Prevention of Dental Caries

Prevention of Dental CariesMade by, Sonali Kiri (22)Rushda Malek (23)Lakshita Malviya (24)

OverviewIntroductionNeed for preventionAims of preventionLevels for PreventionMethods for PreventionCurrent Methods for preventionMCQSEvidence

IntroductionDefinition 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 leads to cavitation

ETIOLOGY

Need for Prevention Symptomatic treatment is intensiveThe cost of treatment is highCompromised nutritionResult in dysfunctional speechCauses severe pain

Aims Of PreventionLimiting pathogen growth and metabolismLimitation of caries activityEarly detection of incipient cariesIdentification of high risk patients

Levels of PreventionPrimary PreventionSecondary preventionTertiary Prevention

Primary PreventionActions taken prior to the onset of disease, which removes the possibility that the disease will ever occur By plaque control programme, caries activity test, patients education, topical application , pit and fissure sealants

Secondary PreventionLimits the progression and extent of a disease at as early stage as possible after onsetBy preventive resin restoration Pulp capping

Tertiary prevention Limits the Extent of disabilities once a disease has caused any funtional limtationsBy complex restorative dentistry

Methods to Control cariesChemical MethodsNutritional MethodsMechanical Methods

Chemical MethodsSubstances which alter tooth surface or tooth structureSubstances which interfere with carbohydrate degradation through enzymatic alterationSubstances which interfere with bacterial growth and metabolism

I. SUBSTANCES WHICH ALTER TOOTH SURFACE/ TOOTH STRUCTUREChemicals falling into this categories includeFluoridesIodidesBisbiguanidesSilver nitratesZinc chloride and potassium ferrocyanates

FluorideMost widely used and promising chemical in this categoryFluorides have been administrated principally in two waysSystemic applicationeg:- School water fluoridation, community water fluoridation, milk fluoridation, self fluoridationTopical applicationeg:- Sodium fluoride, aciduated phosphate fluoride, stannous fluorideA fluoride concentration of 1 ppm in drinking water is associated with a marked decrease in dental caries

Mechanism of Action of FluorideThe effect of fluoride influencing its anticaries actions are:-Interference in enzymatic process of bacteriaDirect bactericidal actionReduction of plaque formationEnhancement of enamel remineralizationStimulation of formation of fluorappetite crystalLowers the solubility of enamel

Topical Fluorides1. Professionally applied :-Prophylactic pasteIn high risk caries patientClean and supply fluoride in one stepContain zirconium silicate abrasive

Fluoride solutions Sodium FluorideStannous FluorideFluoride GelsAcidulated Phosphate Fluoride Gel (APF)

Fluoride VarnishesProvide high uptake of fluoride into enamelCost effective

Self Applied Fluoride DentifricesSodium FluorideStannous FluorideSodium monofluorophosphate

Fluoride MouthrinsesSodium FluorideAPF

ChlorhexidineBisguanidesAntisepticAntibacterial

Disadvantages of fluorides and bisguanidesStains teethBacterial resistanceBitter tasteMucosal irritationAllergic Reactions

II. SUBSTANCES WHICH INTERFERE WITH CARBOHYDRATE DEGRADATION THROUGH ENZYMATIC ALTERATIONSIncludes:-Vitamin KSarcosideVitamin KVit. K was found to prevent acid formation in incubated mixtures of glucose and salivaSarcosideSodium-N-lauryl sarcosinate & sodium dehydroacetate were promising enzyme inhibitors or antienzymes. They have the ability to reduce the solubility of powdered enamel

III. SUBSTANCES WHICH INTERFERE WITH BACTERIAL GROWTH AND METABOLISMIncludes:-Urea and ammonium compounds- anticariogenic and antibacterialChlorophyll-reduces the fall in pHNitrofurans- bacteriostatic and bacteriocidalAntibiotics- penicillin, Erythromycin, kanamycinCaries vaccines

NUTRITIONAL MEASURESThe chief nutritional measures advocated for the control of dental caries is restriction of refined carbohydrate intake.

Other measures includeAvoiding sugar that retains of teeth surfaceAvoiding sugar in between mealsEating of phosphated diets

Foods with Anticariogenic EffectsMilk- Contains lactose ( least cariogenic)Cheese- Casien Phosphatase Fibrous foods-Raw vegetables, GrainsSugar substitutes and artifical sweetners- xylitol, mannitol, sorbitolTea- green, black tea

Dental erosionDietary acids play a role in dental erosion. Soft drinks, particularly carbonated beverages (including diet beverages), fruit juices and vinegar all contain mild acids which can promote dental erosion. Prevention: not to brush teeth for atleast 1 hour after consumption of such foods and drinks

Mechanical Measures

Oral ProphylaxisToothbrushingMouth RinsingDental FlossOral Irrigators.Detergent FoodsChewing Gum.

