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PRACTICAL APPLICATION Dr. Abeer Zwain

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REDUCTION OF DENTAL PLAGUE (AND MICROORGANISMS) WITH GOOD ORAL HYGIENE PROCEDURES

The increased frequency of daily toothbrushing had its most significant positive effect on the level of oral hygiene.

The investigators concluded that constant reinforcement is necessary to maintain effective plaque control in preschool children.

The longer the period of interdental flossing, the greater the benefit; however, there was little residual effect after flossing was discontinued.

The achievement and maintenance of high levels of oral hygiene are particularly important as far as a healthy periodontium is concerned. There is little scientific evidence to support the theory that toothbrushing will prevent dental caries, as normal brushing inevitably leaves some plaque in fissures and other stagnation sites where caries occurs. However, the use of a fluoride toothpaste with the toothbrush is obviously of benefit. Children cannot clean effectively until they are able to undertake such tasks as writing their own names legibly. Until this time parents should clean their child’s teeth.

USE OF FLUORIDES AND TOPICAL ANTIMICROBIAL AGENTS Without doubt the repeated use of fluorides is of critical importance for the control and prevention of dental caries in both children and adults. Existing evidence indicates that the cariostatic activity of fluoride involves several different mechanisms. The ingestion of fluoride results in its incorporation into the dentin and

enamel of unerupted teeth; this makes the teeth more resistant to acid attack after eruption into the oral cavity.

In addition, ingested fluoride is secreted into saliva. Although it is present in low concentrations ,fluoride is accumulated in plaque, where it

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decreases microbial acid production and enhances the remineralization of the underlying enamel.

Fluoride from saliva is also incorporated into the enamel of newly erupted teeth, thereby enhancing enamel calcification (frequently called enamel maturation), which decreases caries susceptibility.

As a topically applied therapeutic agent, fluoride is effective in preventing future lesion development, in arresting or at least slowing the progression of active cavitated lesions, and in remineralizing active incipient lesions.

Topical fluoride also has some antimicrobial properties

Recommendations: 1. Communal Water Fluoridation.

Optimal fluoride in drinking water supplies remains the cornerstone of any preventive dentistry strategy.

2. Fluoride-Containing Dentifrices. All children should regularly use correctly formulated fluoride toothpaste according to the manufacturers and dentists instructions.

To reduce the risk of opaci es, children under the age of 6 years and considered to be at low risk of developing dental caries should use a toothpaste containing no more than 600 ppm of fluoride.

Those with a higher risk of developing caries should use a standard (1000 ppm) paste.

Children over the age of 6 years should be encouraged to use a standard (1000 ppm) or higher (1450 ppm) fluoride level paste.

Children under 6 years should use an amount of toothpaste no greater than a small pea.

An adult should supervise the amount of toothpaste used and tooth brushing technique, up to at least 7 or 8 years.

Toothpaste packaging must include clear labelling to indicate the amount of fluoride present, expressed consistently as ppmF.

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3. Fluoride Supplements For children at risk of dental caries dietary fluoride supplements should

be considered. The small potential risk of mild enamel opacities may be outweighed by the benefits of fluoride supplements.

When fluoride is given as tablets, these should be allowed to dissolve slowly in the mouth in order to give a topical as well as a systemic effect.

They should preferably be given at a time separated from tooth brushing to help to reduce the peaks of fluoride ingestion and to maximize the topical effect.

For children living in an area where there is no more than 0.3 ppm fluoride in the drinking water, the currently recommended dosage schedule should be used.

AGE mg F Per Day

6 months to 3 years 0.25

3 years to 6 years 0.50

6 years and over 1.00

4. Topical Fluorides in the Dental Office. Topical fluoride varnishes are of proven benefit in preventing caries and in helping to arrest caries in children with “nursing bottle caries” and cervical decalcification. These are highly concentrated vehicles for fluoride and the recommended dose must not be exceeded.

Other forms of professionally applied fluoride gels (1.23% acidulated phosphate fluoride APF) and solutions (8% stannous fluoride) are recommended by some authorities but have been shown to be of poor cost benefit, although clinically beneficial.

