copyright © 2005 by elsevier inc. all rights reserved. preventive dentistry chapter 15

Copyright © 2005 by Elsevier Inc. All rights reserved.

Preventive Dentistry

Chapter 15


Introduction

The goal of preventive dentistry is tohave a healthy mouth for a lifetime.

To achieve this goal, new and recurring disease must be prevented.


What Is Preventive Dentistry?

• Patient education

• Fluorides

• Dental sealants

• Proper nutrition

• Plaque control program

• Optimum oral health can become a reality.


Guides for Patient Education • Listen carefully: Each patient will have

different needs.

• The initial instruction: Explain the relationship of plaque to dental disease.

• Assess the patient’s motivations and needs: Combine the patient’s motivating factors with the patient’s needs.

• Select the home cleaning aids: Select a toothbrush, toothbrushing method, interproximal cleaning aids such as dental floss, and a toothpaste.

• Keep the instruction simple: Comment positively on the patient’s efforts.


Fig. 15-1 The mother lifts the child’s lip and looks for early signs of decay.


Fig. 15-2 The intraoral camera is a valuable tool in patient education.


Dental Sealants• Dental sealants are used as a means of protecting the

difficult-to-clean occlusal surfaces of the teeth from decay.

• A dental sealant is a plastic-like coating that is applied over the occlusal pits and grooves of the teeth.

• Sealants cover the occlusal pits and fissures where decay-causing bacteria can live.

• Dental sealants are an important component in preventive dentistry.

• In several states, the application of dental sealants is delegated to the dental assistant as an expanded function.


Fig. 15-3 This molar is protected from decay with a dental sealant.(Courtesy 3M ESPE, St Paul, MN.)


Fluoride

• Fluoride has been our primary weapon to combat dental caries for more than 40 years.

• Fluoride slows demineralization and enhances remineralization of tooth surfaces.

• Fluoride is a mineral that occurs naturally in food and water.

• A supply of both systemic and topical fluoride must be available throughout life to achieve the maximum cavity prevention benefits.


Ways of Receiving Fluoride

• Prescription-strength fluorides that are applied in the dental office

• Nonprescription-strength over-the-counter products for at-home use

• Fluoridated water, either bottled or community water


Ways of Receiving Fluoride-cont’d

• Systemic fluoride is ingested in food, beverages, or supplements.

– The required amount of fluoride is absorbed through the intestine into the bloodstream and transported to the tissues where it is needed.

– Excess systemic fluoride is excreted by the body through

the skin, kidneys, and feces.

• Topical fluoride is applied in direct contact with the teeth through the use of fluoridated toothpaste, fluoride mouth rinses, and topical applications of rinses, gels, foams, and varnishes.


Fig. 15-4 Various forms of topical fluoride


How Does Fluoride Work?

• Pre-eruptive development: Before a tooth erupts, a fluid-filled sac surrounds it. Systemic fluoride present in this fluid strengthens the enamel of the developing tooth and makes it more acid resistant.

• Posteruptive development: After eruption, fluoride continues to enter the enamel and alter the structure of the enamel crystals. These fluoride-enriched crystals are less acid-soluble than the original structure of the enamel.


Fluoridated Water

• For more than 40 years, fluoride has been safely added to the communal water supply.

• Most major cities in the United States have fluoridated water, and there are continuing efforts to fluoridate water in other communities.

• From a public health standpoint, fluoridation of public water supplies is a good way to deliver fluoride to lower socioeconomic populations that may not otherwise have access to topical fluoride products such as fluoridated toothpaste and mouthrinses.


Fluoridated Water-cont’d

• Until recently, it was believed that water fluoridation was effective in preventing tooth decay by systemic uptake and incorporation into the enamel of developing teeth.

• It has now been proved that the major effects of water fluoridation are topical and not systemic.

• Topical uptake means the fluoride diffuses into the surface of the enamel of an erupted tooth rather than being incorporated into unerupted teeth during development.


Fluoridated Water-cont’d

• Approximately one part per million (ppm) of fluoride in drinking water has been specified as the safe and recommended concentration to aid in the control of dental decay.

• This is approximately equivalent to one drop of fluoride in a bathtub of water.

• The levels of fluoride in controlled water fluoridation are so low that there is no danger of ingesting an acutely toxic quantity of fluoride.


