Primary Preventive Dentistry 6th Ed. (2004)
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Primary Preventive Dentistry - 6th Ed. (2004)  Working... × PRIMARY PREVENTIVE DENTISTRY - 6th Ed. (2004)Front Matter TITLE PAGE Norman O. Harris, DDS, MSD, FACD Professor (Retired), Department of Community Dentistry University of Texas Health Science Center at San Anotnio San Antonio, Texas Franklin Garcia-Godoy, DDS, MS, FICD Editor, American Journal of Dentistry, Professor and Associate Dean for Research, Director, Clinical Research Center, Director, Bioscience Research Center, College of Dental Medicine Nova Southeastern University Fort Lauderdale, Florida  Upper Saddle River, New Jersey 07458 COPYRIGHT A CIP catalog record for this book can be obtained from the Library of Congress Publisher: Julie Levin Alexander Assistant to Publisher: Regina Bruno ^ Mark Cohen Assistant Editor: Melissa Kerian Editorial Assistant: Mary Ellen Ruitenberg Marketing Manager: Nicole Benson Product Information Manager: Rachele Strober Director of Production and Manufacturing: Bruce Johnson Managing Production Editor: Patrick Walsh Production Liaison: Alexander Ivchenko Production Editor: Patty Donovan, Pine Tree Composition Manufacturing Manager: Ilene Sanford Manufacturing Buyer: Pat Brown Design Director: Cheryl Asherman Design Coordinator: Maria Guglielmo Walsh Cover and Interior Designer: Janice Bielawa Composition: Pine Tree Composition, Inc. Manager of Media Production: Amy Peltier New Media Project Manager: Stephen Hartner Printing and Binding: Banta Book Group Cover Printer: Phoenix Color Corp. Pearson Education, Ltd., London Pearson Education Australia Pty. Limited, Sydney Pearson Education Singapore Pte. Ltd. Pearson Education North Asia Ltd., Hong Kong Pearson Education Canada, Ltd., Toronto Pearson Educacion de Mexico, S.A. de C.V. Pearson EducationJapan, Tokyo Pearson Education Malaysia, Pte. Ltd. Pearson Education, Upper Saddle River, New Jersey Copyright 2004, 1999, 1995, 1991, 1987, 1982 by Pearson Education, Inc., Pearson Prentice Hall, Upper Saddle River, New Jersey 07458. All rights reserved. Printed in the United States of America. This publication is protected by Copyright and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying recording, or likewise. For information regarding permission (s), write to: Rights and Permissions Department. ^ is a trademark of Pearson Education, Inc. Pearson is a registered trademark of Pearson plc Prentice Hall is a registered trademark of Pearson Education, Inc. 10 9 8 7 6 5 4 3 2 ISBN 0-13-091891-1 CONTENTS Preface vii Acknowledgments ix Contributors xi 1 Introduction to Primary Preventive Dentistry 1 ^ 2 The Development and Structure of Dental Plaque (A Bacterial Biofilm), Calculus, and other Tooth-Adherent Organic Materials 23 Max A. Listgarten Jonathan Korostoff 3 The Developing Carious Lesion 45 ^ Adriana Segura 4 The Role of Dental Plaque in the Etiology and Progress of Periodontal Disease 73 Donald E. Willmann Norman O. Harris 5 Toothbrushes and Toothbrushing Methods 93 Samuel L. Yankell Ulrich P. Saxer 6 Dentifrices, Mouthrinses, and Chewing Gums 119 ^ Samuel L. Yankell 7 Oral-Health Self-Care Supplemental Measures to Complement Toothbrushing 145 Terri S.I. Tilliss Janis G. Keating 8 Water Fluoridation 181 Elaine M. Neenan Michael W. Easley Michael Ruiz, Research Assistant 9 Topical Fluoride Therapy 241 Kevin J. Donly George K. Stookey 10 Pit-and-Fissure Sealants 285 Franklin Garcia-Godoy Norman O. Harris Denise Muesch Helm 11 Oral Biologic Defenses in Tooth Demineralization and Remineralization 319 Norman O. Harris John Hicks 12 Caries Risk Assessment and Caries Activity Testing 337 ^ Franklin Garcia-Godoy 13 Periodontal Disease Prevention: Facts, Risk Assessment, and Evaluation 367 Norman O. Harris Donald E. Willmann 14 Sugar and Other Sweeteners 399 Peter E. Cleaton-Jones Connie Mobley 15 Nutrition, Diet, and Oral Conditions 419 Carole A. Palmer Linda D. Boyd 16 Understanding Human Motivation for Behavior Change 449 ^ Alexandra Evans 17 Dental Public-Health Programs 467 Mark D. Macek Harold S. Goodman 18 Preventive Oral-Health in Early Childhood 501 Stephen J. Goepferd Franklin Garcia-Godoy 19 Oral-Health Promotion in Schools 521 ^ Norman O. Harris 20 Preventive Oral-Health Care for Compromised Individuals 559 Roseann Mulligan Stephen Sobel 21 Geriatric Dental Care 589 Janet A. Yellowitz Michael S. Strayer 22 Primary Preventive Dentistry in a Hospital Setting 605 ^ Jeffery L. Hicks 23 Rationale, Guidelines, and Procedures for Prevention of the Plaque Diseases 645 Norman O. Harris Marsha A. Cunningham-Ford Glossary 685 Index 695 PREFACE This is the sixth edition of the text, Primary Preventive Dentistry. The successive editions since 1982 have provided an excellent example of the fact that the useful lifetime of much knowledge is finite. At the time of the first edition even such dental essentials as mechanical and chemical plaque control, access to dental care and dental insurance were only being slowly accepted. Now, a new wave of