Oral Health Advice for a Nursing Mother

Patients and their need:

A 26 years old lady, who is a nursing mother, was referred to me for providing effective Oral Health Advise for preventing the root caries. Root caries are the lesions that occur on the root surface of the tooth, usually below the gingival margin (Schwendicke and Göstemeyer, 2017). Root caries are the common but important dental issue that cause the recurrent dental decay if not receiving the proper oral health advise. The assessment of dental history of this patient shows that the patient

The patient has not been to the dentist clinic for the last two years due to her pregnancy and post-partum heath issues.

She has a history of the root caries on the mandibular molal since the last four years, therefore the lack of oral health advises make her tooth condition worse.

She had the high rate of tooth decay due to the root caries on the surface of the mandibular Molars, premolar (lower left), wisdom tooth and the upper right first Molar.

The soft tissue checks and the extra oral examination showed that the patient has the gingival recession that leads to the exposure of root surface to oral environment thereby increasing the chances of root carries formation

There is also high rates of decay and the gingival recession on canines and incisors

The patient is a nursing mother of a 3 months old baby and she lives with her partner. As her partner is busy is his professional life, the patient has to manage the homemaking work and the baby-care independently which make it difficult for her to manage times to follow the proper oral care regimen. On the other hand, as there are no elderly people at her home to provide the physical support and advise to the patient. this is why she used to live irregular and unhealthy lifestyles such as consuming sugary and unhealthy diet that deteriorate the teeth condition. As a result, the teeth condition gets worse with deterioration of root carries that cause gingiva recession, groves and decay on tooth. If proper oral advise is not given to this patient, she could face the sudden fall of teeth even teeth cancer.

The social factors as well as barriers that were identified in delivery of the oral care to the patient are the traditional social perspectives against the oral healthcare that might provoke the patient to not follow the systematic oral health regimen and the lack of support from her society to visit the oral clinic frequently as it can interfere with the time, she spends to take care of her baby.

Advise provided:

The first session of providing the oral health advise to the patient is held in the staff’s room. During this first visit of the patients I use many resources such as digital leaflets, posters and many digital images on the tooth decay due to caries. By showing these resources I use to provide the comprehensive explanation to the patient about what the caries are, how they form on the tooth surface, the causative factors that are associated with developing tooth caries and the importance of taking good oral health advise to caries prevention (Zhang et al. 2020). I also used the demonstration teeth model, scalpel and images of different tooth caries condition such as the abrasion, abfraction and erosion. I explained about the types and the function of different teeth in human mouth and the impacts of the root caries on the normal functioning of teeth. I also explained to the patient about a good diet and the heathy food consumption on maintaining good oral health. Here I informed the patient that it is obligatory for her to avoid foods with high sugar such as coca cola, packaged fruit juice and cake, as these foods easily get stick to tooth surface thereby increasing the risk of the caries.

I advise the patient to maintain the oral hygiene which is important to have heathy and strong teeth. I also advise the patient that she must brush her teeth twice a day, once when she wakes up in the morning and once before she goes to the bed at night. Regular brushing is important for preventing decay. I provide the patient with information about the right brush selection and right process of brushing which are important for making the teeth healthy and strong. I advise her to place the brush at 45-degree angle to the gumline while brushing teeth (Seifo et al. 2019). I also show a demo toothbrush to the patient to make her understand that what types of brush she would choose to maintain oral hygiene.

I advise the patient to clean the area between the two teeth where brush could not reach. Here I recommend the patient to use the interdental clear or dental floss such as oral B interdental floss or Sulcabrush. I also advise the patient to do not brush too long or aggressively as it can damage the enamel coating of teeth (Hung et al. 2019).

I recommend to the patient to use the fluoride containing toothpaste that will kill bacteria inside mouth thereby preventing the chances the caries (Heasman et al. 2017). I also recommend to chew the disclosing tablets which would help the patient in determining the areas of teeth where the plaques are formed. I explain the direction of using these disclosing tablets. Here the patient needs to first keep the tablet between the upper and lower teeth and then crush the tablet. After that the patient needs to cover the tablet over the entire upper and lower teeth by her tongue, after that the patients needs to wash her month properly so that the plaques on the teeth would be visible the patient.

