Prevention of dental caries
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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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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.


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.


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.



Importance of caries risk assessment
Importance of Caries Risk Assessment:- caries are:

  • 1- Targeting those in most need.

  • 2- Greater effectiveness of preventive procedures.

  • 3- Appropriate level of care.

  • 4- Economic efficacy and cost control.



Preventive program for the individual at home includes
Preventive program for the individual at home includes: caries are:

  • I- Oral hygiene measures.

  • II- Fluoride administration.

  • Ill- Diet and its oral effect.


I oral hygiene measures
I- Oral hygiene measures: caries are:

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: caries are:

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


  • Rinsing the caries are: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 caries are::

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


  • b) caries are: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 caries are::-

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

  • 2- Has selective effect against cariogenic bacteria.


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

  • 4- Inhibits caries formation by decreasing acid production.


Mode of application
Mode of application: caries are:

  • 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: caries are:

  • 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:- caries are:

  • 1- Staining of teeth.

  • 2- Some patients find the taste offensive.

  • 3- Inflammation of gingiva may occur.


Tooth brushing
Tooth brushing caries are:

  • Brushing should start in infancy.

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


Tooth brushing caries are:

It is most widely form of oral hygiene measure.

Type of brush

Brushing technique

  • Manual

  • Powered

  • Ionic

  • Sonic or ultrasonic

Dentifrices


Manual Tooth Brush caries are:

  • 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

Handle

Tufts

Shank

  • 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

Bristles


Manual vs. Powered caries are:

Manual

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


Relative Indications for Powered brush caries are:

  • 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


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 charged electrons

  • 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 charged electronsToothbrushing

1. Scrub technique

2. Fones technique


Techniques of toothbrushing1
Techniques of charged electronsToothbrushing

3. Roll technique

- 450 apically towards A.G.

4. Charters technique

- 450 occlusally lateral, downward

pressure.


Bass method charged electrons

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 charged electrons

Tooth brushing alone cannot effectively control interproximal plaque


Interdental oral hygiene aids1
Interdental oral hygiene aids charged electrons

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 charged electrons

Waxed

1

Dental floss

unwaxed

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


Spool method charged electrons

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


Interdental oral hygiene aids charged electrons

2

Interdental brushes

Indications

Large embrasures

Diastemas

Exposed root furcation

Orthodontic and fixed appliances

Application of fluoride or desensitizing agents


Interdental oral hygiene aids charged electrons

4

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


A charged electronsdjunctive Aids

dental irrigation device

Cosmetic

to decrease halitosis

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

May be also used with antimicrobial agent

Therapeutic

( dextranase, CHX, Fl)


Sewak charged electrons 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.


Dentifrices
Dentifrices charged electrons

Therapeutic

Cosmetic

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

Ingredients

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


Calcium carbonate and calcium phosphate react charged electronsadversely with fluoride ions

Most dentifrices now use silicon oxides and insoluble sodium monophosphate abrasives

Abrasives

They give the foaming action of a dentifrice

They clean tooth surface

Sodium lauryl sulfate is the most common and has antibacterial effect

Detergents


Disclosing agent
- charged electronsDisclosing 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 charged electrons


Diet modification1
Diet Modification charged electrons

1

  • 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

2

Diet Analysis

Diet history assessment


CARIES RISK charged electrons

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. charged electrons

3

  • 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 charged electrons

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

Xylitol

Sorbitol

Mannitol

Saccharin

Aspartame

sucralose



Fluoride- containing dentifrice charged electrons

  • 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: charged electrons

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


Fluoride tablets and supplements
Fluoride charged electronstablets 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 charged electronsMouth 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.


  • Mouthrinse charged electrons 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 charged electronsFluoride Gels:

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


  • The gel is left on the teeth charged electronsfor 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.




All preventive programs in the dental office include
All Preventive Programs in the Dental Office Include: charged electrons

  • I- Oral hygiene instruction.

  • II- Fluoride therapy.

  • III- Sealant application

  • IV- Diet control.


Professional topical application of fluorides
Professional charged electronstopical 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: charged electrons

  • 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: charged electrons

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




Semislow release and slow release fluoride
Semislow-release and slow-release fluoride particularly NaF+ chlorhexidine have combined fluoride and antiplaque effects.

  • 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.



The preventive programs for the community include
The preventive programs for the Community include: particularly NaF+ chlorhexidine have combined fluoride and antiplaque effects.

  • 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 particularly NaF+ chlorhexidine have combined fluoride and antiplaque effects.of Mr. Happy-ToothThank You


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