Aspects of prevention of caries

OHI,DIET,FLUORIDE, FISSURE SEALANTS, CHEMOAGENTS, RECALLS, VACCINES(still under research). What kind of instructions u give to the parents for their Childs? -First of all ,, instruct the parent to use tooth paste which contain fluoride, and start brushing as soon as 1st tooth erupt(may with wiping newly erupted incisors with gauze).

So cleaning of the teeth should begin upon its eruption, there

is no specific age may 6 month may 8 , its as soon as the first tooth erupt, it has to be cleaned. Then; As soon as the molars start erupting we start using the tooth brush.

Types of toothbrush

There are several types of tooth brush, the small ones for infants, they usually finger brushes; -brush the teeth 2x daily(after meals, before going to bed) use small, soft, multi-tufted, nylon bristles toothbrush according to age.

-electric brushes have no clear advantage over manual types, except in special need patients whom have mental problems or skeletal problems(palsy, weakness in the arms) and another advantage for ETB is gadget appearance "in young children especially boys using electric brushes will encourage tooth brush more", but if we talked about cleaning efficiency there is no difference, while the child cleaning and cleaning the right way,, so no difference.

-the technique of brushing is not critical as long as the individual regularly clean the teeth. Children mostly miss cleaning the lingual surface of the teeth and the side of handedness, they should be taught the method most comfortable to them. -the simple technique: to start with the upper right "buccaly" all the way to upper left and then lingualy from the lift to right,, then to the lower, the lower right to the buccal all the way to the lower left then lingual from the lower left to the lower right then the occlusal surfaces upper and lower. - if u teach them this technique they will stick to it, because it's a sequence and then just tell them to do up and down motions,

from gingiva to the incisors for upper, and from gingiva up for lower. And u demonstrate this in clinic, and ask them to brush their teeth in front of u,,, but some of them will use the horizontal technique, but it's not a big deal at this stage. So taught them to clean the hemosurfaces of their teeth especially the side of handedness. -its recommended that parents assume primary responsibility for brushing their child teeth as children under 9. -flossing in children not required bcz wide contact points. -U cannot say specific term that flossing is required or not, u have to examine the patient, by examination u assist if there is wide contact,, so no need to floss it, and vice versa. Again,, how have the responsibility to do flossing??-the parents. -waxed floss better, may be fluoridated. -upon eruption of first permanent molar, spaces start to close to each other the parent most floss.

Disclosing agent
in a tablet form ,blue or red, we ask the patient to shows it , and it will binds to plaque, so it good to teach the patient how to

clean his teeth, after brushing the teeth we give him another tablet to see if the plaque removed or not, and u tell him where the plaque remained and the areas where they are missed.

DIET ADVICE
Diet advice in dentistry aims to reduce caries, or to study cariogenic potential of food, I'm not aiming to give them a diet to decrease their weight or assist the nutritional status. -It's just aiming to look at cariogenic potential of the diet. -We usually stress on the frequency other than quantity and timing, we advise to reduce the frequency and confining the cariogenic food to new times" not between meals", substitute them by give them good substitute.

Example of diet sheet analysis:

1-We ask the patient to fill the diet sheet for consecutive 3 days, One of these days should be a holiday So the patient fills the breakfast, lunch, and dinner and the in between food. 2-we should identified the quantities, if he said that he drank a can of Pepsi or two cans I must counted as two "the quantity is important to identified the number of exposure" 3-After he finish u highlight the cariogenic types then u count them and fill table in the back of the sheet. This table contains 2 components; retentive sugar and sugar in solution.

So chocolate bars we usually consider them sugar in solution, ships are retentive, the tables have sections for during meals and between meals. So if u have one exposure during meals on the first day write one, two exposure between meals on the first day write two, and do this for three days then count them and divide by three the average. -

recalls
after finishing the treatment plan do u want to see the patient again?! Of course, recalls are necessary to diagnose any exciting problems and prevent them. -Recalls after 3,6,12 month depends on the carious risk.

Pits and fissures sealant

Fissure sealant is the material that we used to occlude pits and fissures of teeth to prevent them from caries, so it placed on the pits and fissures in caries susceptible teeth forming micromechanical bond. - so we apply acid etch forming microporosity to the enamel then put the pits and fissures sealant, the resin will form tags

onto this pores "resin tag" forming mechanical retention, so we have the micro from the etching the chemical type, and mechanical type of retention.

SO
We have a protective layer on the tooth that prevent any access of oral virulent or nutrients, preventing bacteria from invade the occlusal surface of the teeth.

Ps: in carious tooth we do filling, not sealant,, sealant apply to prevent caries.
---------((Changes in epidemiology of caries, how the fissure sealant deal)); -We talk about developed country, most disease found in small number of children( 20% of population have 80% of caries). Why caries happen more in pits and fissure? Due to anatomic feature that make the cleaning more difficult, fluoride is less effective in occlusal surfaces(30% versus smooth surfaces 80%).

So in those populations pits and fissure caries is the main. We dont find class V or II as example.

-buonocure(1955); has classic study was the introduction of

the fissure use of acid etch teeth, occluding the pit and fissure.

1967 study; was the first resource about clinical trial of

sealant, they used cyanoacrylate sealant which is not like what we use nowadays(resin sealant).

Later on; they said that occluding the pits and fissures by fissure sealant then for removing of sgatnetching areas for bacteria and plaque and maybe the surfaces easily cleansable.

bonding mechanism
Normal enamel composed of hydroxyapatite crystals, the enamel is one and a half cm thick (1500um) Depth of acid demineralization of enamel rods is about 40um.

-after u acid etch the tooth what happens: deferent type

of demineralization. - imagine hydroxyapatite crystals on the rods taking hexagonal form, the acid etching do demineralization, sometimes its remove the minerals around the periphery of the rod, sometimes from the centers, and sometimes mix between both. after study them under scan electric microscope, found this extreme pattern of acid etch. The retention of the sealant were thought to be lower in primary teeth and attributed to: 1-primary enamel is prism less(only 17% cervical) 2-more organic and less mineral content. We can etch primary teeth as permanent teeth(20 sec).

When we do fissure seal?? relevant to the patient, medical history, patient with spatial needs, high caries risk, medically compromise ,,,etc. OH: good motivated patient, doing fissure seal to the teeth and the patient does not clean them,, so there will be no caries prevention on this case. Behavior: cooperative patient( 6,12 recall) The tooth: -may pri or perm,, u can seal any of them -morphology deep vs wild cleansable fissure -Placed occlusally in molars and premolars with incipient caries in deep occlusal grooves. Ps: incipient caries; white spot lesion, dull chalky in appearance( in this case we can fissure seal on the top of it) and sometime it will be flat where its a beginning of caries. -Sometimes u can inspect the deepness of caries with very small bur if it just in the enamel then go and seal it, and if it reach the dentin then it became PRR. DH: caries experience, if the primary teeth was caries, u should follow the permanent as soon as they erupt. Ps: f u see caries in one molar,, go and seal other sixes as soon as they erupt. Clinical exam:- direct light and dry tooth. -take BW radiograph before doing any sealant, to check if there is any inter proximal lesions( if u have class II, u have to do it then fissure seal).

FINALLY; We must care about primary teeth as same as permanent one, Dont say we will extract it later and it will replaced, some primary teeth serve the child about ten years so,, Think about it, it deserve DONE, Asmaa almawas