Chapter 15 Preventive Dentistry Copyright 2003, Elsevier Science (USA). All rights reserved. No part of this product may be reproduced or transmitted in

Chapter 15Preventive Dentistry

Chapter 15Preventive Dentistry

Copyright 2003, Elsevier Science (USA).

All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher.

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Produced in the United States of America

ISBN 0-7216-9770-4

Copyright 2003, Elsevier Science (USA). All rights reserved.

IntroductionIntroduction

The goal of preventive dentistry is to have a healthy mouth for a lifetime. To achieve this goal, new and recurring disease must be prevented.

The goal of preventive dentistry is to have a healthy mouth for a lifetime. To achieve this goal, new and recurring disease must be prevented.


What Is Preventive Dentistry?What Is Preventive Dentistry? Patient education Fluorides Dental sealants Proper nutrition Plaque control program Optimum oral health can become a reality.

Patient education Fluorides Dental sealants Proper nutrition Plaque control program Optimum oral health can become a reality.


Guides for Patient Education Guides for Patient Education Listen carefully - Each patient will have different

needs. The initial instruction - Explain the relationship of

plaque to dental disease. Assess the patient’s motivations and needs -

Combine the patient’s motivating factors with the patient’s needs.

Select the home cleaning aids - Select a toothbrush, toothbrushing method, interproximal cleaning aids such as dental floss, and a toothpaste.

Keep the instruction simple - Comment positively on the patient’s efforts.

Listen carefully - Each patient will have different needs.

The initial instruction - Explain the relationship of plaque to dental disease.

Assess the patient’s motivations and needs - Combine the patient’s motivating factors with the patient’s needs.

Select the home cleaning aids - Select a toothbrush, toothbrushing method, interproximal cleaning aids such as dental floss, and a toothpaste.

Keep the instruction simple - Comment positively on the patient’s efforts.


Fig. 15-1 The mother lifts the lip and looks at her child’s teeth.Fig. 15-1 The mother lifts the lip and looks at her child’s teeth.

Fig. 15-1Fig. 15-1


Fig. 15-2 The intraoral camera is a valuable tool in patient education. Fig. 15-2 The intraoral camera is a valuable tool in patient education.

Fig. 15-2Fig. 15-2


Dental SealantsDental Sealants Dental sealants are used as a means of

protecting the difficult-to-clean occlusal surfaces of the teeth from decay.

Sealants cover the occlusal pits and fissures where decay-causing bacteria can live.

Dental sealants are an important component in preventive dentistry.

In several states, the application of dental sealants is delegated to the dental assistant as an expanded function.

Dental sealants are used as a means of protecting the difficult-to-clean occlusal surfaces of the teeth from decay.

Sealants cover the occlusal pits and fissures where decay-causing bacteria can live.

Dental sealants are an important component in preventive dentistry.

In several states, the application of dental sealants is delegated to the dental assistant as an expanded function.


Fig. 15-3 Disclosing solution shows heavy plaque formation throughout the mouth.Fig. 15-3 Disclosing solution shows heavy plaque formation throughout the mouth.

Fig. 15-3Fig. 15-3


FluorideFluoride Fluoride has been our primary weapon to

combat dental caries.

Fluoride slows demineralization and enhances remineralization of tooth surfaces.

Fluoride is a mineral that occurs naturally in food and water.

A supply of both systemic and topical fluoride must be available throughout life to achieve the maximum cavity prevention benefits.

Fluoride has been our primary weapon to combat dental caries.

Fluoride slows demineralization and enhances remineralization of tooth surfaces.

Fluoride is a mineral that occurs naturally in food and water.

A supply of both systemic and topical fluoride must be available throughout life to achieve the maximum cavity prevention benefits.


Ways of Receiving FluorideWays of Receiving Fluoride

Prescription-strength fluorides that are applied in the dental office

Nonprescription-strength over-the-counter products for at-home use

Fluoridated water, either bottled or community water

Prescription-strength fluorides that are applied in the dental office

Nonprescription-strength over-the-counter products for at-home use

Fluoridated water, either bottled or community water


Ways of Receiving Fluoridecont’dWays of Receiving Fluoridecont’d Systemic fluoride is ingested in water, food,

beverages, or supplements. The required amount of fluoride is absorbed through the intestine into the bloodstream and transported to the tissues where it is needed. Excess systemic fluoride is excreted by the body through the skin, kidneys, and feces.

