The document discusses the diagnosis and prevention of dental caries. It covers the development and features of caries, methods for detection including examination, radiographs, and devices. It also discusses caries risk in patients, the role of plaque, diet, and fluoride in prevention. Specific fluoride modalities like toothpaste, mouthwashes, and professionally applied treatments are outlined. The use of pit and fissure sealants for caries prevention in teeth pits and grooves is also summarized, along with patient selection and the application method.

1. DIAGNOSIS AND
PREVENTION OF
DENTAL CARIES
DR TAZEEN ZEHRA

2. 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

3. FEATURES
 Early enamel lesion is subsurface
 Dental plaque  70%
microorganisms
 Mutans streptococci good at
metabolizing sugars
 Enamel breaks down as caries
progress through amelodentine
junction
 Precavitation carious lesions'
remineralize
 Etching vs bacterial acid attack?
 Plaque as partial barrier
 pH in erosion

4.  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

5. 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

6. CARIES DETECTION AND
DIAGNOSIS
 Radiograph: bitewing are 1st
choice

7. 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

8. CARIES DETECTION AND
DIAGNOSIS
 Temporary tooth
separation
 placement of an
orthodontic elastameric
separator between the
teeth

9. CARIES DETECTION AND
DIAGNOSIS
 Laser fluorescence devices
 Electronic caries meters

10. 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

11. 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

12. 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

13. PREVENTION OF DENTAL CARIES
 Plaque control/toothbrushing
 Diet
 Fluoride
 Fissure sealing

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20.  Safer foods  Cheese, fruit,
vegetables, crisps and peanuts
 Frequency of eating
 3-day diary record

21. 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.

22. 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

23. 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.

24. FLUORIDE MODALITIES
 Systemic use
 Water fluoridation
 Salt
 Milk
 Mineral water
 Fluoride supplements
 Topical use
 Tooth paste
 Mouth wash
 Fluoride gels
 Varnishes

25. SYSTEMIC USE
Water fluoridation
 Water fluoridation continues
to be effective in reducing
dental decay by 20-40%
 Optimum conc is 1 ppm

26. Flourides Suppliment

27. TOPICAL USE
TOOTH PASTE
 1000 to 1450 ppm fluoride
 Sodium fluoride or sodium mono
floro phosphate or combination
of both
 Twice daily use

28. For child below 6 year
With low caries risk 500ppm
With high caries risk 1000ppm
For child above 6 year
With low caries risk 1000ppm
With high caries risk 1450 ppm

29. 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

30. 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

31. PROFESSIONALLY APPLIED
REMEDY
Fluoride gel
 For professional use high conc.
1.23 ppm (12300 ppm)

32. 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

33. 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

34. Slow-release fluoride devices
 Filling materials
 Short term fluoride release
 Recharging capacity of
GIC
 Fluoride glass devices

35. 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

36. Categories
Resin-based sealants
Glass ionomer sealants

37. 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

38. Tooth selection
Caries in primary molars
Caries in 1st permanent molar
Anatomy of teeth

39. 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

40. 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

41. 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

42. 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

43. 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