Prevention of Dental Caries

1. Prevention of Dental Caries

2. Prevention of Caries

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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...

10. Approaches to prevention of caries:- 3. Diet (external modifying risk factor): Intake of fermentable carbohydrates especially sucrose , but also starch.

11. Approaches to prevention of caries:- 4. Time: Total exposure time to inorganic acids produced by the bacteria of the dental plaque.

12. 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.

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

14. 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.

15. 1-Preventive Program for the Individual at Home

16. Preventive program for the individual at home includes: • I- Oral hygiene measures. • II- Fluoride administration. • Ill- Diet and its oral effect.

17. 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.

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

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

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

21. b) Therapeutic mouth rinses: such as dextranase, chlorohexidine and fluorides. The only recommended antibacterial agent for caries other than fluoride is the chlorohexidine(CHX).

22. 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.

23. 3-Maintains suppression of streptococcus mutans for at least six weeks following discontinuation. • 4- Inhibits caries formation by decreasing acid production.

24. 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.

25. 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.

26. Side effect of Chlorohexidine are:- • 1- Staining of teeth. • 2- Some patients find the taste offensive. • 3- Inflammation of gingiva may occur.

27. 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.

28. Tooth brushing It is most widely form of oral hygiene measure. Type of brush Brushing technique • Manual • Powered • Ionic • Sonic or ultrasonic Dentifrices

29. 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 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

31. Manual vs. Powered 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

32. 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

33. 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

34. 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

35. Techniques of Toothbrushing 1. Scrub technique 2. Fones technique

36. Techniques of Toothbrushing 3. Roll technique - 450 apically towards A.G. 4. Charters technique - 450 occlusally lateral, downward pressure.

37. 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

38. Interdental oral hygiene aids Tooth brushing alone cannot effectively control interproximal plaque

39. 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

40. Interdental oral hygiene aids 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

41. Spool method Recommended for teens and adults with good neuromuscular coordination and mental maturity

43. Interdental oral hygiene aids 2 Interdental brushes Indications Large embrasures Diastemas Exposed root furcation Orthodontic and fixed appliances Application of fluoride or desensitizing agents

44. Interdental oral hygiene aids 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

45. Adjunctive 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)

46. 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.

47. Dentifrices 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

48. Calcium carbonate and calcium phosphate react adversely 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

49. - 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.

50. Diet Modification