Clinicians should play an active role in promoting oral health: up to 19% of children aged 2 to 19 years have untreated cavities, and about 5% of adults aged 40 to 59 years and 25% of those older than age 60 years have no teeth at all.51,52 Nearly 50% of adults aged 30 years and above have some form or periodontal disease, including 8.5% with severe disease. Risk factors for periodontal disease include low income, male gender, smoking, diabetes, and poor oral hygiene. Begin by carefully examining the mouth. Inspect the oral cavity for decayed or loose teeth, inflammation of the gingiva (gingivitis), and signs of periodontal disease such as bleeding, pus, recession of the gums, and bad breath. Inspect the mucous membranes, the palate, the oral floor, and the surfaces of the tongue for ulcers and leukoplakia, warning signs for oral cancer and HIV disease.
To improve oral health counsel patients to adopt daily hygiene measures. Use of fluoride-containing toothpastes reduces tooth decay, and brushing and flossing retard periodontal disease by removing bacterial plaques. Urge patients to seek dental care at least annually to receive the benefits of more specialized preventive care such as scaling, planing of roots, and topical fluorides.
Address diet and tobacco use. As with children, adults should avoid excessive intake of foods high in starches and refined sugars such as sucrose, which enhance attachment and colonization of cariogenic bacteria. Urge patients to avoid use of all tobacco products and to limit alcohol consumption to reduce risk of oral cancer.
Saliva cleanses and lubricates the mouth. Many medications reduce salivary flow, increasing risk for tooth decay, mucositis, and gum disease from xerostomia, especially for the elderly. If medications cannot be changed, recommend drinking higher amounts of water and chewing sugarless gum. For those wearing dentures, recommend removal and cleaning each night to reduce bacterial plaque and risk of malodor. Regular massage of the gums relieves soreness and pressure from dentures on the underlying soft tissue.
Oral Cancer. Over 40,000 cases of cancer of the oral cavity and oropharynx were diagnosed in 2014, and more than 8,000 deaths were caused by these cancers. Tobacco and alcohol account for about 75% of oral cavity cancers. Sexually transmitted infection with the human papillomavirus (HPV) affecting the tonsils, oropharynx, and base of the tongue is an increasingly important cause of oropharyngeal cancers, accounting for 80% to 95% of cases. Risk for HPV infection is associated with age (highest prevalence among those aged 30 to 34 years and 60 to 64 years), male gender, a higher number of sexual partners, sexual behaviors (oral sex), and cigarette smoking. The primary screening test for these cancers is examination of the oral cavity; a critical preventive strategy is HPV vaccination among age-eligible patients. However, in 2014, the USPSTF concluded that there was insufficient evidence to routinely screen asymptomatic adults (grade I recommendation). The American Dental Association recommends that providers be aware of potentially malignant lesions during routine oral examinations, particularly among patients who use tobacco or consume excessive amounts of alcohol.
责任编辑：admin
上一篇：没有了
下一篇：医学文章阅读——Hearing Loss
微信公众号搜索“译员”关注我们，每天为您推送翻译理论和技巧，外语学习及翻译招聘信息。