DIFFERENT LEVELS OF PREVENTION

1. 2. 3.

Primary prevention. Secondary prevention. Tertiary prevention.

PREVENTIVE DENTAL SERVICES

provided by : a. Community agencies b. Professionals (Doctors & auxiliaries) c. Individuals (public)

Classification of preventive dental services

1.Primary preventive services 2.Secondary preventive services 3.Tertiary preventive service
Preventive services are provided by :

i. Community agencies ii. Dental professionals iii. Publicindividuals

PRIMARY PREVENTION
PRIMARY PREVENTIVE SERVICES BY THE COMMUNITY 1. Community water fluoridation. 2. School water fluoridation. 3. Fluoride supplements programmes.
(Tablets, Losenges, Oral drink, Drops, Salts etc)

Fluoride Mouth rinse programmes. Pits & Fissures sealants programmes in schools.

PRIMARY PREVENTION
PRIMARY PREVENTIVE SERVICES BY THE COMMUNITY

1. Community water fluoridation.

Concentration of fluoride in water1p.p.m. (Optimal). 2 .School water fluoridation. Concentration of fluoride in water5 p.p.m. (Optimal). a. Hydroxyapatite crystals Hydroxyfluoroapatite crystals (more resistance to carries attack). b. Systemic Effect only (during development of teeth).

MECHANISM OF ACTION OF SYSTEMIC FLUORIDE

The cariostatic mechanism of systemic fluoride is as follows : 1.The enamel become more resistant to acid dissolution 2.Inhibition of bacterial enzyme systemsystemenzymatic action 3.Modification in the size and shape of teeth to be less susceptible to caries

PRIMARY PREVENTION
PRIMARY PREVENTIVE SERVICES BY THE COMMUNITY 3. Fluoride supplements programmes.
(Tablets, Losenges, Oral drink, Drops, Salts etc). a. Daily supply of fluoride: i. 2.2, 1.1 & 0.5 release 1 mg, 0.5 mg and 0.25 mg flouride respectively ii. Dose for child below 2years is 0.5 mg iii. Dose for child b/w 2-3 years is 0.5-0.7 mg iv. Dose or child above 3 years is 1.0-1.5 mg

PRIMARY PREVENTIVE SERVICES BY THE COMMUNITY Fluoride supplements programmes.

Tablets : swish and swallow technique : With the use of tablets, it seems logical that if a child would chew the tablets, then swish the saliva b/w the teeth for a minute before swallowing . Both a topical and systemic use of flouride achieved this swish and swallow method is advocated whn ever tablets are used .

PRIMARY PREVENTION
PRIMARY PREVENTIVE SERVICES BY THE COMMUNITY
1. Fluoride Mouth rinse programmes. (Flavored, Breath Freshening, Innocent to tissue) Two major regimens : (mostly school based program) i. Sodium fluoride (0.05%) rinse : it contains 230 ppm fluoride which is used daily---5-10 ml of this solution is asked to rinse for one minute. ii.Sodium fluoride (0.2%) rinse it contain 900 ppm Flouride which is used weekly or fortnightlyrinse for 1 minute

The schedule is for one year---30 weeks

PRIMARY PREVENTION
PRIMARY PREVENTIVE SERVICES BY THE COMMUNITY 1. Pits & Fissures sealants programmes in schools.
To prevent Primary carries: Teeth with deep Pits & Fissures are filled with composite materials / Glassionomers. Pits & Fissures which are not cariousfilled with Fissures Sealants.

PRIMARY PREVENTION
PRIMARY PREVENTIVE SERVICES BY THE DENTAL PROFESSIONALS

Two levels: i.Community or public programmes ii. In dental clinics / hospitals

PRIMARY PREVENTION
PRIMARY PREVENTIVE SERVICES BY THE DENTAL PROFESSIONALS

Plaque control (scaling & polishing). Dental caries activity tests. Simple remedies.
a. Professional topical fluoride application. b. Pits & fissures sealants etc.

Diet counseling. Demonstrations & Training to patients.

