Professional and Self Applied Caries Prevention

Caries risk assesment

predicts the likelihood of lesion development and progression of existing lesion

Ex/active lesions, dental history, diet, fluoride exposure, oral hygiene, and xerostomia

Diagnostic process

-Asses the patient's risk of developing caries and make the decision to provide specific intervention/therapy (non-operative or operative)

-Both patient and tooth level considered

Low risk patient treatment

continue status quo

Fluoride efficacy

fluoride works best:

1)after tooth eruption

2)after acid challenge

3)low constant ambient levels

Factors that affect retention phase (5)

1)Clearance forces

2)Salivary flow (eating/drinking)

3)Fluoride concentration

4)Fluoride delivery method

5)Timing fluoride application

Self-applied fluoride interventions (3)

1)Dentifrices

2)Mouthrinses

3)Supplements

Dentifrices (toothpaste)

-most common form of fluoride application

-paste or gel form

-different flavors

-multiple different brands

-want low abrasiveness and neutral pH

Types of fluoride

SnF2, NaF, and NaMFP

High risk patient treatment

-tailored at individual level and involves behavior change

-increased oral hygiene frequency

-prescription toothpaste

-electric toothbrush

-baby progress steps

Mouthrinses

-target inflammation, caries risk, and dry mouth

-recommended for moderate and high-risk patients

Fluoride supplements

used with children that are high risk without access to fluoridated water

Non-operative treatment (5)

1)Reduce cariogenic bacteria (produce acid by fermentation of carbohydrates)

2)Reduce frequency of carbohydrates

3)Address salivary dysfunction caused by medications, radiation, disease, or genetic conditions

4)Increase salivary flow/clearance

5)Antibacterial agents

Self-determination theory

people are innately motivated to engaged in activities that promote health/well-being

Motivational interviewing

explore and help patients attitude towards changing with reflective listening

Treatment for salivary dysfunction

hydration (do not use acidic solutions or alcohol) and comfort

Ex/Biotene helps with dry mouth

Ex/MI paste promotes salivary function

Antibacterial agents (4)

1)Chlorhexidine gluconate: broad spectrum antibacterial

2)Sodium bicarbonate: neutralizes acids

3)Xylitol: substitutes fermentable carbohydrates

4)Iodine: destroys DNA and proteins

Intervals of appointments based on risk

High risk: 3-4 months

Low risk: 6-12 months

Professional applied fluoride interventions (3)

1)Gels/foams

2)Varnishes

3)Silver diamine fluoride (DSF)

In-Office gels/foams

used for high-risk patients >2 times per year (NaF or APF)

Fluoride varnish

used for high-risk patients, 2-4 times per year, and allows targeting of specific areas of concern

Fluoride dosage for varnish

22,600 ppm or 3-5 mg F

Fluoride dosage for OTC toothpaste

1,000 ppm or 0.75-1.5 mg F

Fluoride dosage for prescription toothpaste

5,000 ppm or 3.75-5 mg F

Function of Silver Diamide Fluoride (SDF) (3)

1)arrests dental caries

2)prevents dental caries

3)decreases dentin hypersensitivity

Mechanism of Silver Diamide Fluoride (SDF) (5)

1)Bactericidal: breaks cell walls and membranes

2)Inhibits bacterial growth

3)Remineralization of dentin lesions

4)Increases lesion hardness

5)Prevent demineralization

Silver Diamide Fluoride (SDF)

non-operative treatment for dental caries

Silver Diamide Fluoride (SDF) indications (5)

1)Difficult to treat carious lesions

2)Carious lesions in extreme risk patients

3)Carious lesions that cannot all be treated in one visit

4)Treatment challenged by behavioral management

5)Patient does not have access to care

Silver Diamide Fluoride (SDF) take homes (4)

1)arrests >90% of caries when used 2/year

2)powerful indirect prevention

3)dry before use

4)stains almost everything

Silver Diamide Fluoride (SDF) application steps (5)

1)cotton swab isolation

2)dry tooth gently

3)apply micro-sponge

4)remove excess to prevent taste and ingestion

5)allow to air dry as long as possible

Tooth gel characteristics (4)

1)translucent

2)smooth

3)less minty

4)less foam

Toothpaste characteristics

1)solid color

2)thick

3)more minty

4)more foam

FDA approves the use of Fluoride varnish for ______ and ______, but not for _______

cavity liner, hypersensitivity, caries prevention (off-label)