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Prevention of Dental Caries. Prevention of Caries. Trends in caries prevalence:. Caries prevalence has decreased significantly among industrialized countries during the last two decades as a result of the wide spread use of preventive programs. . Trends in caries prevalence:.

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Prevention of Dental Caries

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Prevention of dental caries

Prevention of Dental Caries

Prevention of dental caries

Prevention of Caries

Trends in caries prevalence

Trends in caries prevalence:

  • Caries prevalence has decreased significantly among industrialized countries during the last two decades as a result of the wide spread use of preventive programs.

Trends in caries prevalence1

Trends in caries prevalence:

  • In developing countries, the general tend is for caries prevalence to increase.

  • In Egypt, although caries prevalence is low and the trend is not increasing, there is accumulated unmet needs.

Preventive dentistry has three levels

Preventive dentistry has three levels:

1. Primary prevention:

  • The aim is to reverse the progress of the initial stages of disease, or to arrest the disease process before treatment becomes necessary.

Prevention of dental caries

2. Secondary prevention:

  • The aim is to use routine treatment methods to terminatethe disease process and to restore tissues to as near normal as possible.

Prevention of dental caries

3. Tertiary prevention:

  • The aim is to use measures to replace lost tissues and to rehabilitate patients so that the function is as normal as possible.

Approaches to prevention of caries

Approaches to prevention of caries:-

  • Dental caries is a multifactorial disease involving the interplay of several factors:-

    1. Micro flora (etiologic factors): acidogenic bacteria that colonize the tooth surfaces.

Approaches to prevention of caries1

Approaches to prevention of caries:-

2. Host (internal modifying factors): Quantity and quality of saliva, the quality of the tooth, macro and macro-anatomy of the teeth that favor plaque retention. Etc...

Approaches to prevention of caries2

Approaches to prevention of caries:-

3. Diet (external modifying risk factor):

Intake of fermentable carbohydrates

especially sucrose , but also starch.

Approaches to prevention of caries3

Approaches to prevention of caries:-

4. Time:

Total exposure time to inorganic acids produced by the bacteria of the dental plaque.

Accordingly the major strategies directed at reducing caries are

Accordingly, the major strategies directed at reducing caries are:

  • 1. fighting caries-inducing microorganism.

  • 2. Increasing the resistance of the teeth to decay.

  • 3. Modifying caries-promoting diet.

Prevention of dental caries

  • These three strategies should be followed at home by the individual patient, in the dental office and at the community level.

Importance of caries risk assessment

Importance of Caries Risk Assessment:-

  • 1- Targeting those in most need.

  • 2- Greater effectiveness of preventive procedures.

  • 3- Appropriate level of care.

  • 4- Economic efficacy and cost control.

1 preventive program for the individual at home

1-Preventive Program for the Individual at Home

Preventive program for the individual at home includes

Preventive program for the individual at home includes:

  • I- Oral hygiene measures.

  • II- Fluoride administration.

  • Ill- Diet and its oral effect.

I oral hygiene measures

I- Oral hygiene measures:

The objectives of oral hygiene measures:

  • 1- Remove all food debris from tooth surfaces.

  • 2- Maintain the least possible amount of dental plaque.

Oral rinsing

Oral rinsing:

  • Simple oral rinsing is very helpful in clearing fermentable carbohydrates and neutralizes any acid present.

Prevention of dental caries

  • Rinsing the mouth after meal with water is recommended especially at school time and among very young children who are unable to brush.

Types of month rinses

Types of month rinses:

  • a) Cosmetic mouth rinses: whichhelp to reduce halitosis, provide pleasant taste and temporary suppresses the bacterial count.

Prevention of dental caries

  • b) Therapeutic mouth rinses:

    such as dextranase, chlorohexidine and fluorides.

    The only recommended antibacterial agent for caries other than fluoride is the chlorohexidine(CHX).

The effectiveness of chx

The effectiveness of CHX :-

  • 1- Chemical property which causes it to adhere to almost everything giving the drug substantively.

