Adolescent Oral Health

8/10/2019 Adolescent Oral Health

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1 www.aap.org/oralhealth/pact

Protecting All Childrens Teeth

Oral Health inAdolescence


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Introduction

Continued focus on oral health during the adolescent period is

important.

Many childhood risk factors persist and new oral health risk factors

may emerge during adolescence. Opportunities exist to prepare,

educate, and empower adolescents to take control of their oral

health as they move toward adulthood.

Because adolescents often have an increased focus on personal

aesthetics, this can provide an opening to discuss oral health

knowledge and behaviors during office visits.


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Learner Objectives

Upon completion of this presentation, participants will be able to:

List common risk factors for dental caries during adolescence.

Define periodontitis and gingivitis and state clinical signs, riskfactors, and anticipatory guidance regarding periodontal disease.

Discuss the prevalence of tobacco use among US adolescentsand oral effects of tobacco.

Recall the adverse oral effects of methamphetamines andmarijuana.

List common signs of oral cancer.

Cite the AAP and AAPD stand on oral piercings and counsel apatient on the risks associated with oral piercings.


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Dental Caries

52% of 12- to 19 year olds have experienced tooth decay in at

least 1 tooth and13% of adolescents have untreated caries.

The pit and fissure surfaces of the molars are the most common

site of caries.

The dynamic caries balance continues throughout adolescence,and the same factors that influence caries risk in children still exist

in adolescence.


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Dental Caries, continued

Special health care needs

Infrequent professional dental care

Risk factors that may first be noted in the adolescent, include

eating disorders and orthodontic appliances that make performing

oral hygiene more difficult


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Anticipatory Guidance

Anticipatory guidance in caries prevention for adolescents is similar

to that of young children:

Encourage fluoridated water intake.

Recommend fluoride supplementation for high risk teens not

having access to fluoridated water (up to age 16).

Encourage fluoridated toothpaste use twice a day.Encourage daily flossing.



Anticipatory Guidance, continued

Encourage and assist in referrals for dental visits that can provide

preventive strategies such as dental sealants, topical fluoride, plaque

andcalculusremoval, and restorative measures.

Promote a healthy diet with rare snacking on sugary or acidic foods

and liquids. Counsel on risk of vending machine options as these are

often placed in locations that teens frequent.

Encourage and empower parental assistance in oral hygiene for

adolescents with special health care needs.



Gingivitis

Gingivitis is gingival (gum) inflammation

due to the build-up of plaque on

tooth surfaces.

Symptoms of gingivitis include red and

swollen gums that easily bleed with

brushing or flossing.

Gingivitis is usually the result of suboptimal oral hygiene, both

inadequate brushing and flossing.

Antonio Moretti, DDS, MS Associate Professor, Department ofPeriodontology. UNC School of Dentistry


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www.aap.org/oralhealth/pact

Periodontitis

Periodontitis is usually accompanied by gingivitis but is a distinct

disease process that involves irreversible destruction of the supporting

tissues surrounding the tooth, including the alveolar bone.

Plaque and tartar accumulate at the gum line and the resultant

inflammation leads to formation of a periodontal pocket between the

gums and the teeth.

The infection and inflammation spread from the gingiva to the

periodontal ligament and alveolar bone that support the teeth. The

destruction of support causes the teeth to become mobile and, if left

untreated, can lead to tooth loss.


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Signs and Symptoms of Periodontal

Disease

Gums that are swollen, bright red,

and tender to touch

Gums that bleed easily

Gingival recession

Tooth Loss

Loose/mobile permanent teeth

Both hormonal changes and externalfactors can affect the periodontal

tissues of the adolescent

Gingival Recession

(affecting the mandibular anterior teeth)

Antonio Moretti, DDS, MS Associate Professor, Department ofPeriodontology. UNC School of Dentistry


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Localized Aggressive Periodontitis

Usually begins at onset of puberty

Alveolar bone loss usually affects incisors and 1stmolars

Destruction of supporting tissues = high risk for tooth loss

Signs can include tooth mobility and migration (increased spacingbetween teeth)

Can occur without obvious inflammation (gingivitis) or other

signs/symptomsDisease typically progresses very quickly

Clinical and radiographic exam by a dental team is very important


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Intra-oral condition is not necessarily linked to any systemic

disease

Genetic predisposition (family dental history should be

evaluated; siblings should be examined)

Destruction can either arrest or progress and affect more teeth

and become Generalized Aggressive Periodontitis (can affect

the entire dentition)A specific group of bacteria have been associated with this

disease, so dental treatment typically includes antimicrobial

therapy


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Photos courtesy of:Antonio Moretti, DDS, MS Associate Professor, Department of

Periodontology. UNC School of Dentistry

Arrows indicate sites with significant alveolar bone loss


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Risk Factors for Periodontal Disease

Poor oral hygiene resulting in plaque and calculus formation

Gingivitis or gingival recession Can be triggered by abrasions from oral piercings

Systemic conditions: Down syndrome

Immunodeficiency (e.g., cyclic neutopenia, leukocyte adhesiondeficiency)

