Dental Public Health Al Azhar University Gaza Lama k El Banna

2. College of Dentistry
Dental Public Health
02Prevention of Dental Caries
Dr. Hazem El Ajrami
Master Degree in Orthodontic & Pedodontic

4. I. Dietary control of dental caries:
1. Reduction of the frequency of carbohydrate
intake.
2. Sucrose substitutes.
3. Addition of caries-inhibiting agents.

5. II. Oral hygiene measures:
1) Tooth brushing:
A. Tooth brush design.
B. Tooth brushing methods.
C. Disclosants.
D. Tooth paste.
2) Other cleaning devices:
A. Dental floss.
B. The tooth pick.
C. The rubber tip.
D. The interdental brush.

6. II. Oral hygiene measures:
1) Tooth brushing.
2) Other cleaning devices.
3) Oral rinsing.
4) Dental prophylaxis:
III.Topical protection of teeth:
1. Fissure sealants.
2. Fluoride varnish.
3. Preventive resin restoration.
4. Atraumatic restorative treatment (ART).

7. C. Disclosants:
Most patients are unaware of the bacterial film
on the teeth. The dentist, too, is often unaware
that the apparently clean-looking teeth have
heavy deposits. It is essential to make these
deposits visible:
1. To confirm to the patient the presence of
harmful film and hence facilitate instruction on
its removal.
2. To enable the dentist, during scaling and
polishing procedures and to confirm that the
tooth surfaces are free from all deposits.

9. Disclosants are water-soluble dyes used to
stain the plaque and other deposits and make them
obvious. The desirable properties of a disclosing
agent should be:

10. 1. Having the ability to stain plaque selectively and
not the other surface of the teeth and their
surrounding.
2. Do not stain the rest of the oral structures, lips,
cheeks and tongue.
3. Does not discolor anterior teeth fillings.
4. Has an acceptable taste.
5. Has no harmful effects on the mucous
membrane, if it is accidentally swallowed, it
should have no possible allergic reaction.

11. Disclosants are available in tablets, liquid,
wafers or swabs. They may be red, blue or
yellow. There is also fluorescent disclosants.
Examples of disclosing solution are:
1.Iodine: 1.6gm, KI: 1.6gm, water: 13.4 ml,
Glycerin to make 30 ml.

13. D. Tooth paste (dentifrices) and tooth powder:
• A dentifrice: is a substance used with a
toothbrush to remove bacterial plaque, material
alba and debris from the gingiva and the teeth
for cosmetic purposes and for applying specific
agents to the tooth surfaces for preventive and /
or therapeutic purposes.
• Therapeutic dentifrices are those containing
agents designated to inhibit the growth of oral
microorganisms increase the resistance of
dental hard tissues.

14. • Some dentifrices long ago used to contain'
ammonium compounds, chlorophyll, antibiotics,
fluorides, etc.
• The best so far are those containing fluorides as
they can be of significant anti caries value when
routinely used.
• Toothpaste should be of acceptable taste and
flavor, and unobjectionable color and
consistency, and any of its components should
not posses any detrimental effect on prolonged
use.

15.  The range of content of the various
components in commercially available
dentifrice is as follows:
 Detergent 1-2%.
 Cleaning and polishing agents 20-40 %.
 Binder (thickener) 1-2%.
 Humactant 20-40%.
 Flavoring 1-1.5%.
 Water 20-40%.
 Therapeutic agent 1 -2%.
 Preservative, sweetener and coloring agent 2-3%.

16. A therapeutic dentifrice has a drug or
chemical agent added for a specific preventive or
treatment action. Tooth powder contains abrasives,
detergents, flavoring, and sweetener. Paste and gel
dentifrice contain the same ingredients plus
binders, humactants, preservative and water.

18.  Fluoride-containing tooth pastes:
 The incorporation of fluoride into dentifrice is
a practical approach to the problem of
delivering topically applied fluoride to large
numbers of persons.
 Several studies have produced positive
results, showing reductions in the incidence
of dental caries in the range of 10-30%.

20.  Analysis of the collected data suggests that
greater caries inhibition is produced in
aproximal surfaces than in occlusal or
buccolingual surfaces.
 The compounds that have been studied most
intensively are sodium monofluorophosphate
(MFP), acidulated phosphate fluoride and amino
fluoride.

21.  The success of any fluoride containing dentifrice
depends upon the availability of a free fluoride
ion capable of reacting with enamel surface on
brushing.
 Since fluoride ion is a highly reactive ion, there
is a greater possibility of combining with other
toothpaste ingredients and thus the expected
value is lost.

22.  Clinical investigations support the value of
stannous fluoride dentifrices although some tooth
pigmentation has been reported. MFP dentifrice
presents greater caries inhibitory effect and no
staining. Sodium fluoride; dentifrices are hot
effective while amino fluoride dentifrices are not
widely commercially available.

23. Special guidelines specific for young children:
 Use a pea-sized amount of toothpaste on the
brush.
 Use formulations with low fluoride
concentration (500-600 ppm) for children
younger than 7 years.
 Children above 8 years are safe to use family
toothpaste.
 To avoid increased risk of toothpaste ingestion
brushing should be supervised by parents.