Safe and Toxic Levels of Fluoride

• Fluorides used in the dental office have been proved to be safe and effective when used as recommended.

• Chronic overexposure to fluoride, even at low concentrations, can result in dental fluorosis in children younger than 6 years with developing teeth.

• Acute overdosing of fluoride can result in poisoning or even death.

• Acute overdosing is very rare.


Fluoride Precautions

• To prevent patients from receiving too much fluoride:

– Evaluate the patient’s current fluoride intake.

– Perform a fluoride “Needs Assessment.”


Fig. 15-5 A, Mild fluorosis


Fig. 15-5 B, Moderate fluorosis


Sources of Systemic Fluoride

• Foods and beverages: Many processed foods and beverages are prepared with fluoridated water.

• Prescribed dietary fluoride supplements may be prescribed by the dentist for children ages 6 months to 16 years.

• NOTE: Toothpaste and mouth rinses: Toothpaste and mouth rinses containing fluoride should not be a source of systemic fluoride because with proper use any excess is spit out and never swallowed.


Fig. 15-6 Preventive dentistry


Fig. 15-7 Fluoride rinse and fluoride dentifrice


Fig. 15-8 Children must be carefully supervised while brushing to avoid swallowing fluoride-containing toothpaste.


Fig. 15-9 Training toothpaste for young children


Fig. 15-10 Various chemotherapeutic products available to consumers. (Courtesy Oral-B Laboratories.)


Sources of Topical Fluoride

• Toothpaste containing fluoride is the primary source of topical fluoride.

• Fluoride mouth rinses

– Prescription

– Nonprescription

• Brush-on fluoride gel

• Professional topical fluoride applications

• Fluoridated water


Nutrition and Dental Caries

• Without dietary sugars, dental caries will not occur.

• Sucrose has a greater decay-causing potential than other sugars, but maltose, lactose, glucose, fructose, and their combinations do have high caries-producing abilities.

• Flour and starches are not usually decay-causing, but when starch is used in conjunction with sugar, i.e., in cookies and so on, the potential for caries increases.


Sugar Substitutes

• Increasing use of less fermentable and noncariogenic (caries-causing) artificial sweeteners.

• Artificial sweeteners are an alternative to sucrose:

– Saccharine (“Sweet and Low”)

– Aspartame (“Nutrasweet” and “Equal”)

– Sorbitol

– Xylitol

– Mannitol


Sugar Substitutes-cont’d

• Of these sugar substitutes, saccharine, aspartame, sorbitol and mannitol are noncariogenic—which means that they do not cause dental caries,

• Xylitol is the only one of the artificial sweeteners that actually prevents caries (anticariogenic).

• Products that contain xylitol are significantly better; however, they are also more expensive than products with other types of artificial sweeteners.


Fig. 15-11 Ford “Extreme Xylitol” gum and “Sugarfree Dental Care” gum containing xylitol and sorbitol


Dietary Analysis

• A dietary analysis is done to determine the patient’s current food intake to assess the need for dietary counseling.

• The patient maintains a food diary that includes everything consumed each day for 1 week.

• The listing includes all meals, supplements, gum, snacks, and fluoridated water.

• It can then be used to reveal any dietary habits that are likely to have an adverse effect on the patient’s oral health.


Plaque Control Program

• Plaque can be kept under control by brushing, flossing, interdental cleaning aids, and antimicrobial solutions.

• A goal of the program is to remove plaque at least once daily.

• The techniques that are selected must be based on the needs and abilities of the individual patient.


Fig. 15-1 Disclosing solution shows heavy plaque formation throughout the mouth.


Oral Hygiene Aids and Methods

• There are a wide variety of oral hygiene products on the market today.

• It is important for dental assistants to remain current on the newest products on the market so that they can advise patients, make recommendations, and answer their questions.


The Toothbrush

• The two basic types of toothbrushes are:

– Manual

– Automatic

• When used properly, both types are effective in the removal of dental plaque.


Fig. 15-12 Examples of manual toothbrushes (From Daniel SJ and Harfst SA: Mosby’s dental hygiene: concepts, cases, and competencies, St. Louis, 2002, Mosby.)


Fig. 15-13 The proper adaptation of the brush head of a powered toothbrush

(From Daniel SJ, Harfst SA: Mosby’s dental hygiene: concepts, cases, and competencies, St. Louis, 2002, Mosby.)


