Preventive Dentistry - the goals and classification PDF

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INTRODUCTION TO PREVENTIVE DENTISTRY

Definition of Preventive Dentistry A branch of dentistry that focuses on those procedures and practices that help people to prevent the beginning or progression of oral diseases and restore function for improved oral health and enhanced quality of life.

The goals of preventive dentistry   

to prevent the onset of oral diseases (before disease occurs) to diagnose and provide treatment as soon as possible (when disease occurs) to provide the proper functional rehabilitation (when disease occurs)

The importance of preventive dentistry    

Dental and oral diseases are prevalent Dental and oral diseases are preventable -Safe and effective measures exist to prevent the most common dental diseases. Dental disease can influence general health and systemic diseases can influence oral health Neglect of dental/oral health require more complex treatment, more dental visits and cost more money, time and pain.

Levels of prevention PRIMARY PREVENTION

SECONDARY PREVENTION

TERTIARY PREVENTION

Controlling a disease at the prepathogenic stage i.e., before the onset of a disease.

Treating a disease after the onset of a disease but before any functional disability has resulted for it.

Mitigating (make something less severe) the long-term sequelae and complications of a disease. Treating the late pathogenic or final stages of a disease

- Provided by: Health promotion; ex - health education Specific protection; ex – immunization, topical application of fluoride

-Provided by: Early diagnosis and prompt treatment; ex – periodic oral examination, screening

PRIMARY PREVENTION Health promotion

Specific protection

Promoting oral health

Use of fluoridated toothpaste

Non-smoking promotion

Use of mouth guard

SECONDARY PREVENTION Early diagnosis and prompt treatment Smoking cessation program Simple restorative treatment

Pit and fissure sealant

Oral cancer screening

Vaccination

Dental recall system

-Provided by: Disability limitation; ex- periodontal surgery Rehabilitation; ex: partial denture

TERTIARY PREVENTION Disability limitation

Rehabilitation

Treatment of oral disease

Provision of appliances to restore function

Periodontal surgery

Implants

Complex restorative treatment

Approaches of prevention

Population-based approach

High-Risk Approach

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Preventive measure widely applied to an entire population

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Target group of individuals at high risk

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Strive for absolute change among many persons

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Strive for strong risk factor control

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Must be relatively inexpensive and non-invasive

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Often times requires clinical action to identify the high risk group and to motivate risk factor control.

PLAQUE CONTROL- MECHANICAL

Plaque control definition   

removal of microbial plaque and the prevention of its accumulation on the teeth and adjacent gingival tissues. Besides, it also deals with the prevention of calculus formation.

MECHANICAL PLAQUE CONTROL Definition •

removal of microbial plaque and

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the prevention of accumulation on the teeth and adjacent gingival surface by the use of tooth brush and

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other mechanical hygiene aids without the use of chemical.

Mechanical plaque control •

Toothbrushing

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Flossing

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Wooden sticks

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Interdental brush

TOOTHBRUSHING Objectives    

remove plaque, clean teeth of food, debris and stain, stimulate the gingival tissues, and apply dentifrice.

Methods

Toothbrush Design 

Soft bristle texture,

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round-ended bristles

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Nylon or polyester filaments,

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Small brush head (appropriate to user’s mouth)

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Longer handles (more comfortable)

Powered Toothbrush  

Toothbrush that uses electric power to move the brush head, Normally the vibration is in an oscillating pattern

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Powered (Electric) toothbrushes are consistently superior to manual toothbrushes for removing plaque, and reducing gingivitis, gingival abrasions, bacterial adherence and viability, and staining.

