Dental Problems in Primary Care

 

Am Fam Physician. 2018 Dec 1;98(11):654-660.

  Patient information: See related handout on common dental infections, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Oral health directly affects overall health and quality of life. More Americans lack dental insurance than medical insurance. Patients with poor oral health are more likely to have respiratory and cardiovascular diseases, adverse pregnancy outcomes, and diabetes mellitus. Early childhood caries is the most common chronic condition in American children. Certain illicit and prescription drugs increase the risk of enamel erosion and caries formation in adults. Incision and drainage is the treatment of choice for dental abscess. Risk factors for periodontal disease include smoking, diabetes, human immunodeficiency virus infection, use of certain medications, and genetic susceptibility. Patients with gingivitis typically present with swollen, erythematous gum tissue that bleeds easily with brushing or flossing. One in three children will have an injury to the primary teeth, and one in five 12-year-old children will have an injury to the permanent teeth. All dental fractures should be evaluated with imaging and managed in conjunction with a dental professional. Immediate reimplantation is the preferred treatment for avulsed permanent teeth. Primary care clinicians are well positioned to reduce rates of oral disease. Family physicians can incorporate oral health into routine practice through counseling about diet, oral hygiene, smoking cessation, and fluoride supplementation; application of fluoride varnish; and screening for dental disease.

At the turn of the millennium, the U.S. Surgeon General declared dental disease a silent epidemic.1 Despite the decades-old tradition of separating oral and systemic health and hygiene, there are inseparable linkages.2,3 Oral health directly affects overall health and quality of life.4 A careful oral examination reveals information about numerous systemic conditions, from nutritional deficiencies to infections and cancer. Poor oral health has been associated with respiratory and cardiovascular diseases, adverse pregnancy outcomes, and diabetes mellitus.5 Training in oral health care varies among medical schools and residency programs.6,7

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Families should be counseled about effective caries prevention in children, including the benefits of dental sealants and not giving milk, formula, or juice in bottles to children whose teeth have started to erupt; and how to brush and floss at all ages.

C

18, 27, 29, 32

Gingivitis can be prevented or reversed with regular dental cleaning, proper brushing, and flossing.

C

19

All dental fractures should be evaluated with imaging and managed in conjunction with a dental professional.

C

23

Immediate reimplantation is the preferred treatment for avulsed permanent teeth.

C

25

Teeth, gums, and oral mucosa should be examined at all child and adult wellness visits.

C

27

Fluoride varnish should be applied when the first primary tooth comes in, then twice yearly in all infants and young children.

B

28, 29

Fluoride supplements should be prescribed for children beginning at six months of age if their primary water source is deficient in fluoride.

B

2830


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Families should be counseled about effective caries prevention in children, including the benefits of dental sealants and not giving milk, formula, or juice in bottles to children whose teeth have started to erupt; and how to brush and floss at all ages.

C

18, 27, 29, 32

Gingivitis can be prevented or reversed with regular dental cleaning, proper brushing, and flossing.

C

19

All dental fractures should be evaluated with imaging and managed in conjunction with a dental professional.

C

23

Immediate reimplantation is the preferred treatment for avulsed permanent teeth.

C

25

Teeth, gums, and oral mucosa should be examined at all child and adult wellness visits.

C

27

Fluoride varnish should be applied when the first primary tooth comes in, then twice yearly in all infants and young children.

B

28, 29

Fluoride supplements should be prescribed for children beginning at six months of age if their primary water source is deficient in fluoride.

B

2830


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The Authors

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MARK B. STEPHENS, MD, MS, FAAFP, is a professor in the Department of Family and Community Medicine at Penn State College of Medicine, State College, Pa....

JOSEPH P. WIEDEMER, MD, FAAFP, is an assistant professor in the Department of Family and Community Medicine at Penn State Health, State College, and Mount Nittany Medical Center, State College.

GEORGE M. KUSHNER, DMD, MD, is a professor of oral and maxillofacial surgery at the University of Louisville (Ky.) School of Dentistry and University of Louisville Hospital.

Address correspondence to Mark B. Stephens, MD, MS, Penn State College of Medicine, 1850 E. Park Ave., Suite 207, State College, PA 16803 (e-mail: mstephens3@pennstatehealth.psu.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

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