Conventional and recent ways in caries prevention and detection

1. Preventive
Dentistry
& Early Caries
Detection
Presented By : -Ghida Lawand
-Roudy Khayat
-Mayss Kamala
-Mostafa Mansour
-Ali Khalaf

2. Methods to reduce
demineralizing factors
Methods to increase
protective factors
Conventional Prevention of Dental caries
Dietary
measures
Methods to
improve oral
hygiene
Methods to
improve flow and
quantity of saliva
Chemicals
altering the
tooth surface or
tooth structure
Use of pit
& fissure
sealants
1.Fluorides
2. Antimicrobial
agents

3. Methods to reduce demineralizing factors
1) Dietary Measures

4. A) Provide substitutions for cariogenic foods
consumed by the patient ,mainly the ones
containing fibers such as raw fruits and vegetables
Intake of raw fruits
and vegetables
Increase the
salivary flow
Removal of food debris
Contain natural
phosphates, phytates and
nondigestable fibers
They do not stick to teeth
Increases caries
protective
mechanism

5. B) Decreasing
the frequency of
consuming
cariogenic food
rather than
imposing dietary
restrictions on
the patient.

6. 2) Methods to improve the oral hygiene:
A) Tooth brushing:
Most reliable means of controlling plaque and providing clean tooth
surface

7. Brushing technique:
A Keep the bristles in gingival sulcus at 45 to the
long axis of the tooth
B Brushing on palatal surface
C Brushing on posterior

8. B) Interdental cleaning:
Dental floss
(Used with normal proximal contacts)

9. Methods to increase protective factors
1) Methods to Improve Flow and Quantity of Saliva
Saliva plays a major role in prevention of caries. Increasing the
salivary flow rate and its buffering capacity play an important role
in prevention.
1) Prescription of salivary stimulants
like (pilocarpine - cevimeline)
considered useful in case of patients
having Xerostomia (dry tongue) with
functional salivary glands.
This can be done by:

10. Mouth rinsing
solution after
eating
2 teaspoons of
baking soda
8 oz of water
2) Baking soda helps in neutralizing the acids and this is
why it must be used with patients who have low salivary
flow.

11. 2) Chemicals altering the tooth surface or tooth structure
Fluoride can reach the enamel in two ways:
Systemically Topically
Through blood supply of
developing teeth
Through direct contact of
fluoride on teeth surfaces
Examples: fluoride drops,
tablets, or treated water
Examples: dentifrice, mouth
rinses, varnish…)
A) Fluoride

12. B) Antimicrobial agents
1) Chlorhexidine
2) Xylitol and soduim hypochrite :
1. Enhances the remineralization process
2. Decreases streptococcus mutans presence
Importance:
1) Non fermentable
2) Non cariogenic sugar
3) Anti-caries effects (reduces: plaque formation, bacterial
adherence…)
Xylitol is recommended for pregnant
mothers. Studies showed that when the
mother chews xylitol gums during her
pregnancy, lower caries formation is
detected in her child.

13. 1. Has anti cariogenic properties
2. Releases calcium and phosphate ions to convert to apatite
enhancing remineralization of the tooth structure.
3. Enhances the stability of the pH of saliva and reduces the
sensitivity of teeth.
3) Amorphous calcium phosphate (ACP)
A supersaturation of saliva with ACP is achieved by the addition
of a protein called Casein phosphopeptide (CCP).

14. Chewing
gums/tablets
Toothpastes
After eating, it is recommended to chew xylitol or ACP
containing gums ,lozenges, and topical solutions to reduce
the acidogenecity of plaque, and increase salivary flow.
Mouthwashes

15. 3) Use of Pit and fissure sealants
Material applied to the pits and fissures of teeth to prevent or arrest
caries that may continue to develop.
Advantages of pit and fissure sealants
 Seals pits and fissures making them more resistant to food impaction
 Make pits and fissures self-cleansable
 Arrest incipient carious lesion

16. Resins
1.Bonded to enamel
by acid etching
technique
2.Most durable
Types of sealants
Glass ionomer
Cement
Compomer
1.Bond chemically to dentin
and enamel along with active
fluoride release into the
surrounding enamel
2.Can’t be used when moisture
control is difficult
Similar Properties
to resin

17. Resin sealant placement technique
Tooth preparation Etching of the prepared
surface
Cleaning and drying the
surface
Application of the resin sealant Light curing of the sealant

18. Genetically modified food
Current Methods in caries prevention
Caries Vaccine

19. What is the aim of it?
The aim is to prevent tooth decay by modifying food
How is this modification done?
Incorporation of antagonist peptides in food that work against
glycosol transferase (catalyze to form glycoside caries)
To Whom are they important?
Patients with ‘high caries risk’
1) Genetically Modified Foods

20. • Vaccine is an immunological material created to form a
specific protection against a given disease.
• It stimulates production of protective antibody and other
immune mechanism.
No commercial vaccine was made till now
Streptococcus mutans is the main causative agent of human
dental caries vaccines should be derived from it
Immunizing Sreptococcus mutans tempts to do an
immune response stops organisms from settling on the
tooth surface stops carious deterioration.
• Vaccine should be given prior to the eruption of primary
teeth
2) Caries vaccine

21. Problems in development of caries vaccine
1. Caries etiology is still not completely known so the effectiveness
of this vaccine is not ultimate.
1. Cross reactivity of Streptococcus mutans cell antigens is found in
the muscles of the heart.

