Oral Health Information for Mental Health Workers

What causes Tooth Decay (dental caries)?

Plaque, which contains cariogenic bacteria, is the primary cause of tooth decay
(Kempe et al, 1982).

Bacterial plaque acting upon dietary carbohydrates and sugars produce acids, which decalcify the tooth structure.

Effective removal of plaque by brushing with fluoride toothpaste and flossing is essential for good teeth and gums
(Sreebny 2000).

The Relationship between Teeth, Diet
and Decay

The following factors interact to cause dental caries:

• Discourage continuous eating, drinking and snacking between meals. This increases and maintains acid production in the mouth leading to tooth decay.
• Consistency of foods eaten - foods that stay around the mouth longer e.g. sweet and sticky foods have more decay causing potential.
• Acidic foods and drinks - e.g. soft drinks, sports drinks, lemons, oranges, pickles, salad dressing, cordials, syrups and some fruit juices, consumed frequently will dissolve tooth structure.
• Time - these factors interplay over time to cause decay.
• Saliva - neutralises acid and provides calcium and phosphates for the remineralisation of enamel. Saliva is very important in the protection against tooth decay. Diseases and drugs that reduce the flow of saliva increase the risk of tooth decay.
  (DHS 1998)

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The Role of Saliva for Oral Health

Saliva secretions:

• lubricate and cleanse the oral tissues providing protection
• act as a buffer to neutralise plaque acids
• aid speech, swallowing, chewing, and digestion
• have anti-bacterial properties
  (Remick et al 1983, FDI 1999)

Reduced saliva means reduced self-cleansing with food particles adhering to tooth surfaces more easily. Without saliva, acids produced by the action of plaque bacteria on dietary carbohydrates are not diluted or neutralised (Remick et al 1983).

Fluoride

• Acts topically on teeth, promoting remineralisation of the teeth enamel and protects teeth against plaque acids (FDI 1999, Loe 2000).
• Has proven anti plaque and anti decay properties
• Has played an important role in the reduction of dental decay due to:
  - fluoridated water
  - fluoride toothpastes
  - fluoride mouthrinses and gels
• Standard, frequently used toothpaste contains 1000 parts per million (ppm) of fluoride (Loe 2000).
• 5000ppm fluoride toothpaste is a suitable regime for high caries risk groups and is available as Colgate Neutrafluor 5000, only from pharmacies and dental clinics.
• Very high consumption of fluoride may cause dental fluorosis. This is a mottling of the teeth occurring usually when the teeth are at their development stage, as in children (DHS 1998).
• A person would need to drink over 1900 litres of water containing one milligram of fluoride per litre, before toxic effects would occur (DHS 2000).
• Similarly, the average adult would need to swallow an excessive amount of high concentration fluoride toothpaste to cause any harmful effects, like vomiting.
• As with any medication, it is important to follow the prescribed directions for high fluoride toothpastes and keep them out of reach of children.

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Checklist for Observation of Teeth & Mouth

1. Are teeth visibly clean?

• free of food particles
• excessive plaque

2. Colour & condition of teeth - note any:

• discolouration or stains
• plaque
• decay
• broken teeth

3. Any unusual swelling, lumps, sores, abscesses, bleeding - does the mouth cavity look healthy?

4. Is the client suffering from any dental pain?

5. Problems eating or refusing to eat?

6. Is the client avoiding smiling or opening the mouth to talk e.g. mumbling?

7. Bad breath or bad taste in the mouth?

8. Grinding teeth, pulling at face or chewing lip?

9. Loose or lost dentures, or doesn't want to wear dentures?

If your client is suffering any pain or has any of the above problems, refer them to a dental professional.

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What does a healthy mouth look like?

• Gums - pink and firm
• Teeth - no broken teeth, no decay/cavities/soft, light brown decayed areas
  (changing colour to become yellowed/browned with age is normal)
• Tongue - free from ulcers, lumps, should be moist.
• Lips - not cracked or dry
• Inside cheeks - pink, free from ulcers, lumps, white or red patches and, moist with saliva.
  
  (Alzheimer's Association South Australia 1997)
  

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