Prevention of dental diseases

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Preventive Dentistry
Third Year

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Prevention of dental diseases

  1. 1. ‫بسم ال الرحمن الرحيم‬ ‫} قالوا سبحانك ل علم لنا إل ما‬ ‫علمتنا إنك أنت العليم الحكيم {‬ ‫صدق ال العظيم‬ ‫البقرة ) آية 23(‬
  2. 2. Prevention of Dental Diseases Khalid S Hassan Assist . Prof .Periodontology April , 23,2008
  3. 3.  Prevention is better than cure .  Prevention is cheaper than cure .  Prevention of a disease is greater good in life than its cure .
  4. 4. Preventive Dentistry    It is a philosophy of dentistry . It comprises the various procedures used by dentists , dental hygienists , nurses , teacher and others to develop scientific oral health knowledge and habits . It consists of prevention of ; 1- initiation of diseases( Primary Prevention). 2- disease progression and recurrence ( Secondary Prevention ) . 3- loss of function ( Tertiary Prevention ) .
  5. 5. Objectives of Preventive Dentistry     Prevent factors which predispose to disease . Prevent the disease itself . Prevent factors evoke more severe manifestation of acute diseases . Prevent factors which tend to maintain disease in a chronic state .
  6. 6.  Prevent the complications of the disease .  Prevent the sequelae of disease , both local and systemic .  Prevent factors which interfere with rehabilitation.
  7. 7. Preventive Dentistry Services ( ( Levels of Prevention  Primary Prevention : occurs in the prepathogenic period ( True prevention ) .  Secondary Prevention : - occurs in the early period of pathogenesis . - involves early diagnosis and prompt treatment . Tertiary Prevention : - occurs in the later period of pathogenesis . - involves prevent sequelae and complications of the diseases . 
  8. 8. Primary Prevention By individual 1- Health promotion 2-Specific protection -Diet planning. -Fluoride dentifrices. -Periodic visits to -Intake of sufficient fluoridated water. the dental office . -Avoidance of sticky foods between meals. -Oral hygiene measures.
  9. 9. Health Promotion- 1 Specific Protection-2 By community Dental health -Community water education programs flouridation -School water flouridation. -School flouride mouth rinse program. -Fluoride supplement program . -School sealant program
  10. 10. Health Promotion- 1 By dental professional Specific-2 -Patient education -TopicalProtection -Plaque control. -Diet counseling. -Dental caries activity tests application of fluoride . -Pit and fissure sealants .
  11. 11. Secondary Prevention By individual Self-examination By community -Periodic screening - x-ray -Complete examination -Prompt treatment of incipient lesions -Preventive resin restoration -Pulp capping By dental professional
  12. 12. Tertiary Prevention By individual By community By dental professional Disability limitation Use of dental services Provision of dental services Rehabilitation The same The same -Treatment of well -Removable and developed lesions fixed prosthodontics -Pulpotomy -Implants -Root canal therapy -Extraction
  13. 13. Fluoridation  What is fluoride ? - It is one of the halogens . - It is the most active element of this group. - It is not present in the free form . - It is anticariogenic effect .
  14. 14. Sources of Fluoride      Three sources: water , foods and air . Sea foods; salmon , sardines , shrimp and crab . Most beverages contain amount of fluoride especially tea . Vegetables , fruits and dairy products contain low amount of fluoride . The average diet provides 0.2-0.3 mg of fluoride daily .
  15. 15. Methods of Providing Fluoride Systemic Fluoride: 1- Water Fluoridation : * There is a direct relationship between fluoride level and the number of caries free individuals . * 1ppm of fluoride optimum safety and anticaries effect . * One part per million = 1mg F / liter . * concentration of F in hot weather due to water intake . 
  16. 16. 2- School water fluoridation :    Indicated if the community water is not possible . Benefit of F only during days and hours. concentration upto 5ppm is effective in caries control .
  17. 17. 3- Fluoride Supplements :     Supplied in form of tablets , drops or syrups . 0.5 mg F / day for children up to 3 years . 1 mg F / day for children over 3 years . Continue administration till the age of complete crown formation of the second premolar ( age of 10 years).
  18. 18. 4- F. incorporation in various foods:  Such as salt , milk , bread , rice .  It is difficult to adjust fluoride concentration .
