Monographs in Oral Science最新文献

Malnutrition can significantly affect oral health, and poor oral health in turn can result in malnutrition. This co-dependent relationship, therefore, relies on good nutritional health promoting good oral health and vice versa. A diet lacking nutrients can lead to disease progression of the oral cavity through altered tissue homeostasis, reduced resistance to microbial biofilm, and a decrease in tissue healing. It may also affect the development of the oral cavity. In the absence of contributing factors, health professionals should consider poor nutritional status with periodontitis, poor healing response to surgical procedures, or recurrent oral disease. This is particularly evident amongst elderly patients and patients in long-stay care. The role of nutrition in oral health and its effects on the immune system and inflammatory pathways has attracted a recent increase in research. This chapter will explore the oral manifestations that can occur with nutritional deficiencies, the association of periodontitis with nutritional deficiencies in vitamins C and D, and the effect of vitamin D deficiency and tooth development.

Vitamins are essential organic compounds that catalyze metabolic reactions. They also function as electron donors, antioxidants or transcription effectors. They can be extracted from food and supplements, or in some cases, synthesized by our body or gut microbiome. Severe vitamin deficiencies result in systemic complications, including the development of scurvy, rickets, pellagra, and beriberi. Some moderate and severe deficiencies also result in oral conditions. A lower intake of vitamin A has been associated with decreased oral epithelial development, impaired tooth formation, enamel hypoplasia and periodontitis. Vitamin D deficiency during tooth development may result in non-syndromic amelogenesis and dentinogenesis imperfecta, enamel and dentin hypoplasia, and dysplasia. Clinical studies have demonstrated an association between vitamin D's endocrine effects and periodontitis. On the other hand, no significant association has been found between cariogenic activity and vitamin D deficiency. Vitamin C deficiency results in changes in the gingivae and bone, as well as xerostomia; while vitamin B deficiencies are associated with recurrent aphthous stomatitis, enamel hypomineralization, cheilosis, cheilitis, halitosis, gingivitis, glossitis, atrophy of the lingual papillae, stomatitis, rashes around the nose, dysphagia, and pallor. The effects of vitamins E and K on oral health are not as clear as those of other vitamins. However, vitamin K has a systemic effect (increasing the risk of haemorrhage), which may affect individuals undergoing oral surgery or suffering an oral injury. Health care professionals need to be aware of the effects of vitamins on oral health to provide the best available care for their patients.

An individual's oral health status has a profound impact on his/her acquisition and utilization of nutrients and interchangeably the nutrients an individual consumes determine the state of oral health by preventing tooth loss and oral diseases. Oral diseases have a considerable impact on the masticatory function which is a critical first step in oral processing of food materials for nutrient procurement. Specifically, a section of this chapter is dedicated to the physiology of masticatory function and to the recent acknowledgement of its influence on memory and cognition, both during development and aging. A description of the occlusal and skeletal pathologies that affect the balance of the chewing pattern and related muscular activation is provided. Intact neurocognitive functions and dentition are essential in mastication to achieve coordinated movements of the teeth and tongue to help propel the food material for ingestion and subsequent nutrient absorption. The tongue is equipped with chemoreceptive, gustatory cells, which modulate taste perception and contain metabolic hormones mediating satiety. Concomitantly, salivary processes, which are stimulated with the anticipation of food ingestion and those which occur during mastication of the food material, initiate digestive enzymes in the mouth and stomach and are important in affecting appetite and food bioavailability. Therefore, oral structures such as the dentition, tongue, and saliva in the context of mastication and nutrient acquisition will be reviewed as well as their impact on food choice and subsequent nutritional status.

