Prevention {1}

Muna Eyad

Ghazala Alghali

8 - 10 - 2015

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Fluoride Toothpastes

*Decline in the prevalence of dental caries (from fluoridate water or

from tooth paste) 80-50 the reduction in dental caries prevalence

*The widespread use of toothpaste that contain fluoride.

➻ Most of toothpastes available now at market more than 94% are

supplied with fluoride, but some are not because some people have

allergies

➻ The only difference between the adult toothpaste and the children

toothpaste is a mount of fluoride in the toothpaste

Because the child cant split the excess of fluoride while he is

brushing his teeth...sometimes he may swallow toothpaste ;so to

prevent any accumulation of fluoride which maybe harmful for his

teeth and bone ;the amount of fluoride must be less compared to

the adult

♧ •Toothpaste ingredients typically consist of:(for adult or childe)

1. Mild abrasivesto remove debris and residual surface stains.

Examples include calcium carbonate, dehydrated silica gels,

hydrated aluminum oxides, magnesium carbonate, phosphate salts

and silicates.

2. Fluoride to strengthen tooth enamel and remineralize tooth

decay. All ADA-Accepted toothpastes contain fluoride. for

children is very important to determine the amount of fluoride and

the age of child

3. Humectantsto prevent water loss in the toothpaste (give

wetness). Examples include glycerol, propylene, glycol and

sorbitol.

4. Flavoring agents, such as saccharin and other sweeteners to

provide taste. Flavoring agents do not promote tooth decay.

Usually non cariogenic sugars are used in toothpaste like

Prevention I

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Saccharinnot cariogenic or other non-cariogenic sweeteners(Note

ADA-Accepted toothpaste contains sugar or any other ingredient

that wouldn’t promote tooth decay.)

5. Thickening agents or binders to stabilize the toothpaste formula

{chemically stable} . They include mineral colloids, natural gums,

seaweed colloids or synthetic cellulose.

6. Detergents to create foaming action. They include sodium lauryl

sulfate, sodium N-Lauryl sarcosinate.

Except the people who have allergiesto the silica otherwise the

toothpastes are safe

➯ (Apart from an unsubstantiated hypothesis linking the ingestion

of silica abrasives with the development of Crohn's diseaseGit

disses cause diarrhea and pain) toothpaste abrasives are

considered safe for human use.

➯ The humectants, binders, flavours, preservatives and colourings

are used routinely in the food and pharmaceutical industries and

should pose minimal health risks when used in toothpaste.

➯ The flavours, colourings or preservatives may give rise to allergic

reactions, but these are relatively rare. The detergent or

essential oil flavours may produce localised mucosal irritation,

but this is also rare.

➯ As ingestion of excessive amounts of fluoride toothpastes by

young children(formative stage of the teeth)has been implicated in

dental fluorosis(accumulation of fluoride in the body lead to change

in tooth color according to severity), parents should supervise

tooth cleaning in order to minimise toothpaste ingestion. For the

majority of people, toothpastes, when used properly, are safe

and help to maintain dental health.

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♧ Types of Toothpaste

•There are many different types of toothpastes on the market.

•Sodium fluoride, stannous fluoride, sodium monofluorophosphate

and amine fluoride. The most widely used fluoride compounds are

sodium fluoride and sodium monofluorophosphate.

♧ Amount of fluoride in toothpaste

•The most efficient method of informing people of the amount of

fluoride in a toothpaste is to give the "parts per million" fluoride

(ppm F). Most manufacturers now give fluoride content in ppm F.

•At present, most toothpastes contain 1,000-1,500 ppm F.

•Children Tooth pastes contains half of this amount. 500ppm(in the

markets all toothpastes have 500ppm fluoride except “mesuak” tooth

paste has 400ppm)

♧ When deciding whether to use fluoridated toothpaste in

children younger than 2, the panel recommends considering:

•The child's risk of dental caries

•The risk of dental fluorosis {so be careful to the amount and age}

•The benefit of the topical application in the form of fluoridated

toothpaste {especiallyfor very young patients because they can’t spit,

so dentist can control topical fluoride by suction or isolation}

•Ingestion of toothpaste increases the risk of enamel fluorosis.

The AAPD suggests a "smear" rise sizeof fluoride toothpaste for

children younger than 2 years of age who are at a moderate or

high risk for dental caries and a "pea-sized" amount for all

children ages 2 to 5.

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• Limit tooth brushing to 2 times a day. or 3 times if he has very sever

type of decay

•Apply less than a pea-sized amount of toothpaste to the brush.