Metabolic diseases (e.g., diabetes, hypophosphatasia) Oncologic (e.g., leukemia, Langerhans cell histiocytosis)

Tobacco or marijuana use

Pregnancy and hormonal contraceptives

Oral trauma


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Periodontal Link to Systemic Disease

Periodontitis may be an independent risk factor for:

Cardiovascular disease (stroke and coronary heart disease)

Diabetes (glycemic control, diabetes complications, and development

of type 2 diabetes)

Adverse pregnancy outcomes (i.e., low-birth weight, premature birth)

Association with multiple other systemic diseases (cancer, arthritis,

obesity, metabolic syndrome, chronic kidney disease) has been

studied, but study size, limitations, and confounders prohibit

statement of causal connection at this time.

Additional studies are warranted to investigate these associations.



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Trauma

Adolescents are at increased risk for trauma to the mouth and

teeth because of their active lifestyle and increased risk-takingbehaviors.

Oral and facial trauma can occur secondary to falls, violence,

athletics, or motor vehicle and other accidents.


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Tobacco

Consider the prevalence of tobacco use among teenagers in the

United States (2009 study):

26% of high school students report some tobacco use (cigarettes,

smokeless tobacco, cigars).

19.5% of high school students were current cigarette smokers.

14% of high school students reported cigar use.8.9% of all high school students used smokeless tobacco.


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Oral Effects of Tobacco

Tobacco has a direct carcinogenic effect on the epithelial cells of theoral mucous membranes and may cause oral cancer.

Tobacco can also have the following oral effects:

Tooth stains and discoloration

Halitosis

Calculus formation

Encouraging patients to quit smoking or using chewing tobacco canhave positive effects on both their general and oral health.


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Illicit Drugs

Illicit drug use can have negative effects on oral health by

affecting salivary flow, changing the acidity of the mouth, and bypromoting poor dietary habits and laxity in oral hygiene.


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Methamphetamines

Street names: Crystal meth, meth, speed, ice, crank.

Potent central nervous system stimulant that stimulates releaseand blocks re-uptake of monoamines in the brain.

Can be smoked, snorted, injected, or taken orally.

Rampant caries progression, termed meth mouth, may result from

a combination of drug-induced xerostomia, increased consumption

of high calorie, sugared, carbonated beverages, tooth grinding and

clenching, and poor oral hygiene.


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Meth Mouth

Signs of meth mouth include:

1. Accelerated tooth decay in teensand young adults.

2. Distinctive pattern of decay on

buccal smooth surface of teeth and

interproximal surfaces of anteriorteeth.

3. Malnourished appearance of user. Used with permission from the American Dental Association


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Meth Mouth, continued

If meth mouth is discovered:

1. Encourage the patient to stop using the drug, ask if they would

like help quitting, and assist them in finding help.

2. Encourage good oral hygiene.

3. Refer to a dentist for evaluation and management.


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Cannabis

The oral health effects of cannabis are similar to tobacco and include:

Gingivitis and periodontal disease

Oral cancer

Xerostomia


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Oral Cancer

Approximately 30,000 Americans are diagnosed annually with oral

cancer. In the 15-24 age group, there are 30 deaths per year.

Approximately 75% of oral cancers are related to tobacco use,

alcohol use, or both.

Tobacco use in any form (cigarettes, cigars, chewing tobacco) can

cause oral cancer.


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Signs and Symptoms of Oral Cancer

1.Oral tenderness, burning, or a sore that does not heal

2. Pain, tenderness, or numbness in the mouth

3. Lump in the mouth4. Color changes in the mouth

5. Difficulty chewing, swallowing, or speaking

6. Change in the way the teeth fit together

7. Leukoplakia

Providers should encourage and assist in tobacco cessation, as well as

examine the oral mucosa for abnormalities, especially in tobacco-using

patients.


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Oral Piercings and Grills

The American Dental Association and the American Academy

of Pediatric Dentistry have officially recommended against

intraoral/perioral piercing and tongue splitting because of the

potential for numerous negative sequelae.


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Jewelry-Related Complications

Injury to the gums.

Chipped (fractured) teeth

Interference with normal oral function.

Allergic reaction/hypersensitivity tometal (eg, nickel).

Interference with oral health evaluation.

Aspiration or ingestion possible ifjewelry becomes loose.Used with permission from the Martha Ann Keels, DDS, PhD; Division Head ofDuke Pediatric Dentistry, Duke Children's Hospital


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Grills

No studies show that grills are harmful

to the mouth. However, there is at least

one case report of a grill acceleratingthe caries process in an adolescent.

Grill wearers should be counseled to:

Remove the grill when eating.Limit the amount of time the grill is worn.

Brush and floss carefully.

Watch for symptoms of allergy to the grill's metal.

Used with permission from the American Academy of Pediatric Dentistry (AAPD);Reproduced with AAPD permission


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Question #1

Which of the following is a risk factor for caries inadolescents?