  • 2- Has selective effect against cariogenic bacteria.

Prevention of dental caries

  • 3-Maintains suppression of streptococcus mutans for at least six weeks following discontinuation.

  • 4- Inhibits caries formation by decreasing acid production.

Mode of application

Mode of application:

  • 1- 0.12% rinse on a prescription basis for high-risk patients for short term use (30 days or less).

  • 2- Self applied (1%) chlorohexidine gel may be applied by flossing or in trays.

Mode of application1

Mode of application:

  • 3-Chlorohexidine varnishes are applied once and repeated if streptococci recolonize the oral cavity.

  • 4- 0.05% fluoride combined with 0.12% chlorohexidine mouth rinses in pregnant women can significantly reduce transmission of mutans streptococci to their children.

Side effect of chlorohexidine are

Side effect of Chlorohexidine are:-

  • 1- Staining of teeth.

  • 2- Some patients find the taste offensive.

  • 3- Inflammation of gingiva may occur.

Tooth brushing

Tooth brushing

  • Brushing should start in infancy.

  • Studies have confirmed that the bacteria for dental diseases are present at the eruption of the primary teeth.

Prevention of dental caries

Tooth brushing

It is most widely form of oral hygiene measure.

Type of brush

Brushing technique

  • Manual

  • Powered

  • Ionic

  • Sonic or ultrasonic


Prevention of dental caries

Manual Tooth Brush

  • Made up of different materials, such as acrylic or polypropylene

  • Its flexibility, size and shape must be convenient for manual use in the mouth

  • the handle must be comfortable and rest securely in the hand

  • It should be thick enough to allow a firm grip and good control




  • Made of either polyester or nylon

  • These are inert polymers

  • Nylon has more wear resistant and more hygienic, due to its antistatic properties

  • bristles may be soft(0.15-0.18mm) , medium (0.18-0.23mm) or hard (0.23-0.28 mm).

  • Children brush should always be soft bristled


Prevention of dental caries

Manual vs. Powered



  • Requires manual dexterity and delegacy

  • Incorrect technique can be harmful

  • Effort needed can cause the person to limit time spent on brushing

  • Only minimal effort is needed to brush properly

  • Can be helpful for people with less manual dexterity

  • Head is small in size, can reach all surfaces

  • More helpful in patients with braces

  • Aids in motivation

Prevention of dental caries

Relative Indications for Powered brush

  • Those with physical or learning disability

  • Aged persons

  • Children

  • Fixed orthodontic appliances

  • Institutionalized patients who depend on health providers for oral care

  • Arthritic patients

  • Individuals with poor dexterity

  • Poorly motivated patients

Prevention of dental caries

Light stimulates titanium dioxide rod to generate negatively charged electrons

Positively charged hydrogen ions in plaque’s acid are attracted by the electrons

The acid is neutralized ad plaque breaks down

Ionic brush

Requirements of a satisfactory method of tooth brushing

Requirements of a satisfactory method of tooth brushing

  • The technique should clean all tooth surfaces, specially the area of gingival crevice and the interdental region

  • The movement of the brush should not injure the soft or hard tissue. Certain methods eg., vertical and horizontal scrubbing methods can produce gingival recession and tooth abrasion

  • The technique should be simple to use and easy to learn

  • The method must be well organized so that each part of the dentition is brushed in turn and no area overlooked

Techniques of toothbrushing

Techniques of Toothbrushing

1. Scrub technique

2. Fones technique

Techniques of toothbrushing1

Techniques of Toothbrushing

3. Roll technique

- 450 apically towards A.G.

