dental disorders
Caries
Prevention of Caries
Regular brushing and flossing Fluoride in water, toothpaste, or both Regular professional cleanings Rarelychlorhexidinerinses and topical fluoride applications For most people, caries is preventable. Cavities first form on permanent teeth in the early teens to late 20s. Caries-prone people typically have low exposure to fluoride and a relatively cariogenic microflora acquired from their mothers and through social contact. Maintaining good oral hygiene is especially important, as are dietary factors, particularly minimizing intake of sugar and acidic drinks and eating a diet rich in sources of calcium. Removal of plaqueat least every 24 hours, usually by brushing and flossing, helps prevent dental caries. The gingival third of the tooth is the most important area to clean but is the area most often neglected. Brushing with an electric toothbrush for 2 minutes is excellent; brushing with a manual soft toothbrush for 3 to 4 minutes suffices. Using excess toothpaste, particularly an abrasive type, may erode the teeth. Dental floss is placed between each of the teeth, curved against the side of each tooth, and moved up and down 3 times, going just beneath the gingival margin. Flosses that are very thin or coated with wax or polytetraethylene can be used for exceptionally tight contacts between teeth or rough filling margins. incorporated into their enamel are more resistant to acidic decalcification and more readily recalcify when pH increases. If drinking water is not adequately fluoridated, oral fluoride supplements are recommended for children from 6 months through 16 years. Fluoride supplements in pregnant women have not been shown to prevent caries in offspring and thus are no longer recommended ( Prevention reference ). Oral supplements for children are available in toothpastes, liquids (for use in a dropper for infants), gels, and tablets. Tablets should be swished in the mouth to enhance topical fluoride absorption before swallowing. The dose must be selected according to the amount of fluoride present in the drinking water and diet, the age of the child, and whether topical fluoride is being used in toothpaste and/or applied during dental care. Excessive fluoride exposure may cause Fluorine Toxicity , causing mild to severe discoloration of teeth. Also, fluoridated toothpaste should be used by people of all ages. Because young children may swallow toothpaste when brushing, which can lead to fluorosis, they should use children's toothpastes, which contain lower amounts of fluoride. Fluoridation offers less protection against caries in pits and fissures than against those on smooth surfaces. Deep, narrow pits and fissures require use of sealants (resin materials that adhere tightly to the surface of the enamel) to prevent nutrients from reaching bacteria, reducing their growth and acid production. If these measures do not decrease cavity formation, more intensive therapy is aimed at changing the flora. After cavities are treated, pits and fissures, which can harborS. mutans,are sealed. This treatment is followed by a 0.12%chlorhexidinemouth rinse used for 60 seconds twice a day for 2 weeks, which may reduce the cariogenic bacteria in plaque and allow repopulation with less cariogenic strains ofS. mutans. To encourage this repopulation,xylitolin the form of hard candy or chewing gum is used for 5 minutes three times a day. Additionally, a 5000 ppm high-fluoride toothpaste regimen may be prescribed, or topical fluoride may be applied by a dentist or used at night in a custom-made fluoride carrier. However, data related to the use ofchlorhexidinefor the sole purpose of preventing caries in adults are inconsistent. For pregnant women with a history of severe caries, preventive measures focusing on improved oral health are recommended (eg, limiting sugary food and drinks, brushing twice daily with toothpaste containing fluoride, daily flossing, and occasionally alcohol-free mouth rinses containingchlorhexidine). If this is not feasible, the mother can usexylitol, as mentioned above, from the time of the child’s birth to the age at which the mother no longer samples the child’s food (a hypothesized mode of transfer). Prenatal interventions may reduce transfer of cariogenic bacteria from mother to child and delay caries formation in the child. For prevention of caries in deciduous teeth (once they have erupted) in infants, bedtime bottles should contain only water. 1.Richards D: No evidence that fluoride supplements taken during pregnancy prevent caries.Evid Based Dent19(3):73, 2018. doi: 10.1038/sj.ebd.6401320 