PRIMARY PREVENTION
PRIMARY PREVENTIVE SERVICES BY THE DENTAL PROFESSIONALS 1.Plaque control (scaling & polishing)
Scaling and polishingby dentist twice a year.

Birthday once a year, dentist twice a year.

PRIMARY PREVENTION
PRIMARY PREVENTIVE SERVICES BY THE DENTAL PROFESSIONALS 2. Dental caries activity tests. (Caries susceptibility tests) . To show existing condition of carries
susceptibility in mouth . These test are used as motivational tools for patients education and to develop habits for prevention like regular brushing and mouth rinsing

Caries activity tests Following tests

1.Synder's Test 2.Lactobacilli colony count Test 3.Alban's Test 4.salivary buffer capacity Test 5.Enamel solubility Test 6.salivary reductase Test 7.streptococcus mutans level in saliva Test

Synder Test:
Used a colour indicator to show amount of acid formed by micro-organisms in carbohydrate micromedium show carries activities.


PRINCIPLE:

 PROCEDURE

 INFERENCE:

Amount of acid produced is proportionate to the number of acid producing lactobacilli present

1 ml of paraffin stimulated saliva of the patient is added to glucose agar containing bromocresol green dye and incubated for 72 hrs at 37 c. The 37 colour change is examined after 24 hours till 72 hrs.

The sooner the colour changes from green to yellow the greater is the caries activity.If colour does not changes in 72 hours then the patient is immune to caries.

PRIMARY PREVENTION
PRIMARY PREVENTIVE SERVICES BY THE DENTAL PROFESSIONALS 3. Simple remedies: a. Professional topical fluoride application. a. Pits & fissures sealants.

Topical Fluorides: Three Agents: a. Sodium fluorides (2% solution)-four (2 solution)applications at one week interval per year at ages 3,7,11 and13 years. and13 b. Stannous Fluorides (8 10% solution)(8 10% solution)one application per year. c. Acidulated phosphate Fluorides (1.2% fluoride gel)-two applications gel)per year Fluorides in mouthwashes, solution, varnish, gel(duraphat, fluorprotector), lozenges and drops are available.

METHOD OF APPICATION OF TOPICAL FLUORID

1.clean and polish all the surfaces of teeth. 2.Isolation of the teeth with cotton roll or rubber dam. 3.Dry the teeth with cotton or compressed air. 4.Freshely prepared soultion or gel or varnish of fluoride is applied to the teeth with cotton applicator.

METHOD OF APPICATION OF TOPICAL FLUORID

5. 2% sodium fluoride is applied on the teeth for 4 min. 6. 8% SnF is applied on the teeth for 4 min & ReRe-application of solution to tooth is done every 15-30 second. 157.The APF gel / solution is applied for 4 min & is continuously and repetedly applied with cotton applicator .

METHOD OF FLUORIDE VARNISH APPLICATION

1. Oral prophylaxis 2.Teeth are dried 3.Teeth are not isolated with cotton rolls as varnish being sticky has a tendency to stick to cotton. 4.The application is done first on lower arch as saliva collects more rapidly around it, and then on the upper arch.

METHOD OF FLUORIDE VARNISH APPLICATION

5. Application of varnish is done with single tufted small brush. 6.Set the patient with open mouth for 4 min. 7. Ask the patient not to rinse or drink any thing for one hr and dont eat hard till next morning.

Dietary Counseling
Fermentable carbohydrate play an important role in the cause of dental caries.

A logical approach to prevent the dental caries is : > To alter the form of dietary carbohydrate intake . > To alter the frequency of dietary carbohydrate intake .

Studies show that changing dietary habits could be an effective approach to prevent dental caries . The patients with the high level of caries activity need motivation

Diet can affect teeth Pre-eruptively :

The intake of fluoride can increase of the teeth to prevent caries. the strength

Post-

eruptively :
The diet can affect the teeth as : i. The use of fluoride prevent caries ii. The use of sucrose cause caries iii. The acidic food / drinks cause the erosion of teeth.

