CONTENTS

Preface xixContributors xxReviewers xxii

UNIT 1 Primary Preventive Dental Concepts

1 lntroduction to Primary Preventive Dentistry 1Christine N. Nathe

Objectives 1Introduction 2

Historical Aspect of Preventive Dental Care 2Dental Diseasesand Systemic Health 5Health Defined and Primary Preventive Care 6

PrimaryPrevention 7Secondaryand TertiaryPrevention 8PreventiveCare 8

Categories of Oral Diseases 9PlaquePrevention 9

Summary 11

UNIT 2 Etiology of Dental Diseases and Conditions

2 Dental Plaque 13Melissa McDougal, Plese

Objectives 13Introduction 14Dental Plaque: A Microbial Biofilm 14Bacterial Colonization of the Mouth 15The Acquired Pellicle 17Dental Plaque Formation 17Molecular Mechanisms of Bacterial Adhesion 18Bacteria in the Dental Plaque 19Dental Plaque Matrix 20

Dental Plaque Metabolism 20Dental Calculus 22Attachment of Calculusto the Teeth 24lnhibition ofCalculusFormation 24

Summary 25

3 Carious Lesions 29PatriciaRegener CampbellObjectives 29Introduction 30Multifactorial Disease Process 30Dental Caries Description 31Physical and Microscopic Features of Incipient Caries 31

PoreSpacesof the DifferentZones 34DirectConnection of the BacterialBiofilmto the Bodyof the Lesion 34

Cariogenic Bacteria 35MutansStreptococciand Caries 36Lactobacilliand Caries 37

Adherence of Bacteria to Tooth 37Ecologyof Caries Development 37

CariesTransmission 37Coronal Dentin Caries 38.Root Caries 38Secondary,or Recurrent,Caries 39Measuring Plaque pH, the Stephan's Curve 40The Relationshipof Saturationto pH 40

Demineralization and Remineralization PrincipIes 41The RelationshipbetweenHAP,FHA,and CaFz 41Depth ofRemineralization 41

Summary 42

4 Periodontal Diseases 46Kathleen O. Hodges

Objectives 46Introduction 47The Periodontium 49The Gingival Sulcus 53Periodontal Microflora 53The Developing Gingival Lesion 54The Deepening Pocket 56Cellular Defense in the Periodontal Disease Process 57Classifications of Periodontal Diseases 58

Risk Factors 60Primary Prevention of Periodontal Diseases 62Summary 63

5 Oral Cancer 67Sandra J. Maurizio

Objectives 67Introduction 68

Epidemiology of Oral Cancer 71Risk Factors 72Tobacco 72Alcohol 72Age 73Raceand Ethnicity 73Actinic Radiation(UltravioletLight)Exposure 73PotentiallyMalignantOral EpithelialLesions 74

Signs and Symptoms of Oral Cavity or OropharyngealCancer 76Detection and Diagnosis of Oral Cancer 76Health History 76Oral Cancer Screening/Examination 78

BiopsyTypes 82Imaging 85

Prognosis of Oral Cancer: Staging System 86Treatment Options for Oral Cancer 86

ConsiderationsRegardingTreatmentOptions 86Surgery 88RadiationTherapy 88Reconstruction 90

Management of Side Effectsfrom Treatment of OralCancer 91Role of the Dental Team 93

Education 93PublicHealth ScreeningforOral and PharyngealCancers 94CulturalSensitivity 94

Summary 94

6 Dental Trauma 99Gary Cuttrell

Objectives 99Introduction 100Etiology 101Initial Examination 102

Soft Tissue Injuries 103Categories of Traumatic Dental Injuries 103Primary Teeth 104

IntrudedPrimaryTeeth 104AvulsedPrimaryTeeth 104

Permanent Teeth 104AvulsedSecondaryTeeth 104FracturedSecondaryTeeth 105IntrudedSecondaryTeeth 106

Public Education on Dental Truama 106Research 106

On DentalTruamaSummary 107

7 Host Defense Mechanisms in the Oral Cavity 109BethE. McKinneyObjectives 109Introduction 110Anatomic Barriers:The Oreat Wall of Mesenchyme 110Normal Oral Flora 113

