ecc and risk assessment handout

8/6/2019 ECC and Risk Assessment Handout

1/42

Proven prac+cal preven+onAnd the children in your prac+ce


2/42

Thank You


3/42

Trends in Oral Health Status

Tooth decay in primary teeth ofchildren aged 2 5 between 1988

1994 and 1999 2004 increased from24 28%CDC 2007 oral health report


4/42

The Caries Sequence

Low IntraoralpH


5/42

Deni+on ECC S-ECCECC = early childhood caries

The presence of one ormore decayed, missing orlled tooth in a child 71months of age or younger.

S-ECC = severe earlychildhood caries< 5 yrs any smooth

surface lesion

3 yrs DMFT of 44 yrs DMFT of 55 yrs DMFT of 6

AAPD reference manual 2010


6/42

What is Risk Assessment?

An es+ma+on of thelikelihood that an event willoccur in the future.


7/42


8/42


9/42


10/42


11/42


12/42


13/42

Disease Indicators for Children

Mother with ac+ve caries Socio economic risk Visible cavita+ons Cavity in the last 2 years Obvious white spot lesions


14/42

Risk Factors for Children (in

descending order) Obvious Plaque Gingiva bleeds easily Inadequate saliva ow Appliances No dental home Medica+ons Bo le use con+nuous or

nurses on demand Bo le use at bed Frequent snacking


15/42

Salivary Flow To determine salivary ow ratehave your pa+ent chew on a paraffinpellet for 1 minute and then spit intoa cup for 3 5 minutes. Flow rate = ml / min. > 1 ml / min is considered normal ow


16/42

pH tes+ng


17/42


18/42

Association between caries andbacterial levels in infants and toddlers.

MS count was highest in children with ECC, lowest in those without

caries, and intermediate in those with incipient lesions The salivary level of LB was highest in children with ECC, but these

bacteria were present at lower levels in children with incipient lesionsand in those with no caries

MS and LB threshold levels associated with caries were lower than those

considered signicant in older children and adults

Francisco J. Ramos-Gomez, Jane A. Weintraub, Stuart A. Gansky, Charles I. Hoove, John D. B.Featherstone. Bacterial, behavioral and environmental factors associated withearly childhoodcaries J Clin Pediatr Dent 26(2): 165-173, 2002


19/42


20/42

Dentocult SM - Strip mutans Test Used to detect S mutans

in saliva and plaque. Based on the use of a

selec+ve culture brothand the adherence andgrowth of S mutansbacteria on the test strip.

Shows S mutans as dark-

blue to light-blue, raisedcolonies on the surface ofthe test strip.


21/42


22/42

Dentocult Tests


23/42

ADA Council on Scien+c Affairs

GuidelinesHIGH CARIES RISK( < 6 years)Any of the following:

Any lesion in the past 3year Mul+ple risk factors Low socioeconomic

status

Insufficient uorideexposure Xerostomia.

HIGH CARIES RISK

( > 6 years)Any of the following: 3 or more lesions in the

past 3 years Mul+ple risk factors Insufficient uoride

exposure Xerostomia.

JADA August 2006 Special Supplement


24/42

The BalanceUnhealthy

ToothHealthy

Tooth

FLUO RIDE

GOO D DIET

GOO D O H

ANT IBAC T ERIALT HERAPY

FREQ UENT SNAC K ING

P OO R ORAL HY GIENE

AC ID PRO DUC ING BAC T ERIA

JDB Featherstone, J Dent Res 83 (Sp Issue C) C39 C42, 2004


25/42

Tools

1) Behavioural:DIET, ORAL HYGIENE

2) Therapeu+cChlorhexidine, xylitol, FLUORIDE VARNISH,

FLUORIDE

3) Repara+ve

sealants, GI


26/42

Pictograms


27/42


28/42

Fluoride Toothpaste The subjects were required to drink 500 mL

of a 120-gm/L sugar solu+on either once, 3,5, 7, or 10 +mes/day for 30 sec on eachoccasion, for a period of 5 days.

While brushing their teeth twice daily witheither a F (1450 ppm NaF) or a F-free

toothpaste. Mineral analysis revealed that when thesubjects used a F toothpaste, netdemineraliza+on was evident only with theseven- and 10-+mes/day regime (ns).

When F-free toothpaste was used,sta+s+cally signicant demineraliza+on wasobserved when the frequency exceeded 3+mes/day.

Duggal MS, Toumba KJ, Amaechi BT, Kowash MB, Higham SM(2001). Enamel demineraliza+on in situ with various frequencies of carbohydrate consump6on with and without uoride toothpaste. J Dent Res 80:17211724.


29/42

Gel vs. Varnish

Gel evidence isinconclusive for efficacy,none less than 4 minute

applica+on. Varnish ease of

applica+on, be erpa+ent compliance, less

swallowed. American Dental Associa+on Council

on Scien+c Affairs, 2006


30/42

Clinpro White Varnish Releases Calcium in the

form of TCP Takes just seconds to

paint on Sets rapidly in the

presence of saliva Flows well Contains 22,600 ppm

Fluoride Classied as a natural

health product Mint, cherry, or melon,


31/42

What is Tri-Calcium Phosphate?