Topical fluoride is applied in direct contact with the teeth through the use of fluoridated toothpaste, fluoride mouth rinses, and topical applications of rinses, gels, foams, and varnishes.

Systemic fluoride is ingested in water, food, beverages, or supplements. The required amount of fluoride is absorbed through the intestine into the bloodstream and transported to the tissues where it is needed. Excess systemic fluoride is excreted by the body through the skin, kidneys, and feces.

Topical fluoride is applied in direct contact with the teeth through the use of fluoridated toothpaste, fluoride mouth rinses, and topical applications of rinses, gels, foams, and varnishes.


Fig. 15-5 Various forms of topical fluoride.Fig. 15-5 Various forms of topical fluoride.

Fig. 15-5Fig. 15-5


How Does Fluoride Work?How Does Fluoride Work? Preeruptive development: Before a tooth

erupts, a fluid-filled sac surrounds it. Systemic fluoride present in this fluid strengthens the enamel of the developing tooth and makes it more acid resistant.

Posteruptive development: After eruption, fluoride continues to enter the enamel and alter the structure of the enamel crystals. These fluoride-enriched crystals are less acid-soluble than the original structure of the enamel.

Preeruptive development: Before a tooth erupts, a fluid-filled sac surrounds it. Systemic fluoride present in this fluid strengthens the enamel of the developing tooth and makes it more acid resistant.

Posteruptive development: After eruption, fluoride continues to enter the enamel and alter the structure of the enamel crystals. These fluoride-enriched crystals are less acid-soluble than the original structure of the enamel.


Safe and Toxic Levels of Fluoride Safe and Toxic Levels of Fluoride

Fluorides used in the dental office have been proved to be safe and effective when used as recommended.

Chronic overexposure to fluoride, even at low concentrations, can result in dental fluorosis in children younger than 6 years with developing teeth.

Acute overdosing of fluoride can result in poisoning or even death.

Fluorides used in the dental office have been proved to be safe and effective when used as recommended.

Chronic overexposure to fluoride, even at low concentrations, can result in dental fluorosis in children younger than 6 years with developing teeth.

Acute overdosing of fluoride can result in poisoning or even death.


Fig. 15-6 A, Mild fluorosis.Fig. 15-6 A, Mild fluorosis.

Fig. 15-6 AFig. 15-6 A


Fig. 15-6 B, Moderate fluorosis.Fig. 15-6 B, Moderate fluorosis.

Fig. 15-6 BFig. 15-6 B


Fluoride Precautions Fluoride Precautions

To prevent patients from receiving too much fluoride:

• Evaluate the patient’s current fluoride intake.

• Perform a fluoride “Needs Assessment.”

To prevent patients from receiving too much fluoride:

• Evaluate the patient’s current fluoride intake.

• Perform a fluoride “Needs Assessment.”


Sources of Systemic Fluoride Sources of Systemic Fluoride Fluoridated water: Approximately one part per

million (ppm) of fluoride in drinking water has been specified as the safe and recommended concentration to aid in the control of dental decay.

Foods and beverages: Many processed foods and beverages are prepared with fluoridated water.

Toothpaste and mouth rinses: Toothpaste and mouth rinses containing fluoride should not be a source of systemic fluoride because with proper use any excess is spit out and never swallowed.

Prescribed dietary fluoride supplements may be prescribed by the dentist for children ages 6 months to 16 years.

Fluoridated water: Approximately one part per million (ppm) of fluoride in drinking water has been specified as the safe and recommended concentration to aid in the control of dental decay.

Foods and beverages: Many processed foods and beverages are prepared with fluoridated water.

Toothpaste and mouth rinses: Toothpaste and mouth rinses containing fluoride should not be a source of systemic fluoride because with proper use any excess is spit out and never swallowed.

Prescribed dietary fluoride supplements may be prescribed by the dentist for children ages 6 months to 16 years.


Fig. 15-7 Preventive dentistry.Fig. 15-7 Preventive dentistry.

Fig. 15-7Fig. 15-7


Fig. 15-8 Fluoride rinse and fluoride dentifrice.Fig. 15-8 Fluoride rinse and fluoride dentifrice.

Fig. 15-8Fig. 15-8


Sources of Topical FluorideSources of Topical Fluoride Toothpaste containing fluoride is the

primary source of topical fluoride.

Fluoride mouth rinses

• Prescription

• Nonprescription

Brush-on fluoride gel Professional topical fluoride applications

Toothpaste containing fluoride is the primary source of topical fluoride.