Oral ProphylaxisCareful polishing of roughened smooth surface and correction of faulty restoration decreases the formation of bacterial plaque and there by reducing the development of new carious lesionScaling

Tooth BrushingTypes of tooth brushingManual PoweredSonic and ultrasonicIonicMethodsModified bass method Charters methodCircular methodSulcular method

Interdental cleaning AidsDental FlossTo remove plaque and dislodged irritating matterNylon, yarn,teflonWaxed and unwaxedWhere interdental papilla fill the interdental spaces

Interdental cleaning AidsWooden sticks Soft ,triangular,wooden toothpicksIn patients with gingival recession

Interdental cleaning AidsInterdental BrushesCone shaped brushesIn patients with wide interdental spaces

Interdental cleaning AidsSingle Tufted brushes Single tuftIn areas of malalignment

Disclosing agentsSolutions, Tablets or wafersErythrosinStains bacterial plaque

Oral IrrigatorsFlushing Devices To deliver antimicrobial agents

Salivary StimulantsAntibacterialBuffering & Flushing actionXerostomia

Pit and fissure SealantsDental ResinIsolates pit and fissuresTypesGIC (Type III)Resin Cements

Current methodsLasers Geneteic modalitiesPolymeric coatingsCaries vaccineXylitolActive and Passive immunization

LasersArgon lasersCO2 lasersEfficiently absorbed by tooth minerals and rapidly transformed into heat to form ceramic like surface thats resistant to acid attack. Reduce rate of demineralization

Genetic modalities

Strains of microorganisms are produced that lack acid forming enzyme or are capable of destroying S. Mutans.Lactobacillus zeae destroys streptococcus mutansInterferes with enzymatic pathway of S. mutansGenetically modified fruits to protect against tooth decay

Polymeric CoatingThin polymeric coating over tooth surfacesIncrease resistance of tooth to dental caries

Caries VaccinesSaliva and gingival fluid are capable of producing effective immune response against oral microrganismsThus caries vaccines are developed based on specific surface antigens of S. mutans In passive immunization, Monoclonal antibodies prepared that prevent adhesion of S. mutans to tooth surfaces.

Prevention Is Better Than CureIt 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..

Interdental cleansing aids includeDental flossWooden sticks Interdental brushAll of the above

Non cariogenic foods includeChocolateCheeseXylitol, Mannitol and sorbitolBoth B & C

Professionally applied topical fluorides includeDentifricesMouth rinsesFluoride varnishes & Prophylactic pasteSchool water fluoridation

The caries vaccine is based on the specific surface antigen of:Streptococcus mutansStaphylococcus aureusSpirochetesE. Faecalis

Chemical Methods of Caries Prevention Include:ChlorhexidineSarcosideNitrofuransAll of the above

Pit and fissure sealants versus fluoride varnishes for preventing dental decay in children and adolescents.Hiiri A1,Ahovuo-Saloranta A,Nordblad A,Mkel M.Author informationAbstractBACKGROUND:The majority of the detected increment in dental caries among children and adolescents is confined to pit and fissure surfaces of first molars.OBJECTIVES:The objective of this study was to compare the effectiveness of pit and fissure sealants with fluoride varnishes in the prevention of dental decay on occlusal surfaces.SELECTION CRITERIA:Random or quasi-random allocation study design; sealants versus fluoride varnish or sealants and fluoride varnish combination versus fluoride varnish alone; and subjects under 20 years of age. The primary outcome of interest was the increment in the numbers of carious occlusal surfaces of permanent premolars and molars.DATA COLLECTION AND ANALYSIS:Two review authors independently screened search results, extracted data and assessed the risk of bias of trials. Risk ratios (RR) were calculated for differences between intervention and control groups and in split-mouth studies for differences of paired tooth surfaces being carious or not. No data could be combined or meta-analyses undertaken due to the clinical and methodological diversity between study designs.MAIN RESULTS:Four studies were eligible for inclusion in the review. Results of one split-mouth study at low risk of bias and one cluster randomised study at moderate/high risk of bias revealed the effectiveness of pit and fissure sealants to be statistically significantly higher than an application of fluoride varnish every 6 months in preventing occlusal decays of first molars at 23 months (with a RR of 0.74, 95% confidence interval (CI) 0.58 to 0.95); and at 4 years and 9 years (with a RR of 0.42, 95% CI 0.21 to 0.84 and RR of 0.48, 95% CI 0.29 to 0.79, respectively). One small parallel group study at moderate/high risk of bias failed to find a difference between sealants and fluoride varnishes. Further, one split-mouth study at low risk of bias with 24 months of follow-up found significantly more caries on the fluoride varnished tooth surfaces, compared to sealed plus fluoride varnished surfaces, with a RR of 0.36 (95% CI 0.21 to 0.61).CONCLUSIONS:There was some evidence on the superiority of pit and fissure sealants over fluoride varnish application in the prevention of occlusal decays. However, current scarce data limit recommendations on whether to apply pit and fissure sealants or fluoride varnishes on occlusal surfaces.