Preventive Dentistry Third Year

1. ‫بسم ال الرحمن الرحيم‬
‫} قالوا سبحانك ل علم لنا إل ما‬
‫علمتنا إنك أنت العليم الحكيم {‬
‫صدق ال العظيم‬
‫البقرة ) آية 23(‬

2. Prevention of Dental
Diseases
Khalid S Hassan
Assist . Prof .Periodontology
April , 23,2008

3. 
Prevention is better than cure .

Prevention is cheaper than cure .

Prevention of a disease is greater good
in life than its cure .

4. Preventive Dentistry



It is a philosophy of dentistry .
It comprises the various procedures used by dentists ,
dental hygienists , nurses , teacher and others to
develop scientific oral health knowledge and habits .
It consists of prevention of ;
1- initiation of diseases( Primary Prevention).
2- disease progression and recurrence
( Secondary Prevention ) .
3- loss of function ( Tertiary Prevention ) .

5. Objectives of Preventive Dentistry




Prevent factors which predispose to disease .
Prevent the disease itself .
Prevent factors evoke more severe
manifestation of acute diseases .
Prevent factors which tend to maintain
disease in a chronic state .

6. 
Prevent the complications of the disease .

Prevent the sequelae of disease , both local
and systemic .

Prevent factors which interfere with
rehabilitation.

7. Preventive Dentistry Services
( ( Levels of Prevention

Primary Prevention : occurs in the prepathogenic
period ( True prevention ) .

Secondary Prevention :
- occurs in the early period of pathogenesis .
- involves early diagnosis and prompt treatment .
Tertiary Prevention :
- occurs in the later period of pathogenesis .
- involves prevent sequelae and complications of
the diseases .


8. Primary Prevention
By individual
1- Health promotion
2-Specific protection
-Diet planning.
-Fluoride dentifrices.
-Periodic visits to
-Intake of sufficient
fluoridated water.
the dental office .
-Avoidance of sticky
foods between
meals.
-Oral hygiene
measures.

9. Health Promotion- 1
Specific Protection-2
By community
Dental health
-Community water
education programs flouridation
-School water
flouridation.
-School flouride
mouth rinse
program.
-Fluoride
supplement
program .
-School sealant
program

10. Health Promotion- 1
By dental
professional
Specific-2
-Patient education -TopicalProtection
-Plaque control.
-Diet counseling.
-Dental caries
activity tests
application of
fluoride .
-Pit and fissure
sealants .

11. Secondary Prevention
By individual
Self-examination
By community
-Periodic screening
- x-ray
-Complete examination
-Prompt treatment of
incipient lesions
-Preventive resin
restoration
-Pulp capping
By dental professional

12. Tertiary Prevention
By individual
By community
By dental
professional
Disability
limitation
Use of dental
services
Provision of
dental services
Rehabilitation
The same
The same
-Treatment of well -Removable and
developed lesions
fixed prosthodontics
-Pulpotomy
-Implants
-Root canal therapy
-Extraction

13. Fluoridation

What is fluoride ?
- It is one of the halogens .
- It is the most active element of this group.
- It is not present in the free form .
- It is anticariogenic effect .

14. Sources of Fluoride





Three sources: water , foods and air .
Sea foods; salmon , sardines , shrimp and crab .
Most beverages contain amount of fluoride
especially tea .
Vegetables , fruits and dairy products contain low
amount of fluoride .
The average diet provides 0.2-0.3 mg of fluoride
daily .

15. Methods of Providing Fluoride
Systemic Fluoride:
1- Water Fluoridation :
* There is a direct relationship between
fluoride level and the number of caries free
individuals .
* 1ppm of fluoride
optimum safety and
anticaries effect .
* One part per million = 1mg F / liter .
* concentration of F in hot weather due to
water intake .


16. 2- School water fluoridation :



Indicated if the community water is not
possible .
Benefit of F only during days and hours.
concentration upto 5ppm is effective in caries
control .

17. 3- Fluoride Supplements :




Supplied in form of tablets , drops or syrups .
0.5 mg F / day for children up to 3 years .
1 mg F / day for children over 3 years .
Continue administration till the age of
complete crown formation of the second
premolar ( age of 10 years).

18. 4- F. incorporation in various foods:

Such as salt , milk , bread , rice .

