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Caries prevention
Caries prevention
Reduce the numbers of cariogenic bacteria
Preventive treatment methodes are designed to limit tooth
demineralization caused by cariogenic bacteria
• By limiting pathogen growth
• Its metabolism
• Increasing resistance of the tooth surface to
demineralization
Caries control
• Are the operative methods used to :
• stop the advance of individual lesions
• prevent spread of pathogenic bacteria to other tooth
surfaces
• Cavitated lesions should be treated in short period of time
• Fluoride treatment makes tooth surface more acid resistant,
and in same circumstances can arrest active caries
• Identify the patients with high caries risk
• Consider the patient resistance to infection by cariogenic
bacteria
• Design appriopriate treatment plan
• Reduce the numbers of cariogenic bacteria
Identification of the patients with high caries
risk
Identification of the patients with high caries
risk
Identification of the patients with high caries
risk
Identification of the patients with high caries
risk
Identification of the patients with high caries
risk
Identification of the patients with high caries
risk
Patients resistance to the cariogenic bacteria
The factors:
• General health status
• Function of immune system
• Saliva production
• Fluoride exposure history
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Diet
Oral hygiene
Use of antimicrobial agents
Dental care
General health status
• Patients undergoing radiation or chemiotherapy treatment
are immunocompromised
• All patients with chronic illnesses, taking a lot of
medications which idividually or in combination reduce
salivary flow
• Medications:Antispasmodic, antidepressants, antipsychotic,
parkinsonian, arrhytmia medications, antihistamine, appetite
depressants, anticonvusant, anxiolytic, antihypertensive, diuretic,
skeletal muscle relaxants
Patient with chronic diseases
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They shoud be examined for
Plaque index ; for purpose of reducting high score
Salivary flow;
Oral mucosa; red glossy
Gingiva; puffy, red
Teeth with signs of demineralization
Saliva production
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Saliva is important in caries prevention
Normal salivary flow is about 0.5-1 litre per day
Stimulated salivary flow is about 1.0-3.0ml per minute
Without stimulation is 0.25-0.35ml per minute
Consultation with physician may be neccesery to identify
alternate treatment with lower impact on salivary flow
• Use of salivary stimulants:gums, paraffin waxes, saliva
substitutes may be helpful
diet
• Dietary sucrose has two imporant effects on the plaque
• 1.frequent ingestion of the sucrose provides stronger
potential for coloniation by SM, enhancing the caries
potential of plaque
• 2. Mature plaque rapidly metabolizes the sucrose into the
organic acids, which provide long pH drop
• High frequency of ingested sucrose strongly stimulates the
caries activity
Xylitol gums
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Xylitol is natural five-carbon sugar
It keeps the sucrose molecule from binding with MS
MS cannot metabolize xylitol
Xylitol reduces MS by altering their metabolic pathways
Enhences remineralization
helps arrest caries
It is recomended that patient chew a xylitol gum after
eating or snacking for at least 5 minutes
• Chewing stimulates salivary flow and enhances buffering
of pH drop that occurs after eating
Diet sheet
• Dietary advice should be given based on a diet sheet
• On that sheet the frequency of suger intake should be
marked
morning
8 am
breakfast
9 am
mid day meal
12
afternoon
14 pm
Evening meal
18
Evening & night
21
Dietary modification
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Eat the sweets just at the end of the meal
Have a sucrose brakes
Have a sugerfree snacks
Drink a lot of mineral water insted of drinking juices
Oral hygiene
• Plaque free surfaces do not decay
• Daily removal of the plaque by brushing, flossing and
rinsing is highly effective in caries prevention
• Pits and fissures are not accessible becouse of the small
diameter of their orifices, obturation of them by sealants is
highly effective method
• High-risk patients should perform plaque removal after
every meal
• Adults with low caries risk should remove the plaque twice
a day
Flossing
• Persuade the patient that flossing should be the one of
routine plaque control procedures
• Handle the floss by winding it on the ring finger of the
operating hand and ring finger of the other hand
• Anchoring the ends by the second loop overlapping the first
• The remaining lengh should be about 15 cm
• The braced technique is necessary for passing the floss
through contacts atraumatically
• Each contact should be cleaned with fresh section of the
floss
Oral hygiene
• Brushing with soft toothbrush with Bass method
• The bristles are held at 45-degree angle to the tooth surface
and vibrated into the gingival sulcus
• Rinsing follows brushing and flossing
fluoride
• Increases the resistance of the tooth structure to
demineralization
• Reduces the caries activity
• Is essential nutrient for humans that is required in small
quantities
Fluoride availability
• Fluoridated community water systems, the most successful
method
• Diet
• Toothpastes
• Mouthrinses
• Topical professional applications
Fluoride doses
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Optimal daily dose for fluoride ion is 1.5-2mg
The food brings 0.2-0.5mg
The water should have 1mgF\1litre so 1 part per milion
The fluoride tablets contains 0.55mg ,0.25mg Zymafluor
The indication for the fluoride systemic treatment is in
children in regions where the fluoride contant in the water
is below 0.7mg
• for little children fluor drops are indicated
Fluoride anticaries mechanisms
• 1.Enhaces the precipitation into the tooth structure of the
fluoroapatite from calcium and phosphate ions in saliva
• Insoluble precipitate replaces soluble salts that were lost in
demineralization process
• The enamel becomes more acid resistant
• Incipient caries non cavitated lesions become remineralized
• 2. Antimicrobial activity:inhibition of enzymic production
of glucosylotransferase
• In high concentrations fluride is toxic to oral
microorganisms:MS
Best methods of fluoride application
• Children with developing permanent teeth :
• Systemic fluoride treatment through water supply
• Dietary supplementation is indicated when water is not with
fluoride
• Semiannualy topical fluoride application
• Adults at high caries risk also need semiannualy topical
fluoride application
Adults with high caries risk
• Fluoride mouthrinses
• Topical fuoride application
• systemic fluoride treatment
Fluoride mouthrinses
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High dose0.2%F\low frequency rinses used once a week
Low dose0.05%F\high frequency rinese once a day
Have similar effectiveness
For patients who have high risk of caries & patients
exibiting recently increase in caries activity
Flouide varnishes
• Provide high uptake of the fluoride ion into the enamel
• Clinician applies a thin layer of the varnish directly on the
teeth
• Application time is several minutes
• Patients are to avoid eating for several hours and than avoid
brushing until next morning