Summarized presentation about the prevention of tooth decay

2. Dental public health: The art and science of preventing
disease, prolonging life and promoting physical and mental
efficiency, through organized community efforts.
Preventive dentistry: It is the procedure employed in practice of
dentistry and community dental health program which prevent
occurrence of oral disease and oral abnormalities.
Introduction

3. Principles of prevention
1. Controlling of the disease
2. Patient education and motivation
3. Development of host resources
4. Restoration of function
5. Maintenance of oral health

4. objectives of prevention
1. To avert the initiation of disease process
2. To intercept the progress of the disease
3. To control the spread of the disease
4. To limit the complications and the after effects of any disease
5. To provide rehabilitation

5. Levels of prevention
Primordial prevention: It is a new concept, receiving special
attention in the prevention of chronic disease. This is primary
prevention in its purest sense, that is, prevention of the
emergence or development of risk factors in countries or
population groups in which they have not yet appeared. It
concentrates on discouraging children from unhealthy lifestyles.
The main intervention is individual and mass education.

6. Levels of prevention
Primary prevention: Primary prevention can be defined as
“action taken prior to the onset of disease, which removes the
possibility that a disease will ever occur”. The primary
prevention is a practical measure which eliminates the risk
unlike the primordial prevention which is a theoretical measure
which just educate about the dangers of any risk factor.

7. Types of primary prevention
1. Population (Mass) Strategy
It is prevention approach which is directed at the whole
population irrespective
of individual risk levels.
2. High-risk Strategy
It aims to bring preventive care in individuals at special risk.
This requires detection of individuals at high risk by the
optimum use of clinical methods.
Levels of prevention

8. Levels of prevention
Secondary prevention: Secondary
prevention can be defined as “action which
halts the progress of a disease at its
incipient stage and prevents complications”
The mode of intervention is early diagnosis
(e.g. screening tests, case finding programs)
and adequate treatment. By this an attempt
is made to arrest the disease process,
restore health and prevent any irreversible
pathological changes to take place.

9. Levels of prevention
Tertiary prevention: all measures available to reduce/limit
impairments and disabilities, minimize suffering caused by
existing departures from good health and to promote the
patient’s adjustments to irremediable condition” it is used when
the disease has already advanced beyond its early stages.

10. Prevention of teeth decay

11. Dental carries definition
Dental caries is defined as a chronic
infectious disease which results from
the demineralization of the inorganic
portion and destruction of the organic
portion of the tooth.

12. Epidemiology of Dental Caries
Dental caries is an ancient disease; paleontological evidence
shows that it has afflicted mankind since the time that
agriculture replaced hunting and gathering as the principal
source of food due to high carbohydrates present in fruits
and vegetables.

13. Factors affecting dental caries

14. Factors affecting dental caries
The host
1. Age: Caries used to be considered as the disease of the childhood. The
older teenagers were found to have more DMFT compared to the
younger teenagers.
2. Socioeconomic status (SES): Education, income and occupation
govern the SES of the individual which also reflect the attitude and
values. Studies have shown more disease prevalence in the lower SES.
3. Emotional disturbances: There is a widespread clinical impression that
emotional disturbance, particularly transitory anxiety status influence the
incidence of dental caries. Salivary changes have been shown to occur in
connection with changes in the mental health.

15. Factors affecting dental caries
The host
4. Caries susceptibility of the individual teeth and surface: Brekhus
1931, studied a group of students at the university of Minnesota and
reported the following caries susceptibility incidence of the teeth:
Upper and lower first molar 95%
Upper and lower second molar 75%
Upper second bicuspids 45%
Upper first bicuspids 35%
Upper central and lateral incisor 30%
Upper cuspids (canines) and lower 1st bicuspids 10%
Lower central and lateral incisor 3%
Lower cuspids (canines) 3%

16. Factors affecting dental caries
The Agent
The association of micro-organism to tooth decay goes back a long way to
about 5000 BC. According to the Sumerian text, tooth decay was caused
by a worm that drank the blood of the teeth and fed on the roots of the
teeth. In 1915, Kligler became the first to associate lactobacilli as the
causative organism. Later, in working with germ-free rats, Orland et al.,
found that they were unable to produce caries in the presence of a highly
cariogenic diet. In 1924, Streptococcus mutans was detected by Clark
which was considered the main etiological agent for dental caries.

17. Factors affecting dental caries
The Environment
1. Climatological (Geographical trends): Study of variation in dental
caries
with respect to the latitude and distance from the seacoast. Low caries
was observed near the equator. A perfect progression of caries
prevalence with variation in latitude has been reported.
2. Sunshine: A study by BR East, who compared dental caries among rural
children with the mean annual sunshine of the place where they lived,
reveals an inverse relation which is highly statistically significant.

18. Factors affecting dental caries
The Environment (Diet)
1. Vitamins: Vitamin K has been tested as a possible anti caries agent by
virtue of its enzyme-inhibiting activity in the carbohydrate degradation
cycle. Vitamin B-6 has been proposed as an anti caries agent on the
hypothetical grounds that it selectively alters the oral flora by promoting
the growth of non-cariogenic organism’s which will suppress the
cariogenic flora.
2. Milk: Lactose is least cariogenic.
3. Cocoa factor and liquorice: It reduces enamel dissolution and
inhibits glycolysis and increase plaque buffering power.Fruit juices:
Fresh fruit, dried fruits and fresh fruit juices are capable
of causing caries. Fruit flavoured drinks are more risky.

19. Methods of prevention of dental carries
methods
Chemical measures
Nutritional measures
Mechanical measures

20. Methods of prevention of dental carries
Chemical Measures
A vast number of chemical substances have been proposed for the purpose
of controlling caries. These chemicals include:
• Substances which alter the tooth surface or tooth structure: Fluoride,
bisbiguanides, silver nitrate, zinc chloride and potassium ferrocyanide
• Substances which interfere with carbohydrate degradation through
enzymatic alteration: Vitamin K, sarcoside
• Substances which interfere with bacterial growth and metabolism: Urea,
ammonia compounds, chlorophyll, nitrofurans, antibiotics (penicillin,
tetracycline, vancomycin), caries vaccine.

21. Methods of prevention of dental carries
Nutritional Measures
• Increase use of fibrous foods (cleansing and protective foods)
• Restrict the carbohydrate diet to 30–50% of total calorie requirement
• Select soluble form of carbohydrate that clears from the mouth easily
• Avoid excessive use of sugar and other refined carbohydrate, and
Eliminate eating sticky food, if not completely then as much as possible
• Eat nutritious food rich in minerals, vitamins, proteins and less fat
• Avoid carbohydrate snacking in between meals. Take high protein snack
and fibrous fruits

22. Methods of prevention of dental carries
Mechanical Measures
The control of dental caries by mechanical measures refers to procedures
specifically designed for and aimed at removal of plaque from tooth
surfaces. The different methods are:
• Prophylaxis by the dentist
• Toothbrushing
• Mouth rinsing
• Use of interdental aids (dental floss)
• Incorporation of detergent food in the diet
• Pit and fissure sealant
• Use of chewing gum.

23. References
1. Burnett, G.W.; Scherp, H.W.; and Shuster, G.S. Oral Microbiology and
Infectious Disease. Baltimore: Williams and Wilkins Co., 1976.
2. Washington (DC): National Academies Press (US); 1980.
3. Questions and Answers in Community Dentistry, Pradnya Kakodkar
MDS, Mamatha GS BDS