The Immune System in the Oral Cavity 113Saliva and Its Role in Promoting Oral Homeostasis 115

SalivaryGlands 115. Organic Components of Saliva 118Summary 119

UNIT 3 PreventiveStrategies

8 Toothbrushes and Toothbrushing Methods 121Elaine Sanchez Dils

Objectives 121Introduction 122The History of the Toothbrush 123Manual Toothbrush Designs 129Toothbrush Profiles 129Nylon versusNatural Bristles 129Bristle Shape and Texture 129Handle Designs 129Manual Toothbrushing Methods 130

BassMethod 131RollingMethod 132StillmanMethod 132

Charters Method 132Fones Method 132Leonard Method 132Horizontal Method 133Smith Method 133

Scrub Toothbrushing Method 133Modified Brushing Methods 133

Powered Toothbrushes 133Design 133Powered Toothbrush Methods and Uses 135

Toothbrush Efficiency and Safety Evaluations 138Clínical Assessments ofToothbrushing 138Toothbrush Replacement 139Dentures and Removable Orthodontic Applíances 139Tongue Brushing 139The American Dental Association Acceptance Program 139Summary 140

9 Dentifrices, Mouthrinses, and Chewing Gums 141Meg Horst Zayan

Objectives 141Introduction 142Safety and Efficacy 143Dentifrices 144

Packaging 145Dentifrice Ingredients 145Abrasives 146Humectants 147Soaps and Detergents 147Flavoring and Sweetening Agents 148Sweetening Agents 148Baking-Soda Dentifrices 148Methods of Controlling Plaque and Gingivitis 148Therapeutic Dentifrices 148Anti-calculus Dentifrices 150

Antihypersensitivity Products 150Whiteners 151

Mouthrinses 151Cosmetic Mouthrinses: Halitosis 152Xerostomia Mouthrinses 152

Therapeutic Mouthrinse Agents 153Chewing Gum 154Summary 156

10 Self,Care Measures to Supplement Toothbrushing 161Christine French BeattyNahid S. Nikpour

Objectives 161Introduction 162Oral Health Self,Care 166Frequency of Self,Care 166Dental Floss 167Dental FlossingMethods 169Dental FlossHolder 173Dental FlossThreader 174

Other Interdental Aids 175AutomatedFlosser 176InterproximalBrush 177Uni-TuftBrush 179Toothpick 180Rubberor PlasticTip 183KnittingYam 184PipeCleaner 184GauzeStrip 184Rinsing 185Irrigation 187

Oral Malodor and the Tongue 189TongueCleaners 190

Peri-Implant Self,Care 192Self,Care ofDentures 193

Patient Education 195Cleaning the Denture 195Disinfectionof the Denture 199DentureLiners 200DentureAdhesives 200Xerostomiaand the DenturePatient 200

Summary 201

11 Community Water Fluoridation 212WilliamD. BaileyObjectives 212Introduction 213Definition and Background 213History of Community Water Fluoridation 215Mechanisms of Action of Fluoride 220Benefits and Effectiveness of Fluoridation 223Effectsof Discontinuation of Water Fluoridation 226

Enamel Fluorosis 227Reducing the Risk for Enamel Fluorosis 230Optimal Fluoride Levels 231EngineeringAspects:Chemicals and Technical SystemsUsed 232Monitoring and Surveillance of Fluoridation 233Cost of Community Water Fluoridation 234Other Fluoride Vehicles 235Risk Communication 236

Mythsand ActionsRelatedto RiskCommunication 237PrincipIesof RiskCommunication 238

Summary 238

Topical Fluoride Therapy 245PatriciaRegenerCampbell

Objectives 245Introduction 246Mechanism of Action ofTopical Fluoride TreatmentsEffects of Fluoride on Plaque and Bacterial MetabolismTopical Fluoride Applications 250