dental visionaries is coming on the world stage to speak with confidence about future vaccines, genetic engineering and therapeutic stem cells. These are exceedingly important basic science subjects to all health professions and are only now creeping into the general dental lexicon and application. Like in past editions, the information in the text and supporting references has been greatly upgraded, although every effort has been made to retain original citations from past landmark research. An increased emphasis has been given to school programs because of the increasing number of school based health clinics (SBHC) that are being developed to care for children. Risk assessment is highlighted in the text as a necessity for determining at the time of an initial/annual clinical examination whether a patient's treatment is to be preventive or restorative. Remineralization of incipient caries, an old idea, but a relatively new weapon in the dentists' arsenal, offers a new preventive strategy for those seeking to maintain intact teeth for a lifetime. Throughout this approximate last quarter-century of metamorphosis, the format of the book has remained constant. It is written in a style that is user-friendly, whether the user is a dental or dental-hygienist student, a dental assistant, a private- or public-health practitioner, a health educator, or a school nurse. The book and suggested learning strategies have been successfully used for class-paced study; they have been used for remedial programs; and they have been used for remote self-paced learning as well as for scheduled continuing education courses. Each chapter commences with a series of objectivessubject matter that the authors consider essential. Key words and concepts are italicized in each chapter to help focus on information deemed important. Throughout the text, there are embedded clusters of true-and-false questions, as well as answers and fill-in-the-blank questions at the end of the chapter. These are included for student self-evaluation. Following the class presentation of the subject matter it is recommended that about an hour-or-so should be spent outside the classroom to review the chapter. As each question is encountered for which the answer is not completely understood, a check mark should be made before reading on. At the end of the chapter, the marked questions should be again reviewed and the answers learned at the 100% levelnot just memorized. Prentice Hall has, with this sixth edition, established a website for the book that permits a student to take a "mock examination" at the end of each chapter. A personal or institutional computer is a requisite for Prentice Hall to respond to new true-or-false, essay, and to fill-in-the-blank type of questions. The true-or-false questions will be computer marked and returned immediately to the students e-mail address. The essay and fill-in-the blank questions will not be marked because of the variety of possible correct answers submitted, but will be immediately returned to the student along with the "school answers" for comparison. This exchange between the student and the Prentice Hall website is strictly between two computers. No student records will be kept at the website. The goal of the program is to provide the learner with a means of self-evaluation of his/her level of attainment. Student participation in this voluntary, non-jeopardizing, website program can result in a huge step towards achieving long-term mastery learning. The questions in the question bank are also available to teachers who might desire to use them for their own purposes Since curriculum time allocations vary from institution-to-institution, the chapters do not need to be scheduled in a given sequence, being free standing for the indexed subject matter. The 23 chapters include the theory and practice of preventive dentistry in private and public health environments. One chapter discusses plaque formation, while two chapters each emphasize the importance of caries and periodontal disease and disease prevention. To aid in combating these two plaque diseases, there are chapters on dentifrices, toothbrushing and auxiliary tooth cleaning devices used in accomplishing mechanical and chemical plaque control. Sugars, diets, and human motivation are included to facilitate better counseling of patients. A chapter is devoted to the use of pit-and-fissure sealants. Chapters on public health point out the responsibilities of a public health dentist, as well as two chapters on the oral health advantages of fluoridewater fluoridation, and topical applicationsboth of which are prime preventive tools of a public health dentist as well as for the private practitioner. Different age and health status groups are also considered in separate chapterspedodontic, geriodontic, handicapped, and hospitalized individuals. Finally, there is a chapter on how to use risk assessment to integrate prevention into the total treatment plan. In summary, the authors have contributed the chapters of updated information, the editors