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Pencegahan Karies Pada Anak
Pencegahan Karies Pada Anak
PREVENTION IN
CHILDREN
drg. Septriyani K., MDSc., Sp. KGA
FKG UMS
CARIES
ETIOLOGICAL
PHATOGENESIS?
FACTOR?
HOW TO PREVENTION ?
DIAGNOSE ?
BASIC CONCEPT CARIES ETIOLOGY
The main features of the caries
process are:
(1) fermentation of carbohydrate to organic acids by micro-organisms
in plaque on the tooth surface;
(2) rapid acid formation, which lowers the pH at the enamel surface
below the level (the critical pH) at which enamel will dissolve;
(3) when carbohydrate is no longer available to the plaque micro-
organisms, the pH within plaque will rise due to the outward
diffusion of acids and their metabolism and neutralization in
plaque, so that remineralization of enamel can occur; and
(4) dental caries progresses only when demineralization is greater
than remineralization. The realization that demineralization and
remineralization is an equilibrium is key to understanding the
dynamics of the carious lesion and its prevention.
CRITICAL pH
Key Points : Dental caries
• occurs in plaque-covered areas frequently exposed to dietary
carbohydrates;
• the initial lesion is subsurface before the thin surface layer
collapses;
• the initial or pre-cavitation lesion is reversible;
• saliva plays an essential part in caries prevention;
• if all plaque is removed from the surface the carious process
stops.
The stages in caries diagnostic
process
Detect
Diagnose
Record
DETECTION OF CARIES
• Conventional
• using sharp instruments like exproler and probe
• ause more harm by breaking the enamel rods when forced into an
incipient carious lesion.
• Condition:
• Decay is difficult to detect in radiographs unless larger than 2 mm to
3 mm deep into dentin
• Early caries lesion is pre-cavitation: white lesion or brown lesion
• At this early stage of caries remineralization should be considered.
• The problem is detecting the initial stage of caries.
• Minimaly invasive dentistry
• Caries detection devices are another tool aiding in the diagnosis of
caries along with conventional diagnostic tools and good professional
judgment.
• They can be used to monitor the progression of caries and aid in the
decision to prevent, remineralize, or restore.
Diference between white spot
and fluorosis
Fluoresence
The mainstay of preventive
measures are:
(1) plaque control and regular tooth brushing with a fluoride
toothpaste;
(2) sensible dietary advice;
(3) use of fluorides;
(4) fissure sealants;
(5) regular dental checks with appropriate radiographs.
PLAQUE CONTROL
- To maintain proper and healthy oral environment
- Methods:
1. Mechanical plaque control
a. Toothbrush : manual, electric
b. Interdental tools: dental floss, triangular tooth pick
2. Chemical plaque control
a. First generation
- Reducing plaque 20-50%
- Ex: antibiotic, phenol
b. Second Generation
- reducing plaque 70-90%
- Ex: Bisbiguanid, chlorhexidine
c. Third generation
- Block binding microorganism
- Ex: enzyme (dekstranase, lactoperoxidase), povidon iodine
Plaque Control Procedure in
dental clinic
1. Plaque identification
2. Show the plaque to patients
3. Plaque scoring: OHI, PHP
4. Show the patients that plaque is easily removed
5. Show the patients to brush properly
6. Advice patient to use disclosing solution in daily oral hygiene
procedure
7. Fluor suplement if needed
8. Recomend patient to use fluoride containing dental paste
9. Do prophylaxis to remove remaining plaque
PHP
• Syarat: gigi desidui/permanen yang telah erupsi minimal ¾
• Gigi secara imajiner dibagi menjadi 5 area (skor 0: tidak ada plak, 1:
ada plak)
a. A : 1/3 gingiva dari area bagian tengah
b. B : 1/3 tengah dari area bagian tengah
c. C : 1/3 oklusal/incisal dari area bagian tengah
d. D : Area distal
e. E : Area mesial
• Gigi indeks yang diperiksa
a. Gigi paling posterior kwadran kanan atas
b. Gigi kaninus kanan atas
c. Gigi molar pertama desidui atau premolar pertama kiri atas
d. Gigi paling posterior kwadran kiri bawah
e. Gigi kaninus kiri bawah
f. Gigi molar pertama desidui atau premolar pertama kanan bawah
DIET CONTROL
Eat more variety
meals especially water
Varieties containing food like
fruits and vegie