25.  Special purpose of tooth pastes:
Some patients who have sensitive cervical areas
on their teeth may benefit from the use of
desensitizing pastes such as "Sensodyne" or
"Emoform" although there is no justification for
recommending them.

27.  Mouth washes:
Mouth wash or mouth rinse is a product used
for oral hygiene to clean the mouth, freshening
the breath; and reduce plaque & gingivitis. Its
effect will be greater when it's used after
brushing and flossing.

28.  What are the proper steps when using mouth
rinses?
 Before using a mouth rinse, brush and floss teeth.
 Measure the proper amount of rinse
recommended on the container or by a dentist.
 Close lips and keeping teeth slightly apart &
swish liquid around the mouth.
 The suggested rinsing time is 30 seconds to one
minute.
 Finally, spit liquid from mouth.
 Do not rinse or eat for 30 minutes after using a
mouthwash in order not to decrease its effects.

29.  Dental care tips for children:
 Children under 6 years & who cannot rinse
should not use mouthwash.
 Should be used under parental supervision.
 It should not be swallowed.
 Mouth rinses with ethanol should be kept out
of children's reach.

30. • Classification of mouthwashes:
1)Therapeutic:
• They contain an added active ingredient that
helps prevent or treat certain oral health
conditions.
2)Non therapeutic (cosmetic):
• They are available over the counter.
• They are usually formulated to temporarily
freshen breath.
• They can aid in removing food particles.
• Their primary purpose is to mask mouth odor.

31. 3) Herbal:
 Have antiseptic and antibacterial properties.
 Have the advantage of using natural ingredients
which contain the powerful breath freshener
called "Chlorophyll".
 Don't contain stabilizers or preservatives.
 Were effective in reducing gingival
inflammation and plaque in adults patients as
well as reducing mouth odor.

32. 2. Other cleaning devices:
Sometimes it is advisable to use other
devices than a toothbrush to achieve through
plaque removal.

33. A. Dental floss:
• This is a tool used to disorganize and remove
the microbial masses that are located below the
gum margins inter-proximally.
• Dental floss may be either waxed or unwaxed.
• The unwaxed floss is recommended for
cleaning purpose because it is said that in use,
strands open and trap plaque and debris, and
hence clean the interdental space better.

35. • The thin nylon fibers of this floss serve as
individual knives or cutting edges as it is
manipulated to scrap the plaque from the tooth.
• This floss spreads easily over the tooth surface,
which allows it to pass easily between the contact
points of the teeth.

37. Technique of flossing:
A careful demonstration is always necessary.
1.Cut off a length of about 6 inches (l5 cm.) and tie
the ends together to form a loop.
2.Hold between left thumb and right index finger
(to clean upper left quadrant and the fingers are
reversed for the right quadrant).

39. 3. The floss is held between the fingers and gently
worked from the occlusal through the contact
point down to the gingival cervix, wrapped
round half the circumference of the tooth and
scrapped upwards for its entire length. Where it
is impossible to introduce the floss through a
contact point (e.g. soldered contacts of bridge
pontics or splints), the floss is passed under the
contact using a floss threader.

41. • There is also special flossing devices none of
them is recommended because they are not
easier to handle than the floss itself. Each
patient will develop a technique that is
comfortable for him.

43. B. The tooth pick:
• This is used to remove bacterial mass from
areas inaccessible to the brush bristle.
• They should be only recommended where there
is sufficient interdental space not filled with
gingival tissues.
• They should be inserted into the embrasure
pointed end first, with the stick at an angle of
45° to the long axis of the tooth, and the sharp
edge of the stick away from the gingiva.

45. • The stick is rubbed about 12 times in each space
with the tip pointing coronally.
• They are also effective in disturbing the plaque in
periodontal pockets, cleaning root surfaces,
cleaning buccal surfaces of third molars and the
lingual surfaces of lower molars.
• Medicated and plastic tooth picks are available.
• Tooth picks are usually used in cases of wide
embrasures while dental floss is preferred in cases
of tight interproximal contact.

46. C. The rubber tip:
• Located on the handle of some tooth brushes
and it is used for further stimulation of the
gingiva.
• The rubber tip is placed between the teeth
pointing towards the occlusal surface. It is held
at 45° angle to the gum.
• Pressure is maintained against the gum; and
the tip is vibrated.
• The use of the rubber tip helps in cleaning the
interdental space as well as stimulating and
massaging the gingival tissues.

49. D. The interdental brush:
• It is a single tufted brush used for cleaning the
interdental spaces from the lingual and labial
aspects.
• Patients find no difficulty in its handling.
• The brush has the advantage of reaching
posterior areas easily.

53. 3. Oral rinsing:
• The purpose of rinsing the mouth is to remove
the material that has been loosened with the
floss and the toothbrush bristles.
• The teeth and the mouth are rinsed by forcing
water vigorously back and forth through the
teeth several times.
• This is also quite effective in removing traces of
sugar from the mouth.
• Oral rinsing can be recommended when it is not
possible to brush the teeth after the intake of
potentially cariogenic food.