22. Visual-tactile
method
Radiographic
methods
Electrical
conductance
measurement
Early Caries detection Tools
Lasers

23. Visual-tactile method
Conventional
Methods
Advances in
visual method
Tactile
examination
Visual
examination
Illumination
Dyes
a) Fiber optic trans
illumination (FOTI)
b) Digital imaging FOTI
(DIFOTI).

24. Tactile examination
• If the probe sticks in its place, roughness in the surface and a lesion
may be possible.
• Advanced smooth surface caries and root caries feels soft upon
penetration of the probe.
Dental probe:

25. 1. Pits and fissure caries are examined tactilely as
softness, but mechanical binding of an explorer in
the pits or fissures may be due to noncarious
causes (shape of the fissure, sharpness of the
explorer, force of application…)
Disadvantages
3. Not effective for interproximal
detection of caries
2. Transfer of cariogenic bacteria
from the tip of the probe to other
uninfected pits and fissures

26. Visual examination
Cavitation
Early caries lesion
Discoloration
White lesions
Cavitated carious lesion

27. Conventional Methods of Radiography
Bitewing Radiographs
• Estimation of the proximal tooth surfaces before they
are detected clinically.
• Detect incipient lesions at contacts of the teeth.
Radiographic methods of diagnosis

28. Digital imaging uses the
conventional radiology
technique where the film is
used in recording the image
and then final image is
exposed to digital
processing to harvest the
final result.
Recent Methods of Radiography
1) Digital Radiography

29. Advantages
• Readily manipulated
• Better stored
• Better quality
• Includes the logicon system :contains in its database radiographic
patterns of sound teeth.
Bitewing radiograph of a
suspected interproximal area
is taken
System will
compare it to the
sound tooth
radiographic
pattern
Informs the
operator whether it
is sound,
decalcified or
cavitated.

30. Qualitative Laser Fluorescence(QLF)
Light induced fluorescence

31. • Depends on measuring light induced fluorescence of the
tooth.
• Fluorescence of tooth structure is due to the presence of
chromophores within the enamel.
• Intra-oral camera with software for image capture and
storage called Spectra camera is used.
• The caries activity is determined on a scale of 0 to 5.

32. Significance of colors seen:
• Green color: Normal tooth structure
• Blue color: Shows demineralization or incipient
lesions
• Red Color: Appear in caries and plaque indicating the
bacterial presence

33. DIAGNOdent
Laser Fluorescence

34. • The technique is called “quantified laser
fluorescence”. It is based on measuring the
differential refraction of light passing through
tooth structure.
• The fluorescent light of lower frequency
indicates the presence of a carious lesion.
• Requires a clean dry operating field

35. Tooth
Decay
Tip of probe is
too small to
reach decay 
Can’t detect it
until cavity
becomes larger
DIAGNOdent
 Cavity may
be treated
when the
cavity is too
small

36. Value Indication Restorative suggestion
014 No caries No treatment other than
preventive
1520 Histological caries within
the enamel
Pits and fissure sealant
2199 Histological dentinal
caries
Risk
>30 Cavity Operative treatment

37. Changes detected in initial carious lesions include:
Microporosity of enamel structure which will alter
transmission of light. Defects and color changes visible
throughout enamel and dentin.
Visible Light
Fiber optic
transillumination
(FOTI)
Digital imaging fiver
optic transillumination
(DIFOTI)
1. Differentiate between sound tooth
structure and carious tooth.
2. Promote detection of small carious
lesions.

38. Fiber Optic Transillumination (FOTI)
Depends on the
propagation of light
from the source (fiber
optic handpeice) to the
non-illuminated tooth
surface
No Shadow High index of light transmission No Lesion
Darkened shadow low index of light transmission Carious lesion

40. Digital Imaging Fiber Optic
Transillumination (DIFOTI)
Early caries detection without using ionizing radiation.
The light from the
DIFOTI probe is
positioned on the
tooth
Tooth is
illuminated
Images are
captured by a
digital electronic
charged coupled
device camera
(CCD)
Sent to a computer
Analyzed using
branded sequence

41. Optical Coherence Tomography (OCT)
• Uses reflections of
infrared light with
considerable penetration
into tissue without
biological effect.
• Determine not only the
occurrence of decay but
also the depth of caries
progression.

42. Electrical Conductive measurement device:
Porosity of
the affected
tooth
surface
Cause
soaking
(wetting) of
saliva
Increase the
electrical
conductivit
y of the
tooth
Shows a
differential
conductivity of AC
between sound and
carious tooth
surface

43. Alternating Current Impedance Spectroscopy
Consists of an application of multiple
electrical frequencies for the diagnosis
of both occlusal and smooth surface
caries through a device called
“CarieScan PRO”.
Allows to detect the state of the
tooth structure:
-Sound
-Early stages of demineralization
-Badly decayed state.

44. The severity of the carious lesion is determined by
both color and numerical scales.

45. Dyes For Detection Of Caries
It binds to carious lesion which then is disclosed with the fluorescence.

46. Enamel Caries Dyes
Procion
Calcein
Zyglo ZL-22
Brilliant blue
Dentin Caries Dyes
1% acid-red 52 in
propylene glycol base
Iodine

47. Thank you