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Preventive Denyterrdt: - R L R" Ws
Preventive Denyterrdt: - R L R" Ws
7
DENyterrDT
INTRODUCTION
-r m.; li r" Ws
PUBLIC NIMTN OENTISTRY
lealaliffnl :A state of complete physical ,mental and
social well being and not merely the absence of
disease .
DestalPoilielealaffielmetiesfiliosalofilestal
Poiliellealak The science a art of
Preventing disease,
prolonging life,
promoting health & efficiency
through organized community effort (Winslow, 19201
1 1 rr
MIS 411/MIPIBIle
1 Epidemiology:
5 Prereslisiliestisrle
FDA
)..5 Food and Drug Administration
C
CHARACTERISTICS PUBLIC HEALTH:
• 1. PUBLIC HEALTH METHOD DEPENDS ON TEAM WORK.
• 2. PUBLIC HEALTH WORK SHOULD DEAL WITH ALL PARTS OF PROBLEMS; INVOLVING THE HOST,
AGENT AND THE ENVIRONMENT.
2
2C
BECAUSE:
Al PREVENTION OF THE DISEASE IS BETTER AND CHEAPER THAN ITS CURE.
M PREVENTION CAN BE BETTER PERFORMED ON MASS POPULATION THROUGH PUBLIC HEALTH.
• 4. PUBLIC HEALTH DEALS WITH HEALTHY AND APPARENTLY HEALTHY AS WELL AS WITH
• DISEASED PEOPLE.
'VENT YE DENTISTRY
• DEFINITION
C
The Levels of Prevention
PIRI MA.Frer SE C.0 N ID.A.FVer TE-RTUAR_
Prevention Prevention Prevention
Definition An intervention Ark intervention. An intervention
i mplemented before i mplemented after a i mplemented atter a
there is evidence of a disc sehas begun, disease or infury is
dis-e-ase or trip...ay but before it is est-al:Fri -she-1J
syrnptomatic_
I ntent Reduce or eliminate Early identification Prevent s-e-quelae
causative risk factors (through screening) (stop bad- things from
(risk reduction) and treatment getting worse)
Remember that primary prevention activities will actually stop the illness happening, while secondary
activities stop the illnesses getting worse.
PREVENTION OF DENTAL
CARIES
4
4
(
INTRODUCTION
Definition of rit 1-
01 r;arie'
"Dental caries is a microbial disease of the calcified
tissues of the teeth, characterized by
demineralization of the inorganic portion and
destruction of the organic substance of the tooth
which often leads to cavitation"
Cyr uses
Susceptibie
Cavities? Tooth
Ik
ORAL ANSWERS
IIMS OF PREVENTION
pb
3. Tertiary prevention(prevent
loss of function)
■ Limits the extent of disabilities once a
disease has caused any functional
li mitation.
■ By complex restorative dentistry.
Level's cif Prevention
Seco-nd
Primary Terttory
Preventive Siervkes Eurfy Dios, MTh mind
Provided by the l-lealth Pro.i.riatiahr, Specific PIP-4ritectio-n Frumpt Treatrriffnt Disability LirrpitaEllori Rehabilitation.
Individual Approach
Individual pa- Diet planning; Appropriate. use of Self-examination Use of dental Use of dental
tient (self- demand for pre- fluoncUe and referral; use services services
administered) yen -dye serwices; Fluoridated water of dental services.
periodic dental ▪ Fluoride
visits prezcripti iris
▪ fluoride
den-trifice
▪ Oral hygiene
Dental pro canal Pa.tient education; Topical fluoride; Complete examina- Complex mst.E. !native Removable and
plaque control fluoride tion; prompt dentistry; pul-pot- _fi xed prosthodon-
program; diet supplement /rins-e treatment of in- orny; root canal tics; nurbor tooth
counseling; recall prescription; pit cipient lesions; therapy; extrac- movement;
reinforcement; and. fi.s. -uve preventive resin -Lions implants
dental caries ac- sealarkt- restorations;
tivity tel.itz5p simple restc. -)Tative
dentist; pulp
caPI:Ping
Conituu n ity Approach
Comm u n i tV Dental h.eaLth ed -u- Cornm-unity or Periodic screening Provision of dental Provision of dental
catkin prow- 8.; school water flu.- and referral; pro- services services
promotion of re- oridation; sch.0-01 vision of dental
search, policy. fluoride mouth services
ancl Legislation rirLs-e or tablet
program; school
beatat program
Modified from Chunning P61: Principab in/de -Fria? pub/ir !malt& eell 4, Cambridge.. MA. 1986, Harvard University l' -ress; I'Vlardel
-
Pm-LP Vent r 1 97 4; Les -ke Rips 1W, Callaimen. VA; Preventi. Ora of dental disea.ses_ In Icing AW. editor! fa rm irthi den 1.1;1 hea
Asmaa Aly
associate professor
pediatric and preventive
public health
INTRODUCTION
Disease Health
Lesion progression Lesion arrest or regression
Protective factors:
( -..
S
•Antibacterial
Risk Factors •Fluorides
acteri •Effective die
•Absence of saliva
Diseas • indicators •Dietary
•Whi spots habits poor
•Restorations > ,
years
•Enamel lesions
•Cavities/ dentin
Caries progression
RISK ASSESSMENT
Risk assessment is a professional judgment of an individual's future risk
of disease based on the best information available.
GOALS
iil Screen out low risk patients
El Identify high risk patients before they become
caries- active and
177
Monitor changes in disease status in caries-active
patients
ISK FACTOR RISK INDICATOR
!ague
_JIM I
An environmental, behavioral or biological factor is a factor or circumstance that is indirectly associated
which if present directly increases the probability of with the disease.
disease occurring and if absent or removed reduces
the probability.
