Diagnosis and prevention of dental caries, DEVELOPMENT OF DENTAL CARIES, CARIES DETECTION AND DIAGNOSIS, DEVELOPMENT OF DENTAL CARIES, PREVENTION OF DENTAL CARIES, Nutrition and diet in caries control, Fluoride and caries control, Water fluoridation, Fluoride supplements, Other methods for providing systemic fluoride, Fissure sealing, TREATMENT PLANNING FOR CARIES PREVENTION,

1. Diagnosis and prevention of dental
caries
by Dr. Zainab Mohammed Al-Tawili 1

2. • Dental caries is caused by dietary carbohydrates being fermented by plaque
bacteria to acid.
• Dental caries progresses only when demineralization is greater than
remineralization.
• Dental caries process:
• The pioneer of this area of research was Robert Stephan.
• Plot of the pH of dental plaque against time: this is commonly known as a Stephan curve.The
curve was produced by rinsing with a 10% glucose solution.The dotted line represents a typical
pH value below which enamel will dissolve (the critical pH).
by Dr. Zainab Mohammed Al-Tawili 2

3. by Dr. Zainab Mohammed Al-Tawili 3
The critical pH: Below pH 5.5 demineralization of the enamel
occurs.

4. • The identification of caries depends on a systematic examination of clean dry
teeth. The basic equipment consists of adequate lighting, compressed air for
drying, dental mirror, and blunt or ball ended probe.
by Dr. Zainab Mohammed Al-Tawili 4
cocci predominate
filamentous
organisms and
veillonellae increase
Immature
plaque
mature
plaque
White
spot
brown
spotProgression of
enamel
demineralization

5. • Radiographs can help in detection of caries, those are:
• bitewings, (the first choice view for caries diagnosis) orthopantomogram
(OPT).
• Bimolars.
• periapicals.
• An interesting clinical phenomenon which may help the clinician decide if radiographs are
warranted is the presence of a bleeding papilla, this suggesting the presence of an
approximal cavity. This occurs because the cavity will be full of plaque, which together
with driving the carious process on will cause gingivitis and thus the bleeding papilla.
by Dr. Zainab Mohammed Al-Tawili 5

6. • The four practical pillars to caries prevention are:
• Plaque control/Tooth brushing.
• Diet.
• Fluoride.
• Fissure sealing.
• Plaque control and tooth brushing:
• tooth brushing is a very important way for:
1. controlling gingivitis and periodontal disease.
2. tooth brushing with toothpaste is a very important way of conveying fluoride to the tooth
surface.
by Dr. Zainab Mohammed Al-Tawili 6

7. • Frequency of eating.
• Eating meals leads to periods of acid attack when tooth mineral is lost. At the end of
the meal or snack the acid is buffered by saliva and the mineral loss stops and
reverses under favorable conditions. Therefore, brushing twice per day with a
fluoride toothpaste, subjects should safely be able to have five meal moments per
day.
• This is a sensible and achievable dietary message for patients.
by Dr. Zainab Mohammed Al-Tawili 7

8. • Non-sugar sweeteners.
• Confectionery products which have passed a well-established acidogenicity test
can be labelled with the Mr. Happy-Tooth logo which is a protected trademark,
which informs the purchaser and consumer that these products are dentally safe.
• Dietary advice for the prevention of dental caries.
• The basic advice is straight forward⎯ reduce the frequency and amount of intake of
fermentable carbohydrates.
by Dr. Zainab Mohammed Al-Tawili 8

9. by Dr. Zainab Mohammed Al-Tawili 9
Mr. Happy-
Tooth logo

10. • Fluoride and caries control:
• Mode of action of fluoride and the caries process:
by Dr. Zainab Mohammed Al-Tawili 10
[Ca10.(PO4)6.(OH)2] [Ca10.(PO4)6.F2]
fluorapatitehydroxyapatite fluoride
Carbonated portions weaken the structure
and render the tissue susceptible to
attack
more stable and resistant to further acid
attacks
demineralizes when pH 5.5 demineralizes when pH 3.5