Dental erosion is the partial demineralisation of the tooth surface caused by repeated exposure to acids. The loss of surface tissue, which results from simultaneous and/or subsequent exposure to mechanical forces is known as erosive tooth wear (ETW). Excessive consumption of acidic beverages and foods has been the main focus of research into erosion. Enamel dissolution is significantly associated with chemical parameters: pH, buffer capacity, titratable acidity, viscosity, as well as calcium, phosphate and fluoride concentrations in the beverages and foods. Some of these parameters are used to calculate the degree of saturation of a given substance, which represents its driving force to demineralise dental hard tissues. Undersaturated substances with low pH and high titratable acidity and high buffer capacity have greater erosive potential, while substances with high concentrations of Ca2+ and phosphate cause less demineralisation. Other physical parameters also modulate the demineralisation processes. Swishing drinks in the mouth tends to cause more erosion, since the Nernst layer is continuously renewed and does not reach saturation. Recent systematic reviews confirm that frequent consumption of carbonated/soft drinks are the main dietary factor associated with ETW. Vitamin C and frequent consumption of natural fruit juices and acidic snacks or sweets are also significantly associated with more ETW; whereas higher consumption of milk and yoghurt is a protecting factor. Patients presenting with ETW should have their dietary habits assessed by recording their complete dietary intake in a diet record sheet. Dentists should assess the erosive potential of the different beverages and foods, as well as the frequency of ingestion, then elaborate specific preventive measures and dietary interventions individually tailored to each patient.

Historically, traditional carious lesion management focused on the importance of removal of all carious tissue, with little thought to the lesion origins. The surgical removal of any sign of a carious lesion was prioritised with little, or no, consideration to pulp vitality, loss of tooth structure, or caries disease management. This symptomatic approach concentrating on lesions rather than on the cause of the disease, focused on preventing secondary carious lesion development. Early detection and improved understanding of the caries process - that lesion progress can be arrested or slowed - has led to preventive measures and less destructive management as a focus. The choice of lesion management depends on: whether a primary or permanent tooth is involved; which tooth surface(s) is/are involved; whether the lesion is confined to enamel or extends into dentine; the lesion depth, and lesion cleansability. Use of preventive and minimally invasive operative strategies is complicated by the lack of predictable ways of recording lesions' status to allow early detection of failed strategies and early intervention. Because re-restoration usually makes the cavity larger and, consequently, the tooth weaker, the clinician should be certain about initiating the repeat restoration cycle, delaying the first restoration as much as possible. The 3 main principles that support preventing or slowing the repeat restoration cycle are: (1) avoid restoration placement until there is no other option; (2) place them for maximum longevity; (3) if re-restoration is necessary, repair or refurbishment is preferable to replacement of a defective restoration.

Non-cleansable carious lesions where sealing is no longer an option should be restored in the vast majority of cases. Prior to restoring the cavity, carious tissue removal is performed, mainly to increase the longevity of the restoration. Such removal, however, should not be conducted in a way that the vital pulp is harmed. This means that in teeth with shallow or moderately deep lesions, selective removal to firm dentine is recommended, while in deep lesions (radiographically extending into the pulpal third or quarter of the dentine) selective removal to soft dentine should be performed. In permanent teeth, stepwise removal is a possible alternative, while in primary teeth the Hall Technique can be considered too. To assess carious tissue removal, the hardness of the dentine should be the primary criterion. Moisture, colour, and additional parameters (like fluorescence of bacterial porphyrins, etc.) might be used, but should be critically evaluated towards their validity and patients' benefit. There is insufficient evidence to recommend a specific single carious tissue removal method. However, hand or chemomechanical excavation seem useful, as they reduce pain and discomfort during treatment. Current evidence also does not support any specific restoration material or (bonding) strategy for restoring cavities resulting from different carious tissue removal strategies. Prior to restoring the cavity, cavity disinfection is not recommended any longer.

Restoring carious lesions can be challenging, especially for deep lesions in proximity to the pulp. A number of factors can influence restoration longevity. This chapter will discuss aspects that should be considered when restoring carious lesions. In the first part, factors that might have an effect on the pulp such as preparation trauma, tooth hypersensitivity, and the use of liners will be described. In the second part, the challenges and limitations of adhesive bonding to (sound and carious) dentine will be discussed. Lastly, recommendations on the suitability of different bonding techniques and restorative materials in different situations will be given.