have established the learning system, while Prentice Hall has provided a website for worldwide user self-evaluation. ACKNOWLEDGMENTS For a multiauthored and multi-edition book text, there is a need for a lot of credit to go around. Lest we forget, the authors of the first edition established the foundation, from which the several later editions in preventive dentistry have been upgraded. Approximately 60 authors and authoresses have contributed of their knowledge and time through their writings from the first to the present sixth edition. These authors and authoresses have come from research laboratories, state and national public health agencies and teaching institutions in the United States and overseas. Authors from Canada, Korea, England, South Africa, Switzerland and Sweden are represented in the latter group. A spin-off Spanish edition of the fifth edition of the text has been published reflecting this multinational approach to the book. Manufacturers and dental-supply houses have contributed photos and information on their products, while journal publishers have given permission for use of copyright material. Teachers using the book, and students learning from the book, have both made suggestions that have enhanced the value of the texts. Very few texts would be published without the help of a publisher. For this publication by Prentice Hall, there is Melissa Kerian who kept us on schedule, Amy Peltier who has lent her computer expertise, and Mark Cohen, the book editor, who harmoniously kept everyone staying the course. To those many other known and unknown individuals who helped develop this edition of the primary dental prevention text, the editors desire to voice heartfelt appreciation. Of a more personal nature, both editors wish to thank their wives, Katherine Garcia-Godoy and Grace Harris for their continuing support and encouragement. Norman O. Harris DDS, MSD, FACD هذا الكتاب بدعم من الشبكة الاسلامية للتعليم www.allislam.net Franklin Garcia-Godoy DDS MS, FICD CONTRIBUTORS Linda D. Boyd, MS, RDH, R Assistant Professor Department of Periodontology Oregon Health Sciences University School of Dentistry Portland, OR ^ Professor of Experimental Odontology Director, Dental Research Institute Director, Medical Research Council University of Witwatersrand Witwatersrand, South Africa Marsha A Cunningham-Ford, RDH, BS, MS Associate Professor Department of Preventive Dentistry and Community Dentistry University of Iowa, Iowa City, IA ^ Professor Director Postdoctoral Pediatric Dentistry Department of Pediatric Dentistry University of Texas Dental School at San Antonio San Antonio, TX Michael Easley, DDS, MPH, FACD Associate Professor Department of Health Promotion and Administration Eastern Kentucky University Richmond, KY ^ Assistant Professor Department of Health Promotion, Education and Behavior University of South Columbia, SC Stuart Fischman, DMD, FACD, FICD Professor Emeritus School of Dental Medicine State University of New York at Buffalo Buffalo, NY ^ Associate Dean for Research Professor of Restorative Dentistry Professor of Pediatric Dentistry Nova Southeastern University Fort Lauderdale, FL Stephen J Goepferd. DDS, MS Professor Department of Pediatric Dentistry College of Dentistry University of Iowa Iowa City, IA ^ Associate Professor Department of Pediatric Dentistry Baltimore College of Dental Surgery, Dental School University of Maryland Baltimore, MD Norman O. Harris, DDS, MSD, FACD Professor (Retired) Department of Community Dentistry Department of Dental Hygiene University of Texas Dental School at San Antonio San Antonio, TX Denise Muesch Helm, RDH MA Assistant Professor Northern Arizona University Department of Dental Hygiene Flagstaff, AZ ^ Associate Professor General Dentistry University of Texas Dental School at San Antonio San Antonio, TX M. John Hicks, DDS, MS, PhD, MD Associate Professor of Pathology and Director of Surgical and Ultrastructure Pathology Department of Pathology Texas Children's Hospital Houston and Baylor College of Medicine Houston, TX ^ Senior Scientist National Institute of Dental and Craniofacial Research National Institutes of Health Bethesda, MD Janis G. Keating, RDH Professional Educator Phillips Oral Healthcare, Inc. Littleton, CO ^ Assistant Professor Department of Periodontics University of Pennsylvania Philadelphia, PA Max A. Listgarten, DDS Professor Emeritus University of Pennsylvania, Philadelphia, PA Visiting Professor, University of California in San Francisco Foster City, CA ^ Assistant Professor Department of Oral Health Care Delivery and Director of Community Programs Baltimore College of Dental Surgery, Dental School University of Maryland Baltimore, MD Connie Mobley, PhD Associate Professor Department of Community Dentistry University of Texas Dental School at San Antonio San Antonio, TX ^ Associate Professor, Nutrition University of the Incarnate Word San Antonio, TX Roseann Mulligan, DDS, MS Associate Professor and Chairman Department of Dental Medicine and Public Health Section of Geriatric and Special Care