•Supervise tooth brushing and encourage children to spit out excess

toothpaste.

•Keep toothpaste out of the reach of young children to avoid

accidental ingestion.

•To prevent fluorosis, parents should make efforts to minimize the

swallowing of toothpaste, or consider using only water or a non-

fluoridated toothpaste.

♤ DENTAL FLOSS

•Coated with Waxor un-waxed

•Flavoured floss

•Coated with Flouride

You can choose whatever you want

accordingto the case and to the child age

•Ultra floss is spongy and soft.

•Flattened floss is designed to increase

the contact surface with the tooth.

•Round floss is relatively thinner

*Parents should begin flossing the child’s teeth as soon as the

tooth surfaces touch each other. Flossing should be assisted by a

parent until the child is 10 years old, once per day before sleeping

-Before 9 years old parents have to help the child

- 9-10years old you determine if he can use floss alone if he can tie his

laces

-toothpick is another aid, is used to clean teeth

but is not recommended because it is abused and

made injuries.

-You can’t use Miswak only and leave tooth brush.

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♤ Fissure Sealantis another way to prevent the decay

㋡ Definition

•“Pit and fissure sealant”

is a material that is placed

in the pits and fissures of

caries-susceptible teeth,

thus forming a

micromechanically-bonded

(need acid etching which

make pores in the enamel,

just to make the material

retentive to the tooth

surfaces) protective layer

(it make them smooth and

easy to clean so no food

accumulation any more)

cutting access of caries-

producing bacteria from

their source of nutrients.

It blocks fissures and pits in

the tooth surface so it

prevent accumulation of

food ,plaque, material alba in

the deep surfaces in the pits

and fissures so it is

mechanical aid make

surfaces easy to clean and

prevent plaque accumulation

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♤ Epidemiology of caries

**Changes in the epidemiology of caries distribution overthe last 3

decades:there is decrease in the prevalence of decay when we use FS

which mean FS is very good measure to prevent the decay, if we make

follow up

Retention rate for FS minimal 6 months so it very benefit for us

•1. Despite a decline in prevalence of dental caries in children,

still dental caries the most chronic disease affecting children.

•2. Concentration of caries in pits & fissures (84% of DMFS; Ripa

et al., 1988),

-due to anatomic feature that harbor bacteria, *inaccessibility to

cleaning,

- closeness to ADJso bacteria reach dentin easily

-Also, fluoride least effective on occlusal surfaces (30%) vssmooth

surfaces (80%) (Backer-Dirks,1974)

If you use FS before starting of the decay, it will be very good way to

prevent decay.

♤ Historic development of preventive techniques:

•1923 so long time ago, they used restoration as prophylactic, but

they didn’t use risen, but they got benefit – Hyatt – “Prophylactic

restoration”

•1929 – Bodecker – “Prophylactic Odontotomy”

•1942 - Klien and Knutson- Ammonical AgNO3

•1955 – Buonocore – “Acid Etching of Enamel” Buonocore, et.al

(1967) study was the first report of a clinical trial of sealant use

(cyanoacrylate sealant)

•1965, Bowen, the bis-GMA resin (bisphenol A and

glycidylmethacrylate) {until they reach to the risen type which is the

best retentive type}

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Note: for newly erupted teeth “not fully erupted or it covered by

operculum“you have to used GIC as FS, after complete eruption of the

tooth then you can use risen type as FS

♤ Rational for occlusal sealant use

•Occluding the pits and fissures by the FS, therefore, removing

stagnation areas for bacteria and plaque and making the surface

easily cleansable.

♤ Requirement of a Sealant Material:

1. Adhesion to enamel for extended periods.{acid etching make

mechanical pores }

2. Simple clinical application.

4. Non-injurious to oral tissues.{Not irritant, safe to use it}

5. Free flowing.{Very easy to apply the material, it can flow}

6. Rapidly polymerized.{Use light curing}

7. Low solubility in oral fluids.{It retain for 6ms at least}

8. Enoughstrength to withstand mastication.

♤ Bonding mechanism of sealants

Enamel prisms are at right angles to the tooth surface,

•Normal enamel is comprised of Hydroxyapatite crystals arranged

in hexagonal prisms forming rods oriented at right angles to the

surface.

•Enamel is about 1500 𝛍𝐦 thick

•Depth of acid demineralization of enamel rods is about 40 𝛍𝐦{resin

penetration into porous etched enamel, forming tags 40 𝛍𝐦 deep}

✿ Silverstone, 1975:

Increased Surface area & porosity as a result of selective

demineralization of enamel prisms

•Surface patterns possible depend on etch time & acid typ.

