Transcript
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…
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