ppt

Mr. Charles Walker Mariam Klait DHY 8330 Management of Evidence-Based Dental Hygiene Care April 19th , 2012

Information:

54 year old, African American; unemployed, lives with his Aunt.

Medical history : Hypertension, diabetes, allergic to penicillin, negative to infectious disease, or kidney disease. Smokes marijuana on a daily basis and a former cocaine addict , takes insulin for diabetes, Lisinporil for hypertension.

Dental history: Presents with generalized cervical caries and periodontal bone loss, heavy calculus and poor oral hygiene.

Treatment planned for scaling and root planning on four quadrants. As I noticed Mr. Walker’s un-usual cervical decay, I started by asking him if he consumes a lot of sugars or acids, he answered “I drink mountain dew and I smoke weed , also I am a former cocaine addict. Do you think that’s why I have a lot of cavities, and I would like to know what the best home product for my cavities is”? I was not sure how to answer this question, so I told him I would conduct more research and answer his question at the next visit.

Clinical case

Chief Complaint:

“ I don’t like how my teeth look, because I have visible cavities”

Patient concern/ question: “ Is smoking marijuana linked to caries and if so which in-home fluoride should I use”

Chief Complaint/ Concern

Development of PICO question

My patient has more than one concern, the first being what is the cause of his caries, since he is a marijuana user. The second concern he had is using an at home product that would help him reduce his tooth decay.

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Databases:

PUBMED, Journal of dentistry

Search terms:

1-Cervical decay 2-Marijuana effects on teeth 3-Fluoridated toothpaste 4. Cervical decay and marijuana 5. Benefits of fluoride and cervical decay 6. Caries effects on tooth enamel.

MeSH terms:

Cannabis/adverse effects*, Dental Caries, Marijuana Abuse/complications*, Smoking/adverse effects Toothpaste/ therapeutic use

Discuss any problems that you had with your search:

I limited my search to marijuana effects on teeth and caries. I also limited my search to home fluoride products, especially for those with high risk caries. I limited my search to middle aged males and links to free full length articles.

I spend more than two days researching the data bases. The PICO question had two parts to it, and I needed to research two topics (fluoride and the marijuana linked to caries). It was very hard finding a full length article. I was limited because some of the full articles had a fee in order to view it.

Research 3 article

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Citation: Schulz-Katterbach M, Imfeld T, Imfeld C. Schweiz Monatsschr Zahnmed. Cannabis and caries - does regular cannabis use increase the risk of caries in cigarette. Department of Preventive Dentistry and Oral Epidemiology. 2009, 119 (6) :576–83.

The study design of this article: Quantitative Primary Research/ Experimental Study.

level of evidence of the study: Level 5.

Article one

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Citation:

Pulido MT, Wefel JS, Hernandez MM, Denehy GE, Guzman-Armstrong S, Chalmers JM, Qian F. The Inhibitory Effect of MI Paste, Fluoride and a Combination of Both on the Progression of Artificial Caries-like Lesions in Enamel. Oper Dent. 2008, 33(5):550-5.

Study design : The study design of this article is in Vitro testing.

Level of evidence of the study : Level 5(Test tube research).

Article two

it is appropriate for a patient with high caries to use a fluoridated home product as well as comparing different home products. It compared various products and the research made it clear that a high caries patient should use prevident toothpaste.

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Citation:

Karlinsey RL, Mackey AC, Walkerl ER, Bennett T, Karthikeyan AR, Najobfard K, Pfarrer AM. Remineralization potential of 5,000 ppm fluoride dentifrices evaluated in a pH cycling model. Am. J. Dent. 2009, 2: 1-6.

Study design: Quantitative Primary Research, Experimental Study: (ANIMAL STUDY)

Level of evidence: The level of evidence using the numerical pyramid scheme is a Level 5.

Article three

Did clinical testing on bovine teeth on 5,000 ppm fluoride to evaluate the effectiveness on teeth.

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Citation: Schulz-Katterbach M, Imfeld T, Imfeld C. Schweiz Monatsschr Zahnmed. Cannabis and caries - does regular cannabis use increase the risk of caries in cigarette. Department of Preventive Dentistry and Oral Epidemiology. 2009, 119 (6) :576–83.

The study design of this article : Quantitative Primary Research/ Experimental Study.

Level of evidence of the study: Level 5.

PURPOSE: The aim of this study was to investigate the hypothesis that regular cannabis use increases the risk of caries because of hypo salivation or lifestyle.

Results: The authors states the results in terms of the p values. The hypothesis that cannabis increases the risk of caries was not confirmed by the results of this study. However, the difference between groups in the incidence of decayed surfaces was highly significant. The author discussed the potential clinical significance; the cannabis group had significantly higher DS (decayed surface) values (p = 0.0001) and significantly lower frequencies of daily tooth brushing and dental control visits (p < 0.0001) than the control group. Additionally, the cannabis group reported a significantly higher consumption of sugar containing beverages than the control group (p = 0.0078). Lifestyle combined with short-term hypo-salivation after delta-9-tetrahydrocannabinol consumption is the most probable cause of the high prevalence of caries on smooth surfaces in cannabis users. Further studies are needed to investigate the effects of cannabis use on oral health.

Did the study answer my PICO question? No, this study doesn’t directly answer the PICO question. This is useful however, in answering the most vital part of the question. My patient was concerned about his teeth being decayed and he wanted to know if his excessive use of cannabis is the primary cause. The study suggests that lifestyle can have an effect on the teeth, such as caries

Chosen Article:

I don’t believe my article answered the PICO question in full. My patient had two concerns (caries and a fluoride product), but I had to choose an article with the highest level of evidence to help him answer his question. The results were significant; however, they don’t help my patient in terms of answering which fluoride product to use at home. The article states that most cannabis users consume sweet foods or beverages during the evening, such behavior increases the risk of caries, I can link those results with his habits of consuming a frequency of mountain dew and other sweet food he admits to eating on regular basis. The study shows that caries can be induced through daily habits such as high sugar intake and poor oral hygiene. My patient presented with generalized caries, heavy calculus and poor plaque control. He admits to drinking a cup of mountain dew twice daily and snacking on high carbohydrates. He also admits to dry mouth due to his medication and smoking habits. Overall my patient’s habits are somewhat similar to the study being conducted, there is clinical relevance in terms of the suspected cause of cervical caries, however, the author doesn't reach a definitive conclusion.

Although the article didn’t help answer the PICO question, it related to the my patients case. I am now confident in telling my patients that there is a link between caries induced by sugars, hypo salivation and poor oral hygiene.

Did the article answer PICO question?

My clinical recommendation to my patient is to use Prevident toothpaste once daily to help reduce or maintain his cervical caries. I would explain to the patient that there is more study being conducted on whether cannabis causes cervical decay, but current study links poor oral hygiene, hypo-salivation and diet to caries. I would stress the importance of brushing twice and flossing once daily, furthermore, I would strongly suggest that he maintains his 3 month visit for better oral health. I would help strongly recommend he gets restoration on the teeth with caries and cut down on his sugar intake such as mountain dew.

Clinical recommendation based on the evidence based decision

THANK YOU