Risk factors are part of the causal chain, or expose
the host to the causal chain.
Important to estimate
same sites.
2)- SPECIFIC MICROBES
6.5
Plaque 6.0
pH Remineralisation
5.5
Demineralisation
5.0 I
5 10 15 20
Minutes after sucrose rinse
7 11•
•Infants and toddlers - regularly bottle fed with sweet drinks at
night or breast fed for > twelve months- z> risk factors for
caries.
r.
5) SALIVA
--r -
• Chronically low salivary flow rate —\ one of the strongest
I/
salivary factors r increased risk of developing caries.
__r
• caries is extreme absence of saliva.
—V
DEMINERALIZATION AND REMINERALIZATION
.
su ar-fret
riogenic medi
• Salivary factors • Salivary factors
• Salivary buffers that aid in
• High salivary MS & neutralizing acids
Lactobacilli counts
• Salivary proteins and lipids that
• Poor salivary flow form pellicle & protect tooth
rate impeding
surface Salivary Calcium &
clearance
Phosphate ions can enhance
remineralization & delay
mothers with high salivary MS levels
frequently transmit MS to their babies as demineralization
soon as the first primary teeth erupt,
leading to greater development of caries
ar
• Caries Risk Assessment Tools
Ntrrie
pptriOnc.
Iderallo
Date
9elemel
diseemtt 1°
Exarmer
tie!, conteen
Uioq frogor.ty I
a
Plaque ozmunk i)-2
1..4.11:64
Elpitprgmcci 362
Riolicreprognni
Saliv5secrOon
nutier capacmy
ITN 0-2
IJ
HIGHT RISKTO
The five sectors of -ca
1.The green sector shows an estimation of
the 'Actual chance to avoid new cavities'. The
green sector is 'what is left' when the other
factors have taken their share.
•
T All(
LI
41111141111
:
Asmaa Aly
associate professor
pediatric and preventive dentistry and dental public
health
:What is dental plaque
1 -tooth brush
2-interdental aids
3-other
Tooth brush
• Mechanical
,•
• Electrical 11111.P.ad
11"*.
'
';
Mechanical tooth brushing
t
• handle:The part grasped in the hand
0
during tooth brushing.
0
t
read : it is the working end of tooth
brush that hold bristles.
h
b tufts: clusters of bristles secured
r into head
u
S
h
9,z
Toothbrush bristles I
• Natural: hog
• Artificial filaments: nylon which are
uniform in size & elasticity, resistant to
fracture & doesn't get contaminated. _1
Bristle hardness
• Soft brush: 0.007 inch(0.2 mm)
• Medium brush: 0.012 inch(0.3
mm)
• Hard brush: 0.014 inch(0.4 mm)
BASS Apical toads gingival into sulcus at Short beck and firth vibratory Cervical plaque removal
45 0 to tooth surface motion wi le bristles moil in Easily learned
600ct gingival stimulation
aronally 454 sides of bristles half Sun ciicular motions with apical Hard to learn and position
on teeth and half of gingiva move/lents towards 9in9 awl margin brush
Clears inter proximal
Gingivt I stimlition
Fors Perpendicular to the tooth With teeth in oc elusions, move Easy to learn
brush in rotary ► rotico ova` both Liter proximol um not
arches and gingival margin cleaned
May ma mat
Modif led Pointing apicnIly at and angle of 45Q Apply pressure as in stillmans's Easy to master
stillrnan's to tooth surface method but vibrate brush and also Gingival stimulation
• Brushing our teeth is an i mportant part of our dental care routine.
• For a healthy mouth and s the ADA recommends
• Brush your teeth twic day with a soft-bristled brush. The size and
shape of your brush should lit your mouth allowing you to reach all areas
easily.
• Replace your toothbrush every three or four months. or sooner if the
bristles are frayed. A worn toothbrush won't do a good job of cleaning
your teeth.
• Make sure to use an ADA specified fluoride
toothpaste.
mg z
Powered toothbrushes
1
Ma araical Plamvuoie Cantral
-taoth brush
2-i nterclen ta I aids
ummosa ppaiiri.,
3-other
Dental Floss
Multifilament vs. monofilament
Twisted vs. untwisted
• Waxed vs. unwaxed
12-18 inches for use
• Stretch: thumb and forefinger
• wrapped around proximal surface, and removes plaque by using
several up-and-down strokes. The process must be repeated for
the distal surface of tooth
dent a -pictures ow om
Floss holder
.4 !M
begins to shred.
mg z
ftwalalliin
411111.8
g
r ■
ig IMMMIX
Wooden or rubber tip
• Wooden tips are used either with or without a handle. Access
• is easier from the buccal surfaces for those tips without
• handles, primarily in the anterior and bicuspid areas.
I ndividual r-rl chanical plaq ues cbntrc:)1 is
achi e v € d by :
■ Gingival massage
can be performed with a toothbrush
rubber tip stimulator or interdental
cleaning devices •
it produces :- r
\00,
-I
'724 --
1 epithelial thickening
2 increased keratinization
3 increased mitotic activity in epithelium
and connective tissue
irrigation devices
11111
11,.=•
TONGUE CLEANER
Methods of Plaque Control :
Mechanical :
Chemical ;
• Antimicrobial
• Plaque removal
• Remineralization
i• sensitivity
ehicles for the delivery of chemical agents
• Toothpaste
• Mouthrinses
• Spray
• Irrigators
• Chewing gum
Dentifrices
• capable of staining
bacterial plaque deposits on
the surfaces of teeth,
tongue, and gingiva
• Erythrosine
• Fluorescein-containing dye
The Role of
DENTIST
in Detection and Prevention
of Oral Cancer
ASMAA ALI
0At present, total prevention of cancer before its
occurrence is nearly impossible.