54. • The use of forced water stream to remove oral
debris may be sometimes essential.
• There is a special appliance available for this
purpose (the water irrigator) it is used to clean
the pockets that form along the sides of the roots,
around and under bridges, and around and under
orthodontic appliances.
• The forced water stream used should be gentle
and the water flow may be continuous or
intermittent.

57. 4. Dental prophylaxis:
• This procedure consists of removing the hard
deposits on the surfaces of the teeth by
scaling, then smoothening and polishing the
surfaces with pumice on rubber cups and
brushes.
• The smooth well polished surfaces of the
teeth are less susceptible to be stained or
coated by dental plaque.
• By this procedure, early carious lesions can
be easily recognized.

59. III.Topical protection of teeth:
• This includes all measures applied to increase
the resistance of the intact outer tooth
surface.
• Among these measures are operative
dentistry, prophylactic odontotomy,
prophylactic fissure filling, topical
chemotherapy, fissure sealants, preventive
resin restoration and atraumatic dentistry
(ART) are the most essential.

60. 1. Fissure sealants:
Fissure sealants are materials used to
(correct) seal deep pits and fissures and
change them into non-retentive surfaces.
There is considerable evidence that a
significant caries reduction observed when
fissure sealants are correctly applied to deep
pits and fissures of newly erupted teeth.

62. • Types of sealant materials:
Nowadays several materials are commercially
available. These are either chemically cure or
light cure (using visible light). These are:
1.BIS- GMA resin (filled or unfilled).
2.Glass ionomer cement.
3.Compomer.

63. • Application of pit and fissure sealants:
It should be noted that newly erupted posterior
teeth with deep pits and fissures are the suitable
teeth for application.

64. Steps of application are:
1) Remove any debris using pumice slurry on
small brush or prophylactic rubber cup.
2) Wash the tooth with air water spray.
3) Isolate the tooth with cotton rolls and use saliva
ejector.
4) Dry the tooth with compressed air.
5) Etch the occlusal tooth surface with enamel
etching solution or gel (37% ortho-phosphoric
acid) for one minute.
6) Wash thoroughly with air water spray.

66. 7) Dry with compressed air until chalky white
enamel surface appears.
8) Apply the fissure sealant with little brush.
9) Polymerize light cure sealant for 20 seconds
keeping the tip of the light gun as close to the
surface as possible.
10)Check the height (high spots) of the polymerized
material and correct with fine stone when
possible.
11)Check the success of sealant application at 6
monthly period.

70. 2. Fluoride varnish:
It is a sticky yellowish protective coating in a
resin base that is painted over the teeth surface
in an attempt to prevent dental caries or to allow
remineralization of initially demineralized
enamel surfaces. Studies showed about 18-70%
reduction of smooth surface caries.

72. Advantages:
 Easy application.
 Patient's acceptance.
 Higher fluoride than gels and foam.
 Negligible amount of ingested fluoride.

73. • It has the ability to adhere to enamel for long
periods and thus release fluoride slowly to the
teeth.
• The commercially available varnishes contain
either 5% Sodium fluoride or 1 % Fluorosilane.
• It is applied by brush and allowed to harden for
5-6 minutes. The application should be repeated
at 3-6 months interval.

74. 3. Preventive resin restoration:
This procedure was born of fissure sealant.
The technique is based upon restoring minimal
carious lesion usually in young permanent
molars with minimum removal of tooth
structures, while concomitantly preventing
caries from attacking other pits and fissures on
the same surface without mechanically removal
of these areas.

76. • Technique:
A small round bur may be used for access and
removal any carious tissue. The tooth is then
etched as for sealant application, and a pit and
fissure sealant is applied. A composite of thin
consistency may be used.

77. 4. Atraumatic restorative treatment (ART):
The two main principle of ART are:
A. Removing carious tooth tissue using hand
instruments only.
B. Restoring the cavity with adhesive filling
material currently as glass ionomer.

78. Carious cavities suitable for ART should be:
A. Involving the dentin with no pulpal
involvement.
B. Accessible to hand instruments.

80. • The advantages of ART include:
1.Use of easily available and inexpensive
procedure to conserve sound tooth surfaces.
2.Permit oral health care workers to reach people
who otherwise never would have received any
oral care; such as handicapped, villages in rural
and suburban areas, homebound, institutionalized
people and economically less developed
countries.

81. • Laser Light in preventive dentistry:
Recently, laser has been introduced for use in
dentistry. Different approaches has been thought
to be promising in caries prevention for:
1.Increasing the resistance of dental tissues to
caries by reducing the rate of demineralization.
2.Sealing pits and fissures and homogenizes the
enamel surface by melting structural elements.

83. 3. Laser application encourages fluoride uptake by
dental tissues.
4. Laser application to carious lesions vaporizes
enamel caries and adjacent sound enamel fuses
and eliminates small defects.
5. Application of laser prior to application of fissure
sealants improves its retention.

84. Thank You