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In addition, powered toothbrushes are particularly useful for removing interproximal plaque, which accumulates quickly and is difficult to remove with a manual brush. Patients with limited manual dexterity are strongly recommended to use electric toothbrushes It is also beneficial for: o cleaning children’s teeth o For care givers brushing institutional elderly

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INTERDENTAL CLEANING

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Dental Floss and tape  Floss is usually made from nylon filaments or plastic monofilaments.  It may be treated with flavouring agents, such as mint, to make flossing more pleasant.  There is no difference in the effectiveness of waxed or unwaxed floss  Flossing helps remove debris and interproximal dental plaque Woodsticks Interdental brushes Single turf brushes

PLAQUE CONTROL – CHEMICAL (DENTRIFRICES) Definition Content

Percentage

Water

15-50 %

Abrasive

20-60 %

Surfactant (Detergents) Humectant Binding Agents

1-2 % 20 -60 % 1-2 %

Flavouring agents

0.5-1.5 %

Colouring agents

0.05-3 %

Therapeutic agents

up to 5 %

Therapeutic agent

Anti-caries

Anti-plaque

Anti-calculus

Anti-hypersensitivity

Whitening agent

Anti-halitosis

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Xylitol Fluoride Calcium/phosphate Sodium bicarbonate Sodium Lauryl Sulphate (SLS) *Triclosan Metal-ions, eg. Zinc and stannous Amyloglucosidase and Glucose oxidase Essential oils Chlorhexidine Pyrophosphate Zinc potassium nitrate, stronium chloride, and sodium citrate Stannous fluoride Abrasive Dimethicones Papain Sodium bicarbonate Zinc (inhibits the production of volatile sulphur-containing compound (VSC) in the oral cavity)

 sodium benzoate  methylparaben Preservatives  ethylparapen. *A 0.3% triclosan-containing dentifrice (safe for human use) resulted in significant reductions in dental plaque formation and gingival inflammation.

* FLOURIDE (Anti-caries agent)

Types sodium fluoride (NaF) 0.22% sodium monoflurophosphate 0.76% (MFP) stannous fluoride (SnF2) 0.4%

1,000 ppm

FLUORIDES IN THE PREVENTION OF DENTAL CARIES

FLOURIDE Definition   

Fluoride occurs naturally (found in rocks, soils, sea) Fluoride is the ionic form of the element fluorine. Fluoride has a high affinity for calcium. It is, therefore, very compatible with teeth and bone.

Metabolism    

Most of ingested fluoride are absorbed in the digestive tract ---- the blood Absorption occur in the stomach and duodenum by passive diffusion Fluoride in circulating plasma deposited into: o Teeth. bones, soft tissues (very small amounts) Excretion: o urinary system (major pathway), sweat, milk (small amount), saliva, digestive juice

Historical perspective •

Early 1900: – Dr.Frederick S. McKay – established practice at Colorado Springs, Colorado, USA.

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In 1908: – Dr. McKay - initiated a study to investigate the cause of a developmental enamel defect which he called "Colorado Brown Stain”.

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Late 1920: – Dr. McKay – discovered that that teeth with mottled enamel were free of dental caries.

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1931: – Fluoride in drinking water caused mottled enamel but also inhibited dental caries. Established a community fluorosis index.

Mechanism of action 1. Systemic  improves enamel crystallinity  reduces acid solubility  improves tooth morphology (size and shape) 2. Topical  inhibit demineralisation  enhance remineralisation 3. Antibacterial  Reduce ability of plaque to produce acid

SYSTEMIC (Ingested into body)

TOPICAL (Incorporated onto the surface of teeth) By making the enamel more Fluoride, through topical resistant to acid application, inhibit demineralisation demineralisation and enhance Fluoride from water and food remineralisation through is incorporated into the constant supply of developing tooth during fluorides locally mineralisation

ANTIBACTERIAL Fluoride inhibits the bacterial enzyme system which converts sugars into acids in plaque. This affect the production of adhesive polysaccharides. When fluoride is constantly present, Streptococcus mutan produce less acid.

The hydroxyapatite of the enamel has an affinity for fluoride ions. The hydroxyl group of the hydroxyapatite are exchanged for fluoride to fluorapatite. The fluoroapatite reduces enamel solubility. By modifying the size and shape of teeth Teeth exposed to fluorides pre-eruptively tend to be smaller, cusps and have shallower pits and fissures Methods of administration Systemic Fluorides are ingested into the body and become incorporated into forming tooth structures.