It is difficult to adjust fluoride concentration .

19. Self administered F. application
(( By the individual

Fluoride Dentifrices:
- 15-30 % caries reduction following the regular use
of F . Dentifrices .
- The most common F compound are sodium
monofluorophoshate , stannous F and sodium F.
- Ant-calculus agents such as zinc compound or
pyrophosphate can be used .

20. 
Fluoride Mouthrinses:
Indications :
1- Patients with active caries .
2- Orthodontic patient .
3- Patient with reduced salivary flow .
4- Patient with removable appliances .
* 0.05 % neutral sodium F ( 230 ppm F ) is the benefit
concentration .
* 1-2 teaspoon ( 5-10 ml) once / day before bedtime are
recommended .

21. Professional Topical F Application
- Available as solution , gel and prophylaxis .
 Sodium F .
* 2% Sodium F solution used 4 application ,
1 week interval between every application .
* applied every year .

22. Procedure :
1- Prophylaxis is performed .
2- Teeth on one side are isolated .
3- dried the teeth .
4- 2% sodium F solution applied to each surface
with a cotton applicator .
5- The solution is allowed to dry on the teeth for 3-5
min .
6- The same procedure is repeated every week until
4 application .

26. 
Stannous Fluoride :
- Single annual application of 8% stannous F
65%
reduction in caries incidence .
- Need to be prepared freshly for each application
( 0.8gm in 10 ml distilled water ) .

Acidulated phosphate fluoride :
- Combination of sodium F with phosphoric acid .
- No need to be prepared every treatment .

27. 
Prophylaxis Paste :
- Prophylaxis paste containing fluoride .
- Carried out every six months .

28. Mode of action of fluoride






Ionic exchange ; hydroxyapetite changing to
fluoroapetite which is less soluble in acids .
Enzymatic inhibition ; inhibit phosphatase and
anulase enzymes .
Bacterial inhibition .
Has the ability to precipitate calcium phosphate on
the surface of enamel from saliva .
Lowers free surface energy
plaque
accumulation in the treated enamel surface .
Action on tooth size and morphology: shallower
fissures and lower cusp height and smaller size
caries

29. Pit and Fissure Sealants



Sealant are materials used to seal deep pit
and fissure and transfer them into nonretentive surface.
Several sealants based on the BIS-GMA
resin ( main ingredient of composites ) .
Etching , washing and drying
the resin
then applied with a small brush .

32. Sealants

Technique 
Prior to etching the tooth:

Isolate tooth (i.e. rubber
dam, cotton roll)

33. Sealants

Etching: - 35% PA





Deliver to the tooth using
the blue tip, or using a
microbrush
Etch the grooves and
cuspal inclines
Etch for 15 seconds
Wash for 10 seconds
Evaluate “frosted” enamel

34. Sealant



Apply sealant using the spiral
brush tip, or using a
microbrush.
Sealant should flow into
grooves and up cuspal
inclines.
Cure for 20 seconds

36. Diet Counseling
(( Diet Control

Oral clearance of carbohydrate:
1- Keep the carbohydrate content as low as
possible .
2- Select carbohydrate with low retention
such as leafy , green or yellow vegetables .
3- Avoid sticky sweets between meals.

37. 
Diet for good general nutrition must be contain:
1- Sufficient amount of minerals especially
calcium and phosphorous .
2- Sufficient amount of vitamins especially
D&C .
3- Reduced amount of carbohydrates .
4- Enriched phosphates .

38. 
Basic food groups ( good balanced diet ):
1- Milk group .
2- Meat group .
3- Vegetable and fruit group .
4- Bread and cereal group .

39. Objectives
Oral hygiene measures
(( Plaque Control
Removal of soft deposits (dental plaque, materia alba and- 1
( food debris
Gingival massage
keratinization and improve- 2
circulation
protection against microorganisms
. Prevention of calculus formation- 3
Methods
Mechanical
Chemical

40. Mechanical Plaque Control
:- I- Tooth Brushing
** Design of brush:-Firm handle with modest angulation between head and the handle.
-2.5 cm length of head
-15-16.5 cm length of handle
-10mm height of bristles and 0.2mm thickness
-2 to 3 rows of bristles
-Smooth and rounded ends of the bristles
-Bristles may be synthetic or natural
-Nylon bristles are superior to natural , as they resist breaking and contamination
with microbial debris.

