1

ADVANCES IN
PREVENTIVE DENTISTRY
Resource Faculties: Presented by:
Dr.Ashish Shrestha
Priya Sutihar (534)
Additional Professor
Subash
Head of Department
Shrestha(548)

Dr.Tarakant Bhagat
Assosiate Professor

2
Department of Public Health Dentistry
 Contents
 Introduction
 Advances in methods of caries detection
 Methods of caries control
 Fluoride
 Tooth mousse
 Cariogram
 Chemomechanical caries removal
 Caries vaccine
 Pit and fissure sealants
 Advances in Periodontal probes
 Recent advances in toothbrush 3
DENTAL CARIES

An irreversible microbial disease of the calcified

tissues of the teeth, characterized by
demineralization of the inorganic portion and
destruction of the organic substances of tooth,
which often leads to cavitation.

4
Conventional Methods

Patient’s complaint

Meticulous clinical examination

Tactile examination

Conventional radiograph
5
Advanced Methods
Digital Radiography
Digital Substraction Radiography
 Fiber Optic Transillumination
Digital Fiber Optic Transillumination
Diagnodent
 Caries Detector Dyes
Electrical Conductance Measurements
Endoscope / Videoscope
Light Induced Fluorescence / Spectra Camera
6
Digital Radiography
- Digital imaging is the result of
X-ray interaction with electrons in
the electric sensor

Conversion of analog data to

digital data

Computer processing

Display of the visible image on

computer screen 7
 One of the benefit of digital radiographs is the ability to use
of the software program to process the image (make digital
adjustments to contrast, lightness and darkness, and use
other tools) to better see conditions and make more accurate
diagnosis.

Advantages
 Reduced radiation dose
Instant image visualization
No need for darkroom
Image can be magnified
Contrast and density of image can be enhanced 8
Digital Subtraction Radiography
It is a technique by which images which are not of
diagnostic value in a radiograph are reduced so that the
changes in the radiograph can be precisely detected.
Advantages:
Proximal caries can be visualized better
Assess the progression of the carious lesion

Disadvantages:
 Expensive
9
 Fiber Optic Transillumination

In 1970 Friedman and Marcus suggested the use of FOTI

in detection of carious lesions.

Fiber optics applied to transillumination of teeth and other

oral structures is a useful technique for detection of caries,
calculus, and soft tissue lesions.

10
Principle

 There is a different index of light transmission for

decayed and sound tooth.

 Since tooth decay has a lower index of light

transmission than the sound tooth structure, an area of
decay shows up as a darkened shadow that follows
the decay along the path of dentinal tubules.

11
12
13
Advantages
 Non-invasive
No hazards of radiation
Comfortable to patients

Disadvantages
Secondary caries cannot be detected
 Does not provide a permanent record of findings
Difficulty in placing probe in some areas
14
Digitally Imaged FOTI( DIGIFOTI)

Relatively new technique which combines fiberoptic

transillumination(FOTI) and a digital CCD camera.

15
iu
p
sm
o
is
tn
i
h
t
a
e
ti
n
o
e
n
d
a
e
n
sd
a
u
lro
yfn
za
e
ct
d
h
e
e
b
i
yst 16

co
Advantages
Instantaneous image projection
Image quality is easy to control
Early detection of incipient and recurrent caries
Non-invasive

Disadvantages
Does not measure the depth of the lesion
Difficult to distinguish between deep fissure , stain and
dental caries
17
Comparison Between DIFOTI and
Conventional Radiography

18
19
 DIAGNODENT

Chairside , battery-powered quantitative diode laser

fluorescence device.

20
Principle

The unit emits light at 655 nm wavelength from a

fiberoptic bundle directed onto the occlusal surface of a
tooth.

A second fiber optic bundle receives the reflected

fluorescent light beam, and changes caused by
demineralization are assigned by a numeric value,
which is displayed on the monitor.
21
22
Criteria to Assess Caries Progression

0- 13 : No caries

14-20: Enamel caries and preventive care advised.

21-30: Dentin caries and preventive or operative

care
advised.

>30: Operative care advised

23
Advantages
Reliable method for diagnosis of early occlusal caries
Convenient and fast method

Disadvantages
Expensive
Cannot differentiate between caries , hypoplasia ,
stains and calculus
Cannot differentiate between active or inactive lesions.