Fluoride mouth rinses

• Prescription

• Nonprescription

Brush-on fluoride gel Professional topical fluoride applications


Nutrition and Dental Caries Nutrition and Dental Caries

Without dietary sugars, dental caries will not occur.

Sucrose has a greater decay-causing potential than other sugars, but maltose, lactose, glucose, fructose, and their combinations do have high caries-producing abilities.

Flour and starches are not usually decay-causing, but when starch is used in conjunction with sugar, i.e. in cookies and so on, the potential for caries increases.

Without dietary sugars, dental caries will not occur.

Sucrose has a greater decay-causing potential than other sugars, but maltose, lactose, glucose, fructose, and their combinations do have high caries-producing abilities.

Flour and starches are not usually decay-causing, but when starch is used in conjunction with sugar, i.e. in cookies and so on, the potential for caries increases.


Sugar SubstitutesSugar Substitutes Increasing use of less fermentable and

noncariogenic (caries causing) artificial sweetners.

Artificial sweeteners are an alternative to sucrose:

• Saccharine (“Sweet and Low”)

• Aspartame (“Nutrasweet” and “Equal”)

• Sorbitol

• Xylitol

• Mannitol

Increasing use of less fermentable and noncariogenic (caries causing) artificial sweetners.

Artificial sweeteners are an alternative to sucrose:

• Saccharine (“Sweet and Low”)

• Aspartame (“Nutrasweet” and “Equal”)

• Sorbitol

• Xylitol

• Mannitol


Dietary Analysis Dietary Analysis A dietary analysis is done to determine the

patient’s current food intake to assess the need for dietary counseling.

The patient maintains a food diary that includes everything they consume each day for 1 week.

The listing includes all meals, supplements, gum, snacks, and fluoridated water.

It can then be used to reveal any dietary habits that are likely to have an adverse effect on the patient’s oral health.

A dietary analysis is done to determine the patient’s current food intake to assess the need for dietary counseling.

The patient maintains a food diary that includes everything they consume each day for 1 week.

The listing includes all meals, supplements, gum, snacks, and fluoridated water.

It can then be used to reveal any dietary habits that are likely to have an adverse effect on the patient’s oral health.


Plaque Control ProgramPlaque Control Program

Plaque can be kept under control by brushing, flossing, interdental cleaning aids, and antimicrobial solutions.

A goal of the program is to remove plaque at least once daily.

The techniques that are selected must be based on the needs and abilities of the individual patient.

Plaque can be kept under control by brushing, flossing, interdental cleaning aids, and antimicrobial solutions.

A goal of the program is to remove plaque at least once daily.

The techniques that are selected must be based on the needs and abilities of the individual patient.


Oral Hygiene Aids and Methods Oral Hygiene Aids and Methods

§ There are a wide variety of oral hygiene products on the market today.

§ It is important for dental assistants to remain current on the newest products on the market so that they can advise patients, make recommendations, and answer their questions.

§ There are a wide variety of oral hygiene products on the market today.

§ It is important for dental assistants to remain current on the newest products on the market so that they can advise patients, make recommendations, and answer their questions.


The Toothbrush The Toothbrush The two basic types of toothbrushes are:

• Manual

• Automatic

When used properly, both types are effective in the removal of dental plaque.

The two basic types of toothbrushes are:

• Manual

• Automatic

When used properly, both types are effective in the removal of dental plaque.


Fig. 15-12 Various styles of manual toothbrushes.Fig. 15-12 Various styles of manual toothbrushes.

Fig. 15-12Fig. 15-12


Toothbrushing PrecautionsToothbrushing Precautions The patient should be cautioned about

damage that may be caused by vigorously scrubbing the teeth with any toothbrush.

Over time this may cause abnormal abrasion (wear) of the tooth structure, gingival recession, and exposure of the root surface.

The patient should be cautioned about damage that may be caused by vigorously scrubbing the teeth with any toothbrush.

Over time this may cause abnormal abrasion (wear) of the tooth structure, gingival recession, and exposure of the root surface.



Fig. 15-13Fig. 15-13


Toothbrushing Methods Toothbrushing Methods

There are several methods of toothbrushing:

• Bass method

• Charter’s method

• Modified Stillman method

The dental professional will recommend the method best suited to the patient’s needs.

There are several methods of toothbrushing:

• Bass method

• Charter’s method

• Modified Stillman method

The dental professional will recommend the method best suited to the patient’s needs.