Objectives :

Diet Counseling

1. To correct nutritional inadequacies of the diet that may affect the patient's general health and be reflected in oral health 2.To prevent damage to the teeth and other oral tissues as a consequence of the type & frequency of foods taken

Phases: Two general phases

Diet Counselling

1. First phase{ Assessment phase } : Dietary analysis 2. Second phase : Diet advice / instruction / planning.

DIET COUNSELING
First phase : {Assessment / analysis phase} : To evaluate the patient's nutritional status and diet. Activities during the assessment phase : i. Complete medical and social history ii. Thorough clinical examination iii. A detailed dietary analysis

DIET COUNSELING
First Phase
Diet Analysis : is usually accomplished by having: It =>The patient compile a one day,4 to 7 days or a month record of food intake. =>To recognize the cariogenicity of food in their diet.

Diet Analysis
Indications : 1.High caries activity in the mouth 2.unusual caries pattern 3.Suspected dietary erosion

Diet Analysis
Method of diet study :
(most widely used method) A consecutive 3 days analysis (1 week or 2 weeks) of the diet of the patient with recording the :

a. Time of diet taking b. Content of the diet taking c. Quantity of the diet consuming d. Frequency of diet taking
In addition,times of toothbrushing after meal and before bed time should be noted.

Method of diet analysis :

Diet Analysis

1.Ring the main meals. If in any doubt, identify those snaks that contain carbohydrates. Assess nutritional value of meals. 2.Underline all refined sugar intakes in red colour. 3.Identify the snaks b/w the meals. 4.Decide on a maximum of three recommendations.

Diet counseling
Second Phase Diet advice / instruction / planning: This should include an explanation of the affect of sugary snaks eating & drinking b/w the meals. It must also be personal , practical and positive The suggestion that a child should select crisps when friends / class fellows are buying sweets is more likely to be followed than total abstinence.

1. Diet advice / instruction / planning.

Key factors for successful diet advice : 1. Implement gradual changes/reduction in sugar intake rather than drastic/sudden changes or reduction all at once 2.Utilized dietary substitutions rather than outright elimination 3.Utilize continual psychological reinforcement

1. Diet advice / instructions / planning.

1.Restrict the number of eating times to three main meals. 2.Avoid refined sugary snaks in b/w meals. 3.Take low carbohydrates or alternative to sugar like xylitole containing food. 4.take high protein snaks and fibrous fruits in b/w meals 5.Increase eating of high protien food like meat, fish , milk, egg, pulses, etc.

Diet advice / instruction / planning.

6.Restrict carbohydrates eating so that they only provide 30-50% of total calories required to the body. 7.Eliminate eating sticky sweets like chocolates, candies, toffies, cakes, pasteries, etc. if not completely then as much as possible. 8.Eat firm food like raw vegetables and fruits which will reduce dental plaque formation and increase salivary flow

DIET COUNCELING A village dental camp

Diet counseling parents and their children

1. Diet advice / instruction / planning.

Some Suggestions to patients : 1.Suggest saving sweets to be eaten on one day, e.g saturday dinner time 2.All-in-one chocolate are preferable to packets on individual sweets 3.Food which stimulates salivary flow (e.g cheese, sugar free chewing gum) can help to reverse the pH drop due to sugar, if eaten afterwards

1. Diet advice / instruction / planning.

Some Suggestions to patients : 4.Treacle and honey are Cariogenic 5. Artifical sweetners are recommended in adults but should be avoided in preschool children 6.Fibrous foods e.g fruit are preferable to a sucrose snak

Dental health education

Establish a preventive setup in the dental clinic consisting of : a. charts b. models c. pictures d. audio-visual devices .etc. audioDentist and the auxilliaries are available to: i. To educate the patients ii. To make them aware about the dental diseases and their consequences iii. To motivate them to follow the advices to prevent the dental diseases

Pits and fissures sealants

Pits and fissures of the teeth provide a sheltered niche (recess) for bacterial proliferation which cause dental caries. By providing and impervious barrier to pits and fissures system, the pit and fissure sealants can help to prevent dental caries.