0 It can be prevented from causing rapid destruction
of tissues and death to the patient by early detection
and treatment.
0In other words, early detection and the use of control
methods can prevent mutilation of tissues and
metastasis of the disease, providing a greater chance
for survival and complete cure for the patient.
Predisposing factors
TOBACCO&ALCOHOL
ill-fitting dentures,
broken teeth or teeth with sharp edges,
poor diet and
systemic diseases(autoimmune conditions)
PRIMARY LEVEL
OF PREVENTION
0Recognition of the
predisposing factors is of
great importance.
1.Stop smoking
2.Stop alcohol
3.Good oral hygiene
4.Eat fresh vegetables, fruits and balanced food
5.Use a cap when working under sun
6. Wear facemasks/ cover your mouth when
2.Unknown source
of bleeding
3. Loose Tooth
4. Loose Fitting
Dentures
5. Difficulty in Speaking
6. Difficulty in
Swallowing
7. Unexplained Pain
8. Weight
Loss
HOW CAN IT START???
WHAT ARE PRE-
CANCEROUS LESIONS?
/ I • I'Prid Er 7 1 1 =111111P fi AR 4
,Re aUon between cd and, ca I's
chemoparasiiik theonL
of dental plaque
II ealihy Cavity
To
✓ cariogenicity of carbohydrate
varies with:
2. Increase in sugar intake increases caries activity (Higher frequency means more
demineralization and less remineralization.)
❑ The risk of caries is treater, if the su -ar is consumed inform which is stic
a ce ti = is prolcin I
01PE c ea ra vopelP res va ry by
'Indvkilua person (and de end 1 a,
itmetabolism by microorganisms
2. adsorption onto oral surfaces
3. degradation by plaque and salivary enzymes
4. saliva flow, and
5 swallowing. Most carbohydrates will be cleared by these
simultaneous mechanisms
the longer the foods are retained
in the oral cavity, the greater the potential the starch has to
• A n in
-
3- atemi cotcom-position of
carbohydrates
The caries potential of
glucose, fructose, lactose
or maltose were
almost same as of starch
but sucrose was much
more cariogenic sugars
r1
glucose,
sucrose + fructose Monosaccharide
: naturally knuid i n Disaccharide: Polysacchar Ude
due to low molecular weigh fruit ,wetab]€ and
bray
Studies have shown that several types of cheese are not only
.•.• „...1
✓ Milk
Cow's milk and human milk contain lactose which may be
classified as cariogenic. But lactose is least cariogenic of the
dietary sugars and milk also contains calcium, phosphorus
and casein which inhibit caries.
cow's milk is not only non-cariogenic,
but also has an anti-cariogenic effect.
Fibrous Foodc
Fibrous foods protect the teeth because they mechanically
stimulate salivary flow. Other foods that are good gustatory
and/or mechanical stimulants to salivary flow are peanuts,
hard cheese.
ARCH CRIMINAL °F e, fa i,
RIES
zy
Sugar substitut
➢ Sorbitol
➢ Xylitol
➢ Mannitol
MS.
Xylitol
stAIMM
Xylitol is widely used in sugar-free products such as Xylo Swee
chewing gums, candies, and toothpastes 11.4wwwl WI.. •
-Or .
2. How many times a week co you eat the following meals away from home?
Breakfast Lunch Dinner
What types of eating places do you frequently visit? (Check all that apply)
Fast-food Dinericafeteria
Restaurant Other
Aim: — Determination of individual eating habits when vague 3. On average. how many pieces of fruit or glasses of juice do you eat or drink each day?
reports from patient make it impossible to determine whether Fresh fruit Juice (8 oz cup)
an adequate diet is being obtained. 4. On average. how many servings of vegetables do you eat each day?
5. On average, how many times a week do you eat a high-fiber breakfast cereal?'
6. How many times a week do you eat red meat (beef, lamb., veal) or pork?
10. How many times a week do you eat desserts and sweets?
11. That types of beverages do you usually drink? How many servings of each do you drink a day?
Water lk:
Juice Whole milk
Soda 2 % milk
Diet soda 1 % milk
Sports drinks Skim milk
Iced tea
Iced tea with sugar
TECHNIQUE:
—In this analysis the patient has to record his exact food intake for a period of
one day; 3 days or preferably one week and then analyze the report for calories,
—From this analysis factors can be brought to light which may have escaped the
patient's notice.
Diet for good general nutrition is the diet that must contain the essential nutrients:
4. Enriched phosphates.
DIETARY RECOMMENDATION:
I) Keep the carbohydrate content of the diet as low as possible consistent with satisfactory caloric intake. It is preferable
that no more than half the daily calories be carbohydrate.
2) When carbohydrates are used select wherever possible the soluble forms or those that clear the mouth most quickly.
Leafy, green or yellow vegetables are good carbohydrate sources with low retention.Avoid sticky candy and suckers.
3) Consume carbohydrate at meals so far as possible.Avoid between meal snacks, substitute the sticky sweets with nuts, raw
fruits or vegetable for the in-between meal snacks if such snacks are unavoidable.
4) Cheese is recommended as caries preventive food because it causes strong stimulation of salivary flow, raise the calcium
concentration in the plaque and raise the PH within 3 minutes after ingestion.
MS.