AvailableForms 250ApplicationProcedures 251ApplicationFrequency 253

EfficacyofTopical Fluoride Therapy 254Root~SurfaceCaries 255Recommendations: Topical Fluoride Treatments 257Fluoride Varnishes 257Initiation ofTherapy 257Disadvantages of Fluoride Treatments 258Multiple Fluoride Therapy 259Fluoride Rinses 260Fluoride Gels for Oral Self~Care 261Fluoride~ReleasingDental Materials 262Toxicology of Fluoride 262

FluorideToxicity 262EmergencyTreatment 263Chronic FluorideExposure 264HomeSecurityof FluorideProducts 264

Summary 265

Dental Sealants 272Denise Muesch Helm

Objectives 272Introduction 273

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Historical Perspective 273Sealant Use in Dental Care 273

Polymerization of Sealants 274Light-Cured Sealants 275Self-Cured Sealants 275

Types of Sealants 276Glass lonomer Cement Sealants 276Sealants with Bonding Agents 276Self-Etching Light-Cured Sealants 276Fluoride-Releasing Sealants 276Colored versusClear Sealants 276

Sealant Retention 277

Criteria for Selecting Teeth for Sealant Placement 277Sealant Placement 279

lncreasing the Surface Area 279Pit-and-Fissure Depth 279Surface Cleanliness 279Preparing the Tooth for Sealant Application 280Drying the Tooth Surface 280Sealant Application 281Occlusal and Interproximal Discrepancies 282EvaluatingRetentionof Sealants . 282

Placement of Sealants over Carious Lesions 282[:)ental Providers 282Economics 283Disparities in Dental Sealant Use 283Summary 283

14 Nutrition, Diet, and Associated Oral Conditions 287Carole A. Palmer

LiruIaD. BoydObjectives 287Introduction 288Diet Assessment and Counseling in Dental Care 289

PrimaryPrevention 289SecondaryPrevention 289TertiaryPrevention 289

The Basisfor a Healthy Diet 289DietaryReferencelntakes 289DietaryGuidelinesforAmericans 290MyPyramid 293FoodLabels 294

Nutritional Factors Affecting the Oral Cavity 295Protein/CalorieMalnutrition 296

Minerals 298Vitamins 298

Diet and Enamel Demineralization 299Diet and Dental Caries 300

Role of Carbohydrates 300Effectsof Eating Pattems and Physical Form of Foods 301Caries-Protective Foods and Nutrients 301Measuring the Cariogenic Potential of Foods 302

Nutrition and Periodontal Diseases 303

Lifestyle Diet and Oral Health Issues 305Early Childhood Caries 305Eating Disorders 305Aging Issues 307

Dental and Nutritional Implications of Common ChronicConditions 308

Diabetes Mellitus 308

Immunocompromising Conditions 308Oral Surgery and Intermaxillary Fixation 309Summary 311

15 Sugar and Other Sweeteners 316Michelle L. Sensat

Jill L. Stoltenberg

Objectives 316Introduction 317

Taste Perception and Sensation 317History of Sweeteners 318Sucrose and Constituents 320

Uses of Sucrose 320

Evaluation of the Health Aspects of Sucrose 321Sugars and Dental Caries Formation 321The Polyols as Sweeteners 324

Sorbitol 324Mannitol 324Xylitol 324

Intense Sweeteners 326Saccharin 327Aspartame 327Acesulfame-K 327Sucralose 327Neotame 328

Non-nutritive Sweeteners Not Approvedin the United States 328

Alitame 328

Cyclamate 328Neohesperidine 328Stevia (Steveoside) 328Thaumatin 328

Health Considerations 328Obesity 328Diabetesand GlycemicResponse 328Hyperlipidemias 329BehavioralDisorders 329

Summary 329

16 Professional Dental Hygiene Care 332Kathleen O'Neill-Smith

Carolyn Horton Ray

Objectives 332Introduction 333Assessment 333

Medical/DentalHistory 334VitalSigns 334Extraoral/IntraoralExamination 334Dental/PeriodontalExamination 334Self-CareEvaluation 338DiagnosticRadiographs 338

