Preventive Dentistry Third Year

1. ‫بسم ال الرحمن الرحيم‬
Prevention of dental
caries I
Preventive Dentistry
PDS 332

2. Lecture outline




Levels of prevention
Dental caries
Clinical approaches for caries prevention
Professionally applied preventive agents
and procedures
Fluorides
 Pits and fissure sealants


3. Learning outcomes




Describe differences between primary,
secondary, and tertiary prevention
Understand dental caries as an infectious
disease and the associated risk factors
Outline different clinical preventive services for
the treatment of dental caries
Detail the different types of fluoride and other
products available for the prevention of dental
caries and their use in prevention by
professionals and individuals

4. 
Prevention of dental caries includes:

measures to prevent the occurrence of
disease

Risk factor reduction
Arrest the progress of the disease
 Reduce the consequences of the disease


6. 
Dental caries is an infectious bacterial
disease that has plagued humans since
the beginning of recorded history. What is
dental caries? Simply stated, it is
Tooth Decay

7. Dental Caries: A Bacterial
Infection

There are two specific groups of bacteria
found in the mouth that are responsible for
dental caries:

Mutans streptococci (Streptococcus
mutans)

Lactobacilli

8. Dental Plaque

Dental plaque is a colorless, soft, sticky
coating that adheres to the teeth

9. Dental caries

10. Venn diagram

11. Purpose of caries risk
assessment in clinical practice







Evaluate the degree of patient risk of developing
caries
Identify the main etiological agents
Determine whether additional diagnostic testing
is required
Aid in preventive or restorative treatment
decisions
Improve the reliability of the prognosis of the
planned interventions
Provide a basis for oral health promotion
Assess the efficacy at re-eval/recall visits

12. Areas for Development of
Caries




Pit and fissure caries
Smooth surface
Root surface
Secondary, or recurrent

13. Stages of Caries
Development

It is an ongoing process, characterized by
alternating periods of demineralization and
remineralization

Demineralization is the dissolving of the calcium
and phosphate from the hydroxyapatite crystals

Remineralization is the calcium and phosphate
being redeposited in previously demineralized areas

14. Dental Caries

15. Stages of Caries
Development

Incipient lesion

Cavitated lesion

Rampant

22. The Role of Saliva




Physical protection
Chemical protection
Antibacterial
If salivary function is reduced for any reason, such as
from illness or medications or due to radiation therapy,
the teeth are at increased risk

23. Diagnosis of Dental Caries




Visual
Tactile sensation
Radiographs
Caries technological
detectors

27. Change in Paradigm for Dealing
with Dental Caries
Old Paradigm --> Surgical / ‘Drill and Fill’
(deal with the consequences of the disease)
⇓
Later Paradigm: Prevention!!!
(but generally “one size fits all”)
⇓
“Current” Paradigm: Early Intervention, Risk
Assessment, Anticipatory Guidance, Individualized
Prevention and Disease Management

28. Prevention and
treatment protocols of
initial carious lesions
University of Texas Health
Science Center

29. Fissured surfaces

30. Proximal surfaces

31. Smooth surfaces

32. Root surfaces

33. Clinical approaches
for caries prevention

34. Clinical approaches for caries
prevention

Risk-based preventive strategies depend
on two assumptions:
Identification of patients at increased risk
 The patient will receive appropriate preventive
care based on etiological factors


What are the risk factors for dental caries?

35. Risk factors for dental caries




Bacteria
Tooth/Host
Diet
Time

41. Professionally applied
preventive agents and
procedures

42. Fluorides

44. Fluoride: What does it do?



It inhibits the process by which cariogenic
bacteria metabolize carbohydrates to
produce acid
It re-mineralizes the enamel of the tooth
(e.g., white spot)
Community water fluoridation should have
0.7-1.2 ppm fluoride to be effective

45. 


Fluoride remains one hallmark of dental
caries prevention
20% to 40% caries reduction rate by
professional application
Commonly used fluorides
1.23% Acidulated Phosphate Fluoride (AFP)
 2% Neutral Sodium Fluoride
 5% fluoride varnish


46. Fluoride varnish

Protective coating that is painted on the
surfaces of teeth to prevent new cavities
from forming and to help stop cavities that
have already started

The protective effect of the fluoride varnish
will continue to work for several months

51. Dental Sealants

52. 
Highly effective in preventing dental caries
in the pit and fissure areas of the teeth
Made of a resin material

Noninvasive technique

Success rate high if firm adhesion to the
enamel surface


62. Summary





Three levels of prevention
Dental caries as an infectious disease
Clinical approaches for caries prevention
Professionally applied fluorides
Professionally applied sealants