THANKYOU
D n if rvir)
A A
••■/
J J
(,)
■■■
ASMAA ALY
ASSOCIATE PROFESSOR
PEDIATRIC AND PREVENTIVE DEN'
PUBLIC HEALTH
Pathological factors Protective factors
■ Frequent consumption • Healthy diet
of dietary sugars • Brushing with fluoride
• Inadequate fluoride toothpaste twice daily
■ Poor oral hygiene ■ Professional topical fluoride
11....mmm------- -
PREVENTIVE • Salivary dysfunction ■ Preventive and therapeutic
sealants
• Normal salivary function
DENTISTRY .r
Topical protection
protection of teeth:This includes all measures applied
Setdgekor
- —
PrerwWw Simko crly Pigeno.is end
Pftwkied tr, the fiecilth Peen.fien Specific P.m.., Phbrpr Trecer.ent ilfiabiny
lodivIdual Approach
Individual pa,
tient OAF
adniinistened)
Diet planning;
demand for pt.,
ventive services;
Appropriate use
fluoride:
• Fluoridated water
Al self-...simliork
and referral; use
of dental services
Use of denial
serviemk
Use of dental
services
to increase the resistance of the intact outer tooth surface.
periodic dental • Fluoride
2. Fissure sealants.
COMOVLIn ity Approach
l:nrnmu es Dental health edu- Community or Periodic scnrenIng Poavision of dental Provision of dental
cation programs; school water fil• and referral: pro- services srrvicea
promotion of re- oriclarlon; school viSkrk 4 1 c1,-..1
scorch. pot try, fluoride mouth services
and legislation rinse or tablet
program: school
sealant program
3. Preventive resin restoration.
Modified from Donning JAM ridsrlrots oftrwtel pu61rc Ipalra, ed 4. cornbekig, MA, 1., 1-1,11 , ...ti Unnia .ly Frr, Mandel WI.
Deg 25, 1471, 1,24g. Ca ripe LW, Callanen VA: Prey...if. a dultill 41114dera. re Iunp, SW, AditsA conestorin i r ifortio hoe, Asmaa Aly
associate professor
pediatric and preventive den
4. A traumatic dentistry (ART) are the most essential.
health
ams-
ASSESSMENT
PERIODONTAL DISEASES
Periodontal diseases are inflammatory conditions affecting the
na r i nrinn*
i.
2) periodontal ligament
3) Alveolar bone
4) Cementum
These all 4 parts are the Root-
Periodontal Disease?
Healthy tooth Gingivitis
& gum tissue Bacteria create plaque buildup
& inflame the gum tissue
Plaque
Gum buildup
i nflammation
8. bleeding
_ '•••• a
• • 4... • •
• • ••••
• • • •;
•• ;
•
• •• •
•• ••••,...
: • - • "
•
• • • -
le
- a
• • • • • •
a• • .• ■
•
Periodontitis Advanced
Plaque hardens into calculus,
pockets form around teeth & Periodontitis
bone loss begins Significant bone loss & pockets
Pocket from I Advanced Deepening of
lk Beginning of pockets
gum bone loss bone loss 8a
recession tissue damage surrounding
•••• •••••
• • !'
a • • • • " .
• • • 4
■
• • • • •
:
• - .
• . -
a. eriodontal diseases
Local factors Systemic factors
• Poor oral hygiene resulting in •
accumulation of dental plaque and • Malnutrition- deficiency of vitamins A and C
calculus
i• Endocrine disturbances
• Food impaction
- Physiological (puberty, pregnancy and the menopause)
•Chewing and smoking of tobacco
- Pathological (hyperthyroidism, hyperparathyroidism and
• Faulty restorations diabetes mellitus)
• Badly designed partial dentures : Decreased immunity (HIV infection, persons on
i mmunosuppressive drugs)
•Orthodontic appliances
r Blood disorders: Anaemia, leukaemia
• Malalignment of teeth •
• Drug induced- phenytoin sodium .
• Lack of lip seal/mouth-breathing —,--
r hruichincr tprhninuip
Primary
Prevention: prevention Secondary
prevention
100%
Tertiary
Periodontal support
Health prevention
• Prevention of periodontal
disease encompasses a set Gingivitis 1.
of various actions which
ultimately aim at preventing
or controlling the disease. It Periodontitis
may apply to any point of
the disease process.
Time
Fig. 4. Levels of prevention according to periodontal
conditions.
Primary Secondary Tertiary
• Falls
• Violence
• Traffic accidents
• Baby walkers
• Child abuse
• Bike and car accidents
epidemiology
1. Age The main peak periods for dental injury are described as
being between the ages of 1 &3, and again between the ages of
6 &12 (school aged children).
3. Gender
Males are more commonly affected than females.
• Oral piercing
• A quite new category is TDIs that result from piercing of the
tongue and lips, lip and tongue piercing may lead to chipping and
fracturing of teeth and restorations .
• Inappropriate use of teeth
• many individuals have injured their teeth
when using them as a tool to open hair
clips, fix electronic equipment, cut or
hold objects or opening bottles of soda.
3-Oral predisposing factors
a) Use safety gates at the top and bottom of stairs and in the
doorways of rooms with hazards.
b) Retentive.
c) Comfortable. Providing ease of speech and breathing. And don’t
exceed the free-way space.
HH"//\ QA i
rn copq ft—QM]
0
. ,■.. QE
ASMAA ALY
ASSOCIATE PROFESSOR
PEDIATRIC AND PREVENTIVE DEN
PUBLIC HEALTH
Topical protection of teeth:This includes all measures applied
to increase the resistance of the intact outer tooth surface.
Among these measures are:
THE PROCESS OF DECAY OF THE TOOTH INVOLVES 3 MAJOR FACTORS:-
Bacteria Diet
I. 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.
2. Types:
• Dimethacrylate bis-GMA resin (the most commonly used) •
Before Fissure After Fissure
• Glass ionomer: provide good adhesion and fluoride release. Sealant Sealant
• • Compomer.
Fissure s lat
Coq-JD:Ma ream
pulpal involvement.
b.Accessible to hand instruments.