24
25
Caries Detector Dyes

Various dyes have been used in the detection of

-Enamel caries: Calcein, Zyglo ZL-22
-Dentin caries: Fuschin, Acid red system, 9-Aminoacridine

26
In human carious dentin, two layers of decalcification
can be observed:
1.Infected dentin
2. Affected dentin

Dyes selectively stains the infected , demineralized

dentin while the affected dentin remains unstained.
27
 Electrical Conductance
Measurements
Sound enamel is an insulator due to its high inorganic
content
On the other hand , carious enamel has a measurable
conductivity which increases with the degree of
demineralization
Based on this ,two devices were developed:
1.Vanguard electronic caries detector
2.Caries meter
28
Both instruments measure the electrical conductance
between the tip of probe placed in a fissure and a
connector attached to an area of high
conductance(gingiva or skin).

The measured electrical conductivity indicates the

degree of demineralization.

29
30
Advantages:
More accurate in diagnosing early occlusal caries than
visual method, radiographs or FOTI.
Can monitor the progress of caries.

Disadvantages:
Hypomineralized areas, enamel cracks can cause
misleading readings.
Time consuming procedure.
Requires the use of sharp metal explorers which can
cause traumatic defects in pits and fissures.
31
 Endoscope / Videoscope

Based on theory that when a tooth is illuminated with

blue light in the wavelength of 400-500nm,sound enamel
and carious enamel demonstrate different fluorescence.
When viewed through filter , white spot lesions appear
darker than sound enamel.
Additionally , a camera can be used to store the image.
The integration of an intraoral camera with the
endoscope is called videoscope.
32
Advantage:
Provides magnified image and also clinically
feasible

Disadvantage:
Requires meticulous drying and isolation of teeth
Time consuming and very costly
Cannot be used in inaccessible areas

33
 Light Induced
Fluorescence/Spectra Camera

Special LEDs project high-energy violet or blue light

onto the tooth surface.
Light of this wavelength stimulates porphyrins-
metabolites unique to cariogenic bacteria-to appear
distinctly red , while healthy enamel appears green.
Using this technology , data captured by Spectra
system are analyzed by imaging software.
34
Methods of caries control

Chemical measures

Mechanical measures

Nutritional measures

35
Chemical Measures

Substances which alter the tooth surface or tooth structure.

Substance which interfere with carbohydrate degradation

through enzymatic alteration.

Substance which interfere with bacterial growth and

metabolism

36
Substances which alter the tooth surface or
tooth structure

 Fluorides
 Iodides
 Bis-guanides
 Silver nitrate
 Zinc chloride
 Potassium ferrocyanide

37
Substances which interfere with carbohydrate
degradation through enzymatic alterations

Vitamin K
Sarcodide

38
Substances which interfere with bacterial growth
and metabolism

Urea and ammonium compounds

Chlorophyll
Nitrofurans
Antibiotics
Caries vaccine

39
 Mechanical Measures
Oral prophylaxis
Tooth brushing
Mouth rinsing
Dental floss or toothpicks
Chewing gums
Detergent foods

40
 Fluorides

Professionally Applied Topical Fluorides

 Includes tablets, lozenges, gels, foams, rinses and
varnish.

 Safe, effective, easy to apply.

 Promotes remineralization of enamel ; arrest / reverse

early caries .

 Decreases enamel solubility.

 Inhibits the growth of cariogenic organisms, thus

decreases acid production. 41
 Fluoride effect on remineralization and demineralization of
enamel
Promote remineralization

F-

Reduce demineralization Inhibit acid generation from plaque bacteria

• The anti-caries action of fluoride is due to its favorable effect on tooth

remineralization and demineralization
• Fluoride acts via topical mechanisms which in summary include: enhancement of
remineralization at crystal surfaces of the tooth; inhibition of demineralization and
inhibition of bacterial enzymes 42
Fluoride Varnish

Incorporation of fluoride in varnish like coating, favors

the deposition of more permanently bound fluorapatite
and fluorhydroxyapatite
Duraphat ( NaF varnish containing 2.26% fluoride
inorganic lacquer)
Fluoroprotector (Silane fluoride with 0.7% F in a
polyurethane-based lacquer)
Carex (1.8% fluoride)
43
44
 Tooth Mousse

 Topical tooth cream that helps strengthen and

rejuvenate the patient’s teeth.
Has a unique ability to deliver bio-available calcium and
phosphate when the patient’s saliva is acidically -
challenged by the normal digestive process.
Recommended for use in adults who are in need of
powerful remineralisation and decay prevention.
Active ingredient is CPP-ACP , a water based , sugar
and fluoride free cream. 45
 Tooth Mousse Plus

Enhanced with a patented form of fluoride ( increases

bioavailability of fluoride ) to strenghthen tooth enamel
and protect teeth from caries development.