Stable crystal structure similar to natural toothmineral (hydroxyapa+te- HAP) Predictable chemical proper+es Biocompa+ble and bioac+ve

Coated calcium mineral does not bind to uoridein the Vanish formula+on Op+mized to release calcium & phosphate at the

tooth surfaceKarlinsey RL, Mackey AC, Walker ER, Frederick KE. Prepara+on, characteriza+on and in vitro efficacy of an acid-modied beta-TCP

material for dental hard-+ssue remineraliza+on. Acta Biomaterialia 2010;6:969-978

Vanish 5% Sodium Fluoride White Varnishwith Tri-Calcium Phosphate

3M ESPE 2007. All Rights Reserved


32/42

The Studies Several recent studies have shown that uoride varnish is efficacious in reducingdecay in the primary teeth of high-risk children.

Programs using uoride varnish will be more likely to demonstrate benets andreduce dental caries in at-risk popula+ons when applica+ons are offered at least atsix-month intervals over at least two years in dura+on in combina+on withcounseling. For the preven+on of early childhood caries, ini+a+on of uoridevarnish should begin no later than age one for highest risk children.

Weintraub, Ramos-Gomez, June, 2006Lawrence, Binquis, Douglas et al, 2006


33/42

Before Caries is ObservedThere is evidence that the preven+ve effect is strongest when uoride varnish is

applied before the onset of detectable dental caries.

Randomized clinical trial in Canada,1,146 young aboriginal children with high caries incidencecaregiver counselinguoride varnish three +mes a yeartwo yearsreduc+ons in dental caries of 18% to 25%WHEN INITIATED BEFORE CARIES IS OBSERVED Infants, toddlers and preschool children who were caries free at baseline

beneted most from the interven+on. (Lawrence, Binquis, Douglas et al, 2006)


34/42

CHLORHEXIDINE Bisguanide an+sep+c Mechanism of ac+on is to

damage the cell wall of the micro-organism

Effec+ve on a wide range ofmicro-organisms, including gram ve, ve, anaerobes and yeast.

Adherent over prolonged periodsof +me and thus is its an+-bacterial proper+es are releasedover +me

Its an+ plaque proper+es areunsurpassed

Leads to a decrease in the pHdrop


35/42

Recommended Regimen

Rinse bid for 1 minute with0.12% CHX for one week

Rinse bid for 1 minute witha 0.5% uoride rinse for thesubsequent 3 weeks

Repeat the cycle

For children unable to rinseand spit, brush teeth withCHX


36/42

Xylitol

A natural sugar found inplums, strawberries, andraspberries, xylitol is usedas a sweetener in some

"sugarless" gums andcandies. Not only does xylitol

replace sugars that canlead to tooth decay, italso helps to preventcaries by inhibi+ng thegrowth of bacteria, suchas Streptococcus mutans .


37/42

Mechanism of Ac+on of Xylitol

Not fermented by bacteria Acid is not produced and

the pH is not decreased Demineraliza+on is

prevented andremineraliza+on isenhanced

Reduces the accumula+onof plaque on the surface ofthe tooth.

Xylitol s+mulates salivaryfunc+on

Over +me the bacterialmake up of the plaquechanges allowing for lessand less strep mutans tosurvive


38/42

Recommended Dosage

According to studies the recommendeddosages for cavity preven+on ranged from 4.3to 10 gm per day.

These doses are divided throughout the day,usually a|er meals.

(Frequency of less than 3 +mes per dayshowed no effect) Rekola M Correla+on between caries incidence and frequency ofchewing gum sweetened with sucrose or xylitol. Proc Finn Dent Soc 1989; 85(1): 21 - 4


39/42

Turku studies

DMF of sucrose gum chewers was 2.92 DMF of xylitol gum chewers was 1.04

Scheinin A eta alFinal report of the effects of sucrose fructose and xylitol diets on caries incidence in man. Acta OdontolScand 1976; 34 (4) 179 216.


40/42

Mechanism of Ac+on

Physically obstruc+on of the pits and grooves Prevents coloniza+on

Prevents penetra+on of fermentablecarbohydrates


41/42

Simplied Sealant Technique Brush self etch adhesive onto surface to be sealed; scrub for 15 seconds

applying moderate pressure. Do not shorten this +me. Proper bonding willnot occur if the solu+on is simply applied and dispersed.

Use a gentle stream of air to thoroughly dry the adhesive to a thin lm. A

second layer is not required for bonding sealants. Apply sealant Light-cure the sealant and adhesive together.


42/42

Glass Ionomers

Fluoride releasing bonding and restora+vematerials have been shown to be benecialand are best u+lized as part of acomprehensive preventa+ve program in thedental home

AAPD reference manual 2010/2011 Nowak AJ, Cassamassimo PS The dental home A primary care oral health concept. J Am Dent Assoc 2002;

133 (1): 93 -8.

ecc and risk assessment handout

Documents