Topical (local) Fluoride is incorporated onto the surface of teeth 

    

Water fluoridation Fluoride in Tablets Fluoride in vitamins Fluoridated milk Fluoridated salt

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Topical application of fluoride o Sodium fluoride o Stannous fluoride o Acidulated Phosphate o Fluoride (APF) Fluoride mouth rinse Fluoride Dentifrices Prophylactic paste

WATER FLOURIDATION

Definition Water fluoridation is the adjustment of the natural fluoride concentration of fluoridedeficient water to the level recommended for optimal dental health. Optimum Level 



The optimum level of fluoride in o Malaysia is 0.5 parts per million (ppm). Range 0.4ppm – 0.6 ppm o United States is in the range of 0.7 to 1.2 ppm This range (optimal level of fluoride) effectively reduces tooth decay while minimizing the occurrence of dental fluorosis.

1 Part Per Million •

One part per million (ppm) is identical to one milligram per liter (mg/L) – One milligram of fluoride is diluted in one litre (1000cc) of water

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At 1 ppm: – one part of fluoride is diluted in a million parts of water

Aim  

Achieve mass prevention against dental caries in large populations. It is an example of population-based strategy of preventing dental/oral diseases

Chemical Used In Adjusting Fluoride Content in Water      

Sodium fluoride (NaF) Sodium silicofluoride (Na2SiF6) Magnesium silicofluoride (MgSiF6H20) Hydrofluorosilisic acid (H2SiF6) Ammonium silicofluoride ((NH4)2SiF6 Calcium fluoride (CaF2)

Effectiveness of Water Fluoridation •

Earlier studies: reductions of 50–60% in childhood cavities

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More recent studies: lower reductions (18–40%)

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This change may be due to increasing use of fluoride from other sources (toothpaste, supplements and other topical agents), notably toothpaste, and high geographic mobility of our populations

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In 1993, the results of 113 studies in 23 countries were compiled and analyzed.

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59 out of the 113 studies analyzed were conducted in the United States.

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This review provided effectiveness data for 66 studies in primary teeth and for 86 studies in permanent teeth.

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Taken together, the most frequently reported decay reductions observed were: 

40-49% for deciduous teeth; and

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50-59% for permanent teeth

In a second review of studies conducted from 1976 through 1987, when data for different age groups were isolated, the decay reduction rates in fluoridated communities were: 

30-60% in the primary dentition;

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20-40% in the mixed dentition* (aged 8 to 12);

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15-35% in the permanent dentition (aged 14 to 17); and

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15-35% in the permanent dentition (adults and seniors).

A comprehensive analysis of the fifty-year history of community water fluoridation in the United States further demonstrated the findings of a half-century ago, that is: 

the inverse relationship between higher fluoride concentration in drinking water and lower levels of dental decay

Safety AE:   

dental fluorosis - critical period of exposure is between ages one and four years, with the risk ending around age eight. bone fracture – slightly lower fracture risk cancer – no clear association

More than 60 major international health organisations throughout the world support water fluoridation, including the: – World Health Organisation (WHO) – International Dental Federation (FDI) – Pan American Health Organisation (PAHO) – International Association of Dental Research (IADR), and – Every national dental association in the world.

The ethics of water fluoridation 1. It is a safe process which confers benefits on human beings (protection from tooth decay) 2. It does not conflict with basic human rights (only a personal preference) 3. It is replicating a situation which occurs naturally (where fluoride already exists at the correct levels). 4. It does not have any harmful consequences

PITS AND FISSURE SEALENTS Definition   

A resin material that is applied into the occlusal pit and fissures of cariessusceptible teeth for the purpose of acting as a physical protective barrier against caries-producing bacteria entering the tooth.

Functions 

Occludes the pits and fissures and so provides a physical barrier so that cavitycausing bacteria cannot invade the pits and fissures on the occlusal surfaces of teeth.

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Deprived bacteria (Streptococcus mutans) from nutrients

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Prevent colonisation of new bacteria from oral cavity into pits and fissures

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Make pit/fissures easier to clean by tooth brushing and mastication

Indications 

A deep or irregular fissure or pit is present, especially if it catches the tip of the explorer (for example, occlusal pits and fissures, buccal pits of mandibular molar, lingual pits of maxillary incisors).