46
p
n
t
h
d
h
a
a
tm
Mechanism of Action
t
e
a
ib
in
i
o
tn
n
a
d
si
s
n
ts
t
o
o
a
c
t
o
sh
n
u
e
vp
e
t 47

r
o
t
 Clinical application

White spot prevention (during/after orthodontic treatment,

fluorosis)
Post bleaching
Post scaling and root planning
Dentinal hypersensitivity
Treatment of erosion and incipient carious lesion
Caries prevention
48
 Cariogram

 Is a graphical picture illustrating in an interactive way

the individual's risk for developing new dental caries in
the future.
Also simultaneously expresses to what extent different
etiological factors of caries may affect the caries risk for
that particular patient.
 Also indicates where targeted actions to improve the
situation will have the best effect.
49
The original cariogram was introduced by Bratthall in
1994.

A circle divided into three sectors,each representing

factors strongly influencing carious activity : diet,
bacteria, and susceptibility.

50
 Interactive CARIOGRAM
Programme

 New method of
illustrating the
interaction of factors
contributing to the
development of caries

 Re-introduced by
Bratthall et all in 1999
51
Chemomechanical Caries
Removal

52
Conventional caries removal and cavity preparation
entails the use of burs.

Disadvantages:
-Perception by patients that drilling is unpleasant
-LA is frequently required
-Can cause deleterious thermal effects and pressure
effects on the pulp
-Can cause removal of softened,but uninfected dentin
resulting in excessive loss of sound tooth tissue
53
 Chemomechanical Caries Removal

Is a non-invasive technique eliminating infected dentin

via a chemical agent,based on dissolution.

Brings together atraumatic characterstics and bactericidal

/ bacteriostatic action.

A chemical agent is used which softens the predegraded

collagen of the lesion without pain or undesirable effects
to adjacent healthy tissues. 54
Caridex

Involves the intermittent application of preheated N-

monochloro-DL-2-aminobutyric acid to the carious
lesion.

Cause disruption of collagen in the carious dentin,thus

facilitating its removal.

55
Disadvantages
Expensive
Bulky caridex delivery system which includes a
reservoir , a heater , a pump and a handpiece with
an applicator tip
Process is slow

56
Carisolv

57
 Composition

Consists of a red gel and transparent fluid

Red gel
glutamic acid
leucine
lysine
sodium chloride
erythrosine
water and sodium hydroxide

Transparent fluid
0.5% sodium hypochlorite 58
Mechanism of Action

59
Recent Concepts

60
61
Caries vaccine

A vaccine to prevent and protect against tooth decay,

particularly S. mutans.
S. mutans is implicated as the primary causative
organism of dental caries.

Cell-surface protein antigen + Glucosyltransferases

(GTFs) produced by S. mutans

Major colonization factors 62

 Rationale

Immunization with S.mutans induce an immune

response which might prevent the organism from
colonizing the tooth surface and thereby prevent decay.

Experimental immunization against dental caries has

been extensively done on animals. 63
 Active Immunization

1. Synthetic peptides
Enhance immune response - elicited both IgG and T-cell
proliferative response
Gives antibodies not only in GCF but also in the saliva

2. Liposomes
Increases IgA antibodies 64
3. Coupling with cholera toxin subunits
It has been found that coupling of the protein with
nontoxic unit of the cholera toxin was effective in
supressing the colonization of S.mutans

4. Fusing with Salmonella

The avirulent strains of Salmonella are an effective
vaccine vector so that fusion using recombinant
technology have been used.

65
 Passive Immunization

Monoclonal antibodies
Bovine milk and whey
Egg-yolk antibodies
Transgenic plants

66
Researchers are working on ways to inject a peptide – a
fragment of a protein that blocks the bacterium S.mutans
which causes tooth decay into the fruit so that cavities and
painful visits to the dentists could become a thing of the
past.