The advantages of ART include:
a. Use of easily available and inexpensive procedure to conserve sound tooth
surfaces.
b. 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, home-bound, institutionalized people and economically less
developed countries.
• SMART: a Simplified and Modified ""q1111111kk6a
Atraumatic Restorative Treatment is a
1
- Water from deep wells and artesian wells usually provide high natural
fluoride concentration. (fluorosis) 10 3 inilk 4) Sea food
- Most vegetables, fruits and dairy products contain low amount of fluoride. 10 1
- But sea foods (fish sp. salmon and sardines, shrimp, crab, etc) may
contain
2.5 ppm. FLOURIDE SOURCES
- Most beverages especially tea.
0 0
- Fruit juices and soft drinks are generally low in fluoride, but the fluoride
content of the water used in the preparation of such beverages or in the
cooking of food will be reflected in the fluoride concentration of the final EGG FLOWMATION TEA LEAVES
product. If all that doesn't make fluoride available enough, then there are
several dental products with fluoride included.
41111k
AM&
— The average diet provides 0.2-0.3 mg of FISH MEAT EGG FLOUFWATION TEA HEAVES
fluoride daily.
Uptake of Fluoride by the Teeth:
— Fluoride is incorporated in enamel and dentine in two stages:
A. BEFORE ERUPTION:
During Calcification, traces of fluoride incorporated into the crystalline
structure of appetite lattice.
B.AFTER ERUPTION:
■ Enamel surface continues to pick up fluoride derived from diet,
water and saliva.
■The post-eruptive acquisition of fluoride continues throughout life
and is directly proportional to the concentration in food and water
ingested.
Action on tooth size and morphology: In communities with
fluoridated water supply, there is a trend towards shallower
Fluoride lowers free surface fissures and lower cusp height and smaller tooth size.This will
energy:This will decrease decrease caries susceptibility.
the plaque
accumulation on the
. Enzymatic inhibition: interfering with the
treated enamel surface.
breakdown of glucose to lactic
Car bonated
hydroxyapatite
and pyruvic acid. Both phosphatase and
enamel crystal enolase enzymes are inhibited by
Dem ineralization
Acid in plaque fluoride.
3. Bacterial inhibition: fluoride has a
Partly dissolved
crystal direct inhibitory effect on the bacteria of
Remineralization the dental plaque
Fluoride in •laque
Fluorapatite-like
Ionic exc ange of fluoride with the
coating on remineralized
crystal
hydroxyl group of calcium
Hydroxy appetite in the surface
DerninereNration mp;th F present
saturated Solutions:As H
fluorapatite
saliva is saturated by minerals, fluoride favors the F
fir.
H . PO.- thdroxy•shadt.
Ca jPO4 1.101-1),
which is less sol
F
precipitation of the calcium C'
remineralization of partially Cr •
FLUORIDES
Systemic fluoridation:
which means ingestion of
calculated amount of
fluoride to be
SYSTEMIC FLUORIDES
incorporated in the
I.Water Fluoridation developing teeth.
i. Community Water
I Likavy5eth.crg
DENTAL HEALTH
life is 6 ~ tt ~ r WITH TEETIs
A merican rade ny
odE
Prza isit ri
Fluoridation
61110116,
II. Milk Fluoridation
III. Fluoride tablets/ drops/ low
1: 4.
:_ir
01011-11.1-1:1
.0■••
Qualliesc'
FLUORIDES DELIVERY METHODS
•Dentifrices
•Neutral Sodium fluoride
•Mouth Washes
•Stannous fluoride
•Fluoride Gels
•APF
•low fluoride concentration
• Solu /Gels products ranging from
•Varnish 200-1000ppm or 0.2-1 mgF/ml.
TOPICAL FLUORIDES
Topical fluorides are those fluoride containing agents which are applied to
the tooth surface in regular intervals in order to prevent the development of
caries.
2. Children shortly after periods of tooth eruption, especially those who are not
carries free.
3. Medication to reduce salivary flow or had undergone head and neck radiation.
_■ -
SELF APPLIED TOPICAL FLUORIDES
Self applied fluorides products are usually bought and dispended by the individual patient but at the
recommendation of a dental professional. These fluoride products are of low concentration ranging
from 200-1000 ppm or 0.2-1.0 mgF/ml. The self applied fluoride usually are:-
1. Fluoride Dentifrices
2. Fluoride gels(1.23% fluoride)
3. Fluoride rinse
0.2% sodium fluoride-0.02% will reduce dental caries
incidence.
I KFTSUERSCHIREFKRAIGIVANHILIHTXHCA110410 CZ BK1
very dilute fluoride solution.
This is to be done after the routine tooth brushing to
obtain clean tooth surface
•- M_
■ -•
Percentage 2% 8% 1.23%
Fluoride 9,200 19,500 12,300
concn.(ppm)
pH Neutral (7) 2.4 - 2.8 3.0
4
Un-waxed dental floss is passed between the inter-proximal areas.
4
oral prophylaxis done Teeth are isolated and dried with air.
4
4 SnF2 is applied using the paint on technique and the solution is kept for4
minutes.
teeth isolated either by quadrant or by half mouth 4 Ifiatig?ithrOptintaiik FOITiisB ttai
Repeat applications are made every 6 months or more frequently if patients is
susceptible to caries.