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•Surface patterns possible after etch (all of them good for

retention):(Silverstone, 1975)

1) Type I- preferential removal of prism core ( intact peripheries)

2) Type II- preferential removal of prism periphery

3) Type III- random pattern of both types

•Retention of sealants is the direct result of resin penetration into

porous etched enamel , forming tags 40 𝛍𝐦 deep; hence, micro-

mechanical retention ( Silverstone, 1975 )

Etch enamel pores flow able risen material is cured tags

•Clinically, acid etched enamel has a chalky, dull-opaque

appearance.

Isolation very important when risen material is used, if any

contamination with saliva or oil ,acid etching must be repeated

♧ Bonding mechanism-primary teeth

•Retention rates for sealants were thought to be lower in primary

teeth{until now there is hypothesis but no real study, in the past they

etch primary tooth 2 times compere to the Permanente teeth,

Permanent teeth was etched for one minute while primary for 2

minute, but now permanent teeth are etched for 20s while primary for

40s} are attributed to:

•1. Primary enamel is “prismless” {can’t make pores; so acid etching

need more time to get more retention} (Ripa, 1966) (only 17%,

cervical , Silverstone, 1970)

•2. More organic & less mineral content (Silverstone, 1976) {enamel

is 98% inorganic material and 2% organic, but in the primary tooth

more organic material compere to the non-organic}

❢ Indications for fissure sealants- caries risk

I. Patient:

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•- Medical History:pts with special needs, medically compromised {

they are indicated for FS from beginning also for their primary teeth

even if they don’t have any decay, because they can’t take care for

their oral hygiene and sometimes they aren’t cooperative to use tooth

brush } , physically disabled, learning difficulties

•- OH: good motivated pt

•- Behavior: cooperative pt dependable for 6/12 recall

II. Tooth:

•- primary {if it is near to exfoliation time no mean to put FS}or

permanent teeth

•- morphology: deep {if it is not deep and no accumulation of food no

need to FS}vs wide cleansable fissures

•- placed occlusally in molars or premolars with incipient caries in

deep occlusal grooves{there is many types of FS, fluoridate type is

the best, so if you have incipient caries and you don’t want to

interrupted using rotary you can use fluoridate FS because decay is in

the enamel only, then you should review the case} & upper incisors

with deep lingual pits.

•- Sound or incipient lesion { we put FS in sound teeth , when we are

sure that no caries , if you aren’t sure you can make enamel biopsy or

enameloblasty to make sure that this pit or fissure free from decay

before FS},

recently erupted{ pits and fissure in Esare not Meeting closely so

there will be accumulation of bacteria and food especially in the

premolars if they erupt beforehand due to any early loss of primary

teeth “they erupt before the time “} ,

no caries proximally{as soon as the 6s erupt there will be proximal

contacts, so you have to take bite wing x-ray to be sure that there no

proximal caries , any tooth has proximal decay it is not indicated for

FS , you have to treat the decay in advance then it will be PRR not FS}

III. Dental History, caries experience:

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•-History of caries in primary teethindicates sealing onpermanent

teeth as soon as they erupt

•-Caries in one molar indicates sealing other 6’s & 7’s

Indications/ FS in primary teeth

➽FS in Primary teeth { you can use FS for primary teeth like

permanent teeth exactly they have the same benefit , unless they

have very shallow fissure or they near to the exfoliation time }

•Clinical studies reporting on sealant success when applied to

primary molars are rare. Those that have been published report

retention and success equivalent to permanent molar sealants

Disadvantages{we can limit them}

-Technique sensitive.{If you use rubber dame retention will be

excellent}

-Caries susceptibility of etched enamel.{So follow up the case if it’s

off repeated again “put FS again” }

-Economic unfeasible.{Usually resin material expensive}

Clinical :

• Examination: direct light & dry tooth, good vision

•TAKE Bite Wing Radiographsto be sure that there no proximal

decay, if there is any decay then you will do preventive resin

restoration PRR

•If early dentine involvementa Preventive Resin Restoration (PRR)

isindicated.

Marks distribution in this year:

20 midterm exam

20 clinics for first semester, 20 clinics for sec semester 40 total for clinical work

40 finale exam

Requirements:

First semester:6 casesdietanalysis + topical fluoride application + OHI

Second semester: polishing of the teeth + FS + {ART + extraction cases minimum 2 cases

maximum 4 cases}