Diagnosis 338Planning 340Implementation 340Evaluation 343Summary 345

17 Health Education and Promotion Theories 347Mary Catherine Hollister

Objectives 347Introduction 348History of Health Education 348Health BeliefModel 349Oral Health Applications 350

Transtheoretical Model and Stages of Change 350Oral Health Application 351

Theory of Reasoned Action 352Oral Health Applications 353

Social Leaming Theory 354Locus of Control 354Oral Health Applications 356

Sense of Coherence 356Oral Health Applications 357

Irnplernenting Health Education Models 359Adult Health Education 359Motivating Patients 360Motivational Interviewing 360Oral Health Application 361Surnrnary 361

18 Tobacco Cessation 364] oan M. Davis

Objectives 364Introduction 365

Tobacco Use: Morbidity, Mortality, and U.S. PopulationTrends 365Tobacco~RelatedOral Diseasesand Lesions 366

Oral Cancer/PrecancerousLesions 367PeriodontalDiseases 368SmokelessTobaccoand PeriodontalDisease 369

Tobacco Types,Toxins, and Carcinogens 369Nicotine Use: A Biochernical Dependence 372Tobacco Use: A Behavioral and Social Addiction 373

PharmacotherapyforTreatmentofNicotine Dependence 374First~LineMedications 374ProperDosingofNicotine Replacement 375Non-NRTCessationMedications 376Second-LineTherapies 376

Alternative Cessation Methods 377Cornponents of an Effective Tobacco~CessationIntervention 377The PHSGuidelines'5 A:s 377PHS's5 R's 379

Levels of a TCI 379Brieflntervention (1+ minute) 379Moderatelntervention (5 to 10minutes) 380lntensive lntervention (20+ minutes) 380

Establishing a TCI Prograrn 380Step One 380Step Two 381Step Three 381

Tobacco-Prevention Strategies-In~Officeand Cornrnunity 381Surnrnary 382

19 Athletic Mouthguards 387Christine N. Nathe

Objectives 387Introduction 388Historical Perspective 388Mouthguard Use 388Contact Sport Injuries 389Mouthguard Protection and Prevention 390TypesofMouthguards 391Fabrication of the Custom,Made, Vacuum,FormedMouthguard 392Dental Provider's Role in Mouthguard Use 394Summary 394

20 Technological Advances in Primary Dental Care 397Vicki GianopoulosObjectives 397Introduction 398Immunizations in Oral Health 398DentalCaries 399PeriodontalDiseases 400

Genetics 401. Dental Caries 402

PeriodontalDiseases 402Gene Therapy 403Stem Cells in Oral Health 403Summary 404

UNIT 4 Public Health and Target Populations

21 Public Health Programs 406Scott L. Tomar

Objectives 406Introduction 407Public Health Defined 407Dental Public Health Science and Practice 408Public Health Approaches 408PopulationversusIndividualApproach 409ReachversusIntensity 409Balancing Individual Rights and Societal Protection 410

Dental Public Health Organization and Infrastructure 410IntemationalAgencies 410U.S.FederalAgencies 411

State and Local Dental Public Health Programs 412Professional Organizations in Dental Public Health 413

Dental Public Health Activities 413Assessment 413Policy Development 415Assurance in Dental Public Health 416

Summary 419

Pregnancy and Infancy 422Sharon G. Peterson

Objectives 422Introduction 423

Target Populations and Preventive StrategiesPopulation Characteristics 423

Pregnant Women 423Infants 424

Common Oral Manifestations 424Pregnant Women 424Infants 425

Preventive Strategies 427Pregnant Women 427Infants 428

Summary 434

Pediatrics 437Tamara L. Donald

Objectives 437Introduction 438

Population Characteristics 438Child Development 439Early Childhood Development: 2 to 5 Yearsof AgeSchool-Aged Development: 6 to 11 Yearsof AgeAdolescent Development: 12 to 19 Yearsof AgeChildren's Development and Behavior 444

Common Oral Manifestations 445Early Childhood Caries 445

Preventive Strategies 445Communication 446Tell-Show-Do 448Voice Control 448Positive Reinforcement 448Distraction 448