42. :-Tooth Brushing Methods**
:Bass Method
•Intrasulcular method.
•Efficient for removing dental plaque from gingival third and
from shallow gingival sulcus.
•Place the bristles at the gingival margin with angle of 45 degree
to the long axis of the teeth.
•Exert gentle vibratory pressure using short back-and-forth
motions without dislodging the bristles tips (horizontal
direction(.
•Perform about 20 strokes in each position.
•Used a soft brush in this method.

45. Brushing Methods
Bass Method

47. :- Modified Stillman Method
•A soft or medium brush can be used with this method.
• Recommended for patients with gingival recession to
prevent abrasive tissue destruction.
•The sides of the bristles are placed against the gingiva
and teeth with a 45 degrees angle to the long axis
of the teeth.
•Pressure is applied laterally against the gingival
margin to produce blanching.
•Brush is activated by short back-and-forth strokes in
coronal direction.

48. Brushing Methods
Modified Stillman Method

49. Charters Method
- A soft or medium brush can be used.
-Recommended for temporary cleaning in areas
of healing after periodontal surgery.
-The bristles pointed toward the crown at a 45
degree angle to the long axis of the teeth.
-The bristle tips not move across the gingiva.
-The brush is activated with short back-and
forth strokes in coronal direction.

51. Charters method

52. Rotation or Roll Method

The bristles placed apically , nearly parallel to the
tooth surface then in and over tooth surfaces .

Rolling motion on buccal and lingual surfaces .

The occlusal surfaces are brushed with a to and
fro action .

53. Fone’s Method

For young children .

The upper and lower teeth are put together
into occulsion .

Circular motion on the buccal surface .
On the lingual surface a back –and – forth
horizontal motion .


54. Electrical Tooth Brushes
-Useful for: Children, hand- capped, and patients with
orthodontics treatment.
-Less abrasive to tooth surfaces and restoration.
-Do not require special techniques of application.
-Place the brush head next to the tooth at the gingival margin and
proceed systematically around the dentition.
- Not superior to manual type.
-Expensive.

55. Electrical
Toothbrushing Technique

56. :- II- Interproximal Cleaning Aids
• 1- Dental Floss:
Effective for flat or convex proximal tooth surfaces with full
embrasures.
• Waxed, unwaxed or tufted types.
• Tufted and waxed are indicated for rough restoration and tight
contact
• Cut about 12cm and anchored around one finger of each hand.
• Gentle placing at the base of gingival sulcus then moved in an
up-and down along the tooth surface ,right and left.

59. :Interdental Brushes -2
•Small cone-shaped or tapered brushes.
•Used in large open embrasures.
•Inserted interdentally and moved back and forth in
facio-lingual direction.
3- Tooth Picks:•Made from soft-wood and is triangular in shape.
•Used in open contact.
•Tooth pick moved in-and-out or up-and down direction.
•Tooth pick can be placed in special plastic handles to
reach areas with limited access.

64. Chemical Plaque Control
( Mouthrinsing)

Several chemical agents have anti-plaque and
anti- gingivitis effects :
* Chlorhexidine .
* Quaternary ammonium
compounds .
* Sanguinrine .
* Hydrogen peroxide .

65. Chlorhexidine:* The most effective antimicrobial agent in plaque and
gingivitis
•Mechanism of action:- pellicle formation, alteration of
bacterial cell wall lysis of bacteria and
bacterial
adhesion to tooth surfaces.
• has not produce any resistance of oral microorganisms.
•Substantivity: high substantivity.
•Side effects:- staining of teeth , tongue and resin
restorations, and alter taste sensation (temporary).
•0.2%- 0.12% mouth washes Twice/day.

66. Disclosing Agents
•Used to stain the teeth for patient education
and motivation for oral home care.
•Used to locate dental plaque on tooth surface.
•Available in tablets and liquid forms.
•Produce, blue, purple or red stains when
attached to plaque on tooth surface.
•Examples: Bismark Brown solution,
erythrosine and sodium fluorescein dye.

69. Preventive Dentistry Treatment Planning
Problem recognition
( by patient / community /dental professional)
Problem definition
( nature/extent/severity/significance)
Problem data analysis
Interpretation and presentation
Treatment planning