Dental problems, tooth decay, sensitivity, gum bleeding, dental cavities and halitosis

1. DENTAL CARIES
PREPARED BY - SHRUTI TYAGI
M. Pharm Pharmaceutics
Lecturer in Pharmacy at B.S. Anangpuria Institute of
Pharmacy

2. POINTS TO BE CONSIDERED...
Addressing the following conditions through cosmeceutical
formulations:
• Dental cavities or Tooth decay[1, 2]
• Bleeding gums or Gingivitis[5]
• Mouth odor or Halitosis[6]
• Sensitive teeth[7]

3. 1.DENTAL CAVITIES

4. STRUCTURE OF HUMAN TOOTH...

5. DENTAL CAVITIES
Introduction
Tooth decay (also called
cavities or caries) is caused by
bacteria in the plaque on your
teeth, sweet foods and drinks,
and a lack of oral hygiene.
It can harm teeth and cause a
lot of pain, and may even result
in tooth loss.

6. Symptoms
White or brown spots on the teeth are the first sign of tooth decay. If it gets worse,
holes (cavities) develop on the surface of the teeth. If the deeper layers of the teeth are
affected, tooth decay can also harm the nerves in the teeth and the roots. Then the teeth
become sensitive and hurt – especially whenever we eat or drink anything cold or sweet.
Tooth decay can damage the teeth so much that they need to be replaced, for example
with a bridge.
TOOTH DECAY
BRIDGING

7. Causes and risk factors
Tooth decay is often the result of a combination of three things: plaque,
poor oral hygiene and eating a lot of sugar. Plaque covers the teeth like a
film and feels a bit “fuzzy” when you touch it with the tongue. It is made
up of bacteria, saliva and food particles. When bacteria break down the
food particles and the sugar in them, acid forms on the surface of the
teeth. If the teeth aren’t cleaned or treated, this acid attacks the enamel
coating the teeth and slowly destroys them. Bacteria that cause tooth decay
can be spread through saliva.
Plaque
Poor oral hygiene
Sugars, choclates
candies, etc.
DENTAL CAVITIES

8. Diagnosis
All a dentist needs to do to diagnose tooth decay is to take a
close look at the teeth. X-rays can also be used to tell how much
the teeth have decayed – and whether the spaces between the
teeth or under any fillings are affected or not.
X-RAY OF HEALTHY TEETH X-RAY OF DECAYED TEETH

9. Prevention
• One can lower their risk of tooth decay
by regularly brushing their teeth with
fluoride toothpaste. Limiting sugar
intake lowers the risk of tooth decay.
Soft drinks and candy contain a lot
of sugar, as do fruit juices and
ketchup.
• Regular check-ups at the dentist can
also protect the teeth because any tooth
decay can be detected early and then
treated. The pits and grooves on the
larger back teeth (molars) can also be
sealed using special plastic materials
known as dental sealants.

10. Treatment
• In early stages of tooth decay (when white or brown spots appear on the
teeth) it might be enough just to brush the teeth regularly with fluoride
toothpaste.
• If there is a hole in the tooth, known as a cavity, filling is done. Here the
dentist will use a drill to remove decayed material, and then fill the
cavity with synthetic resins (composite resins), amalgam, ceramic
material or a precious metal. If the tooth damage is more severe, a
partial or full crown may be needed for the tooth. A root canal is
commonly recommended if nerves are also affected. Sometimes the tooth
may need to be pulled (extracted). It can then be replaced by a bridge
or fixed dentures supported by an implant.
• Besides the conventional ways of treating tooth decay, a technique called
“caries infiltration”can be used, which involves using plastic to harden
the tooth.

11. Brushing Filling
Crowning

12. *Gutta-percha latex is biologically inert, resilient, and is a good electrical insulator with a high dielectric
strength.

13. Caries Infiltration
• Infiltration therapy provides an entirely new treatment option for incipient
caries without the use of anesthesia or drilling. It is indicated for non-
cavitated lesions in any-age patient. It is a simple, painless, and
ultraconservative technique that allows for immediate treatment of lesions
not advanced enough for restorative therapy. It has been shown to stop
caries progression in lesions that are too advanced for fluoride therapy.
• Caries infiltration is a major breakthrough in micro-invasive dentistry that
will fill, reinforce, and stabilize demineralized enamel. Caries infiltration
prevents lesion progression so it has the potential to delay additional
treatment of a caries site and, thus, prolong the life expectancy of that
tooth.[3,4]. It has the potential to help patients avoid more extensive
treatment and invasive restorative procedures[3,4].

