Summary Preventive Dentistry Dental health education

What to prevent ? 1- Dental caries 2- Periodontal disease 3- Oral cancer 4- Dental erosion Who should give it ? • Any health practitioner • Nurse and hygienist are accepted How ? 1- Mass media 2- Community program 3- One to one ------------------------------------------------------------------------------------------------------------------------- Oral infections They are : 1-Bacterial infections including • oral mucosa infections ( Tb , syphilis , scarlet fever ) • dentoalveolar infections ( dental caries , periodontal disease , dentofacial infections ) 2-Viral infections 3-fungal infections Dental caries • Sugar dependant infectious bacterial disease . • Dynamic process of demineralization ( ↓pH ) & remineralization ( ↑pH) till cavitation occurs. • Dental caries = dissolution of organic matrix + demineralization of inorganic content • Dental caries = Bacteria + Susceptible tooth surface + Time + Carbohydrates Enamel caries • Initial lesion is ( chalky white spot ) due to demineralisation of prisms of subsurface layer with the surface E. layer is still more mineralized . • Then .. smooth surface → rough surface → stained surface → pitting → cavitation N.B : Repair may occur as remineralizes E. concentrates Fluoride which has larger crystals & ↓ surface area , while regaining organic matrix never occurs . • Lactobacillus in fissure caries • Strept mutans the main caries bacteria Dentine caries • Demineralization → Bacterial invasion • Differs from Enamel caries due to : 1. Proximity to pulp 2. Once bacteria reaches ADJ , lateral spread occurs & under minds Root caries • Most commonly occurs with gingival recession • Treated by : 1. Oral hygiene instructions ( OHI ) 2. Topical Fluoride application 3. Restoration with GIC for active lesion • Strept salivarius ,, actinomyces Active & Inactive ( arrested ) Caries Arrested dentine caries : Hard , Dark & Leathery Active decay : Soft & Yellow Arrested enamel caries : Dark brown Susceptible sites for caries : • Proximal enamel surface • Cervical margins • Pits & fissures Caries Diagnosis As caries can be arrested or even reversed , early diagnosis is important . 1. Good eyesight & ( clean , dry , well illuminated tooth ) so , use of magnification loops is better . 2. Blunt probe ( only to remove plaque away from fissures ) , not sharp probe which may induce scratches & stick to pits & fissures 3. Bitewing X .ray for occlusal & proximal caries. • Best approached systematically viewing proximal , occlusal , proximal surface of each tooth ,,Enamel then dentine ,, by naked eye then viewing box or magnification. • Clinical situation is more advanced than x-ray • However, E caries on X. ray indicates no cavitation clinically 4. Fibro-optic trans illumination ( FOTI ) probes • 0.5 mm tip • Used for detection of proximal caries • Used with B/W X.ray 5. Laser based ( DIAGNOdent® ) (CarieScan PRO®) are still of uncertain value If in doubt whether lesion is capitated or not , use orthodontic elastic separators for 3-7 days to be visualized . Caries prevention I. Tooth protection ( fluoride application & fissure sealant) II. Reduction of microbial substrate in food III. Removal of plaque ( mechanical & chemical )