Pits and fissures sealants

Definition: A cement or a resin which is filled to the unprepared pits and fissures of the teeth which are susceptible to caries, forming a mechanical and physical protective layer against the action of acit released by the bacteria. Indications: > Non carious deep pits, fissures, grooves and fossae are sealed. > A small carious pit is filled and rest of pits and fissures are sealed. sealing the pits and fissures just after tooth eruption may be the most important event in their resistance to caries.

Pits and fissures sealants

Sealants are not recommended on patients who do not have signs of caries activity. If caries activity is noted either clinically or radiographically, sealing all pits and fissures should be strongly recommended

Pits and fissures sealants

Types : Following materials are used as sealants : i. Polyurethanes ii. Cyanoacrylates iii. BIS-GMA (Bisphenol A-Glycidyl Methylacrylate) These materials are polymerised by two methods : i. Light curing ii. Chemical curing

Pits and fissures sealants

Procedure / technique of pits and fissures sealants application : i. Clean the surface of the tooth ii. Isolate and dry the tooth iii. Etch for 20 sec. With 30-50% phosphoric acit 30-50% iv. Wash thoroughly , re-isolate and dry very well, avoid rethe contact of saliva with the tooth v. Apply the pits and fissure sealant on the etched pits, fissures, grooves and fossae vi. Now let the sealants polymerized vii. Do the occlussal adjustment if required

Light curing a fissure sealant.

Chemically curing fissures sealant

PRIMARY PREVENTION
PRIMARY PREVENTIVE SERVICES BY THE INDIVIDUALS

AgeAge-group of individuals 1. Infants & Children of age 3 to 5 years old. 1. School going children & adults.

DENTAL CARE PROGRAM (Involve Parents)

a. Early infancy.
a.Care of toothless gums. a.Care b.Care of even single tooth b.Care (when appears). c.Care of milk teeth. c.Care d.Bottle feeding. d.Bottle e.Care of permanent teeth e.Care (when appear).

2. A young child of 35 years old.

PRIMARY PREVENTION (INDIVIDUALS)

Schools going Children & Adults. Self examination. Diet planning & control. Oral hygiene practice (home care).

SELF EXAMINATION

PRIMARY PREVENTION
(INDIVIDUALS) DIET PLANNING AND CONTROL
a. Nutrition and Host resistance.
a. b. Children Adults

b.
a. b.

Fluoride

Local application Systemic use

c.

Sweets & Host resistance

a. b. Amount of sweet taking. Frequency of sweet taking

(gradual decrease in sugar taking)

Diet control

DIET CONTROL

Fruits are preferred over sweets

PRIMARY PREVENTION
HOME CARE INSTRUCTIONS
a. b. c. d. e. f. g. h.

i. j.

Plaque disclosing agents (Tincture Iodine, coloring agents). Tooth brushes (selection and uses). Dentifrices (powder, paste, liquid, gel). Tooth brush techniques. Inter-dental hygiene. Special cleaning aids. Electric tooth brushes. Irrigation devices (water, fluoride, saline, M/W). Chemically plaque control (chlorhexidine). Fluoride supplement programme (Tablets, Losenges, Oral Drink, Drops)

PLAQUE DISCLOSING

PRIMARY PREVENTION
Home Care Instructions
Tooth brushing techniques
a. b. c. d.

Horizontal Reciprocating Vertical sweeping Rotating Vibrating

Inter-dental Hygiene
(Tooth pick, inter-dental brushes, Dental floss, Gauze strips, Polishing cloth, Rinsing etc)

BASS TECHNIQUE

VIBRATING MOVEMENTS

VERTICAL SWEEPING

PRIMARY PREVENTION
HOME CARE INSTRUCTIONS
INTERINTER-DENTAL HYGIENE (Tooth pick, inter-dental brushes, interDental floss, Gauze strips, Polishing cloth, Rinsing etc)

INTER DENTAL FLOSSING

INTERDENTAL FLOSSING

INTER DENTAL FLOSSING

INTER DENTAL FLOSSING

INTER DENTAL FLOSSING

INTERDENTAL GUAZE STRIPS

INTERDENTAL BRUSHES

WATER JET DEVICE