14. 2. BLEEDING GUMS

15. BLEEDING GUMS or GINGIVITIS
The longer plaque and tartar are on teeth, the more harmful they become.The bacteria
cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums
become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that
can usually be reversed with daily brushing and flossing, and regular cleaning by a
dentist or dental hygienist. This form of gum disease does not include any loss of bone
and tissue that hold teeth in place.

16. Periodontitis
When gingivitis is not treated, it can advance to “periodontitis”
(which means “inflammation around the tooth”). In periodontitis,
gums pull away from the teeth and form spaces (called “pockets”)
that become infected. The body’s immune system fights the
bacteria as the plaque spreads and grows below the gum line.
Bacterial toxins and the body’s natural response to infection start
to break down the bone and connective tissue that hold teeth in
place. If not treated, the bones, gums, and tissue that support the
teeth are destroyed. The teeth may eventually become loose and
have to be removed.

17. Risk Factors
• Smoking.
• Hormonal changes in girls/women.
• Diabetes.
• Other illnesses and their treatments. Diseases such as AIDS and its treatments can
negatively affect the health of gums, as can treatments for cancer.
• Medications. There are hundreds of prescription and over the counter medications
that can reduce the flow of saliva, which has a protective effect on the mouth.
Without enough saliva, the mouth is vulnerable to infections such as gum disease.
And some medicines can cause abnormal overgrowth of the gum tissue; this can
make it difficult to keep teeth and gums clean.
•Genetic susceptibility. Some people are more prone to severe gum disease than
others.

18. Symptoms of gum diseases
• Bad breath that won’t go away
• Red or swollen gums
• Tender or bleeding gums
• Painful chewing
• Loose teeth
• Sensitive teeth
• Receding gums or longer appearing teeth
Diagnosis - X-ray can be done.

19. Treatment
• Deep Cleaning (Scaling and Root Planing)-
The dentist removes the plaque through a deep-cleaning method called scaling and root
planing. Scaling means scraping off the tartar from above and below the gum line.
Root planing gets rid of rough spots on the tooth root where the germs gather, and helps
remove bacteria that contribute to the disease. In some cases a laser may be used to
remove plaque and tartar. This procedure can result in less bleeding, swelling, and
discomfort compared to traditional deep cleaning methods.
• Medications-
Medications may be used with treatment that includes scaling and root planning, but
they cannot always take the place of surgery. Example of some medications that are
currently used. Chlorhexidine mouthrinse, Antiseptic chip, Antibiotic gel,
Antibiotic microspheres(minocycline), Enzyme suppressant, Antibiotic tablets or
capsules.

20. Flap Surgery
Surgery might be necessary if inflammation and deep pockets
remain following treatment with deep cleaning and medications. A
dentist or periodontist may perform flap surgery to remove tartar
deposits in deep pockets or to reduce the periodontal pocket and
make it easier for the patient, dentist, and hygienist to keep the
area clean. This common surgery involves lifting back the gums
and removing the tartar. The gums are then sutured back in
place so that the tissue fits snugly around the tooth again. After
surgery the gums will heal and fit more tightly around the tooth.
This sometimes results in the teeth appearing longer.

21. Bone and Tissue Grafts
These procedures help to regenerate any bone or gum tissue lost to
periodontitis. Bone grafting, in which natural or synthetic bone is placed in
the area of bone loss, can help promote bone growth. A technique that can
be used with bone grafting is called guided tissue regeneration. In this
procedure, a small piece of mesh-like material is inserted between the bone
and gum tissue. This keeps the gum tissue from growing into the area
where the bone should be, allowing the bone and connective tissue to
regrow. Growth factors – proteins that can help your body naturally
regrow bone – may also be used. In cases where gum tissue has been lost,
the dentist or periodontist may suggest a soft tissue graft, in which
synthetic material or tissue taken from another area of the mouth is used to
cover exposed tooth roots.

23. 3. Mouth odor or Halitosis

24. Mouth odor or Halitosis
Oral malodour on awakening is common and generally not regarded
as halitosis. Longstanding oral malodour is usually caused by oral,
or sometimes nasopharyngeal disease.
The most likely cause of oral malodour is the accumulation of food
debris and dental bacterial plaque on the teeth and tongue,
resulting from poor oral hygiene and resultant gingival (gingivitis)
and periodontal (gingivitis/periodontitis) inflammation. Although
most types of gingivitis and periodontitis can give rise to malodour,
acute necrotising ulcerative gingivitis (Vincent's disease, trench
mouth) causes the most notable halitosis.