Dental FlossDental Floss Dental floss or tape removes bacterial plaque and

thus reduces interproximal bleeding.

Dental floss is circular in shape and dental tape is flat.

Floss and wax can be purchased in various colors and flavors.

Floss and tape are available in waxed or unwaxed varieties.

Research has shown that there is no difference in the effectiveness of waxed or unwaxed floss for plaque removal.

Dental floss or tape removes bacterial plaque and thus reduces interproximal bleeding.

Dental floss is circular in shape and dental tape is flat.

Floss and wax can be purchased in various colors and flavors.

Floss and tape are available in waxed or unwaxed varieties.

Research has shown that there is no difference in the effectiveness of waxed or unwaxed floss for plaque removal.


Fig. 15-17 The dental assistant assists the patient in learning to floss..Fig. 15-17 The dental assistant assists the patient in learning to floss..

Fig. 15-17Fig. 15-17


Interdental AidsInterdental Aids

End-tuft brushes

Bridge cleaners

Automatic flossers

PerioAid

End-tuft brushes

Bridge cleaners

Automatic flossers

PerioAid


Fig. 15-21, A and B. End tuft toothbrush for anterior and posterior teeth.Fig. 15-21, A and B. End tuft toothbrush for anterior and posterior teeth.

Fig. 15-21Fig. 15-21


Fig. 15-22 Bridge cleaner and dental floss.Fig. 15-22 Bridge cleaner and dental floss.

Fig. 15-22Fig. 15-22


Fig. 15-23 Automatic flosserFig. 15-23 Automatic flosser

Fig. 15-23Fig. 15-23


Fig. 15-24 Perio-aid.Fig. 15-24 Perio-aid.

Fig. 15-24Fig. 15-24



Fig. 15-25Fig. 15-25


Dentifrice (toothpaste) Dentifrice (toothpaste) Dentifrice (toothpaste) contains ingredients

designed to help remove food residue and abrasives to help remove stain.

Highly polished tooth surfaces will stain less readily and remain clean longer.

Most brands of toothpaste now contain fluoride. They also contain flavoring agents to give the mouth a fresh and clean feeling.

Some toothpaste now contains a compound that reduces calculus formation when it is used regularly following a dental prophylaxis.

• It will not remove existing calculus.

Dentifrice (toothpaste) contains ingredients designed to help remove food residue and abrasives to help remove stain.

Highly polished tooth surfaces will stain less readily and remain clean longer.

Most brands of toothpaste now contain fluoride. They also contain flavoring agents to give the mouth a fresh and clean feeling.

Some toothpaste now contains a compound that reduces calculus formation when it is used regularly following a dental prophylaxis.

• It will not remove existing calculus.


Fig. 15-26 Marketing toothpaste for childrenFig. 15-26 Marketing toothpaste for children

Fig. 15-26Fig. 15-26


Mouth Rinses Mouth Rinses Many patients like the feeling of freshness

provided by a mouth rinse.

There is a wide variety of mouth rinses on the market today, and some also contain fluoride.

Recovering alcoholics should select a mouthrinse that does not contain alcohol.

Rinsing the mouth with water is recommended after meals and snacks when toothbrushing and interdental cleaning is not possible.

Many patients like the feeling of freshness provided by a mouth rinse.

There is a wide variety of mouth rinses on the market today, and some also contain fluoride.

Recovering alcoholics should select a mouthrinse that does not contain alcohol.

Rinsing the mouth with water is recommended after meals and snacks when toothbrushing and interdental cleaning is not possible.


Irrigation Devices Irrigation Devices Oral irrigators deliver a pulsating stream of

water or chemical agent through a nozzle to the teeth and gingiva.

Oral irrigation can be applied at home by the patient or in the dental office.

Oral irrigation helps to keep the subgingival bacterial levels at a minimum.

For selected patients, oral irrigation can supplement other oral hygiene techniques.

Oral irrigators deliver a pulsating stream of water or chemical agent through a nozzle to the teeth and gingiva.

Oral irrigation can be applied at home by the patient or in the dental office.

Oral irrigation helps to keep the subgingival bacterial levels at a minimum.

For selected patients, oral irrigation can supplement other oral hygiene techniques.

Documents

Chapter 15 Preventive Dentistry Copyright 2003, Elsevier Science (USA). All rights reserved. No part of this product may be reproduced or transmitted in