Community and Preventive Dintistry

8/3/2019 Community and Preventive Dintistry

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DIFFERENT LEVELS OF PREVENTIONDIFFERENT LEVELS OF PREVENTION

1.1. Primary prevention.Primary prevention.

2.2. Secondary prevention.Secondary prevention.

3.3.Tertiary prevention.Tertiary prevention.

PREVENTIVE DENTAL SERVICESPREVENTIVE DENTAL SERVICESprovided by :provided by :

a.a. Community agenciesCommunity agenciesb.b. Professionals (Doctors & auxiliaries)Professionals (Doctors & auxiliaries)

c.c. Individuals (public)Individuals (public)


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Classification of preventive dentalClassification of preventive dental

servicesservices1.Primary preventive services

2.Secondary preventive services

3.Tertiary preventive service

Preventive services are provided by:

i. Community agencies

ii. Dental professionals

iii. Publicindividuals


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PRIMARY PREVENTIONPRIMARY PREVENTIONPRIMARY PREVENTIVE SERVICES BY THE

COMMUNITY

1. Community water fluoridation.

2. School water fluoridation.

3. Fluoride supplements programmes.

(Tablets, Losenges, Oral drink, Drops, Salts etc) Fluoride Mouth rinse programmes.

Pits & Fissures sealants programmes in

schools.


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PRIMARY PREVENTIONPRIMARY PREVENTION

PRIMARY PREVENTIVE SERVICES BY THE COMMUNITY

1. Community water fluoridation.

Concentration of fluoride in water1p.p.m. (Optimal).

2 .School water fluoridation.Concentration of fluoride in water5 p.p.m. (Optimal).

a. Hydroxyapatite crystalsHydroxyfluoroapatite crystals(more resistance to carries attack).

b. Systemic Effect only (during development of teeth).


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MECHANISM OF ACTION OFMECHANISM OF ACTION OF

SYSTEMIC FLUORIDESYSTEMIC FLUORIDEThe cariostatic mechanism of systemic fluorideThe cariostatic mechanism of systemic fluoride

is as follows :is as follows :

11.The enamel become more resistant to acid.The enamel become more resistant to aciddissolutiondissolution

22.Inhibition of bacterial enzyme system.Inhibition of bacterial enzyme system--enzymatic actionenzymatic action

33.Modification in the size and shape of teeth to.Modification in the size and shape of teeth tobe less susceptible to cariesbe less susceptible to caries


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PRIMARY PREVENTIVE SERVICES BY THECOMMUNITY

3. Fluoride supplements programmes.(Tablets, Losenges, Oral drink, Drops, Salts etc).

a. Daily supply of fluoride:

i. 2.2, 1.1 & 0.5 release 1 mg, 0.5 mg and 0.25

mg flouride respectivelyii. Dose for child below 2years is 0.5 mg

iii. Dose for child b/w 2-3 years is 0.5-0.7 mg

iv. Dose or child above 3 years is 1.0-1.5 mg


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PRIMARY PREVENTIVE SERVICES BY THEPRIMARY PREVENTIVE SERVICES BY THE

COMMUNITYCOMMUNITY

Fluoride supplements programmes.Fluoride supplements programmes.

Tablets : swish and swallow technique :Tablets : swish and swallow technique :

With the use of tablets, it seems logical that if a childWith the use of tablets, it seems logical that if a childwould chew the tablets, then swish the saliva b/w thewould chew the tablets, then swish the saliva b/w theteeth for a minute before swallowing .teeth for a minute before swallowing .

Both a topical and systemic use of flouride achievedBoth a topical and systemic use of flouride achieved

this swish and swallow method is advocated whn everthis swish and swallow method is advocated whn ever

tablets are used .tablets are used .


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1. Fluoride Mouth rinse programmes.

(Flavored, Breath Freshening, Innocent to tissue)

Two major regimens :(mostly school based program)

i. Sodium fluoride (0.05%) rinse : it contains 230 ppm fluoridewhich is used daily----

5-10 ml of this solution is asked to rinse for one minute.

ii.Sodium fluoride (0.2%) rinse it contain 900 ppm Flouride which

is used weekly or fortnightlyrinse for 1 minute

The schedule is for one year---30 weeks


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1. Pits & Fissures sealants programmes inschools.

To prevent Primary carries:

Teeth with deep Pits & Fissures are filled with

composite materials / Glassionomers.Pits & Fissures which are not cariousfilled with

Fissures Sealants.