25. Common causes of the symptom of oral malodour
(halitosis)
Oral disease
Food impaction
Acute necrotising ulcerative
gingivitis
Acute gingivitis
Oral ulceration
Oral malignancy
Respiratory disease
Foreign body
Sinusitis
Tonsillitis
Malignancy
Systemic causes
Respiratory tract infection
Helicobacter pylori
infection
Hepatic or Renal failure
Diabetic ketoacidosis
Leukaemias
Volatile
foodstuffs
Garlic
Onions
Spiced foods
HALITOSIS

26. Diagnosis
Gas chromatography of oral breath is a potential method
of determining the components of oral malodour, but this
is not of practical clinical application. Likewise, the
detection of trypsin-like activities of bacteria (the
benzoylarginine-naphthylamide test, dark field
microscopy, and real time quantitative polymerase chain
reaction detection of likely causative oral microbe falls
outside the routine clinical assessment of oral malodour.

27. Treatment of oral malodour
• Investigate and manage possible systemic (non-oral) source if
organoleptic method detects malodour from both mouth and nose.
• Improve oral hygiene by professional and patient administered tooth
cleaning.
• Regular atraumatic tongue cleaning.
• Regular use of antimicrobial toothpastes and mouthwashes, such as,
Chlorhexidine gluconate, Cetylpyridinium, Oil-water rinse,
Triclosan/co-polymer/sodium fluoride toothpaste.
• Regular clinical review to ensure maintenance of effective oral
hygiene.
• Halitophobia warrants referral to clinical psychologist.

28. 4. SENSITIVE TEETH

29. Sensitive teeth
Introduction
Dentine hypersensitivity (DHS) is one of the most commonly encountered
dental problems. It is characterized by short, sharp pain arising from
exposed dentine in response to stimuli, typically thermal, evaporative,
tactile, osmotic or chemical and which cannot be ascribed to any other
dental defects or pathology. Hypersensitivity may present on several teeth,
in one area of the mouth, or on one specific tooth.

30. Etiology of Dentine Hypersensitivity
Dentin is covered by enamel in the crown region and by
cementum in the radicular region. When the enamel or
cementum is removed, the underlying dentin will be exposed
along with the dentine tubules, producing dentin hypersensitivity.
It has been postulated that DHS develops in two phases namely
lesion localization and lesion initiation. Lesion localization
occurs by loss of protective covering over the dentin, thus
exposing it to external environment. Lesion initiation occurs
after the protective covering of smear layer is removed, leading to
exposure and opening of dentine tubules. Evidence already
showed that the lesions of DHS have many more and wider open
tubules than do non sensitive dentin [8,9].

31. CAUSES OF DENTINE SENSITIVITY
Gingival recession Tooth wear
Other factors
Over zealous tooth
brushing, lack of tooth
brushing, periodontal
treatment's side effects.
Physiological causes
like age advances, and
tooth extrusion due to
the nonexistence of an
antagonist tooth.
Attrition,
Abrasion,
Erosion or
Abfraction

32. Assessment of DHS
Traditionally DHS has been evaluated on the basis of the individual response to the presenting stimulus
which could be in the form of verbal rating, visual analogue scales and questionnaires. Commonly,
DHS might either be assessed in terms of a stimulus intensity required to elicit pain called stimulus-
based assessment or as a subjective evaluation of the pain caused by a distinct stimulus named response-
based assessment.
Diagnosis of DHS and Differential Diagnosis
Since DHS is based on a diagnosis of exclusion, the clinician should use all his skills in gaining the
necessary information relating to a patient’s history screening, identification of etiologic and
predisposing factors, particularly dietary and oral hygiene habits associated with erosion and
abrasion. This is in order to exclude other dental conditions that present with dental pain similar to that of
DHS and to make a definite diagnosis of DHS and ultimately to a successful treatment strategy.

33. Control measure for prevention of DHS and removal of the
etiological factors
1. Not to use a hard tooth brush use only a toothbrush with soft filaments.
2. Avoid using of an excessive pressure or force during brushing.
3. Brushing time should not be extended for prolonged period of time.
4. Excessive scrubbing at the cervical part of the tooth that damages to the supporting structures and causes
gingival recession should be avoided.
5. Not to use large amounts of dentifrice or reapplying it during brushing.
6. Avoid using a highly abrasive tooth powder or paste.
7. Desensitizing dentifrices containing an active agent potassium salts such as potassium nitrate, potassium chloride
or potassium citrate, where the potassium ions can decrease the excitability of A fibers, which surround the
odontoblasts resulting in a significant reduction tooth sensitivity.
8. Remineralizing toothpastes containing sodium fluoride and calcium phosphates.
9. Avoid excessive flossing or improper use interproximal cleaning devices or toothpicks.
10. Reduce the quantity and the frequency of taking foods containing acids.
11. Avoid brushing for at least 30 minutes after taking acidic food or drinks.
12. Maintain good oral hygiene.

34. REFERENCES
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35. THANKYOU!