Overview Introduction Need for prevention Aims of prevention Levels of prevention Methods to control caries Current methods pf prevention Infant oral health care

INTRODUCTION

Definition of dental caries?“Dental caries is an irreversible microbial disease of

the calcified tissues of the teeth, characterized by demineralization of the inorganic portion and destruction of the organic substance of the tooth , which often leads to cavitation” 

NEED FOR PREVENTION

Symptomatic treatment is intensive The cost of treatment is high Compromises nutrition Results in dysfunctional speech Causes severe pain

AIMS OF PREVENTION

Limiting pathogen growth and metabolism

Limitation of caries activity Early detection of incipient

caries Identification of high risk

patients

LEVELS OF PREVENTION

Primary prevention Secondary prevention Tertiary prevention

1. Primary prevention Actions taken prior to the onset of the disease,

which removes the possibility that the disease will ever occur.

By plaque control programme, caries activity test, patient education, topical application, pit and fissure sealants.

LEVELS OF PREVENTION

2. Secondary prevention Limits the progression and extent of a disease at

as early stage as possible after onset.

By preventive resin restoration, pulp capping.

LEVELS OF PREVENTION

3. Tertiary prevention Limits the extent of disabilities once a

disease has caused any functional limitation.

By complex restorative dentistry.

LEVELS OF PREVENTION

METHODS TO CONTROL CARIES

Chemical methods Nutritional methods Mechanical methods

1. Chemical methods Substances which :• Alter the tooth surface or structure.• Interfere with carbohydrate degradation

through enzymatic alteration.• Interfere with bacterial growth and metabolism.

METHODS TO CONTROL CARIES

1.Alter the tooth surface or structure

Fluorides Iodides Bisbiguanides Silver nitrates Zinc chloride and potassium

ferrocyanates

CHEMICAL METHODS

FLUORIDESMechanism:• Precipitates fluorapatite• Remineralisation• Mineralisation on hypomineralised areas• Interferes with bacterial enzymatic process• Modifies tooth morphology

CHEMICAL METHODS

CHEMICAL METHODS

FLUORIDES Delivery Methods

SYSTEMIC FLUORIDES

TOPICAL FLUORIDES

1.Professionally applied :-Prophylactic paste• In high risk caries patients• Clean and supply fluoride in one step• Contain zirconium silicate abrasive

1.Professionally applied Cont... :-Fluoride solutions• Sodium fluoride• Stannous fluoride

TOPICAL FLUORIDES

1.Professionally applied Cont... :-Fluoride gels• Acidulated phosphate fluoride gel (APF)

TOPICAL FLUORIDES

1.Professionally applied Cont... :- Fluoride varnishes• Provide high uptake of fluoride into enamel• Cost effective

TOPICAL FLUORIDES

2. Self applied :-Fluoride dentifrices• Sodium fluoride• Stannous fluoride• Sodium monofluorophosphate• Spitted rather than rinsing

TOPICAL FLUORIDES

2. Self applied :- Fluoride mouthrinses• Sodium fluoride• APF• Along with topical or

systemic application

TOPICAL FLUORIDES

CHLORHEXIDINEBisbiguanideAntisepticAntibacterial

CHEMICAL METHODS

Disadvantages of fluorides&bisguanides : • Stains teeth• Bacterial resistance• Bitter taste• Mucosal irritation• Allergic reaction

CHEMICAL METHODS

2. Interfere with carbohydrate degradation through enzymatic alteration

Vitamin K: Prevents acid formation in mixtures of glucose and saliva

Sarcoside: sodium-N-lauryl sarcosinate and sodium dehydroacetate

CHEMICAL METHODS

3. Interfere with bacterial growth and metabolismUrea and ammonium compounds: • Anticariogenic agents• Gram positive bacteria

