Prevention Of Dental Caries PDF

Prevention of dental caries Presented by dr: mohira ezzeldin Dental caries – Dental caries is a preventable disease of the mineralized tissues of the teeth with a multi-factorial aetiology related to the interactions over time between tooth substance and certain micro-organisms and dietary carbohydr...

Prevention of dental caries Presented by dr: mohira ezzeldin Dental caries – Dental caries is a preventable disease of the mineralized tissues of the teeth with a multi-factorial aetiology related to the interactions over time between tooth substance and certain micro-organisms and dietary carbohydrates producing plaque acids.  There are four practical factors to the prevention of dental caries:  Plaque control/ tooth brushing.  Diet control. home  Fluoride.  Fissure sealing. professional Plaque control 1. Mechanical plaque removal by the individual 2. Mechanical plaque removal by the dental professional 3. Chemotherapeutic method of plaque control 1. Mechanical plaque removal by the individual: A. Tooth-brushing o The toothbrush is the most common method for removing plaque from the oral cavity. o Tooth brushing should start with the eruption of the first tooth at about 6 month o Tooth brushing should be performed on at least two occasions every day. o Numerous types of brushes (manual and powered) and toothpastes are available.  Manual tooth brush Most commercially available toothbrushes are manufactured with synthetic (nylon) bristles. Toothbrushes are classified as soft, medium, or hard based on the diameter of these bristles. The soft brush is preferable because of :  decreased likelihood of gingival tissue trauma  increased interproximal cleaning ability. a toothbrush with a smaller head and a thicker handle is preferred. It is best to replace the toothbrush when it appears well worn(approximtely 3 months) – Use the correct amount of a toothpaste with ageappropriate fluoride concentration – Under 3 years old: use a small smear of paste – containing not less than 500 ppm fluoride. – 3–6 years inclusive: use a pea-sized amount of – paste containing not less than 1000 ppm fluoride. – 7 years old or over: use paste containing 1350-1500 ppm fluoride. Summary of tooth brushing techniques:Method Starting position Tips of bristles Direction of bristles Movements* Scrub On gingival margin Horizontal Scrub in antero-posterior direction, keeping brush horizontal. Roll On gingival margin Pointing axially, parallel to the long axis of the teeth. Roll brush occlusally, maintaining contact with gingival, then with the tooth surface. Bass On gingival margin Pointing apically, about 45° to the long axis of the tooth. Vibrate the brush, not changing the position of the bristles. Stillman On gingival margin Pointing apically, about 45° to the long axis of the tooth. Apply pressure to blanch the gingival, then remove. Repeat several times. Slightly rotate the brush occlusally during the procedure. Modified Stillman On gingival margin Pointing apically, about 45° to the long axis of the teeth. Apply pressyre as in Stillman method, but at the same time vibrate the brush and gradually move it occlusally. Fones On gingival margin Horizontal With the teeth in occlusion, move the brush in a rotary motion against the maxillary and mandibular tooth surfaces and gingival margins. Charters Level with occlusal surfaces of teeth Pointing occlusally, about 45° to the long axis of the teeth Vibrate the brush while moving it apically to the gingival margin. * Systematic approach to teeth brushing Recommended Tooth brushing technique  Horizontal scrub- most successful (for children).  Roll method(recommended for mixed dentition)  Modified Bass( for adult) – Children do not have the manual dexterity to brush their teeth effectively until they can tie their own shoelaces (about 7 years of age). – The caregiver must brush the child teeth until 7 years then supervised child until 12 years while the child attempts to do so himself.if any area doesn’t clean by child the care giver clean it for him or her (active supervision) A simple message for patients  ‘Brush your teeth first thing in the morning and last thing at night’.  Brush your teeth at least two time per day  Brush for at least two minutes twice daily.  Spit don't rinse.  Powered mechanical plaque removal decrease the need for dexterity by automatically including some movement of the toothbrush head.(useful for special need children) Powered toothbrushes removed significantly more plaque than the manual toothbrushes for children B. Interdental cleaning aids : o dental floss, o Inter dental brush o Tooth picks o Flossing  interproximal cleaning beyond brushing is necessary  Several different types of floss are available:  flavored and unflavored.  waxed and unwaxed.  thin, tape, and meshwork.  