Preventive Dentistry

& Early Caries Detection

Presented By : -Ghida Lawand -Roudy Khayat -Mayss Kamala -Mostafa Mansour -Ali Khalaf

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.Fluorides2. Antimicrobial

agents

Methods to reduce demineralizing factors

1) Dietary Measures

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 teethIncreases caries

protective mechanism

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

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

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

B) Interdental cleaning:

Dental floss (Used with normal proximal contacts)

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:

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.

2) Chemicals altering the tooth surface or tooth structure 

Fluoride can reach the enamel in two ways:

Systemically TopicallyThrough 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

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.

1. Has anti cariogenic properties2. 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).

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

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

Resins

1.Bonded to enamel by acid etching

technique2.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

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

Genetically modified food

Current Methods in caries prevention

Caries Vaccine

 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

• 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

Problems in development of caries vaccine

1. Caries etiology is still not completely known so the effectiveness of this vaccine is not ultimate.

2. Cross reactivity of Streptococcus mutans cell antigens is found in the muscles of the heart.

Visual-tactile method

Radiographic methods

Electrical conductance measurement

 

Early Caries detection Tools

Lasers

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).

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:

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

Visual examination

Cavitation

Early caries lesion

Discoloration

White lesions

Cavitated carious lesion

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

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

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.

Qualitative Laser Fluorescence(QLF)

Light induced fluorescence

• 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.

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

DIAGNOdent

Laser Fluorescence

• 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

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

Value Indication Restorative suggestion014 No caries No treatment other than

preventive1520 Histological caries within

the enamelPits and fissure sealant

 

2199 Histological dentinal caries

Risk

>30 Cavity Operative treatment

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.

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

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

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.

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

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.

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

Dyes For Detection Of Caries

It binds to carious lesion which then is disclosed with the fluorescence.

Enamel Caries Dyes

Procion Calcein Zyglo ZL-22Brilliant blue

Dentin Caries Dyes

1% acid-red 52 in propylene glycol baseIodine

Thank you