2% NaF solution is painted on the air dried teeth so that all surfaces are visibly
Adverse effect wet Ia
4
allowed to dry for 3.4 minutes Staining of teeth,
repeated for each of the isolated se pnts until all teeth are treated Pigmentation of hypo plastic
areas and margins of
2nd, 3rd and 4th NV application, each not preceded by a prophylaxis, is
scheduled at intervals of approximately one week. restoration
Metallic taste, due to low pH &
The fourth visit procedure is recommended for ages 3,7,11 and [3 years,
coinciding with the eruption of different age groups of primary and permanent high conc. of Sn2F
teeth. Thus, most of the teeth will be treated soon after their eruption. maximizing
the protection afforded by topical application. Astringent taste and difficult to
16
mask with flavoring agents
Procedure for application of Sodium Fluoride
Knutsons echniquel:
oral prophylaxis done
2% NaF solution is painted on the air dried teeth so that all surfaces are visibly
wet
repeated for each of the isolated segments until all teeth are treated
2nd, 3rd and 4th NaF application, each not preceded by a prophylaxis, is
scheduled at intervals of approximately one week.
The fourth visit procedure is recommended for ages 3,7,11 and 13 yea
coinciding with the eruption of different age groups of primary and permarn
teeth. Thus, most of the teeth will be treated soon after their eruption, maximizi
the protection afforded by topical application.
Procedizahr _ataalaua.FIQuiicie
1 Muhler's Technique 1
4
tin-waxed dental floss is passed between the inter-proximal areas,
1
Teeth are isolated and dried with air.
.4,
SnF2 is applied using the paint on technique and the solution is kept for 4
minutes,
1
Repeat applications are made every 6 months or more frequently if patients is
susceptible to caries,
Procedure for application of Acidulated Phosphate Fluoride
The patient seated upright position in chair & Oral prophylaxis is done& teeth are treated
completely.
Clinical application of APF gel by tray technique [disposable foam line tray is preferred] To
reduce ingestion a minimal amount of fluoride lgel kept [coverage of tooth surfaces ,<5m1 ]
The patient is told not to swallow the gel but to exert slight pressure using the cheeks and the
tongue as well as light biting forces in order to cause the gel to flow inter-proximally. The gel
thins out under the biting force because of thixotropic nature.
I
The fluoride gel should be in mouth for 4 minutes and remaining oral fluids should be
expectorated.
I
saliva ejector is used to wipe out saliva and excess fluoride
I
The patient is instructed not to eat drink or rinse his mouth for at least 30 minutes.
FLUORIDE VARNISH:
>Child-Friendly
FLUORPROTECTOR:
>Its a clear polyurethane based product containing 7000 ppm fluoride from
difluorosilane.
>Its dispensed in 1ml ampules each ampule containing 6.21mg of fluoride.
FOAM:
111
Developed to minimize the risk of fluoride over dosage as well as to
Orultuu
maintain the efficacy of topical fluoride treatment.
NEUTRAL
FLUORIDE
FO
MIXED
BERRY
Advantages : NEUTRAL
SODIUM
FLUORIDE
P~ IPE qtr.-
CRIftIPX /o
Ells lighter than a conventional gel & therefore only a small amount of
agent is needed for topical application
1-
Public Health
• Definition of Public Health:
Public Health is that it is the art and science of:
1-preventing disease
2-prolonging life
3-promoting physical and mental efficiency
Through organized community effort.
− The individual patient is not the sole object of study. Now the entire
community is the focus.
− This includes not only those suffering from disease, but also healthy
people, both resistant and susceptible to disease.
• Definition of health:
According to WHO "Health is a state of complete physical, mental and social
well-being, and not a mere absence of disease or disability".
• Definition of Dental public health:
It was defined by the American Dental Association as the science and art of
preventing and controlling dental diseases and promoting dental health through
organized community efforts.
• Dental public health is concerned with:
Preventive Dentistry
• Definition:
− Preventive Dentistry comprises the various procedures used by dentists,
dental hygienists, physicians, nurses, teachers, and others to develop scientific
oral health knowledge and habits.
− It consists of those techniques which prevent the initiation of oral diseases and
prevention of such sequelae of neglecting these diseases. [As oral and
systemic infection and interference with normal growth and development.]
Risk Assessment
• Definition:
It is the identification of individuals at high risk for any future disease as dental
caries, periodontal disease, etc.
• Importance of caries risk assessment:
1. Defines those in most need.
2. Improves the effectiveness of preventive measures and levels of treatment.
Accordingly, preventive dent. Should involve individuals at higher risk.
• Advantages:
1. Permit the identification of individuals with a higher risk of developing dental
caries.
2. Permit dental health personnel to screen large segments of the population e.g.
school children.
3. Provide a patient with an evaluation of caries risk before dental procedure
and therefore gives the appropriate line of treatment.
− Diet refers to the total oral intake of substance that provide nourishment and or
calories.
− Improving the oral environment through the prompt eliminating of fermentable
carbohydrates has an important effect upon caries rate after the teeth are fully
developed and functioning in the oral cavity.
❖ Oral clearance of carbohydrate:
− The Some forms of carbohydrates take significantly longer time to be cleared
from the mouth.
− The caries activity is greater with increase in clearance time because it stays
for longer time to be cleared from the mouth.
− Sticky sweets such as chocolate, toffee, caramel, are much more harmful than
similar amount of more directly soluble carbohydrates.
− Also there is difference in oral clearance when sweets are consumed with
meals or between meals. It takes significantly longer time for sugar to be
cleared from the mouth when sweets are consumed between meals.
− Caries activity is also directly related to the amount and frequency of
consuming carbohydrates.
− Sucrose is the traditional sweetener, it is sweeter and cheaper than any simple
carbohydrate. Sorbitol, Xylitol, and Mannitol (sugar alcohol) are caloric
sweetener with very low cariogenic potential.
− Sorbitol sweetened chewing gum and candies are much less cariogenic than
those containing sucrose. Xylitol is also used nowadays in confectionary and
toothpaste.
− Apart from sucrose, other simple carbohydrates such as fructose, glucose
occurring naturally in honey, fruits and vegetables can produce acid.
− Human milk is more acidogenic than bovine milk, as bovine milk has higher
calcium phosphate and protein than human milk.
