VARIOUS METHODS FOR PREVENTION OF DENTAL

CARIES

Presentation by:Ritam Chakraborty

3rd year BDS studentHALDIA INSTITUTE OF DENTAL SCIENCES AND

RESEARCH

Guided by:Dr. Rajarshi Banerjee(MDS,MOMS RCPS)

Professor, Dept. of Oral and Maxillofacial Surgery, HIDSAR

Dr. Rupam Sinha(MDS)Professor & HOD, Dept. of Oral Medicine & Radiology, HIDSAR

INTRODUCTIONIn spite of widespread awareness, dental caries is still the second

most common disease of human civilization after common cold-According to WHO

Dental caries is a preventable disease of the mineralized tissues of the teeth with a multi-functional etiology related to the interactions over time between tooth substance & certain micro-organisms & dietary carbohydrates producing plaque acids.

This paper aims to throw light on various modalities of caries prevention

Steps of caries preventionPRIMARY PREVENTION

SECONDARY PREVENTION

TERTIARY PREVENTION

&…… VACCINATION

PRIMARY PREVENTION

Primary prevention protects individuals against disease,often by placing barriers between the

aetiological agent and the host.

Primary prevention is about keeping children’s teeth free from dental caries.

PREVENTION IS BETTER THAN CURE

Risk factors of Dental cariesClinical evidence

Dietary habits

Social history

Use of fluoride

Plaque control

Saliva Medical history

High risk

New lesionsNo fissure sealantsFixed appliance orthodonticsPartial denturesAnterior caries or restorations

Frequent sugar intake

Social deprivationLow knowledgeReady availability of snacksHigh caries in siblings

Drinking water not fluoridated

No fluoride toothpaste

Infrequent, ineffective cleaning

Poor manual control

Low flow rate

Low buffering capacity

High S. mutans & lactobacilli count

Medically compromised

Physical disability

Long term cariogenic medicine

Low risk

No new lesionsFissure sealedNo applianceSound anterior teethNo or few restorations

Infrequent sugar intake

Social advantageDentally awareLimited intake of snacksLow caries in siblings

Drinking water fluoridated

Fluoride toothpaste & supplements used

Frequent, effective cleaning

Good manual control

Normal flow rate

High buffering capacity

Low S. mutans & lactobacilli count

No medical problems

No physical problems

No long term medication

IDENTIFYING CHILDREN AT HIGH CARIES RISK

BEHAVIOUR MODIFICATION ON HIGH CARIES

Dental health education

Oral hygine

Diet & sugar consumption

XYLITOL

Sugar-free chewing gum

Sugar-free medicines

TOOTH PROTECTION IN HIGH CARIES RISK

Sealants

Fluoride tablets & toothpastes

Topical vaccines

Chlorhexidine

SECONDARY PREVENTION

Secondary prevention aims to limit the progression and effect of a disease at as early a

stage as possible after onset. It includes further primary prevention

TERTIARY PREVENTION It is concerned with limiting the extent of

disability once a disease has caused some functional limitation.

The patient’s health status doesn’t return to the pre-diseased state.

It must include further primary and secondary prevention in order to prevent

further carious attack

DIAGNOSIS

Accurate diagnosis & monitoring of lesions over time is required for effective prevention

CLINICAL DIAGNOSIS

o Transillumination

o Flossing

o Temporary restoration of the tooth (eg. With a wooden wedge or orthodontic separator)

Management of carious lesions

Can be divided into three carious sites ->

Occlusal caries

Approximal caries

Smooth surface caries

MANAGEMENT OF OCCLUSAL CARIES

If only part of the fissure system is involved in small to moderate dentine lesions with limited extension,the treatment of choice is a composite sealant restoration.

If caries extends clinically into dentine,then carious dentine should be removed & the tooth restored.

Dental amalgam is an effective filling material which remains the treatment of choice in many clinical conditions. There is no evidence that amalgam restorations are hazardous to the general health.

MANAGEMENT OF APROXIMAL CARIES

Preventive care (eg. topical fluoride varnish)rather than operative care is recommended when approximal caries is confined(radiographically or visually)to

enamel.

Management strategies should also include:

Twice daily use of a toothpaste containing 1000 ppm fluoride.

• Flossing

Dietary advice

In an approximal lesion requiring restoration, a conventional class II restoration should be preferred.

MANAGEMENT OF SMOOTH-SURFACE CARIES

o Twice daily use of a toothpaste containing 1ooo ppm

of fluoride.

o Plaque removal

o Dietary advice

RE-RESTORATIONThe diagnosis of secondary caries is extremely

difficult & clear evidence of involvement of active disease should be ascertained before

replacing a restoration.

INFORMATION FOR NON-DENTAL HEALTH PROFESSIONALS

Dental caries development

Sugar consumption

Dry mouth

Sugar-free medicines

Those who don’t attend a dentist regularly

Medically compromised

Orthodontic appliances

Vaccines

Vaccines are an immuno-biological substance designed to produce

specific protection against a given disease.

Stimulates the production of protective antibodies.

o Main causative organism for dental caries is

Streptococcus mutans

ROUTES OF IMMUNIZATION

In general,two types of immunization have been used with S. mutans :

Active immunization

Passive immunization

ACTIVE IMMUNIZATION

Common mucosal Systemic route of Active gingivo-Immune system Immunization salivary route

Oral route

Intranasal route

Tonsillar route

Minor salivary gland

Rectal

PASSIVE IMMUNIZATION

Monoclonal antibodies

Bovine milk and whey

Egg- yolk antibodies

Transgenic plants (genetically modified tobacco plant)

ADVANTAGES OF VACCINE

Genetic material can be easily exchanged

It is possible to manipulate the antibody structure thus avoiding cross reaction

Large scale production is possible

NEWER APPROACHES

Synthetic peptides

Coupling with cholera toxin subunits

Fusing with salmonella

Microcapsules and microparticles

Liposomes

RISKS OF USING CARIES VACCINE

INFERENCE

With all these advancements, we hope, in recent future, we can enroute dental caries out of the human civilization

Then we can shed off the allegation -

DENTAL CARIES IS THE DISEASE OF CIVILIZATION

THANK YOU ALL