Dentistry School of Dentistry University of Southern California Los Angeles, CA ^ Associate Dean, External Affairs School of Dentistry University of Texas Dental School San Antonio, TX Carole A. Palmer, EdD, RD Professor and Head Division of Nutrition and Oral Health Promotion Department of General Dentistry School of Dental Medicine Tufts University Boston, MA ^ Professor and Head of Prophylaxis School Lecturer in Periodontology University of Zurick Zurick, Switzerland Adriana Segura Donly, DDS, MS Associate Professor Department of Pediatric Dentistry University of Texas Dental School at San Antonio San Antonio, TX ^ Associate Professor of Clinical Dentistry School of Dentistry University of Southern California Los Angeles, CA George K. Stookey, MSD, PhD Distinguished Professor Indiana University School of Dentistry Indianapolis, IN ^ Associate Professor Section of Primary Care College of Dentisitry Ohio State University Columbus, OH Terri S. I. Tillis, RDH, MS, MA Professor Dental Hygiene Department School of Dentistry University of Colorado Health Science Center Denver, CO ^ Professor Department of Pediatric Dentistry Faculty of Odontology University of Lund Malmo, Sweden Donald E. Willmann, DDS, MS Associate Professor Department of Periodontics University of Texas Dental School at San Antonio Dental School San Antonio, TX ^ Research Professor in Periodontics School of Dental Medicine University of Pennsylvania Philadelphia, PA Janet A. Yellowitz, DMD, MPH Associate Professor Department of Oral Health Care Delivery Baltimore College of Dental Surgery, Dental School University of Maryland Baltimore, MD REVIEWERS Chris French Beatty, RDH, Ph.D. Associate Professor Department of Dental Hygiene Texas Woman's University Denton, TX ^ Coordinator Dental Assisting Program Middlesex Community College Lowell, MA Janet Hillis, RDH, MA Chair Dental Hygiene Iowa Western Community College Council Bluffs, IA هذا الكتاب بدعم من الشبكة الاسلامية للتعليم www.allislam.net ^ Director Dental Auxiliary Programs Chattanooga State Technical Community College Chattanooga, TN Vickie Jones, RDH Instructor Department of Dental Hygiene Northeast Mississippi Community College Booneville, MS ^ Associate Professor Dental Hygiene Salt Lake Community College Salt Lake City, UT Barbara Ringle, RDH, M.Ed. Assistant Professor Dental Hygiene Program Cuyahoga Community College Cleveland, OH Katharine R. Stilley, RDH, MS Assistant Professor Department of Dental Hygiene University of Mississippi Medical Center Jackson, MS ^ Instructor Department of Dental Hygiene Tyler Junior College Tyler, TX 0 Copyright © 2004 by Pearson Education, Inc., Pearson Prentice Hall. All rights reserved. (+/-) Show / Hide Bibliographyهذا الكتاب بدعم من الشبكة الاسلامية للتعليم المجاني شبكة الجامعة الاسلامية التعليمية free.........free.....Univesity Welcome to the Islamic Univesity ^ Engineering Books www.allislam.net كتب وبرامج طبية وهندسية باخر اصداراتها Working... × Chapter 1. Introduction to Primary Preventive Dentistry - Norman O. HarrisObjectives At the end of this chapter, it will be possible to 1. Define the following key terms: health, primary prevention, secondary prevention, and tertiary prevention. Also, provide one specific example of each. 2. Name three convenient categories that aid in classifying dental disease and in planning oral-disease prevention and treatment programs. 3. Name four strategies and two administrative means for reducing the prevalence of dental caries and/or periodontal disease. 4. Cite two early actions that are essential for arresting the progression of the plaque diseases once primary preventive measures have failed. 5. Explain why the planned application of preventive-dentistry concepts and practices, including use of sealants and fluoride therapy, when coupled with early detection and immediate treatment of the plaque diseases, can result in a zero or near-zero annual extraction rate. Introduction In the year 2000, in the Executive Summary of the Surgeon Generals Reporta on the "Oral Health in America," some of the major challenges facing American dentistry were listed.1,2 It is appropriate to abstract a number of these problem areas in order to better understand the role that prevention can play in their solution. 1. Tobacco: This is a major societal health problem with very strong relationships to dentistry. Smoking has a very devastating relationship to periodontal disease and oral and pharyngeal cancer, while the use of chewing tobacco is associated with oral cancer as well as root decay (see Chapter 23). 