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PRIMARY PREVENTIONPRIMARY PREVENTIVE SERVICES BY THE DENTAL

PROFESSIONALS

Two levels:i.Community or public programmes

ii. In dental clinics / hospitals


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Plaque control (scaling & polishing).

Dental caries activity tests.

Simple remedies.a. Professional topical fluoride

application.

b. Pits & fissures sealants etc.

Diet counseling.Demonstrations & Training to patients.

PRIMARY PREVENTIONPRIMARY PREVENTIVE SERVICES BY THE DENTALPROFESSIONALS


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PRIMARYPREVENTION

PRIMARY PREVENTIVE SERVICES BY THEDENTAL PROFESSIONALS

1.Plaque control (scaling & polishing)

Scaling and polishingby dentist twice a year.

Birthday once a year, dentist twice a year.


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PRIMARY PREVENTIONPRIMARY PREVENTIONPRIMARY PREVENTIVE SERVICES BY THEPRIMARY PREVENTIVE SERVICES BY THEDENTAL PROFESSIONALSDENTAL PROFESSIONALS

22.. Dental caries activity tests.Dental caries activity tests.(Caries susceptibility tests)(Caries susceptibility tests)

.. To show existing condition of carriesTo show existing condition of carriessusceptibility in mouthsusceptibility in mouth

. These test are used as motivational tools for. These test are used as motivational tools for

patients education and to develop habits forpatients education and to develop habits forprevention like regular brushing and mouthprevention like regular brushing and mouthrinsingrinsing


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Caries activity testsCaries activity tests

FFollowing testsollowing tests

11.Synder's Test.Synder's Test

22.Lactobacilli colony count Test.Lactobacilli colony count Test33.Alban's Test.Alban's Test

44.salivary buffer capacity Test.salivary buffer capacity Test

55.Enamel solubility Test.Enamel solubility Test66.salivary reductase Test.salivary reductase Test

77.streptococcus mutans level in saliva Test.streptococcus mutans level in saliva Test


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Synder Test:Synder Test:Used a colour indicator to show amount of acidUsed a colour indicator to show amount of acid

formed by microformed by micro--organisms in carbohydrateorganisms in carbohydratemediummediumshow carries activities.show carries activities.

PRINCIPLE:PRINCIPLE:Amount of acidAmount of acid

produced isproduced isproportionateproportionateto the numberto the numberof acidof acidproducingproducing

lactobacillilactobacillipresentpresent

PROCEDUREPROCEDURE11 ml of paraffinml of paraffin

stimulated saliva ofstimulated saliva ofthe patient is added tothe patient is added toglucose agarglucose agarcontainingcontainingbromocresol greenbromocresol green

dye and incubated fordye and incubated for7272 hrs athrs at 3737 c. Thec. Thecolour change iscolour change isexamined afterexamined after 2424hours tillhours till 7272 hrs.hrs.

INFERENCE:INFERENCE:The sooner theThe sooner the

colour changescolour changesfrom green tofrom green toyellow the greateryellow the greateris the cariesis the cariesactivity.If colouractivity.If colour

does not changesdoes not changesinin 7272 hours thenhours thenthe patient isthe patient isimmune to caries.immune to caries.


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PRIMARY PREVENTIONPRIMARY PREVENTIONPRIMARY PREVENTIVE SERVICES BY THEPRIMARY PREVENTIVE SERVICES BY THE

DENTAL PROFESSIONALSDENTAL PROFESSIONALS

33. Simple remedies:. Simple remedies:

a.a. Professional topical fluoride application.Professional topical fluoride application.a.a. Pits & fissures sealants.Pits & fissures sealants.


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Topical Fluorides: Three Agents:Topical Fluorides: Three Agents:

a.a. Sodium fluorides (Sodium fluorides (22% solution)% solution)--fourfourapplicationsapplications

at one week interval per yearat one week interval per yearat agesat ages33,,77,,1111 andand1313 years.years.

b. Stannous Fluorides (b. Stannous Fluorides (881010% solution)% solution)--one application per year.one application per year.

c. Acidulated phosphate Fluoridesc. Acidulated phosphate Fluorides

((11..22% fluoride gel)% fluoride gel)--two applicationstwo applications

per yearper yearFluorides in mouthwashes, solution, varnish,Fluorides in mouthwashes, solution, varnish,

gel(duraphat, fluorprotector), lozenges andgel(duraphat, fluorprotector), lozenges anddrops are available.drops are available.


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METHOD OF APPICATION OFMETHOD OF APPICATION OF

TOPICAL FLUORIDTOPICAL FLUORID

11.clean and polish all the surfaces of teeth..clean and polish all the surfaces of teeth.