4. Charters technique

- 450 occlusally lateral, downward


Prevention of dental caries

Bass method

Tips of bristles: on the gingival margin

Direction of bristles: pointing apically, about 45 degree to the long axis of teeth

Movement: vibrate the brush, not changing the position of the bristles

Interdental oral hygiene aids

Interdental oral hygiene aids

Tooth brushing alone cannot effectively control interproximal plaque

Interdental oral hygiene aids1

Interdental oral hygiene aids

Dental floss

  • Removes plaque and debris adherent to interproximal surfaces

  • Polishes proximal surface as it removes plaque

  • Massage the interdental papilla

  • Reduces gingival bleeding

  • Maintenance of general oral hygiene and prevents halitosis

Interdental oral hygiene aids2

Interdental oral hygiene aids



Dental floss


Unwaxed is recommended for individuals with normal tooth contacts

Waxed is recommended for individuals with tight contact, moderate to heavy calculus deposits, crowded teeth, and overhanging restorations

Prevention of dental caries

Spool method

Recommended for teens and adults with good neuromuscular coordination and mental maturity

Prevention of dental caries

Interdental oral hygiene aids


Interdental brushes


Large embrasures


Exposed root furcation

Orthodontic and fixed appliances

Application of fluoride or desensitizing agents

Prevention of dental caries

Interdental oral hygiene aids


Wedge stimulator

Wooden or plastic oral hygiene devices designed for individual cleaning and stimulation, some are treated with xylitol

They are recommended for use only from the facial aspect, where the proximal surfaces are exposed to avoid traumatizing gingiva

Inserted interproximally with the base of the triangle resting on the gingival side

Prevention of dental caries

Adjunctive Aids

dental irrigation device


to decrease halitosis

Eliminate plaque and soft debris by the use of a jet stream of water

May be also used with antimicrobial agent


( dextranase, CHX, Fl)

Prevention of dental caries

Sewak chewing sticks

The miswak, a traditional chewing stick for cleaning teeth, is made from the plant Salvadorapersica

It was concluded that miswak use was at least as effective as tooth brushing for reducing plaque and gingivitis, and that the antimicrobial effect of S. persica is beneficial for prevention/treatment of periodontal disease.





Transports the drug substance to the tooth surface.

Effective to decrease incidence of caries, gingivitis, calculus formation or tooth sensitivity

Cleans, removes materia alba, plaque ,biofilm and food debris


Abrasives 40:50%

Humectant 20-30%

Water 20-30%

Binding agent 1-2%

Foaming agent 1-3%

Flavoring agent 1-2%

Preservative 0.05-0.5

Prevention of dental caries

Calcium carbonate and calcium phosphate react adversely with fluoride ions

Most dentifrices now use silicon oxides and insoluble sodium monophosphate abrasives


They give the foaming action of a dentifrice

They clean tooth surface

Sodium lauryl sulfate is the most common and has antibacterial effect


Disclosing agent

- Disclosing agent:

  • These are harmless dyes that helps the patient to identify plaque and thus, aid in the mechanical removal of plaque by the tooth brush and dental floss.

  • They also help in patient motivation and evaluation of the thoroughness of cleaning.

Diet modification

Diet Modification

Diet modification1

Diet Modification


  • Instruct the patient to write down anything he/she eats or drink

  • For at least 3-7 days including a vacation day

  • Assess fluoride intake


Diet Analysis

Diet history assessment

Prevention of dental caries


Points: [0 ⇔ 1 Low Risk]   [2 ⇔7 Moderate Risk]  [8  ⇔ 9 High Risk]

Diet Analysis for caries risk assessment

Tufts School of Dental Medicine

Dr. Ghada Mahmoud

Diet modification cont

Diet Modification. Cont.


  • Praise good habits

  • Explain healthy balanced diet Decrease consumption of fermentable CHO

  • Restrict sugar intake to meal time

  • Avoid in between meals snacks

  • Select soluble forms and avoid sticky candy

  • Encourage good habits

Remarks & Recommendations

Sugar substitutes

Sugar Substitutes

Non-cariogenic sweeteners are increasingly used to replace sugar in foods, drinks and medicines.

They cannot be fermented by microorganisms to any great extent and so are considered non cariogenic.