  19. 19. Self administered F. application (( By the individual  Fluoride Dentifrices: - 15-30 % caries reduction following the regular use of F . Dentifrices . - The most common F compound are sodium monofluorophoshate , stannous F and sodium F. - Ant-calculus agents such as zinc compound or pyrophosphate can be used .
  20. 20.  Fluoride Mouthrinses: Indications : 1- Patients with active caries . 2- Orthodontic patient . 3- Patient with reduced salivary flow . 4- Patient with removable appliances . * 0.05 % neutral sodium F ( 230 ppm F ) is the benefit concentration . * 1-2 teaspoon ( 5-10 ml) once / day before bedtime are recommended .
  21. 21. Professional Topical F Application - Available as solution , gel and prophylaxis .  Sodium F . * 2% Sodium F solution used 4 application , 1 week interval between every application . * applied every year .
  22. 22. Procedure : 1- Prophylaxis is performed . 2- Teeth on one side are isolated . 3- dried the teeth . 4- 2% sodium F solution applied to each surface with a cotton applicator . 5- The solution is allowed to dry on the teeth for 3-5 min . 6- The same procedure is repeated every week until 4 application .
  23. 23.  Stannous Fluoride : - Single annual application of 8% stannous F 65% reduction in caries incidence . - Need to be prepared freshly for each application ( 0.8gm in 10 ml distilled water ) .  Acidulated phosphate fluoride : - Combination of sodium F with phosphoric acid . - No need to be prepared every treatment .
  24. 24.  Prophylaxis Paste : - Prophylaxis paste containing fluoride . - Carried out every six months .
  25. 25. Mode of action of fluoride       Ionic exchange ; hydroxyapetite changing to fluoroapetite which is less soluble in acids . Enzymatic inhibition ; inhibit phosphatase and anulase enzymes . Bacterial inhibition . Has the ability to precipitate calcium phosphate on the surface of enamel from saliva . Lowers free surface energy plaque accumulation in the treated enamel surface . Action on tooth size and morphology: shallower fissures and lower cusp height and smaller size caries
  26. 26. Pit and Fissure Sealants    Sealant are materials used to seal deep pit and fissure and transfer them into nonretentive surface. Several sealants based on the BIS-GMA resin ( main ingredient of composites ) . Etching , washing and drying the resin then applied with a small brush .
  27. 27. Sealants  Technique  Prior to etching the tooth:  Isolate tooth (i.e. rubber dam, cotton roll)
  28. 28. Sealants  Etching: - 35% PA      Deliver to the tooth using the blue tip, or using a microbrush Etch the grooves and cuspal inclines Etch for 15 seconds Wash for 10 seconds Evaluate “frosted” enamel
  29. 29. Sealant    Apply sealant using the spiral brush tip, or using a microbrush. Sealant should flow into grooves and up cuspal inclines. Cure for 20 seconds
  30. 30. Diet Counseling (( Diet Control  Oral clearance of carbohydrate: 1- Keep the carbohydrate content as low as possible . 2- Select carbohydrate with low retention such as leafy , green or yellow vegetables . 3- Avoid sticky sweets between meals.
  31. 31.  Diet for good general nutrition must be contain: 1- Sufficient amount of minerals especially calcium and phosphorous . 2- Sufficient amount of vitamins especially D&C . 3- Reduced amount of carbohydrates . 4- Enriched phosphates .
  32. 32.  Basic food groups ( good balanced diet ): 1- Milk group . 2- Meat group . 3- Vegetable and fruit group . 4- Bread and cereal group .
  33. 33. Objectives Oral hygiene measures (( Plaque Control Removal of soft deposits (dental plaque, materia alba and- 1 ( food debris Gingival massage keratinization and improve- 2 circulation protection against microorganisms . Prevention of calculus formation- 3 Methods Mechanical Chemical
  34. 34. Mechanical Plaque Control :- I- Tooth Brushing ** Design of brush:-Firm handle with modest angulation between head and the handle. -2.5 cm length of head -15-16.5 cm length of handle -10mm height of bristles and 0.2mm thickness -2 to 3 rows of bristles -Smooth and rounded ends of the bristles -Bristles may be synthetic or natural -Nylon bristles are superior to natural , as they resist breaking and contamination with microbial debris.