made of nylon or Teflon material (polytetrafluoroethylene)  Almost all commercially available floss is made of nylon  Unwaxed nylon filament floss has generally been considered the floss of choice.  Floss-holding devices are an excellent alternative when the dexterity of the parent or child prevents handholding of floss  Below 6 Years o making flossing unnecessary. o if tight interproximal contacts are present, the parent should floss these areas.  6 - 9 Years initiate flossing instruction and parental involvement is required to insure proper technique.  Above 9 Years a child has developed the manual dexterity to floss unaided by the parent. Parental supervision should be encouraged. 2. Mechanical plaque removal by the dental professional: It is carried out with rotating rubber-cup and fluoride containing polishing paste. It is used for children with special needs. 3. Chemotherapeutic method of plaque control – Chemotherapeutic agents have been developed as adjuncts in plaque control. certain patients with dental diseases (e.g., periodontitis) or medical diseases (e.g., immunocompromised conditions) require additional assistance to maintain a normal state of oral health. Chlorhexidine, a positively charged organic antiseptic agent. – It has the ability to reduce plaque and gingivitis scores. – It has strong substantivity, (binding well to many sites in the oral cavity and maintaining an ongoing antibacterial presence). – chlorhexidine has been used in oral rinses, dentifrices, chewing gum, varnish, and gel.(t is used most often in the form of a prescription oral rinse). – Plaque growth can be prevented by twice-daily rinsing with 10 ml chlorhexidine O.12%  side-effects of chlorhexidine – changed taste sensation, – poor taste. – tooth staining.  so it is usually recommended for short term use only to aid periodontal care. Disclosing agent – Several agents have been developed to allow for patient visualization of plaque. – These disclosing agent is used for motivation and education –. These include iodine, gentian violet, erythrosin, basic fuchsin, fast green, food dyes, fluorescein, and two-tone disclosing agent. – a plaque disclosing agent commonly used are: o a liquid to be dabbed onto the teeth with a cotton swab. o a chewable tablet Initially advisable to instruct patients to use the disclosing agent prior to tooth brushing. After a week it is advisable for patients to brush first and then disclose in order to identify areas that are being missed The dye stains the oral soft tissues and dental pellicle, as well as the plaque(except Fluorescein). Dietary advice Factors that determined the cariogencity of the food: Chemical composition of the food.(Food must contains fermentable carbohydrates to be potentially cariogenic. Physical form of carbohydrate. Sticky Frequency of eating meals and snacks.(most important) caries risk The most cariogenic food is simple carbohydrate The commonest simple dietary sugar and the most cariogenic is sucrose.(Found in table sugar, candies, jam, soft drinks, and sugar-containing medications (syrups). Dietary advice should be on two levels:  basic advice.  advice after diet analysis of children with a caries problem.  Your Advise (diet counseling)  Reduce frequency and amount of intake of fermentable carbohydrates.  Sweets are not to be eaten between meals or at bedtime.  Emphasize foods that require chewing, stay away from soft/sticky foods.  Restrict food and drinks containing sugar to no more than four occasions in any one day.  Only milk or water should be served in the nursing bottle.     Recommendation for soft drink: Serve only at meal time Use straw whenever possible don’t give the soft drink for child at bed time or during the night.  Drink only water or milk between meals.  Brush teeth after meals and ALWAYS at Bedtime  Diet analysis : 3-7 days record Diet analysis The diet diary allows us to see (if done properly) what sorts of insults and onslaughts your teeth are facing on a daily basis. Everything you eat and drink should be recorded. Your dentist will look at the findings with you and help you to identify any problem areas; perhaps hidden sugars that you may not be aware of, the dairy was filled by the parent during school holiday Sugar substitutes Two types: I. Bulk sugars: sorbitol, manitol, xylitol Can be very slowly metabolized by bacteria can have a laxative effect and should not be given to children below 3 years of age II. Intense sweeteners Saccharin, aspartame: The intense sweeteners and xylitol are non-cariogenic; Xylitol( NON SUGAR SWEETENERS) Xylitol is a fie-carbon sugar alcohol derived Xylitol reduce levels of mutans streptococci (MS) in the plaque and saliva. reduced adhesion of (MS) to the teeth and other reduced acid production. Xylitol products Xylitol is available in many forms (e.g., gums, mints, chewable tablets, lozenges, toothpastes, mouthwashes, cough mixtures, oral wipes, nutraceutical products).