Intense Sweeteners

Bulk Sweeteners







Home based methods of fluoride delivery

Home-Based Methods of Fluoride Delivery:

Prevention of dental caries

Fluoride- containing dentifrice

  • 1000 , 1100 or 1500 ppm in the form of:

  • Sodium fluoride: directly provides free Fl, can’t be used with abrasive tooth paste

  • Sodium fluoride/silica combination (recent crest formulation)

  • Sodium monofluorophosphate: can be used with calcium containing abrasives, because it holds fluoride ions in complex form (Colgate)

  • Amine fluoride: the superficial enamel layer seems to be more stable after amine Fl application

  • Stannous fluoride: the original crest formula. Discolors tooth , has astringent taste

Use of an accredited fluoride toothpaste

Use of An Accredited fluoride Toothpaste:

  • Brush twice daily, before going to bed and at one other time during the day just after eating.

Fluoride tablets and supplements

Fluoride tablets and Supplements:

  • Dietary fluoride supplements are administered as single dose, either daily or periodically,

  • therefore they produce much higher peaks of fluoride in the plasma than the multiple divided doses received from the water supply

Fluoride mouth rinses

Fluoride Mouth rinses:

  • Self-applied rinsing using 0.05% sodium fluoride for high-risk individuals who are aged 6 years and over, in addition to fluoridated dentifrice and professional fluoride treatment.

Prevention of dental caries

  • Mouthrinse should be used at different time from brushing, to help maintain a low concentration of fluoride throughout the day.

Self applied fluoride gels

Self-Applied Fluoride Gels:

  • These products contain 0.4% stannous fluoride and are formulated in aqueous gel base that doesn't contain an abrasive system.

Prevention of dental caries

  • The gel is left on the teeth for five minutes to exert its maximum cariostatic effect and the patient is instructed not to rinse, eat or drink for 30 minutes, but he should expectorate the excess gel and not swallow it.

  • This routine is followed on daily basis especially before bed time.

Prevention of dental caries

  • They are prescribed for home use for patients with rampant caries or in high risk patients in areas with or without fluoridated water.

Preventive program at the dental office

Preventive program at the dental office:

All preventive programs in the dental office include

All Preventive Programs in the Dental Office Include:

  • I- Oral hygiene instruction.

  • II- Fluoride therapy.

  • III- Sealant application

  • IV- Diet control.

Professional topical application of fluorides

Professional topical application of fluorides:

  • The following systems are available for professional application:

  • fluoride solutions for painting, gels, prophylaxis pastes, and slow-release agents, such as varnishes and glass-ionomer cements.

Fluoride solutions for painting

Fluoride solutions for painting:

  • The most common fluoride solutions for painting are:

  • neutral 2% NaF (1% F)

  • 8% SnF2 (2% F)

  • acidulated phosphate fluoride (1.23% F).

  • Amine fluoride solutions are also used.

Fluoride gels

Fluoride gels:

  • Fluoride gels for professional use neutral NaF, acidulated phosphate fluoride, SnFa , amine fluoride plus NaF, and by prescription, NaF + chlorhexidine.

Prevention of dental caries

  • For optimal accessibility, the gel is syringed into the posterior interproximal spaces, followed by gel application in a customized tray for more than 4 minutes.

Prevention of dental caries

  • Gels containing SnFa, amine fluoride plus NaF, and particularly NaF+ chlorhexidine have combined fluoride and antiplaque effects.

Semislow release and slow release fluoride

Semislow-release and slow-release fluoride

  • Semislow-release and slow-release fluoride agents, such as fluoride varnishes and glass-ionomer cements, are rapidly growing for professional use, because of the greater cost effectiveness of the slow release of fluoride.

Prevention of dental caries

  • Three major fluoride varnishes are commercially available:

  • Duraphat (5% NaF; 2.3% F),

  • Fluor protector (silan fluoride; 0.1% F) and

  • Bifluorid 12 (6% NaF + 6% CaF2, about 6% F).

The preventive programs for the community include

The preventive programs for the Community include:

  • 1- Oral hygiene instruction.

  • 2-Dietary modification on a public health scale.

    3-Fluorides which include:

  • a) Community water fluoridation.

    b) School water fluoridation.

Figure of mr happy tooth thank you

figure of Mr. Happy-ToothThank You

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