11. • Water fluoridation:
• This is a systemic method of providing fluoride on a community basis, It is cheap
and cost-effective but there are opponents to its use.
• over the last 60 years showing that dental caries is reduced by 50%.
by Dr. Zainab Mohammed Al-Tawili 11

12. • Fluoride supplements:
• These are in the form of tablets and drops, No supplements should be
prescribed if the water fluoride level is
• greater than 0.7 ppm.
• A 'Catch 22' situation is the case in that those patients that are
compliant do not need supplements whereas those that will benefit will
not take them.
by Dr. Zainab Mohammed Al-Tawili 12

13. • Other methods for providing systemic fluoride to community:
• These are:
• (1) salt⎯50% caries reductions in Switzerland and Hungary.
• (2) milk⎯15-65% caries reductions.
• (3) mineral Water⎯46% caries reductions in Bulgaria.
• before prescribing fluoride supplements we must first determine the fluoride level of the
patient's drinking water, be that tap or bottled water.
• The 'Halo Effect' is the term used to describe the ingestion of fluoride from hidden sources.
by Dr. Zainab Mohammed Al-Tawili 13

14. by Dr. Zainab Mohammed Al-Tawili 14
Method Reduction of caries Fluoride content
Toothpastes A dramatic decrease in worldwide caries levels has
been seen since their introduction in the early 1970s.
usually contain 1000 or 1450 ppm fluoride
Fluoride gels 26% caries reductions have been reported. for professional use (1.23%= 12,300 ppm).
For home use (1000 ppm).
Fluoride mouth
rinses
20-50% have been reported. daily rinses containing 0.05% (225 ppm).
weekly rinses 0.20% (900 ppm) of sodium
fluoride.
Varnishes 50-70% have been reported in Scandinavian studies. Duraphat 5% by wt. fluoride = 22,600 ppm.
Slow-release fluoride
devices
67% fewer new carious teeth and 76% fewer new
carious surfaces in high caries-risk children after 2
years in a clinical caries trial for children
release a constant low level of fluoride
over a period of at least a year.

15. • Fissure sealing is:
• materials which are applied in order to obliterate the fissures and remove the sheltered
environment in which caries may thrive.
• Several sealant materials are available but the most effective is bis-GMA resin.
• 57% caries reductions at 4 years, with retention of 71-85% at 2 years falling to 52% at 4 years
(Ahovuo-Saloranta et al., 2004).
• Patient selection:
1. Children with special needs. Fissure sealing of all occlusal surfaces of permanent teeth.
2. Children with extensive caries in their primary teeth should have all permanent molars
sealed soon after their eruption.
3. Children with carious-free primary dentitions do not need to have first permanent molars
sealed routinely; rather these teeth should be reviewed at regular intervals.
by Dr. Zainab Mohammed Al-Tawili 15

16. by Dr. Zainab Mohammed Al-Tawili 16
1-Tooth was cleaned with pumice and water then
washed thoroughly and dried
3- After washing, the surface must present a frosty
appearance, including the buccal pit.
2- Acid etch is applied to the entire occlusal pits
and fissures as well as the buccal pit.
4- A well-placed pit and fissure sealant.

17. • Clear preventive messages are promoted by the Health Education Authority (HEA) in
England:
1. Brush twice daily.
2. Brush last thing at night and on one other occasion.
3. Use fluoridated tooth paste with recommended vale for each age and type of risk.
4. Spite out after brushing and do not rinse.
5. The frequency and amount of sugary food & drinks should be reduced & when consumed
limited to meal time.
• Sugars should not be consumed more than four time per day.
by Dr. Zainab Mohammed Al-Tawili 17

18. Reference:
by Dr. Zainab Mohammed Al-Tawili 18