❖ Dietary Recommendation:
1) Keep the carbohydrate content of the diet as low as possible consistent with
satisfactory caloric intake. It is preferable that no more than half the daily
calories be carbohydrate.
2) When carbohydrates are used select wherever possible the soluble forms or
those that clear the mouth most quickly. Leafy, green or yellow vegetables
are good carbohydrate sources with low retention. Avoid sticky candy and
suckers.
3) Consume carbohydrate at meals so far as possible. Avoid between meal
snacks, substitute the sticky sweets with nuts, raw fruits or vegetable for the
in-between meal snacks if such snacks are unavoidable.
4) Consume carbohydrate at meals so far as possible. Avoid between meal
snacks, substitute the sticky sweets with nuts, raw fruits or vegetable for the
in-between meal snacks if such snacks are unavoidable.
5) Cheese is recommended as caries preventive food because it causes strong
stimulation of salivary flow, raise the calcium concentration in the plaque and
raise the PH within 3 minutes after ingestion.
4. Ionic toothbrushes:
− Change the surface charge of a tooth by an influx of positively charged
ions.
− The plaque with a similar charge is repelled from the tooth surface and is
attracted by the negatively charged bristles of the toothbrush.
C. special types of tooth brushes:
1. Orthodontic brush.
2. Tooth brush for dental wearer.
3. Tooth brush for handicapped patient.
1) Motivation:
The nature of the plaque and its adhesion to the tooth is explained. The role of
plaque in caries and periodontal disease is outlined.
2) Education:
The right way for brushing is any one which suits the particular patient. At this
stage paint the teeth with a disclosing agent.
3) Demonstration:
− The patient is asked to bring the brush which up to the present has been
used at home, not a new one, and is asked to demonstrate completely how
the usual brushing is carried out.
− Errors in brushing, areas omitted, lack of organized method are noted.
− Using life-size models for tooth brush demonstration, each quadrant is
divided into three areas: posterior, middle and anterior.
− Each surface should be brushed with 10 strokes of the brush (buccally,
lingually and occlusally) in a systematic manner.
− The usual effective brushing time is between 2-4 minutes.
4) Assessment:
− After each demonstration, this patient is asked to brush his teeth similarly
and disclosing agent is used to indicate the amount of residual plaque
overlooked.
− Further training is given and other devices may be prescribed.
Disclosing agents:
Definition:
Disclosing agents are water soluble dyes used to stain the plaque and other
deposits and make them obvious to point out the plaque to the patient.
Advantages:
• Visualize dental plaque to the patient and hence facilitate instruction on its
removal.
• Enable the dentist to confirm that teeth surfaces are free of all deposits during
scaling and polishing.
Forms:
Tablets, liquid, wafers, swabs.
Types:
Iodine, Basic fuccine.
Requirements:
• Stain plaque selectively.
• Do not stain the rest of the oral structures.
• Do not discolor anterior teeth fillings.
• Has an acceptable taste.
• Has no harmful effect when swallowed.
When brushing techniques are instructed, it should not be forgotten to stress that:
a) The brushing should be done immediately after eating at least twice a day.
b) While brushing, teeth should be put in occlusion.
c) Systematic way of brushing should be used so that all the teeth receive proper
brushing.
d) Brushing the lingual surfaces of the teeth must be done.
Sometimes it is advisable to use other devices than a tooth brush to achieve through
plaque removal.
A. Mouth Wash:
• Advantage:
− Clean the mouth.
− Freshen the breath.
− Reduce plaque and gingivitis.
B. Dental Floss:
− This is a tool used to disorganize and remove the microbial masses that are
located below the gum margins interproximally.
− Dental floss may be either waxed or un-waxed or medicated (fluoride,
chlorohexidine).
− The un-waxed 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.
− 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.
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.
III- Topical protection of teeth:
This includes all measures applied to increase the resistance of the intact outer tooth
surface. Among these measures are:
1. Operative dentistry.
2. Prophylactic odontotomy.
3. Prophylactic fissure filling.
4. Topical chemotherapy.
5. Fissure sealants.
6. Preventive resin restoration.
7. A traumatic dentistry (ART) are the most essential.
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.
− Types:
• Dimethacrylate bis-GMA resin (the most commonly used)
• Glass ionomer: provide good adhesion and fluoride release.
• Compomer.
− Technique:
• A small round bur may be used for access and removal any carious tissue.
• The tooth is then etched then bonding agent is applied
• A composite of thin consistency is used to restore the cavity.
• then, fissure sealant is applied over the remaining pits and fissures
Sources of Fluoride:
− Humans obtained fluoride from three sources: water, foods and air.
− Water and food, may contribute significant amounts to the daily intake.
− Water from deep wells and artesian wells usually provide high natural fluoride
concentration.
− Most vegetables, fruits and dairy products contain low amount of fluoride.
− Meat and poultry also contain little fluoride
− But sea foods (fish sp. salmon and sardines, shrimp, crab, etc) may contain
2.5 ppm.
− Most beverages contain amounts of fluoride especially tea.
− Fruit juices and soft drinks are generally low in fluoride, but the fluoride
content of the water used in the preparation of such beverages or in the
cooking of food will be reflected in the fluoride concentration of the final
product.
− The total amount of fluoride consumed daily will depend upon both the
concentration of the fluoride in the water and food as well as the amount
consumed.
Recommended optimal fluoride dose:
− The recommended optimal fluoride doses for community water supplies vary
with the annual mean of the maximum daily temperature (0.7 to 1.2 ppm).
− The average diet provides 0.2-0.3 mg of fluoride daily.
b. After eruption:
▪ Enamel surface continues to pick up fluoride derived from diet,
water and saliva.