22.Isolation of the teeth with cotton roll or rubber.Isolation of the teeth with cotton roll or rubberdam.dam.

33.Dry the teeth with cotton or compressed air..Dry the teeth with cotton or compressed air.

44.Freshely prepared soultion or gel or varnish of.Freshely prepared soultion or gel or varnish of

fluoride is applied to the teeth with cottonfluoride is applied to the teeth with cottonapplicator.applicator.


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METHOD OF APPICATION OFMETHOD OF APPICATION OF

TOPICAL FLUORIDTOPICAL FLUORID55.. 22% sodium fluoride is applied on the teeth% sodium fluoride is applied on the teeth

forfor 44 min.min.

66.. 88% SnF is applied on the teeth for% SnF is applied on the teeth for 44 min &min &ReRe--application of solution to tooth is doneapplication of solution to tooth is doneeveryevery 1515--3030 second.second.

77.The APF gel / solution is applied for.The APF gel / solution is applied for 44 min & ismin & iscontinuously and repetedly applied with cottoncontinuously and repetedly applied with cottonapplicator .applicator .


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METHOD OF FLUORIDE VARNISHMETHOD OF FLUORIDE VARNISH

APPLICATIONAPPLICATION11. Oral prophylaxis. Oral prophylaxis

22.Teeth are dried.Teeth are dried

33.Teeth are not isolated with cotton rolls as.Teeth are not isolated with cotton rolls asvarnish being sticky has a tendency to stick tovarnish being sticky has a tendency to stick tocotton.cotton.

44.The application is done first on lower arch as.The application is done first on lower arch assaliva collects more rapidly around it, and thensaliva collects more rapidly around it, and thenon the upper arch.on the upper arch.


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METHOD OF FLUORIDE VARNISHMETHOD OF FLUORIDE VARNISH

APPLICATIONAPPLICATION55. Application of varnish is done with single. Application of varnish is done with single

tufted small brush.tufted small brush.

66.Set the patient with open mouth for.Set the patient with open mouth for 44 min.min.

77. Ask the patient not to rinse or drink any thing. Ask the patient not to rinse or drink any thingfor one hr and dont eat hard till next morning.for one hr and dont eat hard till next morning.


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Dietary CounselingFermentable carbohydrate play an important role in the cause

of dental caries.

A logical approach to prevent the dental caries is :

> To alter the form of dietary carbohydrate intake .

> To alter the frequency of dietary carbohydrate intake .

Studies show that changing dietary habits could be an effective

approach to prevent dental caries .

The patients with the high level of caries activity need motivation


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Diet can affect teeth

Pre-eruptively :The intake of fluoride can increase the strength

of the teeth to prevent caries. Post-

eruptively :

The diet can affect the teeth as :i. The use of fluoride prevent caries

ii. The use of sucrose cause caries

iii. The acidic food / drinks cause the

erosion of teeth.


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Diet CounselingObjectives :1. To correct nutritional inadequacies of

the diet that may affect the patient's

general health and be reflected in oralhealth

2.To prevent damage to the teeth and

other oral tissues as a consequence ofthe type & frequency of foods taken


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Diet Counse ing

1. First phase{ Assessment phase } : Dietary analysis

2. Second phase : Diet advice / instruction / planning.

Phases: Two general phases


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DIET COUNSELING

First phase :{Assessment / analysis phase} :

To evaluate the patient'snutritional status and diet.

Activities during the assessmentphase :

i. Complete medical and socialhistory

ii. Thorough clinical examinationiii. A detailed dietary analysis


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DIET COUNSELING

Diet Analysis : It

is usually accomplished by having:

=>The patient compile a one day,4 to 7 days or a month

record of food intake.=>To recognize the cariogenicity of food in their diet.

First Phase


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Diet AnalysisIndications :

1.High caries activity in the mouth

2.unusual caries pattern

3.Suspected dietary erosion


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Diet AnalysisMethod of diet study :

(most widely used method)

A consecutive 3 days analysis (1 week or

2 weeks) of the diet of the patient

with recording the :a. Time of diet taking

b. Content of the diet taking

c. Quantity of the diet consuming

d. Frequency of diet taking

In addition,times of toothbrushing after meal and

before bed time should be noted.


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et na ys sMethod of diet analysis :

1.Ring the main meals. If inany doubt, identify those

snaks that contain

carbohydrates.

Assess nutritional value ofmeals.