  35. 35. :-Tooth Brushing Methods** :Bass Method •Intrasulcular method. •Efficient for removing dental plaque from gingival third and from shallow gingival sulcus. •Place the bristles at the gingival margin with angle of 45 degree to the long axis of the teeth. •Exert gentle vibratory pressure using short back-and-forth motions without dislodging the bristles tips (horizontal direction(. •Perform about 20 strokes in each position. •Used a soft brush in this method.
  36. 36. Brushing Methods Bass Method
  37. 37. :- Modified Stillman Method •A soft or medium brush can be used with this method. • Recommended for patients with gingival recession to prevent abrasive tissue destruction. •The sides of the bristles are placed against the gingiva and teeth with a 45 degrees angle to the long axis of the teeth. •Pressure is applied laterally against the gingival margin to produce blanching. •Brush is activated by short back-and-forth strokes in coronal direction.
  38. 38. Brushing Methods Modified Stillman Method
  39. 39. Charters Method - A soft or medium brush can be used. -Recommended for temporary cleaning in areas of healing after periodontal surgery. -The bristles pointed toward the crown at a 45 degree angle to the long axis of the teeth. -The bristle tips not move across the gingiva. -The brush is activated with short back-and forth strokes in coronal direction.
  40. 40. Charters method
  41. 41. Rotation or Roll Method  The bristles placed apically , nearly parallel to the tooth surface then in and over tooth surfaces .  Rolling motion on buccal and lingual surfaces .  The occlusal surfaces are brushed with a to and fro action .
  42. 42. Fone’s Method  For young children .  The upper and lower teeth are put together into occulsion .  Circular motion on the buccal surface . On the lingual surface a back –and – forth horizontal motion . 
  43. 43. Electrical Tooth Brushes -Useful for: Children, hand- capped, and patients with orthodontics treatment. -Less abrasive to tooth surfaces and restoration. -Do not require special techniques of application. -Place the brush head next to the tooth at the gingival margin and proceed systematically around the dentition. - Not superior to manual type. -Expensive.
  44. 44. Electrical Toothbrushing Technique
  45. 45. :- II- Interproximal Cleaning Aids • 1- Dental Floss: Effective for flat or convex proximal tooth surfaces with full embrasures. • Waxed, unwaxed or tufted types. • Tufted and waxed are indicated for rough restoration and tight contact • Cut about 12cm and anchored around one finger of each hand. • Gentle placing at the base of gingival sulcus then moved in an up-and down along the tooth surface ,right and left.
  46. 46. :Interdental Brushes -2 •Small cone-shaped or tapered brushes. •Used in large open embrasures. •Inserted interdentally and moved back and forth in facio-lingual direction. 3- Tooth Picks:•Made from soft-wood and is triangular in shape. •Used in open contact. •Tooth pick moved in-and-out or up-and down direction. •Tooth pick can be placed in special plastic handles to reach areas with limited access.
  47. 47. Chemical Plaque Control ( Mouthrinsing)  Several chemical agents have anti-plaque and anti- gingivitis effects : * Chlorhexidine . * Quaternary ammonium compounds . * Sanguinrine . * Hydrogen peroxide .
  48. 48. Chlorhexidine:* The most effective antimicrobial agent in plaque and gingivitis •Mechanism of action:- pellicle formation, alteration of bacterial cell wall lysis of bacteria and bacterial adhesion to tooth surfaces. • has not produce any resistance of oral microorganisms. •Substantivity: high substantivity. •Side effects:- staining of teeth , tongue and resin restorations, and alter taste sensation (temporary). •0.2%- 0.12% mouth washes Twice/day.
  49. 49. Disclosing Agents •Used to stain the teeth for patient education and motivation for oral home care. •Used to locate dental plaque on tooth surface. •Available in tablets and liquid forms. •Produce, blue, purple or red stains when attached to plaque on tooth surface. •Examples: Bismark Brown solution, erythrosine and sodium fluorescein dye.
  50. 50. Preventive Dentistry Treatment Planning Problem recognition ( by patient / community /dental professional) Problem definition ( nature/extent/severity/significance) Problem data analysis Interpretation and presentation Treatment planning

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