The periodic professional topical application of more concentrated fluoride solutions, gels, foams, or varnishes has been repeatedly demonstrated to result in a significant reduction in the incidence of dental caries in both children and adults as well as the arrestment of incipient lesions. As a result, professional topical fluoride applications are routinely recommended for all children and adolescents.

Even in the absence of dental caries activity, topicalapplications to children are recommended as acontent of the enamel oresistance of these teeth to caries formation.

A 4-minute treatment time has been typically recommendedprofessionally applied topical fluoride solutions,

The trays should be about one third to one half full for gel and full (level with the edge) for foam.

The patient sits in an upright position with head tippedforward to allow excess saliva and fluoride to flow

Patients who follow instructions well mayvelocity evacuator tip to help

or they may be given ahead forward even more and catch the drooled liquid in thewhich is later discarded.

The dentist or appropriateand provide assistance as needed.

Patients requiring assistance also often need during the procedure.

the patient shouldminutes after the treatment to maximize fluoride uptake in

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Even in the absence of dental caries activity, topicalapplications to children are recommended as a means of raising the fluoride content of the enamel of newly erupted teeth and thereby increasing theresistance of these teeth to caries formation.

minute treatment time has been typically recommendedprofessionally applied topical fluoride solutions, gels, or foams.

be about one third to one half full for gel and full with the edge) for foam.

patient sits in an upright position with head tippedto allow excess saliva and fluoride to flow toward the lips.

Patients who follow instructions well may be provided with the highvelocity evacuator tip to help control the drooling themselves,or they may be given a plastic "drool bag" that enables them

forward even more and catch the drooled liquid in thewhich is later discarded. The dentist or appropriate office staff should supervise the treatment

assistance as needed. Patients requiring assistance also often need positive reinforcement during the procedure. the patient should be encouraged not to eat, drink, or rinse for 30

after the treatment to maximize fluoride uptake in enamel.

Even in the absence of dental caries activity, topical fluoride means of raising the fluoride

erupted teeth and thereby increasing the

minute treatment time has been typically recommended for gels, or foams.

be about one third to one half full for gel and full

patient sits in an upright position with head tipped slightly toward the lips.

be provided with the high-control the drooling themselves,

plastic "drool bag" that enables them to tip the forward even more and catch the drooled liquid in the bag,

office staff should supervise the treatment

positive reinforcement

be encouraged not to eat, drink, or rinse for 30 enamel.

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Extra caution and special application techniques are required when topical solutions, gels, or foams are placed in the mouths of young children (around 4 years old and younger). The agent is usually brushed on to the teeth in small amounts and the excess is wiped away with gauze.

5. Self or parent-applied fluoride for children at high caries risk. Home fluoride treatments using mouthrinses can be recommended for daily use in children over 6 years. If a high caries risk patient cannot comply with home fluoride therapy then frequent professional fluoride treatments should be substituted.

6. Combinations of Fluoride Therapies. Chlorhexidine and Thymol. As an oral antimicro-

bial,chlorhexidine has been used in oral rinses, dentifrices, chewing gum, varnish, and gel.

Povidone Iodine. Xylitol. Xylitol is a low-calorie sweetener that inhibits the growth

of S. mutons. Numerous studies seem to confirm its anticariogenic capability. Xylitol has been tested as an additive to a variety of foods and to dentifrice. The use of xylitol chewing gum seems to be gaining popularity as another caries prevention strategy. It should be readily accepted by many children.

CARIES VACCINE A vaccine to prevent the disease of dental caries has been an anticipated scientific breakthrough since at least the early 1940s. Research efforts assume that MS is the principal etiologic organism of dental caries, and the development of a method of immunization specifically targeted at neutralizing MS has been a major thrust of caries vaccine research. Bowen reported that monkeys remained caries-free for more than 6 years after the animals received intraoral injections of killed MS, even though the monkeys were fed highly cariogenic diets and had severe malocclusion that would predispose them to caries. Most current research is being directed toward a greater understanding of the immune system and specifically of immune responses to MS. The route of administration of the vaccine is usually mucosal absorption by intraoral or intranasal tissues.