Dental Caries

Despite efforts focused on the prevention of dental diseases, caries remains the single most common chronic infectious disease of childhood. As children transition into adolescence, there may be shifts in caries risks and patterns. By 17 years of age, 78% of adolescents have experienced at least one carious lesion or restoration. Socioeconomic status influences caries rates among adolescents to a significant degree with more caries among adolescents of lower socioeconomic status.
 

While caries patterns in children are more localized to the pits and fissures of young permanent teeth, adolescents experience more smooth surface lesions, especially in interproximal areas. The upward incidence in dental caries among adolescents has been attributed to immature permanent tooth enamel, total increase in susceptible tooth surfaces, and environmental factors such as independent diet choices, care seeking and avoidance. (Figure 1) Interventions to interrupt active caries among adolescent patients should take advantage of the adolescent’s inward focus on the self. Dental health care providers need to invest sufficient time and develop enhanced communications with their adolescent patients, on a one-on-one basis, to increase the likelihood that the patient will become intrinsically motivated to practice an effective oral health regimen throughout adulthood, perhaps remaining caries-free.
 

Daily flossing of the interproximal surfaces of the teeth combined with tooth brushing using a fluoride containing toothpaste are essential. In addition, professionally applied topical fluoride agents and fluoride mouth rinses for home use are beneficial for those at increased risk. Community water fluoridation has proved to improve dental health substantially for persons residing in such communities.
 

An area of increasing concern with devastating effects on the dentition is methamphetamine abuse and its impact on oral health. Methamphetamine is a readily available and comparatively inexpensive illegal drug. According to a national survey published in 2003, the majority of users are between 18 and 34 years of age; 12.3 million Americans have tried this substance at least one time. Rampant tooth decay is a common side effect among addicts, including adolescents. Affected teeth often appear discolored, decayed, and destroyed beyond repair, frequently requiring extraction. The 12-hour duration of the drug’s effects contributes to the multifactorial etiology of this form of rampant decay. These factors include xerostomia, acidic oral environment, increased craving for carbonated beverages, increased clenching and grinding of teeth, and lack of attention to oral hygiene.
 

Methamphetamine users may exhibit both behavioral and physiological disturbances. Behavioral components may include inability to sit still in the dental chair, irritability, excessive talking, and exaggerated behavior. Observation of these behaviors should alert the dentist to evaluate several physiological parameters. Methamphetamine may cause dilated pupils, increased blood pressure, irregular heart beat, increased respiratory rate, tremors, and convulsions, among others. These adverse effects must be considered in the choice and administration of local anesthetics with epinephrine to diminish the possible precipitation of a dentally related medical emergency from the vasoconstrictor effects of the epinephrine. Prior to the administration of any local anesthetic agent in a methamphetamine user, blood pressure should be measured and if high (systolic > 180 mm of Hg or diastolic > 110 mm of Hg), treatment should be postponed.
 

Dentists who treat adolescent patients should be alert to possible intraoral signs of methamphetamine use such as a sudden increase in dental caries along with unusual caries patterns that often challenge the skills of the dentist to provide functional esthetic restorations. For example, large facial surface and cervical decay on both maxillary and mandibular anterior teeth, as well as attrition and destructive caries on the posterior dentition provide an entree for questioning the adolescent regarding abuse of methamphetamine.

Periodontal Disease

Evidence continues to mount regarding the relationship between oral health and systemic health. Previously, the pathogenesis of periodontal disease emphasized the presence of local bacterial plaque as the source of a focal infection. Recent research has identified the host-immunologic response to pathogenic biofilm on both the teeth and the periodontium. This new evidence has resulted in revised therapeutic protocols. In addition to debridement, identification and modification of risk factors for the development of systemic conditions should include both tooth-based outcomes and the identification of patient-based markers for oral and systemic health.
 

As patients mature from childhood to adolescence, increased emphasis should be placed on periodontal health. Both reversible and irreversible periodontal diseases become more prevalent during this period. The combined effects of genetics, nutrition, and hormonal fluctuations all contribute to the increased likelihood for developing adolescent periodontal diseases.
 

While adolescent patients may be susceptible to a wide spectrum of periodontal diseases, this educational resource guide will highlight some of the more common conditions likely to be encountered by the dental health team.