Course overview Even when used according to recommendations, many common medications can damage, discolor, and otherwise adversely affect the hard and soft oral structures. Oral healthcare providers (OHCPs) must be prepared to address such conditions, which are common among dental patients. OHCPs are increasingly observing the oral effects of polypharmacy in larger numbers of their patients. Furthermore, given the constant evolution of pharmaceutical formulations, dental professionals must keep abreast of new medications and their effects on the oral hard and soft tissues. The purpose of this basic-level course is to prepare dentists, dental hygienists, and dental assistants to identify professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact Implicit bias in healthcare Implicit bias significantly affects how healthcare
these medication-related adverse effects and treat or assist in treating them. This course begins by presenting conditions involving damage to the hard dental structures caused by fluoride, anticonvulsants, chemotherapeutics, and medications such as bisphosphonates that are associated with osteonecrosis of the jaw. Tooth discoloration is also discussed. Damage to oral soft tissues is then reviewed. Color changes to the oral mucosa, including mucosal pigmentation and black hairy tongue, are described. Drug-related gingival enlargement and other mucosal disorders, oral allergic reactions, drug- related white lesions, and conditions of the salivary glands are examined. health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
DAMAGE TO ORAL HARD TISSUES
Formulations of medications may contain sugars, which can cause an increase in caries risk (Donaldson, M., Goodchild, J. H., & Epstein, J. B., 2015). Medications may also cause xerostomia, demineralization, and malformation of the dentition; they may even cause osteonecrosis of the jaw (Kuroshima, S., Sasaki, M., & Sawase, T., 2019). The following sections will review some of the potential changes to the dentition that can result from these external factors. Warren, Broffitt, & Cavanaugh, 2006). Average daily fluoride intake between 0.04 and 0.06 mg F/kg is associated with a significantly higher risk of fluorosis (23.0% for maxillary central incisors, 14.5% for first molars), and the risk increases for average intake greater than 0.06 mg F/kg (38.0% for maxillary central incisors, 32.4% for first molars). Findings suggest that the prevalence of fluorosis is related to elevated average fluoride intake in the first 3 years of life (Buzalaf & Levy, 2011), especially intake that is elevated for all of the first 3 years of life. In 2015, the U.S. Public Health Service updated its fluoride recommendation for drinking water, reducing it to 0.7 mg/L for all communities (U.S. Department of Health and Human Services Panel on Community Water Fluoridation, 2015). The earlier Public Health Service recommendation ranged from 0.7 to 1.2 mg/L, based on local outdoor air temperatures. The thinking in 1962, when the earlier recommendation was published, was that children living in cooler locations were likely to drink less water and should therefore be exposed to more fluoride in their drinking water than children who lived in warmer climates. Newer evidence has contradicted this assumption. Furthermore, in recent decades, surveys have shown an increase in dental fluorosis, probably because children are now exposed to fluoride from various sources (mouth rinses; supplements; dental applications; and toothpaste, often inadvertently swallowed) in addition to
Changes to the human dentition can have any number of different causes. Such changes can result from external factors , such as erosive acids or abrasive forces – for example, aggressive tooth brushing – or intrinsic factors , such as structural problems in the development of the tooth. The patient may also cause changes in the dentition by engaging in such parafunctional habits as clenching or bruxing (Kuhn, M., & Türp, J. C., 2018). One often overlooked source of damage to hard tissues is medication. Enamel fluorosis Excess intake of fluoride during enamel formation in the pre- eruptive development of teeth can cause hypomineralization of enamel. Typically, enamel fluorosis appears as fine white lines or pitting or stained enamel. In patients who have a history of greater fluoride exposure, the tooth may have a white, chalk-like appearance, and the translucency of the enamel may be lost. Additionally, the enamel surface may be damaged to the degree that there is pitting on the enamel surface, resulting in fracturing of the enamel (da Cunha Coelho, A. S. E., et al., 2019). The most universally accepted classification system for fluorosis is the Dean fluorosis index (Dean, 1956). This classification system scores the amount of fluorosis in a given patient’s oral cavity. A score of 0 indicates a normal presentation of enamel. A score of 4 indicates a severe presentation of fluorosis. Scores between 0 and 4 provide a gradation of severity, with specific criteria indicating the relative degree of fluorosis. This classification system, with the criteria for severity, is presented in Table 1. Data derived from the longitudinal Iowa Fluoride Study indicates that a cumulative average daily intake (from birth to 36 months) of 0.04 mg F/kg (body weight) or less is associated with a “low risk” of fluorosis (12.9% for maxillary central incisors, 6.8% for first molars) (University of Iowa College of Dentistry and Dental Clinics, 2019; Hong, Levy,
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