2. The statistics of dental need: Children a. Dental caries is the most common chronic childhood disease. b. Over 50% of 5- to 9-year-olds have at least one cavity or filling; by age 17, the percentage has increased to 78%. c. As a part of childhood, children have many injuries to the head, face, and neck. d. Twenty-five % of the children have not seen a dentist before entering kindergarten. e. More than 51 million school hours are lost each year to dental-related illness. Adults a. Most adults show signs of periodontal or gingival diseases. Severe periodontal disease [measured as 6 millimeters of periodontal attachment loss (pockets)] affects about 14% of adults aged 45 to 54. b. Employed adults lose more than 164 million hours of work each year because of dental disease and dental visits. c. A little less than two-thirds of adults report having visited a dentist in the past 12 months. ^ a. Twenty-three % of 65- to 74-year-olds have severe periodontal disease (characterized by 6 millimeters or more of periodontal attachment loss). At all ages, men are more likely than women to have more severe disease. b. About 30% of adults 65 years and older are edentulous, compared to 46% 20 years ago. c. Oral and pharyngeal cancers are diagnosed in about 30,000 Americans annually. Nine thousand die from these diseases each year. Prognosis is poor. d. At any given time, 5% of Americans aged 65 and older (currently some 1.65 million people) are living in long-term care facilities where dental care is problematic. aUnited States Public Health Service. Throughout the entire Surgeon General's report, there is major emphasis on the great disparity between those who get dental care and those that do not have access to a dental facility.3,4 These are the people who are poor,5,6 are mentally handicapped,7 those that are disabled,8 children,9-12 the aged,13 and those without dental insurance. There are others living in underserved geographical areas,14 and still others who do not have access to dental care because of disease,15 culture, or race.16 To address these problems a national program and guidelines of dental care is needed that will include these dentally neglected groups. The questions then become, "What kind of a national program should it be? Is it possible to take care of so many people with so few dental health professionals?" It is the goal of the dental profession to help individuals achieve and maintain maximum oral health throughout their lives. Success in attaining this objective is highlighted by the decline of caries throughout the Western world,17 and the dramatic reduction of tooth loss among adults in the United States. This progress has been mainly attributed to the use of water fluoridation and fluoride-containing productstoothpastes and mouthrinsesand the growing acceptance and practice of primary preventive care.18 Yet, dental caries remains a major public-health problem. Untold millions of research hours and money have been invested in reaching our present capability to control the ravages of the plaque diseases. Effective strategies that can markedly reduce the number of carious teeth and better control of periodontal disease are now available. They only need to be used. All health professions emphasize that patients should seek entry into well-planned preventive programs. For dentistry, lack of prevention results in more restorations, periodontal treatment, extractions, and dentures. The changeover in priority from treatment to prevention will require active leadership and health promotion by the dental profession, consumer advocates, public health educators, and health-policy planners. Public-health delivery systems, such as the military, national and state public-health services, and industrial organizations that provide benefits to their personnel, have usually been in the forefront of such change because of the economic advantages accruing to the provider and health benefits to the recipients. For example, in 1989, a report by Malvitz and Broderick19 recounted the results following the change of focus toward a maximum emphasis on prevention for dental services by the Indian Health Service in the Oklahoma City area. The total number of visits increased by 10%, yet the number of dental personnel remained constant. The percentage of preventive services increased, along with a decrease of restorative procedures. ^ For the patient who thinks in terms of economic benefits and enjoyment of life, prevention pays. Many studies document the prevalence of dental disease, but behind these numbers there is little mention of the adverse affects on humans caused by dental neglect. One study points out that 51% of dentate patients have been affected in some way by their oral health, and in 8% of the cases, the impact was sufficient to have reduced their quality of life.20 If preventive programs are started early by the patient (or, preferably, by the parents of young children) long-range freedom from the plaque diseases is possiblea sound cost-benefit investment. After all, the teeth are needed over a lifetime for eating. Speech is greatly improved by the presence of teeth. A pleasant smile enhances personality expression. Teeth also contribute to good nutrition for all ages. At rare times, teeth have even provided a means of self-defense. On the other hand, the absence of teeth or presence of broken-down teeth often results in a loss of self-esteem, minimizes employment possibilities and often curtails social interaction. |
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