PREVENTIVE DENTISTRY

-- encompasses all aspects of dentistry and those practices by dental professionals, individuals, and communities that affect oral health. -- refers to the treatments or mechanisms employed to avert or intercept dental or oral diseases and conditions which tend to destroy or make less effective the oral structures and their functions.

Preventive Dentistry:

-- refers to the phase of dentistry concerned with he preservation of healthy teeth and maintenance of oral structures in a state of optimal health for a long period of time. -- includes all clinical tests, treatments, and patient education for the purpose of preventing oral disease and supporting the effectiveness of treatment.

Preventive Dentistry:

Goal
to assist the patient in either establishing control of his or her dental disease or in continuing to maintain good oral health

~ healthy mouths chew more easily ~ children learn to speak more quickly and clearly and gain more nutrients from the foods eaten ~ healthy mouth is more ~ better chance of general health, attractive, giving confidence because disease in the mouth in their appearance can endanger the rest of the ~ less extensive body

Importance

~ less expensive

Natural History of Diseases

-- a series or a sequence o events that occurs in human organism from the time of exposure of the agent until termination of stages

Three Stages

Pre-Pathogenesis Stage (Primary Preventive Services)

-- services that prevent the initiation or onset of a disease

-- services that provide health promotion and specific protection

Pre-Pathogenesis Stage
Health Promotion Specific Protection
-- the process of advocating health to enhance the probability that personal, private and public support of positive health practices will be a social norm -- any planed combination of educational, regulatory or organizational supports for actions and conditions conducive to the health of individuals, groups or community -- designed to protect against disease agents by decreasing the susceptibility of the host or establishing barriers against agent and environment

Pathogenesis Stage (Secondary Preventive Services)

-- services that intervene or prevent the progression or recurrent of disease

-- are designated as activities that are aimed at an early diagnosis and prompt treatment of a disease in order to prevent the sequelae

Pathogenesis Stage
Sequelae
-- a morbid condition following as a result from a disease

Tertiary Preventive Services (Replacement Services)

-- prevent the loss of function -- provides disability, limitation and rehabilitation

Levels of Prevention

Primary Prevention
-- refers to measures taken before the disease to occur to reduce susceptibility

Services Provided by the INDIVIDUAL

Health Promotion Specific Protection

-- diet planning -- demand for preventive services -- periodic visit to dental office

-- appropriate use of fluoride -- ingestion of sufficient fluoridated water -- appropriate use of fluoride prescriptions -- use of fluoride dentifrices -- oral hygiene practices

Services Provided by the COMMUNITY

Health Promotion Specific Protection

-- dental health education -- promotion of research efforts

-- community or school water fluoridation

Services Provided by the DENTAL PROFESSIONAL

Health Promotion Specific Protection

-- patient education -- plaque control program -- diet counseling -- recall reinforcement -- dental caries activity tests

-- topical application of fluoride -- fluoride supplement or rinse prescription -- pit an fissure sealant

Secondary Prevention
-- refers to measures taken to diagnose a disease that is already present (early diagnosis & prompt treatment)

Services Provided by the INDIVIDUAL

~ self-examination and referral ~ use of dental services

Services Provided by the COMMUNITY

~ periodic screening and referral
~ provision of dental services

Services Provided by the DENTAL PROFESSIONAL

~ complete examination

~ prompt treatment of incipient lesions

~ preventive resin restorations

~ simple restorative dentistry

~ pulp capping

Tertiary Prevention
-- it involves all measures taken to return the individual to a normal state of health or to keep the person alive

Services Provided by the INDIVIDUAL

Disability Limitation Rehabilitation

-- use of dental services

-- use of dental services

Services Provided by the COMMUNITY

Disability Limitation Rehabilitation

-- provision of dental services

-- use of dental services

Services Provided by the DENTAL PROFESSIONAL

Disability Limitation Rehabilitation

-- complex restorative dentistry -- pulpotomy -- RCT -- extractions

-removable & prosthodontics -- minor tooth movements -- implants

fixed

Community Water fluoridation

Community Water Fluoridation

-- fluorides are added to communal water supplies to reduce the incidence of caries -- the adjustment of fluoride content of a communitys water supply to n optimal level for the prevention of dental caries (tooth decay)