Professor David James , a plant biotechnologist at the

Horticulture Research International in Southern England , is
trying to find ways to deliver the peptide into the mouth
through apples or strawberries. 67
 Ozone therapy

Involves the delivery of an ozone gas to the surface of a

tooth or mucosal lesion.

Advantages
 Minimal invasive
Good patient compliance
 Supports rapid remineralization and arrest caries
68
 Pit and Fissure Sealants

A material that is introduced into the occlusal pits and

fissure of caries susceptible teeth , thus forming a
micromechanically bounded , protective layer cutting
access of caries producing bacteria from their source of
nutrients.

69
70
 Indications and Contraindications
Surface Clinical Do seal Do not seal
diagnosis considerations

Carious Occlusal If pits and fissures Carious pits and

anatomy are separated by fissure
transverse ridge,a
sound pit or fissure
may be sealed
Questionable Status of Sound Carious
proximal surface

General caries Many occlusal Many proximal

activity lesions,few lesions
proximal lesions
71
Surface Clinical Do seal Do not seal
diagnosis Considerations

Sound Occlusal Deep , narrow pit Broad , well

morphology and fissure coalesced pit
and fissure

Tooth age Recently erupted Teeth caries

teeth free for 4 years
or more

Status of proximal Sound Carious

surface

72
Recent Pits and fissure sealants

1. ACP releasing sealant

73
2. Enamel Loc™
-The first self-etching light-cured pit and fissure
sealants with the following propreties:

Fluoride release
One step application
Natural white color
Low viscosity
Filled resin

74
3. Embrace™ WetBond ™ pit and fissure sealant

Is unique because it bonds to the moist tooth , and

provides an easy way to dispense and use.

75
Advances in Periodontal Probe

Perio temp probe

Florida probe
Foster – Miller probe
Toronto automated probe
DNA probe

76
 Perio Temp Probe

Helps to detect early inflammatory

changes in the gingiva by
detecting temperature rise.
Detects pocket temperature
differences of 0.1 deg. C from a
reference subgingival temperature.
Higher temperature pockets are
signaled with a red-emitting diode.
77
 Florida Probe

A computerized periodontal probe consisting of a probe ,

handpiece , a digital readout , a foot switch , a computer
interface and a computer.
Used to measure pocket depth.
Advantages
-Constant probing force
-Digital readout
-High degree of accuracy 78
Foster – Miller Probe

Couples pocket depth determination with detection

of CEJ from which clinical attachment level is
automatically assessed.

79
Toronto Automated Probe

Used to measure clinical attachment levels.

Sulcus is probed with a Ni-Ti wire that is extended

under air pressure.

80
Helps to identify organism associated with periodontal
disease.
Identifies species – specific sequences of nucleic acids
that make up DNA , thereby permitting identification.
81
 Recent Advances in Toothbrush
 Tooth brush without toothpaste

 Powered toothbrush / Electronic toothbrush

 Triple headed toothbrush

 Magic toothbrush

 Snake toothbrush
82
 Toothbrush without toothpaste

Has ‘ultra fine tipped’ and

tapered bristles are small
enough to reach even the most
difficult areas.
Coated in nano-sized mineral
ions which pass from bristles to
teeth during brushing,
removing impurity,stains and
forms a protective coating on
the enamel. 83
 Powered toothbrush/Electronic
toothbrush

Based on oscillating/translating ,
vibrating , or ultrasonic technology.
Significant reduction in plaque as
compared to manual toothbrushes.
Reduces the brushing force needed
during brushing to reduce gum
recession.
84
 Triple headed toothbrush

With its unique triple-

headed design, these
brushes brush
simultaneously on the
occlusal , buccal and
lingual/palatal surfaces of
the teeth.

85
 Magic toothbrush / Ion Field
toothbrush

Breaks the bond between plaque

and tooth by temporarily reversing
the polarity of tooth surfaces (+).
 As you brush, plaque molecules
are actively repelled by your teeth
and are drawn to the negatively
charged bristles (-).

86
Snake toothbrush

87
REFERENCES

 Essentials of Preventive and Community Dentistry –

Soben Peter.
Clinical Operative Dentistry Principles and Practice-
Ramya Raghu
Sturdevant’s Art and Science of Operative Dentistry
 Text Book of Pedodontics – Shobha Tandon.
Textbook of Pediatric Dentistry-Nikhil Marwah
www.google.com 88
89
90