review an eight-year-old patient’s brushing technique.  

To teach brushing habits to children, parents should be included in the oral hygiene instruction making it enjoyable. Children copy what parents do, so it’s easy to make your child learn while watching parents (Ibrahim, , Helaly, & Ahmed, 2021). Aids to help the patient understand the importance, there are story books on dental education which helps children the importance of brushing every tooth, use a pea-sized amount of standard fluoride toothpaste. I would ask parent if the child does not like it, the taste of the toothpaste shall also be changed. Also, the brushing of teeth along with gum line is important. Parent shall stand in front of children, while they are brushing. Brushing gently in small circles, cleaning every tooth and brushing the inside, outside and chewing surfaces of teeth are very important. To motivate the patient and review them, usage of electronic toothbrushes and practice of reward systems will also be done. The importance of removing plaque to children can also be described by making them learn that they will not be able to eat lollipops or sugary chocolates if their dental health is not good. Also, they might lose their teeth, can cause bacteria inside the body or sore throats. The use of calcium sources like milk, broccoli and yogurt to be included in the patient’s diet for strong teeth.Parents are the only one who are responsible for child’s dental hygiene. Therefore, they have to be involved in the child brushing technique(Ilyas, Ashraf, & Jamil, 2018)

References

Ghazali, N., Mohammad , N., Ramli, H., Yazid , F., & Ibrahim, A. Z. (2019). Level Of Salivary Flow Rate, pH Level, Buffering Capacity After Consumption Of Malaysian Tualang Honey: A Preliminary Study. . Journal of International Dental and Medical Research., 6.

Ibrahim, , R. H., Helaly, M. O., & Ahmed, E. M. (2021). Assessment of Brushing Techniques in School Children and Its Association with Dental Caries, Omdurman, 2019. International Journal of Dentistry. Retrieved from https://doi.org/10.1155/2021/4383418

Ilyas, M., Ashraf, S., & Jamil, H. (2018). TOOTH BRUSHING TECHNIQUES: RELATIVE EFFICACY AND COMPARISON IN THE REDUCTION OF PLAQUE SCORE IN 8-11 YEARS OLD CHILDREN. The Professional Medical Journal, 25(01), 135-139.

Jablonski, A. M., Nothelfer, R., Morawietz, M., Kiesow, A., & Korbmacher, H. S. (2020). Impact of self-assembling peptides in remineralisation of artificial early enamel lesions adjacent to orthodontic brackets. Scientific reports, 10(1), 1-10.

Khan, M. S., Dighe, K., Wang, Z., Srivastava, I., Daza , E., & Schwartz-Dual, A. S. (2018). Detection of prostate specific antigen (PSA) in human saliva using an ultra-sensitive nanocomposite of graphene nanoplatelets with diblock-co-polymers and Au electrodes. Analyst, 143(5), 1094-1103.

Krichauff, S., Hedges, J., & Jamieson, L. (2020). There’sa wall there—and that wall is higher from our side’: drawing on qualitative interviews to improve Indigenous Australians’ experiences of dental health services. International Journal of Environmental Research and Public Health, 17(18). Retrieved from https://doi.org/10.3390/ijerph17186496