2.Underline all refined sugar

intakes in red colour.

3.Identify the snaks b/w the

meals.

4.Decide on a maximum of

three recommendations.


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Second Phase

Diet advice / instruction / planning:

This should include an explanation of the

affect of sugary snaks eating & drinking b/w

the meals.It must also be personal , practical and

positive

The suggestion that a child should selectcrisps when friends / class fellows are buying

sweets is more likely to be

followed than total abstinence.

Diet counse ing


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1. Diet advice / instruction / planning.

Key factors for successful diet advice :

1. Implement gradual changes/reduction in

sugar intake rather than drastic/sudden

changes or reduction all at once

2.Utilized dietary substitutions rather

than outright elimination

3.Utilize continual psychologicalreinforcement


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1. Diet advice / instructions / planning.1.Restrict the number of eating times to three main meals.

2.Avoid refined sugary snaks in b/w meals.

3.Take low carbohydrates or alternative to sugar like

xylitole containing food.

4.take high protein snaks and fibrous fruits in b/w meals

5.Increase eating of high protien food like

meat, fish , milk, egg, pulses, etc.


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Diet advice / instruction / planning.

6.Restrict carbohydrates eating so

that they only provide 30-50% oftotal calories required to the body.

7.Eliminate eating sticky sweets like

chocolates, candies, toffies, cakes,

pasteries, etc. if not completelythen as much as possible.

8.Eat firm food like raw vegetables

and fruits which will reduce dental

plaque formation and increasesalivary flow


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1. Diet advice / instruction / planning.Some Suggestions to patients :

1.Suggest saving sweets to be eaten on one day, e.gsaturday dinner time

2.All-in-one chocolate are preferable to packets on

individual sweets

3.Food which stimulates salivary flow (e.g cheese,

sugar free chewing gum) can help to reverse the

pH drop due to sugar, if eaten

afterwards


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1. Diet advice / instruction / planning.

Some Suggestions to patients :4.Treacle and honey are

Cariogenic

5. Artifical sweetners are

recommended in adults but

should be avoided in pre-

school children

6.Fibrous foods e.g fruit are

preferable to a sucrose snak


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Dental health educationDental health education

Establish a preventive setup in theEstablish a preventive setup in thedental clinic consisting of :dental clinic consisting of :a. charts b. models c. picturesa. charts b. models c. picturesd. audiod. audio--visual devices .etc.visual devices .etc.

Dentist and the auxilliaries areDentist and the auxilliaries are

available to:available to:i. To educate the patientsi. To educate the patientsii. To make them aware about theii. To make them aware about thedental diseases and theirdental diseases and theirconsequencesconsequencesiii. To motivate them to follow theiii. To motivate them to follow the

advices to prevent the dentaladvices to prevent the dentaldiseasesdiseases


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Pits and fissures sealantsPits and fissures sealants

Pits and fissures of the teeth provide a sheltered nichePits and fissures of the teeth provide a sheltered niche(recess) for bacterial proliferation which cause dental caries.(recess) for bacterial proliferation which cause dental caries.

By providing and impervious barrier to pits and fissuresBy providing and impervious barrier to pits and fissuressystem, the pit and fissure sealants can help to preventsystem, the pit and fissure sealants can help to prevent

dental caries.dental caries.


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Pits and fissures sealantsPits and fissures sealantsDefinition:Definition:A cement or a resin which is filled to the unprepared pits and fissures of the teethA cement or a resin which is filled to the unprepared pits and fissures of the teethwhich are susceptible to caries, forming a mechanical and physical protective layerwhich are susceptible to caries, forming a mechanical and physical protective layeragainst the action of acit released by the bacteria.against the action of acit released by the bacteria.

Indications:Indications:> Non carious deep pits, fissures, grooves and fossae are sealed.> Non carious deep pits, fissures, grooves and fossae are sealed.> A small carious pit is filled and rest of pits and fissures are sealed.> A small carious pit is filled and rest of pits and fissures are sealed.

sealing the pits and fissures just after tooth eruption may be the most important event sealing the pits and fissures just after tooth eruption may be the most important eventin their resistance to caries.in their resistance to caries.


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Pits and fissures sealantsPits and fissures sealants

Sealants are not recommended on patients who do notSealants are not recommended on patients who do nothave signs of caries activity.have signs of caries activity.