I recommend the patient to consume the balanced and nutritious meals that is free from excess sugar and high fat. Here I recommend the patient to consume the homemade vegetables that can strengthen the root surface of teeth by supplying essential minerals and calcium. I strictly recommend the patient to avoid the sticky foods that can easily stick to the gum such as chips, chocolates, pastry and jam.

I advise the patients to use the supplement fluoride that will strengthen her teeth and prevent the teeth from any kind of bacterial infection. I also recommended the patient to drink fluoridate water that would protect her teeth from any kind of bacteria attack from caries.

Reference list:

AlQranei, M.S., Balhaddad, A.A. and Melo, M.A., 2020. The burden of root caries: Updated perspectives and advances on management strategies. Gerodontology.

Gavriilidou, N.N. and Belibasakis, G.N., 2019. Root caries: the intersection between periodontal disease and dental caries in the course of ageing. British dental journal, 227(12), pp.1063-1067.

Heasman, P.A., Ritchie, M., Asuni, A., Gavillet, E., Simonsen, J.L. and Nyvad, B., 2017. Gingival recession and root caries in the ageing population: a critical evaluation of treatments. Journal of clinical periodontology, 44, pp.S178-S193.

Hung, M., Voss, M.W., Rosales, M.N., Li, W., Su, W., Xu, J., Bounsanga, J., Ruiz‐Negrón, B., Lauren, E. and Licari, F.W., 2019. Application of machine learning for diagnostic prediction of root caries. Gerodontology, 36(4), pp.395-404.

Miyaji, H., Kato, A. and Tanaka, S., 2020. Suppression of root caries progression by application of Nanoseal®: A single-blind randomized clinical trial. Dental materials journal, 39(3), pp.444-448.

Schwendicke, F. and Göstemeyer, G., 2017. Cost-effectiveness of root caries preventive treatments. Journal of dentistry, 56, pp.58-64.

Seifo, N., Cassie, H., Radford, J.R. and Innes, N.P., 2019. Silver diamine fluoride for managing carious lesions: an umbrella review. BMC Oral health, 19(1), pp.1-10.

Uemura, R., Miura, J., Ishimoto, T., Yagi, K., Matsuda, Y., Shimizu, M., Nakano, T. and Hayashi, M., 2019. UVA-activated riboflavin promotes collagen crosslinking to prevent root caries. Scientific reports, 9(1), pp.1-11.

Zhang, J., Sardana, D., Li, K.Y., Leung, K.C.M. and Lo, E.C.M., 2020. Topical fluoride to prevent root caries: systematic review with network meta-analysis. Journal of dental research, 99(5), pp.506-513.

The second visit was a follow up to check the usefulness of the oral health advise that were given to the patient during her first visit to me. In this second visit I check the current oral health of the patient such as checking that whether there is any improvement of teeth, the cleanliness and strength of each tooth, the condition of gum, gingival areas and root surface. here I checked the condition of the upper and lower quadrants, to determine that whether there is any pain on these areas. I also go through the reports of the extra oral examination, occlusal examination, mouth screening and periodontal assessment to check that whether there is any improvement of teeth condition.

By assessing recent oral health report of the patients, I understand that although there is a sign of oral hygiene in patient’s teeth, there is not the expected improvement of the teeth caries on molar and pre molars (Tan et al. 2017). I suggest the patient that she needs to be more serious to follow the clinical regimen regarding caries prevention that were advised her in first visit. After checking the BPE score and the oral hygiene assessment, I suggested the patient that despite providing oral health advice to her in her first visit she fails to implement them into practices which is the reason behind there is still no apparent improvement in her in teeth condition. I advised her for immediately implement a good nutritious and heathy diet plan and a good oral hygiene routine. In this context, I provide her a hardcopy of a leaflet in which it is described that what to eat and which oral heath regimen needs to be followed to have a healthy and strong tooth. I also provide her some YouTube video links from which the patient can learn how to maintain good oral health by following systematic life.

