Disorders of the Teeth
DENTAL PLAQUE AND CARIES
Tooth decay is an erosive process that begins with the action of bacteria on fermentable carbohydrates in the mouth, which produces acids that dissolve tooth enamel. The extent of damage to the teeth depends on the following:
• The presence of dental plaque
• The strength of the acids and the ability of the saliva to neu-thantralize them
• The length of time the acids are in contact with the teeth
• The susceptibility of the teeth to decay
Dental plaque is a gluey, gelatin-like substance that adheres to the teeth. The initial action that causes damage to a tooth occurs under dental plaque.
Dental decay begins with a small hole, usually in a fissure (a break in the tooth’s enamel) or in an area that is hard to clean.Left unchecked, the affected area penetrates the enamel into the dentin. Because dentin is not as hard as enamel, decay progresses more rapidly and in time reaches the pulp. When the blood, lymph vessels, and nerves are exposed, they become infected andan abscess may form, either within the tooth or at the tip of the root. Soreness and pain usually occur with an abscess. As the infection continues, the patient’s face may swell, and there may be pulsating pain. The dentist can determine by x-ray studies the extent of damage and the type of treatment needed. Treatment for dental caries includes fillings, dental implants, and extractions. If treatment is not successful, the tooth may need to be extracted. In general, dental decay is associated with young people, but older adults are subject to decay as well, particularly from drug-induced or age-related oral dryness (see the accompanying GerontologicConsiderations box).
Measures used to prevent and control dental caries include practicing effective mouth care, reducing the intake of starches and sugars (refined carbohydrates), applying fluoride to the teeth or drinking fluoridated water, refraining from smoking, controlling diabetes, and using pit and fissure sealants (Chart 35-1).
Healthy teeth must be conscientiously and effectively cleaned on a daily basis. Brushing and flossing are particularly effective in mechanically breaking up the bacterial plaque that collects around teeth.Normal mastication (chewing) and the normal flow of saliva also aid greatly in keeping the teeth clean. Because many ill patients do not eat adequate amounts of food, they produce less saliva, which in turn reduces this natural tooth cleaning process. The nurse may need to assume the responsibility for brushing the patient’s teeth. In any case, merely wiping the patient’s mouth and teeth with a swab is ineffective. The most effective method is mechanical cleansing (brushing). If brushing is impossible, it is better to wipe the teeth with a gauze pad, then have the patient swish an antiseptic mouthwash several times before expectorating into an emesis basin. A soft-bristled toothbrush is more effective a sponge or foam stick. The lips may be coated with a watersoluble gel to prevent drying.
Dental caries may be prevented by decreasing the amount of sugar and starch in the diet. Patients who snack should be encouraged to choose less cariogenic alternatives, such as fruits, vegetables, nuts, cheeses, or plain yogurt.
Fluoridation of public water supplies has been found to decrease dental caries. Some areas of the country have natural fluoridation; other communities have added fluoride to public water supplies. Fluoridation may be achieved also by having a dentist apply a concentrated gel or solution to the teeth, adding fluoride to home water supplies, using fluoridated toothpaste or mouth rinse, or using sodium fluoride tablets, drops, or lozenges.
The occlusal surfaces of the teeth have pits and fissures, areas that are prone to caries. Some dentists apply a special coating to fill andseal these areas from potential exposure to cariogenic processes.
These sealants last up to 7 years.
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