DIAGNOSIS AND
PREVENTION OF
DENTAL CARIESDR TAZEEN ZEHRA
DEVELOPMENT OF DENTAL CARIES
The main features of the caries process are:
(1) fermentation of carbohydrate
(2) rapid acid formation
(3)pH rise when carbohydrate is no longer available
(4) dental caries progressesion
FEATURES
Early enamel lesion is subsurface
Dental plaque 70% microorganisms
Mutans streptococci good at metabolizing sugars
Enamel breaks down as caries progress through amelodentinejunction
Precavitation carious lesions' remineralize
Etching vs bacterial acid attack?
Plaque as partial barrier
pH in erosion
1st stage is 'white spot'
precavitation lesion Stage
Occur within a few weeks if
conditions are favourable
2-4 years for caries to
progress through enamel
into dentine at approximal
sites
Enamel breaks down as
caries progress through
amelodentine junction
Saliva is natural defence
CARIES DETECTION AND
DIAGNOSIS
Systematic examination of clean dry teeth
The basic equipment consists of
i. adequate lighting
ii. compressed air for drying
iii.dental mirror
iv. Blunt or ball ended probe
CARIES DETECTION AND DIAGNOSIS
Radiograph: bitewing are 1st
choice
CARIES DETECTION AND DIAGNOSIS
Fibre-optic transillumination
(FOTI)
Consists of the placement of
a 0.5 mm light source in the
embrasure
If a carious lesion is present it
will show as a dark shadow
CARIES DETECTION AND DIAGNOSIS
Temporary tooth
separation
placement of an
orthodontic elastameric
separator between the
teeth
CARIES DETECTION AND DIAGNOSIS
Laser fluorescence devices
Electronic caries meters
The presence of a bleeding
papilla
Phenomenon which may help the
clinician, suggesting the presence of
an approximal cavity. This occurs
because the cavity will be full of
plaque, which will cause gingivitis
and thus the bleeding papilla
Carries Detection
Sharp probe are contra-indicated:
• 'sticky' fissure means the probe fits the fissure.
• Probing a demineralized lesion will break the
enamel matrix making remineralization
impossible
• The probe may transfer cariogenic bacteria
from one site to another
Characteristic of Caries
1st visible sign is white spot
lesion
Seen when surface is dried
As lesion progress seen
without drying
White spot is lesion or
fluorosis?
Active VS Inactive lesion
PREVENTION OF DENTAL CARIES
Plaque control/toothbrushing
Diet
Fluoride
Fissure sealing
High Caries Risk Patient
High caries-risk' groups comprising:
• The caries prone⎯especially early childhood
caries (nursing bottle caries).
• The handicapped⎯medical and physical.
• The socially deprived, that is, low socio-economic
groups.
• Ethnic minority groups usually residing in inner city
areas
Low Caries Risk Patient
Low caries-risk children:
Caries-free or have well-controlled caries
Have good oral and dietary habits,
Highly motivated
Attend their dental appointments
regularly
Plaque control and toothbrushing
plaque disclosing tablets and
solutions
Plaque charts
demonstrating the plaque
disclosing procedure
Tooth brush with cartoon
characters
Children below 5yrs need help with
tooth brushing
At which age a child will have
manual dexterity
Plaque control and toothbrushing
Small smear of fluoride toothpaste
Not to rinse with water
Brush your teeth first thing in the
morning and last thing at night
Nutrition and diet in Caries control
Intrinsic (sugar within cell membrane,
for example, fruits)
Extrinsic (readily available sugars, for
example, refined sugars)
Bacteria need a fermentable source of
carbohydrate to produce acid
Dietry advice
Make sure patient eat sensibly and safely
Positive reinforcement
Baby drinks given in baby bottles led to 'nursing bottle' caries
only milk or water is given to children in a baby bottle
children drinks consumed from trainer cups, beakers, or straws
Safer foods Cheese, fruit,
vegetables, crisps and peanuts
Frequency of eating
3-day diary record
INTRODUCTION
Use of fluorides for the prevention and control of
caries is documented to be both safe and highly
effective.
Fluoride has several caries-protective mechanisms
of action, including enamel remineralization and
altering bacterial metabolism to help prevent
caries.