Chlorophyll: • Reduces the pH fall

CHEMICAL METHODS

Nitrofurans: • Bacteriostatic and bactericidal• Aerobic and anaerobic bacteria

Antibiotics:• Penicillin,Erythromycin,Kanamycin

Caries vaccines

CHEMICAL METHODS

3. Interfere with bacterial growth and metabolism

Restriction of refined carbohydrate intake

Avoiding sugar in between meals

Phosphated diet

NUTRITIONAL METHODS

Foods with anticariogenic effects:

• Milk- contain lactose (least cariogenic)

• Cheese- casien phosphatase

• Fibrous foods- raw vegetables,grains

• Sugar substitutes & artificial sweetners -

xylitol,mannitol,sorbitol

• Tea- green and black tea

NUTRITIONAL METHODS

XYLITOL

Prevents Streptococcus mutans from binding to sucrose

Neutralises plaque acidsIncreases salivary flowBacteriostaticEnhance remineralisation

DENTAL EROSION

Dietary acidsSoft drinks, fruit juices,

vinegarPrevention: Not to brush

teeth for atleast 1 hr after consumtion of such foods and drinks.

Oral prophylaxis Tooth brushing Interdental cleaning aids Disclosing agents Oral irrigators Detergent foods Salivary stimulants Pit and fissure sealants

MECHANICAL METHODS

ORAL PROPHYLAXIS

Decreases the formation of dental plaque by careful polishing

Scaling

Types :• Manual• Powdered• Sonic and ultrasonic• Ionic

Methods :• Modified bass method• Charters method• Circular method• Sulcular method

TOOTH BRUSHING

SULCULAR METHOD

TOOTH BRUSHING

Dental floss :• To remove plaque and dislodged

irritating matter• Nylon,yarn,teflon• Waxed or unwaxed• Where interdental papillae fill the

interdental spaces

INTERDENTAL CLEANING AIDS

Dental floss

INTERDENTAL CLEANING AIDS

Wooden sticks:• Soft, triangular,

wooden toothpicks.• In patients with

gingival recession

INTERDENTAL CLEANING AIDS

Interdental brushes:• Cone shaped brushes• In patients with wide

interdental spaces

INTERDENTAL CLEANING AIDS

Single tufted brushes:

• Single tuft

• In areas of malalignment

INTERDENTAL CLEANING AIDS

Solutions, tablets or wafers.

ErythrosinStains bacterial plaque

DISCLOSING AGENTS

Flushing devices To deliver anti-

microbial agents

ORAL IRRIGATORS

Fibrous food prevents lodging of food

DETERGENT FOODS

AntibacterialBuffering&flushing actionXerostomia

SALIVARY STIMULANTS

Dental resin Isolates pit and

fissures Types:• GIC• Resin sealants

PIT AND FISSURE SEALANTS

Lasers Genetic modalites Polymeric coatings Caries vaccines Active and passive immunisation

CURRENT METHODS

Reduces rate of demineralisation

Argon laser

LASERS

Organisms• Strains of streptococcus mutans that lack lactate

dehydrogenase• Lactobacillus zeae.

Food:• Fruits• Interfere with enzymatic pathways of

streptococcus mutans

GENETIC MODALITIES

Increase the resistance

POLYMERIC MODALITIES

Stimulates production of protective antibodies.

CARIES VACCINES

ACTIVE IMMUNISATION

Monoclonal antibodies Bovine milk Egg yolk antibodies Transgenic plants

PASSIVE IMMUNISATION

Synthetic peptides Coupling with cholera toxin

subunits Fusing with salmonella Liposomes

NEWER APPROCHES TO VACCINES

Guidelines to parents :• Should bring their child for his/her

first dental visit.• Avoid frequent use of bottles with

sugar containing milk or drinks {nursing bottle caries}

• Clean the gums and later teeth with soft brush after every meal or before sleep.

INFANT ORAL HEALTH CARE

- It is imperative that we, as dentists should focus on treating not only those who are ill, but also treat those who are more likely to get ill…

• Text