Summary 448

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24 Adult Dental Care 451Maria Perno Goldie

Objectives 451Introduction 452

Population Characteristics 452Adolescence to YoungAdulthood: 13-20 Yearsof Age 452Early Adulthood: 21-39 Yearsof Age 452Mature Adulthood: 40-60 Yearsof Age 452

Common Oral Manifestations 453Dental Caries 453Periodontal Diseases 455Oral and Pharyngeal Cancer 455Women's Oral Health 456

Preventive Strategies 457Adolescence to YoungAdulthood: 13-20 Yearsof Age 457Early Adulthood: 21-39 Yearsof Age 457Mature Adulthood: 40-60 Yearsof Age 458

Summary 460

25 Geriatrics 462Charles D. Tatlock

Objectives 462Iptroduction 463Population Characteristics 463

Frail Elderly 465Health 466PhysiologicChanges 467Functional Status 467Cognitive Changes 468

Common Oral Manifestations 469Long-Term Care 470Surgeon General's Report 470

Preventive Strategies 471Senior-Friendly Dental Practice 471Health Promotion 471Public Policy 472Dental Providers 473

Summary 473

26 Medically Compromised Populations 476Elaine Sanchez Dils

Objectives 476Introduction 477

Arthritis 477Population Characteristics and Common Oral Manifestations 477Strategies to Prevent Oral Manifestations 477

Bulimia 478Population Characteristics and Common Oral Manifestations 478Strategies to Prevent Oral Manifestations 478

Cancer 478Population Characteristics and Common Oral Manifestations 478Strategies to Prevent Oral Manifestations 478

Cardiac Arrhythmias 479Population Characteristics and Common Oral Manifestations 479Strategies to Prevent Oral Manifestations 479

Congestive Heart Failure 479Population Characteristics and Common Oral Manifestations 479Strategies to Prevent Oral Manifestations 479

Depression 479Population Characteristics and Common Oral Manifestations 479Strategies to Prevent Oral Manifestations 480

Diabetes 480Population Characteristics and Common Oral Manifestations 480Strategies to Prevent Oral Manifestations 480

Epilepsy 480Population Characteristics and Common Oral Manifestations 480Strategies to Prevent Oral Manifestations 481

Hemophilia 481Population Characteristics and Common Oral Manifestations 481Strategies to Prevent Oral Manifestations 481

HIV and AIDS 481Population Characteristics and Common Oral Manifestations 481Strategies to Prevent Oral Manifestations 483

Hypertension 483Population Characteristics and Common Oral Manifestations 483Strategies to Prevent Oral Manifestations 484

Organ Transplants 484Population Characteristics and Common Oral Manifestations 484Strategies to Prevent Oral Manifestations 484

Pulmonary Disease 484Population Characteristics and Common Oral Manifestations 484Strategies to Prevent Oral Manifestations 484

Renal Disease/Failure 485Population Characteristics and Common Oral Manifestations 485Strategies to Prevent Oral Manifestations 485

Substance Abuse Disorders 485Population Characteristics of Alcohol Abuse and Common OralManifestations 485Population Characteristics ofTobacco Use and Common OralManifestations 485Population Characteristics of Marijuana Use and Common OralManifestations 486Population Characteristics of Cocaine Abuse and Common OralManifestations 486Population Characteristics of Methamphetamine Abuse and CommonOral Manifestations 487Strategies tú Prevent Oral Manifestations 487

Thyroid Dysfunction 487Population Characteristics and Common Oral Manifestations 487Strategies to Prevent Oral Manifestations 488

Summary 488

27 Populations with Developmental Disabilities 495Elaine Sanchez Dils

Objectives 495Introduction 496Mental Retardation 496

Population Characteristics and Common Oral Manifestations 496'Preventive Strategies 497

Autism 497Population Characteristics and Common Oral Manifestations 497Preventive Strategies 497

Cerebral Palsy 497Population Characteristics and Common Oral Manifestations 497Preventive Strategies 498

Down Syndrome 499Population Characteristics and Common Oral Manifestations 499Preventive Strategies 499

Summary 499

Glossary

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