If caries activity is noted either clinically orIf caries activity is noted either clinically orradiographically, sealing all pits and fissures should beradiographically, sealing all pits and fissures should be

strongly recommendedstrongly recommended


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g


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Pits and fissures sealants

Types :Following materials are used as sealants :

i. Polyurethanesii. Cyanoacrylates

iii. BIS-GMA (Bisphenol A-Glycidyl Methylacrylate)These materials are polymerised by two methods :

i. Light curingii. Chemical curing


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Pits and fissures sealantsProcedure / technique of pits and fissures sealantsProcedure / technique of pits and fissures sealantsapplication :application :

i. Clean the surface of the toothi. Clean the surface of the toothii. Isolate and dry the toothii. Isolate and dry the toothiii. Etch foriii. Etch for 2020 sec. Withsec. With 3030--5050% phosphoric acit% phosphoric acitiv. Wash thoroughly , reiv. Wash thoroughly , re--isolate and dry very well, avoidisolate and dry very well, avoid

the contact of saliva with the tooththe contact of saliva with the toothv. Apply the pits and fissure sealant on the etchedv. Apply the pits and fissure sealant on the etched

pits, fissures, grooves and fossaepits, fissures, grooves and fossaevi. Now let the sealants polymerizedvi. Now let the sealants polymerizedvii. Do the occlussal adjustment if requiredvii. Do the occlussal adjustment if required


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Light curing a fissure sealant.


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Chemically curing fissures sealant


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PRIMARY PREVENTIONPRIMARY PREVENTIONPRIMARY PREVENTIVE SERVICES BY THEPRIMARY PREVENTIVE SERVICES BY THEINDIVIDUALSINDIVIDUALS

AgeAge--group of individualsgroup of individuals

1.1. Infants & Children of ageInfants & Children of age 33 toto 55 yearsyearsold.old.

1.1. School going children & adults.School going children & adults.


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DENTAL CAREDENTAL CARE

PROGRAMPROGRAM

(Involve Parents)(Involve Parents)

a.a. Earlyinfancy.Earlyinfancy.a.a.Care of toothless gums.Care of toothless gums.

b.b.Care of even single toothCare of even single tooth(when appears).(when appears).c.c.Care of milk teeth.Care of milk teeth.d.d.Bottle feeding.Bottle feeding.e.e.Care of permanent teethCare of permanent teeth(when appear).(when appear).

22.. A young child ofA young child of 3355years oldyears old..


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Schools going Children & Adults.

Self examination.

Diet planning & control.

Oral hygiene practice (home care).

PRIMARY PREVENTION (INDIVIDUALS)


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SELF EXAMINATION


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PRIMARY PREVENTION(INDIVIDUALS)

DIET PLANNING AND CONTROL

a. Nutrition and Hostresistance.

a. Children

b. Adults

b. Fluoride

a. Local application

b. Systemic use

c. Sweets & Hostresistance

a. Amount of sweet taking.

b. Frequency of sweet taking


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Diet control


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DIET CONTROL

Fruits are preferred over sweets


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PRIMARY PREVENTION

HOME CARE INSTRUCTIONSa. Plaque disclosing agents (Tincture Iodine,

coloring agents).b. Tooth brushes (selection and uses).c. Dentifrices (powder, paste, liquid, gel).d. Tooth brush techniques.e. Inter-dental hygiene.f. Special cleaning aids.g. Electric tooth brushes.h. Irrigation devices (water, fluoride, saline,

M/W).i. Chemically plaque control (chlorhexidine).

j. Fluoride supplement programme (Tablets,Losenges, Oral Drink, Drops)


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PLAQUE DISCLOSING


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PRIMARY PREVENTION

Home Care Instructions

Tooth brushing techniques

a. Horizontal Reciprocating

b. Vertical sweeping

c. Rotating

d. Vibrating

Inter-dental Hygiene(Tooth pick, inter-dental brushes, Dental floss,

Gauze strips, Polishing cloth, Rinsing etc)


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BASS TECHNIQUE

VIBRATING MOVEMENTS


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VERTICAL SWEEPING


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HOME CARE INSTRUCTIONSHOME CARE INSTRUCTIONS

INTERINTER--DENTAL HYGIENEDENTAL HYGIENE

(Tooth(Tooth pick,pick, interinter--dentaldental brushes,brushes,DentalDental floss,floss, GauzeGauze strips,strips, PolishingPolishingcloth,cloth, RinsingRinsing etc)etc)


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INTERDENTAL FLOSSING


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INTER DENTAL FLOSSING


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INTERDENTAL GUAZE

STRIPS


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INTERDENTAL BRUSHES


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WATER JET DEVICE

Documents

Community and Preventive Dintistry