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An intact occlusal surface is present where the contra lateral tooth surface is carious or restored.

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If there is no radiographic evidence of dental caries.

Sealing times •

Ages 3-4 for Ds & Es

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Ages 6-8 for 6s

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Ages 11-13 for 7s

Use of Pit and Fissure Sealants in Public Health Programmes •

Pit and Fissure Sealants are used in dental health programmes to prevent dental caries : -

Pit and Fissure sealants are effective in reducing Pit and Fissure caries

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Targeting most vulnerable or high risk children

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Timing of Pit and Fissure Sealant Placement:

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1st molar is between age of 7-8 years

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2nd molar is between age of 12-13 years

Sealing premolars or primary molars may not be part of dental health programs

SMOKING CESSATION

Effect of Smoking  Oral cancer •

Tobacco smoke has a direct carcinogenic effect on the epithelial cells of the oral mucous membranes

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Oral cancer and oral pre-cancer are much more frequent in smokers than in non-smokers

 Periodontal disease Increased in prevalence and severity of periodontitis with greater marginal bone loss, deeper periodontal pockets, severe attachment loss and more teeth with furcation involvement

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 Delayed healing after tooth extraction or other oral surgery Smokers are also poor healers (impaired wound healing), this being witnessed by the high incidence of dry-socket infections following tooth removals. Less-favorable clinical outcomes for periodontal therapy and dental implants in smokers vs. nonsmokers Dental implant failure rates are significantly higher in smokers than in nonsmokers

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• •

 Diminished sense of taste and smell  Stained teeth and tongue • •

Smoking often leads to discoloration of teeth Smokers inevitably have bad breath from the tobacco itself and secondarily from the gum disease. They often try to mask this with lozenges, mouth-washes, chewing gum, candies or breath mints. Over time this habit causes decay and\or tooth erosion.

 Dental caries • •

Smokers also have higher plaque rates than nonsmokers Significantly greater number of carious or restored tooth surfaces among: – smokers than nonsmokers – heavy smokers than light smokers.

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It has been suggested that smokers as a group have: – poorer oral hygiene habits and skills, – make fewer visits to dentists, and – have lesser overall health standards than nonsmokers.

 Smoker’s face •

The face wrinkles prematurely around the mouth, eyes and neck, simply from the continuous act of inhaling.

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Their skin lacks blood flow  pale, unhealthy appearance.

Some considerations:  Be sensitive to the patient’s reaction (is he reluctant to discuss the subject); Do not argue with your patients  Listen to and respect his reluctance  Be familiar with relevant information  Be prepared for people and institutions for patient to contact;  Openly encourage all efforts taken;

Five A’s Strategy  ASK 

ASK patients about their tobacco habits; “Do you use tobacco?” “Have you thought about quitting?”

 ADVISE 

ADVISE them on the importance of giving up; “There are many reasons to quit smoking including improving your oral health”

 AGREE 

AGREE with them a quit date

 ASSIST 

ASSIST them in achieving this goal; “We can refer you to cessation programmes”

 ARRANGE 

ARRANGE follow-up Schedule follow-up contact within first week after quit date

SUGAR & ORAL DISEASES

The Emergence of Sugar 1. HONEY   

Natural but limited quantity High cost & expensive Access limited to higher SES (social economic status)

2. CANE SUGAR 

Sugar = Sucrose = Table sugar



Mass produced in 1400s -

processed and refined from cane sugar

3. HIGH-FRUCTOSE CORN SYRUP 

Sugar of choice in SSBs and processed foods -

Good shelf-life

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Low cost

Characteristics of Sugar  

SWEET! ADDICTIVE!

Sugar:    

Sucrose Table sugar Cane sugar Beet Sugar

The Abolition Of The Sugar Subsidy 

because of the high diabetic rate among Malaysians under the age of 30.

Tax On Unhealthy Foods And Drinks By 2020  

Eg: SSB, sweetened creamer and condensed...