MECHANISM OF ACTION OF
FLUORIDE
During tooth formation, makes enamel crystals
larger and stable
Inhibit plaque bacteria by blocking enzyme enolase
during glycolysis
Inhibit demineralization when in solution
Enhances remineralization by forming fluorapatite
Make pits and fissure shallower
Flourides
Fluorides
• Fluoride ion in the oral fluid is of most importance in
reducing enamel solubility rather than having a high
content of fluoride in surface enamel.
• A constant supply of low levels of intraoral fluoride,
particularly at the saliva/plaque/enamel interface, is of
most benefit in preventing dental caries.
FLUORIDE MODALITIES
Systemic use
Water fluoridation
Salt
Milk
Mineral water
Fluoride supplements
Topical use
Tooth paste
Mouth wash
Fluoride gels
Varnishes
SYSTEMIC USE
Water fluoridation
Water fluoridation continues
to be effective in reducing dental decay by 20-40%
Optimum conc is 1 ppm
Flourides Suppliment
TOPICAL USE
TOOTH PASTE 1000 to 1450 ppm fluoride
Sodium fluoride or sodium mono
floro phosphate or combination
of both
Twice daily use
For child below 6 year With low caries risk 500ppm
With high caries risk 1000ppm
For child above 6 yearWith low caries risk 1000ppm
With high caries risk 1450 ppm
MOUTH WASH
Active ingredient sodium fluoride
(Protect G)
Daily rinse 0.05% (225ppm)
Weekly use 0.2% (900ppm)
Not recommended for children
below 6 year
Recommended daily mouth rinse
for orthodontic patients
FLUORIDE GELS
Can be applied with brush or in trays
Can be for home use and professional
use
For home use in low conc. 1000-5000
ppm
At home at bedtime after regular
brushing
Do not use under 6 year of child
PROFESSIONALLY APPLIED
REMEDY
Fluoride gel
For professional use high conc.
1.23 ppm (12300 ppm)
Recommendations for preventing
fluoride toxicity
No more than 2ml per tray
Use saliva ejector
Sit patient upright
Instruct patient to spit out for 30sec
after procedure
Do not use for children under 6
years
Fluoride varnishes
Duraphat 5%(22,600ppm)
Used with cotton bud
A small pea size is
sufficient for full mouth
application in children
upto 6 year
Slow-release fluoride devices
Filling materials
Short term fluoride release
Recharging capacity of
GIC
Fluoride glass devices
PIT AND FISSURE SEALANTS
Molar teeth account for most of decay
in primary and permanent
Fissures and pits are difficult to keep
clean
These are the sites most susceptible to
developing decay
Pit and fissure sealants are materials
that are applied to the pits
and fissure surfaces of teeth to create a
thin barrier which protects
the sealed surface from decay
Categories
Resin-based sealants
Glass ionomer sealants
Patient selection
Moderate to high risk for caries
Caries limited to enamel of pits and fissure
Medically or physically compromised patients
Sufficiently erupted teeth with susceptible pits
and fissures
Tooth selection
Caries in primary molars
Caries in 1st permanent molar
Anatomy of teeth
Contraindications
A sealant is contraindicated if:
1. Patient behavior does not permit use of adequate dry
field (isolation) techniques throughout the procedure
2. There is an open occlusal carious lesion
3. Caries, particularly proximal lesions, exist on other
surfaces of the same tooth
4. A large occlusal restoration is already present.
5. If pits and fissures are well coalesced and self-cleansing
Method
STEP 1. SELECT APPROPRIATE TEETH
Sealants are not for all caries-free pits and fissures
1. overall caries susceptibility
2. existing restorations and carious lesions
3. occlusal anatomy
STEP 2. PUMICE OCCLUSAL SURFACE AND RINSE
Flour of pumice applied with a rotary brush
STEP 3. REMOVE PUMICE FROM GROOVES WITH
EXPLORER
STEP 4. ISOLATE WITH RUBBER DAM OR COTTON
ROLLS
STEP 5. DRY AND ETCH
.Thoroughly dry the tooth (30 seconds) t
.Apply etchant solution with the acid-etch brush
which is packaged with in sealant kit or a cotton
pellet.
Usual etching time for permanent teeth is 20-30
seconds
STEP 6. RINSE 20-30 SECONDS
STEP 7. RE-ISOLATE
STEP 8. DRY 20 SECONDS – CHECK ETCHED SURFACE
STEP 9. APPLY SEALANT IN 30 SECONDS
STEP 10. CHECK APPLICATION WITH EXPLORER
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