Community Water Fluoridation

Enamel Fluorosis
-- a condition which is caused by ingestion of excessive amounts of fluoride during the period of tooth development

Community Water Fluoridation

-- US public health service recommends 1 ppm (part per million) of fluoride equals 1 mg fluoride per liter -- for dental purposes, the optimal level of fluoride in drinking water is between. 0.7 and 1.2 ppm

Community Water Fluoridation

Compounds Used For The Fluoridation Process

~ sodium fluoride ~ hydrofluosilicic acid ~ sodium silicofluoride

Community Water Fluoridation

One of the Most Impt. Public Health Measures Because:
~ it is effective in reducing tooth decay in both children and adults ~ it is safe ~ its low cost / cost-effective ~ it benefits everyone in the community served by the water supply regardless of socio-economic status, educational background, or financial ability to seek dental care ~ it requires no cooperative effort on the part of the individuals

School Water fluoridation

-- similar to community water fluoridation in that no direct action is needed by individuals accrue its benefits other than consuming the water or foods prepared with it. -- used only when the school has an independent water supply -- the recommended concentration of fluoride for school water supply is 4.5 ppm -- researchers found up to 40 % reduction in dental caries after 12 years

School Water Fluoridation

School Water Fluoridation

Disadvantages:
~ installation costs relatively expensive ~ workers must be trained to operate, monitor and maintain fluoridation units

Fluoride Supplement Programs

Fluoride Supplement Programs

Forms of Fluoride:
~ lozenges ~ oral rinse supplements ~ drops and fluoride-vitamin preparations younger children)

for

Note: Fluoride supplement is not recommended to expectant mothers.

Fluoride Supplement Programs

Fluoride Supplementation Should Begin:
~ shortly after birth and continue until the eruption of the permanent second molars (12-14 yrs.) ~ ADAs council on dental therapeutics (until age 13) ~ American Academy of Pediatrics (until age 16)

Fluoride Supplement Programs

Dietary Fluoride Tablets

-- this self-applied fluoride regimen is for use only in communities in which the water supply is fluoride-deficient

Fluoride Supplement Programs

Procedure:

1. dispense the fluoride tablets 2. put the tablet in the mouth 3. chew it for 30 seconds 4. the resultant solution is hen vigorously swished between the teeth for another 30 seconds before swallowing the solution

Fluoride Supplement Programs

Advantages:
~ easy to perform ~ requires little time ~ no waste products to dispose of ~ provide about 20-30% reduction in new forming caries ~ safe & effective ~ inexpensive ~ non-dental personnel can supervise ~ provides systemic & topical benefits

Fluoride Mouthrinse Programs

Fluoride Mouthrinse Programs

-- one of the most widely used caries preventive public health methods

Fluoride Mouthrinse Programs

Advantages:
~ inexpensive ~ little time required ~ provides topical benefits

Disadvantage:

~ if swallowed over time, may contribute to fluorosis among children 6 years of age or younger because of some of their permanent teeth are still developing

Fluoride Mouthrinse Programs

Composition:
~ consisted of mixing a preweighed packet of fluoride powder with a specified amount of water in a container with a plastic pump calibrated to dispense 5 or 10 ml of solution that would yield 0.2 % neutral sodium fluoride rinse

Fluoride Mouthrinse Programs

Procedure: 1. dispense the solution into paper cups
2. put the solution in the mouth 3. rinse vigorously for 60 seconds 4. empty the contents of the mouth back into the cup 5. blot the lips with the napkin 6. waste products are then put into a plastic bag for disposal

Fluoride Mouthrinse Programs

Amount of Rinse:
5 ml kindergarten children 10 ml all others

School Sealant Programs

School Sealant Programs

-- 6 years old -- highly effective means of preventing pit and fissure caries
How long will a sealant last?