▪ The post-eruptive acquisition of fluoride continues throughout life
and is directly proportional to the concentration in food and water
ingested.
Toxicity of Fluoride:
Acute fluoride toxicity:
− High doses of fluoride are toxic and may be lethal. Fortunately, this is rare
and only few accidental cases are reported (4-5 gm for adult, 0.25 mg for
infants).
− Ingestion of massive single dose of fluoride may cause, vomiting, nausea,
coma hypocalcemia and cardiac arrest.
− For treatment of this case, intake of large amount of calcium orally like milk
is a must. And give 10% calcium gluconate injection to control convulsions.
Chronic fluoride toxicity:
− Chronic fluorosis results in skeletal or dental changes. If fluoride was ingested
during the tooth developmental period at levels injurious to the ameloblasts.
− Mottled enamel (dental fluorosis) may result with various degrees of severity
when water fluoride concentration is (6-8 ppm).
− Later in life, the ingestion of high levels of fluoride may result in bony
deformities joint fixation and calcification of the ligaments.
1. Water fluoridation:
− There is an inverse relationship between the fluoride level in drinking water
supplies and the incidence of dental caries.
− It should be noticed that there is also a direct relationship between fluoride
level in water and the incidence of mottled enamel.
− A fluoride concentration of 1 ppm in communal water was found to be
optimum regards the effective anti-caries effect and lower mottled enamel.
− It is recommended that optimal dose of fluoride ingested daily in children
from 0.5 -1.0 mg fluorides (WHO).
− So this 1 ppm fluoride concentration in water is suitable for countries with
cold weather whereas in countries with hot weather the concentration of
fluoride in public water supplies should be lower and this depends on the daily
water consumption which is usually double or triple them in comparison with
cold weather .
− In Egypt the fluoride concentration of Nile water is about 0.36 ppm in which
is considered optimum.
3. Fluoride supplements:
− When fluoridation of water supply is not possible, fluoride supplements can
be resorted.
− This can be in the form of fluoride tablets, drops or syrups.
− Studies have shown considerable reduction in dental caries in deciduous and
permanent dentition when consumption of fluoride has been started early
enough.
− The usual dose is 0.5 mg F/day for children up to 3 years of age and 1.0 mg
F/day for children over 3 years of age.
− The fluoride tablets usually contain 1.0 mg F, to be crushed in water or fruit
juices.
− Fluoride administration should continue till the age of complete crown
formation of the second permanent molar, i.e. about the age of 10 years.
− Fluoride preparations should be kept out of reach of children to avoid over
dosage.
− Fluoride tablets digested as sweets are not advised.
DOSE:
6M.-3Y…….0.25mg/day
3y-6y……….0.5mg/day
6y-12y………1mg/day
The topical application of fluoride can be carried out either by the patient himself or
by members of the dental profession.
a. Sodium fluoride:
− The recommended procedure of 4 applications of a 2% sodium fluoride
solution, one-week interval, between every application result in a 40%
reduction in dental caries incidence.
− These 4 applications are considered a single application and have to be
applied every year or at the age of 3, 7, 10, and 13 years.
− Sodium fluoride has a good shelf-life, the solution can be kept for a
long period of time without deterioration.
b. Stannous fluoride:
− Single annual application of 8% stannous fluoride gives about 65%
reduction in caries incidence.
− Stannous fluoride solution is unstable.
− It has a short shelf life3 so it has to be prepared freshly for each
application by dissolving 0.8 gm. Of stannous fluoride in 10 ml distilled
water.
− The solution has a disagreeable astringent taste, and it discolors
decalcified enamel.
−
c. Acidulated phosphate fluoride:
− Combination of sodium fluoride with phosphoric acid.
− 1.23% sodium fluoride in 0.1 Mole ortho-phosphoric acid produces an
acidulated phosphate fluoride mixture which when applied topically to the
teeth of children on an annual basis has decreased caries from 50-70%.
− This agent is stable, so it does not have to be prepared freshly for every
treatment as in cases of stannous fluoride.
− also it does not discolor decalcified enamel.
d. Prophylactic paste:
− The routine uses of prophylactic pastes containing fluoride in the dental office
is expected to increase the fluoride content of surface enamel and
consequently, its resistance to additional attack.
− This will be advantageous when carried out every six months as part of the
regular dental examination.
− The. most recently available are stannous fluoride - zirconium silicate paste
and an acidulated phosphate fluoride - silicone dioxide paste.
e. Fluoride varnish:
− 5% sodium fluoride containing varnish is available commercially in several
countries.
− The varnish is applied using a paint-on technique using a brush and allowed
to harden foe 5-6 minutes.
− It should be applied at interval f 3-6 months.
− Advantage:
• Ease application
• Accepted by patient
• Higher fluoride acquisitions than gel and foam.
• Negligible amount of ingested fluoride.
Prevention of periodontal disease
Periodontal disease
- It is the affection of periodontium or the supporting tissue of the teeth. It may
range from mild inflammation of the gingiva to severe destruction of
periodontal ligament or bone.
- Normal gingiva is pink, firm, stippled, and have shallow gingival sulcus
depth.
- While inflamed gingiva (gingivitis) characterized by redness, swelling of the
gingival margin with loss of stippling and bleeding.
- In more advanced case (periodontitis) there is destruction in the periodontal
ligament, bone resorption, with pocket formation and looseness of the tooth.
− It should be recommended that children eat some hard, fibrous and fresh foods
in addition to the rather soft diet prevalent today.
− It must be stressed also that the toothbrush is really a mouth brush and the care
of the gingival tissues is just as important as that of the teeth.
V- Mouth breathing:
This should be treated either by clearing the air passages (Oro-nasal part) by surgical
or medical specialists, or by orthodontic means as oral screen.