Professional Documents
Culture Documents
prac+cal
preven+on
And
the
children
in
your
prac+ce
Thank
You
Trends
in
Oral
Health
Status
Decrease
in
Growth
of
the
Acidogenic
Protec+ve
Bacteria
Commensals
Defini+on
ECC
S-‐ECC
ECC
=
early
childhood
caries
The
presence
of
one
or
more
decayed,
missing
or
filled
tooth
in
a
child
71
months
of
age
or
younger.
S-‐ECC
=
severe
early
childhood
caries
<
5
yrs
–
any
smooth
surface
lesion
3
yrs
–
DMFT
of
4
4
yrs
–
DMFT
of
5
5
yrs
–
DMFT
of
6
• AAPD
reference
manual
2010
What
is
Risk
Assessment?
ANTIBACTERIAL
THERAPY
ACID
PRODUCING
BACTERIA
GOOD
OH
FREQUENT
SNACK
ING
FLUORIDE
JDB
Featherstone,
J
Dent
Res
83
(Sp
Issue
C)
C39
–
C42,
2004
Tools
1)
Behavioural:
DIET,
ORAL
HYGIENE
2)
Therapeu+c
Chlorhexidine,
xylitol,
FLUORIDE
VARNISH,
FLUORIDE
3)
Repara+ve
sealants,
GI
Pictograms
Toothpaste
• “250
ppm
fluoride
den+frice
was
not
as
effec+ve
in
caries
preven+on
in
permanent
den++on
as
den+frice
containing
1,000
ppm
F
or
more”
Systema)c
Review
of
Studies
Comparing
the
An)-‐Caries
Efficacy
of
Children’s
Toothpaste
Containing
600
ppm
of
Fluoride
or
Less
with
High
Fluoride
Toothpastes
of
1,000
ppm
or
Above
A.B.
Ammari,
A.
Bloch-‐Zupan,
P.F.
Ashley
Department
of
Paediatric
Den)stry,
Eastman
Dental
Ins)tute
for
Oral
Health
Care
Sciences,
University
College
London,
London,
UK
Vol.
37No.
2,
2003
Fluoride
Toothpaste
• The
subjects
were
required
to
drink
500
mL
of
a
120-‐gm/L
sugar
solu+on
either
once,
3,
5,
7,
or
10
+mes/day
for
30
sec
on
each
occasion,
for
a
period
of
5
days.
• While
brushing
their
teeth
twice
daily
with
either
a
F
(1450
ppm
NaF)
or
a
F-‐free
toothpaste.
• Mineral
analysis
revealed
that
when
the
subjects
used
a
F
toothpaste,
net
demineraliza+on
was
evident
only
with
the
seven-‐
and
10-‐+mes/day
regime
(ns).
• When
F-‐free
toothpaste
was
used,
sta+s+cally
significant
demineraliza+on
was
observed
when
the
frequency
exceeded
3
+mes/day.
Duggal
MS,
Toumba
KJ,
Amaechi
BT,
Kowash
MB,
Higham
SM
(2001).
Enamel
demineraliza+on
in
situ
with
various
frequencies
of
carbohydrate
consump6on
with
and
without
fluoride
toothpaste.
J
Dent
Res
80:1721–1724.
Gel
vs.
Varnish
• Gel
–
evidence
is
inconclusive
for
efficacy,
none
less
than
4
minute
applica+on.
• Varnish
–
ease
of
applica+on,
beder
pa+ent
compliance,
less
swallowed.
• American
Dental
Associa+on
Council
on
Scien+fic
Affairs,
2006
Clinpro
White
Varnish
• Releases
Calcium
in
the
form
of
TCP
• Takes
just
seconds
to
paint
on
• Sets
rapidly
in
the
presence
of
saliva
• Flows
well
• Contains
22,600
ppm
Fluoride
• Classified
as
a
natural
health
product
• Mint,
cherry,
or
melon,
Vanish™
5%
Sodium
Fluoride
White
Varnish
with
Tri-‐Calcium
Phosphate
“Programs
using
fluoride
varnish
will
be
more
likely
to
demonstrate
benefits
and
reduce
dental
caries
in
at-‐risk
popula+ons
when
applica+ons
are
offered
at
least
at
six-‐month
intervals
over
at
least
two
years
in
dura+on
in
combina+on
with
counseling.
For
the
preven+on
of
early
childhood
caries,
ini+a+on
of
fluoride
varnish
should
begin
no
later
than
age
one
for
highest
risk
children.”
Weintraub,
Ramos-‐Gomez,
June,
2006
Lawrence,
Binquis,
Douglas
et
al,
2006
Before
Caries
is
Observed
There
is
evidence
that
the
preven+ve
effect
is
strongest
when
fluoride
varnish
is
applied
before
the
onset
of
detectable
dental
caries.
• Scheinin
A
eta
alFinal
report
of
the
effects
of
sucrose
fructose
and
xylitol
diets
on
caries
incidence
in
man.
Acta
Odontol
Scand
1976;
34
(4)
179
–
216.
Mechanism
of
Ac+on
• Physically
obstruc+on
of
the
pits
and
grooves
• Prevents
coloniza+on
• Prevents
penetra+on
of
fermentable
carbohydrates
Simplified
Sealant
Technique
• Brush
self
etch
adhesive
onto
surface
to
be
sealed;
scrub
for
15
seconds
applying
moderate
pressure.
Do
not
shorten
this
+me.
Proper
bonding
will
not
occur
if
the
solu+on
is
simply
applied
and
dispersed.
• Use
a
gentle
stream
of
air
to
thoroughly
dry
the
adhesive
to
a
thin
film.
A
second
layer
is
not
required
for
bonding
sealants.
• Apply
sealant
• Light-‐cure
the
sealant
and
adhesive
together.
Glass
Ionomers
• “Fluoride
releasing
bonding
and
restora+ve
materials
have
been
shown
to
be
beneficial
and
are
best
u+lized
as
part
of
a
comprehensive
preventa+ve
program
in
the
dental
home”
• AAPD
reference
manual
2010/2011
• Nowak
AJ,
Cassamassimo
PS
The
dental
home
A
primary
care
oral
health
concept.
J
Am
Dent
Assoc
2002;
133
(1):
93
-‐8.