A. Poor oral hygiene

B. Inadequate access to topical fluoride

C. Previous caries experience

D. Frequent access to sugars

E. All of the above


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Answer

Which of the following is a risk factor for caries inadolescents?

A. Poor oral hygiene

B. Inadequate access to topical fluoride

C. Previous caries experience

D. Frequent access to sugars

E. All of the above


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Question #2

Which of the following is not a sign or symptom ofperiodontal disease?

A. Loose teeth

B. Leukoplakia

C. Halitosis

D. Swollen gums

E. Gums that bleed easily


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Answer

Which of the following is not a sign or symptom ofperiodontal disease?

A. Loose teeth

B. Leukoplakia

C. Halitosis

D. Swollen gums

E. Gums that bleed easily


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Answer

Which of the following behaviors can affect salivary flow and

change the acidity of the mouth?

A. Oral piercings

B. Using tobacco

C. Using illicit drugs

D. Wearing a grill

E. All of the above


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Question #4

True or False? Approximately 30% of high school studentsare smokers.

A. True

B. False


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Question #5

Which of the following can cause gingivitis?

A. PregnancyB. Smoking

C. Certain medications

D. All of the above

E. None of the above


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Question #5

Which of the following can cause gingivitis?

A. PregnancyB. Smoking

C. Certain medications

D. All of the above

E. None of the above


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References

1. American Academy of Pediatric Dentistry. Guideline on Adolescent Oral Health Care. AAPD

Reference Manual. 2005-2006. P. 72-79.

2. American Academy of Pediatric Dentistry. Policy on Intraoral/Perioral Piercing and Oral

Jewelry/Accessories. Revised 2011. Reference Manual. 35 (6): 65-66. Accessed December 20, 2013.

3. American Academy of Pediatric Dentistry. Periodontal Diseases of Children and Adolescents.

Reference Manual. 2004; 35(6): 338-345.

3. American Dental Association. Grills, grillz, and fronts. JADA. 2006; 137:1192.

4. American Dental Association. Oral piercing and health. JADA. 2001; 132:127.

5. Borgnakke W, Ylostalo P, Taylor G. et al. Effect of periodontal disease on diabetes: Systematic

review of epidemiologic observational evidence. J Periodontol. 2013; 84(4 Suppl): 135152.6. Brown LJ, Brunelle JA, Kingman A. Periodontal status in the United States, 1988-1991:

prevalence, extent and demographic variations [special issue]. J Dent Res. 1996; 75:672-83

7. Campbell A, Moore A, Williams E, Stephens J, Tatakis DN. Tongue piercing: impact of time and

barbell stem length on lingual gingival recession and tooth chipping. J Periodontology.2002;

73(3):289-297.


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References

8. Casamassimo P. Bright futures in practice: Oral health. Arlington, VA. National Center for

Education in Maternal and Child Health. 1996.

9. CDC. Youth Risk Behavior Surveillance, United States2009, Surveillance Summaries, June 4.

MMWR 2010; 59(No. SS-5).10. Dietrich T, Sharma, P, Walter, C et al. The epidemiological evidence behind the association

between periodontitis and incident atherosclerotic cardiovascular disease. J Periodontol. 2013; 84

(Suppl 4), 7084.

11. Hollowell WH, Childers NK. A New Threat to Adolescent Oral Health: The Grill. Pediatr Dent.2007; 29(4): 320-2.

12. Howe AM. Methamphetamine and childhood and adolescent caries.Aust Dent J. 1995;

40(5):340.13. Ide M, Papapanou PN. Epidemiology of association between maternal periodontal disease andadverse pregnancy outcomes - systematic review. J Periodontol. 2013. 84(4 Suppl): 181194.

14. Kapferer I, Beier US, Persson RG. Tongue Piercing: The Effect of Material on MicrobiologicalFindings. Journal of Adolescent Health. 2011; 49(1):76-83.


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References, continued

15. Linden GJ, Lyons A, Scannapieco FA. Periodontal systemic associations: review of the evidence.J Periodontol. 2013; 84(Suppl 4):S8-S19.

16. Ludwig DS, Peterson KE, Gormaker SL. Relation between consumption of sugar-sweeteneddrinks and childhood obesity: A prospective, observational analysis. Lancet. 2001; 357(9255):505-8.

17. Oh TJ, Eber R, Wang HL. Periodontal diseases in the child and adolescent. J Clin Periodontol.2002; 29(5):400-10.

18. The Society of Teachers of Family Medicine. Smiles for Life: A national oral health curriculum.Available online at: wwwsmilesforlifeoralhealth.org. Accessed May 25, 2013.

19. US Department of Health and Human Services. Oral health in America: A Report of the SurgeonGeneral. Rockville MD: US Department of Health and Human Services, National Institute of

Dental and Craniofacial Research, National Institutes of Health; 2000. Available online atwww.nidcr.nih.gov/DataStatistics/SurgeonGeneral. Accessed January 18, 2013.

20. Wyshak G. Teenaged girls, carbonated beverage consumption, and bone fractures.ArchPediatr Adolesc Med. 2000; 154(6):610-3.

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Adolescent Oral Health