Chapter 15

Preventive Dentistry

Preventive Dentistry

• To help people have maximum oral health throughout their lives

• To achieve maximum oral health– Dental professionals must work together with

patients to prevent new and recurring disease

Bacteria

• Various types of bacteria found in dental plaque, are responsible for– Dental Caries– Periodontal disease

Patient Education

• Partnership—between patient and dental health team

• Guidelines– Listen carefully– Instruct the patient on how to remove plaque– Assess the patient’s motivations and needs– Select the home care aids– Keep the instruction simple– Reinforce home care

Optimum Oral Health

• Patient education

• Use of fluorides

• Application of dental sealants

• Proper nutrition

• Plaque control program

Fluoride

• Primary weapon to combat dental caries• Referred to as “nature’s cavity fighter”• Provided through

– Prescription-strength fluorides that are applied in the dental office

– Nonprescription-strength, over the counter products for home use

– Consumption of fluoridated bottled water or community water

Fluoride

• Systemic fluoride– Ingested in water, food, beverages or

supplements

• Topical fluoride– Applied directly to the teeth through the use of

fluoridated toothpaste, fluoride mouthrinses, topical applications (rinses, gels, foams and varnishes)

Dental Caries

• Cannot occur without dietary sugars.• Cariogenic (caries-causing)

– Sucrose-sugars– Maltose– Lactose– Glucose– fructose

• Non-cariogenic (do not cause caries)– Sugar substitutes

• Saccharine, aspartame, sorbitol, mannitol

Dietary Analysis

• Determines whether the patient’s current food intake is affecting his or her dental health.

• Food diary– Everything eaten each day for 1 week

Plaque Control Program

• Cannot remove all plaque on teeth every day, but it can be kept under control by:– Brushing, flossing and interdental aids

• Goal– Thoroughly remove plaque at least once daily– After plaque is removed it takes

approximately 24 hours to re-form

Toothbrushes and Brushing

• Manual – There is not an ideal toothbrush for everyone

• Too many sizes, shapes and angles

– Soft-bristled toothbrushes are recommended

• Automatic – Various types – When used properly, works as well as manual

Toothbrushing Methods

• Bass– This method is useful for all types of dental conditions, especially

periodontal problems. With bristles pointed at a 45-degree angle into the gingival sulcus, vibrate the brush gently back and forth about 20 times. Move the brush forward and repeat.

• Rolling strokes – This method is useful for stimulation of the gingiva. Place the brush

above the free gingiva with the bristles pointed toward the apices. Exerting light pressure, draw the brush toward the occlusal surface using a rolling stroke. Use a scrub technique on the occlusal surface

• Modified Stillman’s– This method is useful for patients with hypersensitive gingiva or slightly

reduced interdental papilla. Use the rolling stroke method while vibrating the bristles in a lateral motion.

• Charter’s– This method is useful for patients with severe loss of interdental papilla

height, fixed prosthetic appliances, previous gingival surgery, or subsided ulcerative gingivitis. Perform the rolling stroke first to remove debris from the teeth. Direct the bristle tips toward the occlusal or incisal surface. Gently rotate the handle, flexing the bristles and bringing them into contact with the interdental tissues and exposed proximal surfaces. Vibrate the handle of the brush with a slow, circular motion.

• Fone’s– This method is useful for small children or others with poor manual

dexterity. First, occlude the teeth. Then, lightly press the bristles against the posterior teeth and the gingiva. Revolve the brush head in a fast, circular motion, using circles of large diameter. Continue the circular motion, and slowly move the brush head toward the anterior until all facial surfaces have been brushed. With the mouth open, use the same circular motion on the maxillary and mandibular lingual surfaces.

Dental Flossing/Tape

• Removes bacterial plaque and reduces interproximal bleeding

• Available in waxed and unwaxed

• Floss before brushing– Plaque needs to be removed interproximally

first

Interdental Aids

• Used in addition for brushing and flossing– Not take the place of

Dentures

• Need to use denture brush to clean

• Nonabrasive cleaner

Nutrition

• The science of how the body uses food for development, growth, repair, and maintencance.

• Nutrients– Components in food that are needed by the

body

Key Nutrients

• Carbohydrates

• Proteins

• Fats

• Water

• Vitamins

• Minerals

Food Guide Pyramid

• Fats, oils and sweets

• Milk, yogurt and cheese group

• Vegetable group

• Meat, poultry, fish, dry beans, eggs, and nuts group

• Fruit group

• Bread, cereal, rice, and pasta group

Eating Disorders

• Bulimia– Referred to as “bingeing and purging”

disorder– Believes self worth is related to being thin– Easy to recognize because their teeth have

severe wear on the lingual surfaces caused by stomach acid (from vomiting)

• Anorexia Nervosa– Self-starvation-abnormal fear of becoming fat

Eating Disorders, cont.

• Female Athlete Triad– Affects young female athletes– Eating disorder/includes restrictive dieting,

overexercising, weight loss, and lack of body fat

– Results are osteporosis and amenorrhea– Dental risk—enamel decalcification, increased

caries, periodontal and soft tissue inflammation

Management of Eating Disorders

• Anorexia and bulimia are considered psychiatric diseases

• Dental professionals are often first to discover disorders

Healthy Habits

• Eat right—five servings of fruits and vegetables daily

• Keep bones strong—sufficient calcium• Protect immune system—eat whole

grains, green leafy vegetables, seafood, lean meats and moderate amounts of vegetable oils and trace minerals

• Maintain a healthy body weight• Exercise—aerobic exercises