~ 5 years, but can last as long as 10 years {scientific studies have proven that properly applied sealants are 100% effective in protecting he tooth surfaces from caries}

School Sealant Programs

Dental Sealant
-- a thin plastic film painted on he chewing surfaces of molars and premolars (pit & fissures) -- a dental resin that is firmly bonded to he enamel surface and isolate the pits and fissure from caries reducing conditions o the oral environment

School Sealant Programs

Procedure:
agent 1. clean the surface of the tooth 2. rinse the surface to remove all the traces of the
3. an etching solution or gel is applied to the

cleaning its and

enamel surface of the tooth, including the grooves 4. after 15 seconds, the solution thoroughly rinsed away with water 5. after the site is dried, the sealant is applied and harden by using a special curing light

allowed

to

Professional Fluoride Application

Professional Fluoride Application

-- an effective method of preventing the initiation of new enamel caries

Professional Fluoride Application

Topical Fluoride Solution: ~ acidulated phosphate fluoride (APF) or an acidulated-buffered solution of sodium fluoride (12,300 ppm F) and contains 1.23% fluoride ion ~ neutral solution of 2% sodium fluoride (9,040 ppm F) ~ 8% stannous fluoride solution (19,360 ppm F)

Professional Fluoride Application

Stannous Fluoride
-- very effective in reducing dental caries attacks in children and adults

Professional Fluoride Application

Procedure:
1. seat the patient upright 2. tray selection (use tray with absorptive liners) 3. gel is placed on trays (2.5 ml or 0.5 tsp. per tray) 4. air dry the teeth 5. tray is inserted simultaneously over the maxillary 6. gel is left for 4 minutes 7. tray is removed 8. patient is adviced not to eat, drink, or eat/gargle for

and mandibular teeth 30 minutes

Plaque Control Programs

Plaque Control Programs

-- use of chemical agents for control of plaque and gingivitis

Plaque Control Programs

Chlorhexidine Gluconate

-- most extensively applied agent -- applied topically or used as a mouthrinse -- inhibits plaque formation and gingivitis even in the absence of thee oral hygiene measures -- eliminate existing plaque and resolve gingival inflammation -- in addition of oxidizing peroxymonosulfate, reduces the staining without affecting plaque preventive capacity

Plaque Control Programs

Stannous Fluoride
-- exert antimicrobial effects against plaque bacteria -- as mouthrinse/dentifrice -- reduces the numbers of spirochetes and motile rods -- eliminate existing plaque and resolve gingival inflammation -- in addition of oxidizing peroxymonosulfate, reduces the staining without affecting plaque preventive capacity

Procedure: 1. brush at least twice a day

Plaque Control Programs

2. use a sot-bristled brush that fits your mouth 3. use toothpaste with fluoride to help protect your teeth from decay 4. place the brush where the gum meets the tooth, with the bristles at 45 degree angle to your teeth so that they get under the gum line 5. move the brush back and forth in short (tooth-wide) strokes; be gentle; brushing vigorously can actually injure the gums and make them more susceptible to periodontal disease

Procedure: 6. brush both the inner and outer surfaces of the teeth and brush the broad

Plaque Control Programs

chewing surfaces with the entire brush 7. to clean the inner surfaces of the front teeth, use the tip of the brush in gentle up-and-down strokes 8. brush for at least 2 minutes 9. scrub your tongue for about 30 seconds to remove even more bacteria 10. if you dry brush first, follow the same brushing procedure for about a minute and a half without paste, then brush again for 2 minutes

Plaque Control Programs

Procedure:
11. rinse the tooth brush thoroughly 12. change brushes every 3 months or so, or when the bristles are bent or frayed, or after a cold or illness

Diet Counseling

-- may involve a detailed dietary analysis, or it may be limited to warning about sweet consumption -- US Dept. of Agricultures food pyramid makes it clear that sugars should be consumed only in moderation

Diet Counseling

-- sugar consumption is a key component of the caries process

{Sugar must be present for caries to occur.}

-- If you must consume sugars, do so at meals and in moderation.

Diet Counseling

Diet Counseling
-- when we eat foods or drink beverages that contain sugar or starch, bacteria produce acids that attack tooth enamel; the thickness of plaque keeps the harmful acids against the teeth, which can contribute to tooth decay -- limit snacks and eat nutritious, well-balanced meals

Diet Counseling
Nizel Suggests 3 Rules to Adopt When Recommending Dietary Modifications: 1. the prescribed diet should vary from the normal as little as possible 2. the diet should meet the bodys requirements for the essential nutrients 3. the prescribed diet should take into consideration and accommodate the patients likes and dislikes, food habits, and other environmental factors as long as it does not interfere with the therapeutic or prophylactic objectives

Dental Caries Activity Tests

Dental Caries Activity Tests

-- referred as CARIES SUSCEPTIBILITY TEST -- are unreliable predictors of future caries experience

The end