By discussing with the patient regarding whether she followed the oral health advise that was provided to her in her first visit to me, I came to know that as she is nursing mother, she is unable to manage time to follow some of the advice such as using the disclosing tablet, following the right process of brushing the teeth, eat healthy and homemade foods etc. I also come to know that when the patient takes the disclosing tablet and the fluoridate water, they cause severe irritation and pain in her gum which is the reason she skips these two things. In this context I advise the patient to skip the disclosing tablets and fluoridate water rather she must use the fluoride containing toothpaste that also can help her to prevent the root caries (Castro et al. 2020).

I advise the patient that she must develop an effective care plan for her oral health which will help her to manage time for following all the necessary advice regarding maintaining good oral health. I explain to her the importance of regular dental checkup because it not only assists her to have good teeth and oral health but also have good health and wellbeing (Daneshyar et al. 2018). I advised the patient that maintaining oral hygiene is not enough for preventing caries, rather she needs to follow a strict and healthy oral health regimen to have healthy and strong teeth.;

From the extraoral and peri-dental screening I come to know that the advice that were given to the patients in her first visit were not properly implemented inro practices, this is why there is traces of the formation of deep groove in teeth along with the root caries. here I suggest the patient that she must give proper attention to her oral health regimen otherwise there may be risk of the permanent deep groves and root caries the teeth that cannot be cured through any preventive measure (Schwendicke et al. 2018) Here I recommend the patient to replace her brush in every month and choose the right brush according to the size and shape of her teeth. after checking her teeth, I show a demo brush and strictly recommender the patient to use this kind of brush to get rid of tooth cries, I also advise her to undertake the predental and extraoral screening in the dental clinic in every mouth that will let her know about her current teeth condition.

Finally, I provide the patient with an oral health information sheet and recommend her to strictly follow all huge information of this sheet to have a healthy and strong teeth, I also suggested her take the oral heath advise and the visits dental clinic on every month to maintain systematic routine of oral healthcare.

Reference list:

Cai, J., Palamara, J.E.A., Manton, D.J. and Burrow, M.F., 2018. Status and progress of treatment methods for root caries in the last decade: a literature review. Australian dental journal, 63(1), pp.34-54.

Castro, R.J., Maltz, M., Arthur, R.A. and Giacaman, R.A., 2020. Anti-caries effect of fluoridated milk-based drink consumed by older adults on an in vitro root caries experimental model. Archives of Oral Biology, 118, p.104878.

Daneshyar, F., Khamverdi, Z., Toliat, T. and Alikhani, M.Y., 2018. Effect of green tea varnish on depth of root caries. The journal of contemporary dental practice, 19(2), pp.137-142.

McReynolds, D. and Duane, B., 2018. Systematic review finds that silver diamine fluoride is effective for both root caries prevention and arrest in older adults. Evidence-based dentistry, 19(2), pp.46-47.

Oliveira, B.H., Cunha-Cruz, J., Rajendra, A. and Niederman, R., 2018. Controlling caries in exposed root surfaces with silver diamine fluoride: A systematic review with meta-analysis. The Journal of the American Dental Association, 149(8), pp.671-679.

Schwendicke, F., Krois, J., Schiffner, U., Micheelis, W. and Jordan, R.A., 2018. Root caries experience in Germany 1997 to 2014: analysis of trends and identification of risk factors. Journal of dentistry, 78, pp.100-105.

Tan, H., Richards, L., Walsh, T., Worthington, H.V., Clarkson, J.E., Wang, L. and Velo, M.M.D.A.C., 2017. Interventions for managing root caries. The Cochrane Database of Systematic Reviews, 2017(8).

Velo, M.M.D.A.C., Agulhari, M.A.S., Rios, D., Magalhães, A.C., Honório, H.M. and Wang, L., 2019. Root caries lesions inhibition and repair using commercial high-fluoride toothpastes with or without tri-calcium phosphate and conventional toothpastes containing or not 1.5% arginine CaCO 3: an in situ investigation. Clinical oral investigations, pp.1-10.

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