Toothbrushing Precautions

• The patient should be cautioned about damage that may be caused by vigorously scrubbing the teeth with any toothbrush.

• Over time this may cause abnormal abrasion (wear) of the tooth structure, gingival recession, and exposure of the root surface.


Fig. 15-14 Observing toothbrushing technique


Fig. 15-15 Improper brushing techniques can result in abrasion of the tooth surface and can cause gingival recession.

(Courtesy Dr. Robert Meckstroth.)


Toothbrushing Methods

• There are several methods of toothbrushing:

– Bass method

– Modified Bass

– Charter’s method

– Stillman method

– Fones method

• The dental professional will recommend the method best suited to the patient’s needs.


Dental Floss

• Dental floss or tape removes bacterial plaque and thus reduces interproximal bleeding.

• Dental floss is circular in shape and dental tape is flat.

• Floss and wax can be purchased in various colors and flavors.

• Floss and tape are available in waxed or unwaxed varieties.

• Research has shown that there is no difference in the effectiveness of waxed or unwaxed floss for plaque removal.


Fig. 15-16 The dental assistant assists the patient in learning to floss.


Interdental Aids

• End-tuft brushes

• Bridge cleaners

• Automatic flossers

• PerioAid


Fig. 15-18 A and B, End-tuft toothbrush for anterior and posterior teeth

A B


Fig. 15-19 Bridge cleaner and dental floss


Fig. 15-20 Automatic flosser


Fig. 15-21 PerioAid


Fig. 15-22 Denture and denture brush


Dentifrice (Toothpaste)

• Dentifrice (toothpaste) contains ingredients designed to help remove food residue and abrasives to help remove stain.

• Highly polished tooth surfaces will stain less readily and remain clean longer.

• Most brands of toothpaste now contain fluoride. They also contain flavoring agents to give the mouth a fresh and clean feeling.

• Some toothpaste now contains a compound that reduces calculus formation when it is used regularly following a dental prophylaxis.

– It will not remove existing calculus.


Fig. 15-23 Marketing toothpaste for children


Fig. 15-24 Mouthrinses. A, Two prerinses (left) and several non–alcohol-containing mouthrinses (right). B, Familiar brands of mouthrinses containing alcohol ranging from 8% to 27%.

(Courtesy Dr. W.B. Stilley II, Brandon, Miss. From Daniel SJ, Harfst SA: Mosby’s dental hygiene concepts, cases, and competencies–2004 update, St. Louis, 2004, Mosby.)


Fig. 15-25 Irrigator. Unit is shown with supragingival and marginal irrigation tips and two reservoirs.The larger reservoir is on top of the unit and is designed for water. The smaller reservoir is designed for chemotherapeutic agents (for example , chlorhexidine) and is tinted to reduce light degradation.

(Courtesy Waterpik Technologies, Fort Collins, Colo.)


General Guidelines for Home Care Products

• The ADA Council on Dental Therapeutics conducts an independent review of the scientific evidence of the research claims and evaluation of home care products.

• When a product meets the appropriate standards, it is given the ADA Seal of Acceptance. The ADA's Seal of Acceptance provides a quality assurance guarantee for consumers and professionals.

• Check the ADA's web site at http://www.ada.org to receive current information on toothbrushes, dentifrices, interproximal aids, and products for the prevention of gingivitis and caries.


Fig. 15-26 The American Dental Association’s Seal of Acceptance


MouthRinses

• Many patients like the feeling of freshness provided by a mouthrinse.

• There is a wide variety of mouthrinses on the market today, and some also contain fluoride.

• Recovering alcoholics should select a mouthrinse that does not contain alcohol.

• Rinsing the mouth with water is recommended after meals and snacks when toothbrushing and interdental cleaning are not possible.


Irrigation Devices

• Oral irrigators deliver a pulsating stream of water or chemical agent through a nozzle to the teeth and gingiva.

• Oral irrigation can be applied at home by the patient or in the dental office.

• Oral irrigation helps to keep the subgingival bacterial levels at a minimum.

• For selected patients, oral irrigation can supplement other oral hygiene techniques.

copyright © 2005 by elsevier inc. all rights reserved. preventive dentistry chapter 15

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dental disease

dental floss

dental caries

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dental sealantsdental

application of dental

fluoride mouth rinses