Dentists can provide, promote or direct patients to information about lifestyle behaviors and/or services that can aid in reducing the risk of problems and improving overall oral health.
Beyond the general and personalized recommendations above, there are specific ADA policies that address lifestyle considerations to help reduce risks to oral health. Four policies are discussed below:
1) At-Home Orthodontic Treatments
At-home orthodontic treatments, such as direct-to-consumer (DTC) and do-it-yourself (DIY) orthodontia are both forms of orthodontic treatment discouraged by the ADA due to patient safety concerns. DTC orthodontic treatment services allow consumers to order teeth straightening kits directly from a supplier and often rely on patient-supplied impressions or photographs. Unlike impressions and radiographs taken by an experienced, licensed dental professional, patient-supplied impressions may be more likely to result in user error, which can ultimately lead to an improper fit of orthodontic appliances. A poor fit can cause the gum tissue to be impinged or stripped, and may also increase the chances of tooth loss or misalignment; or problems with the temporomandibular joint (TMJ). In addition to assuring proper fit, dental professionals can provide pre-treatment dental evaluations and take radiographs. These play an important role in planning treatment, and identifying underlying problems, such as periodontal disease, which can impact both oral health and orthodontic results.46 For example, while patients who undergo orthodontic treatment are more likely to experience root resorption than those who do not,47 the process may be exacerbated by periodontal disease.48 The importance of regular dental visits is greater during orthodontic treatment to ensure the well- being of the teeth being treated. Regular dental visits, including radiographs, as part of the orthodontic treatment plan can help identify tooth structure loss or other problems as they occur, and address the problem in real time.
The use of rubber bands and paper clips to adjust teeth is ill advised. DIY orthodontia commonly involves using household items and can result in permanent damage and/or require corrective measures to avoid adverse results, such as tooth loss or misalignment.49 Citing concern about patient harm, and the importance of dental oversight throughout orthodontic treatment, the ADA passed a resolution discouraging the use of DIY orthodontic treatment in 2017 (Do-It-Yourself Teeth Straightening (Trans.2017:XXX)).50
2) Consumption of Fluoridated Water
Much of the literature evaluated in systematic reviews examining the association between consumption of fluoridated water and reduced levels of caries in primary and permanent dentition derives from studies conducted before the 1980’s.51 One experiment, in which a Canadian community discontinued its community water fluoridation to allow for the comparison of caries rates within a socioeconomically similar, adjacent community which maintained its water fluoridation demonstrated a significant increase in primary tooth decay and an increasing trend for increased decay in permanent dentition 2.5 – 3 years post cessation among residents who reported usually drinking tap water.52 In 2016, the U.S. Surgeon General expressed the view that community water fluoridation was an important component for developing a culture of disease prevention and helping to ensure health equity for all.53 The ADA’s most recent resolution supporting community water fluoridation was passed in 2015 (Operational Policies and Recommendations Regarding Community Water Fluoridation (Trans.1997:673; 2015:273).50
3) Use of Tobacco Products
While the various forms of tobacco have a variety of health consequences, the oral consequences of cigarette smoking54 and smokeless tobacco products55 can include adverse effects on gingival health, enamel discoloration and erosion, and oral cancer. For these reasons, the ADA has long advocated for smoking and tobacco cessation initiatives both at the policy (Policies and Recommendations on Tobacco Use (Trans.2016:323))50 and practice levels.
4) Oral Piercings
The literature on the oral consequences of oral piercings show tooth fracture, tooth wear and gingival recession among the commonly reported adverse events, and the ADA established policy discouraging oral piercing in 1998 ( Policy Statement on Intraoral/Perioral Piercing and Tongue Splitting (Trans.1998:743; 2000:481; 2004:309; 2012:469; 2016:300).50