preventive dentistry and early caries detection
TRANSCRIPT
Preventive Dentistry
& Early Caries Detection
Presented By : -Ghida Lawand -Roudy Khayat -Mayss Kamala -Mostafa Mansour -Ali Khalaf
Methods to reduce demineralizing factors
Methods to increase protective factors
Conventional Prevention of Dental caries
Dietary measures
Methods to improve oral
hygiene
Methods to improve flow and quantity of saliva
Chemicals altering the
tooth surface or tooth structure
Use of pit & fissure sealants
1.Fluorides2. Antimicrobial
agents
A) Provide substitutions for cariogenic foods consumed by the patient ,mainly the ones containing fibers such as raw fruits and vegetables
Intake of raw fruits and vegetables
Increase the salivary flow Removal of food debris
Contain natural phosphates, phytates and
nondigestable fibers
They do not stick to teethIncreases caries
protective mechanism
B) Decreasing the frequency of consuming cariogenic food rather than imposing dietary restrictions on the patient.
2) Methods to improve the oral hygiene:A) Tooth brushing: Most reliable means of controlling plaque and providing clean tooth surface
Brushing technique:
A Keep the bristles in gingival sulcus at 45 to the long axis of the tooth B Brushing on palatal surface C Brushing on posterior
Methods to increase protective factors
1) Methods to Improve Flow and Quantity of Saliva
Saliva plays a major role in prevention of caries. Increasing the salivary flow rate and its buffering capacity play an important role in prevention.
1) Prescription of salivary stimulants like (pilocarpine - cevimeline) considered useful in case of patients having Xerostomia (dry tongue) with functional salivary glands.
This can be done by:
Mouth rinsing solution after
eating
2 teaspoons of baking soda
8 oz of water
2) Baking soda helps in neutralizing the acids and this is why it must be used with patients who have low salivary flow.
2) Chemicals altering the tooth surface or tooth structure
Fluoride can reach the enamel in two ways:
Systemically TopicallyThrough blood supply of
developing teeth Through direct contact of fluoride on teeth surfaces
Examples: fluoride drops, tablets, or treated water
Examples: dentifrice, mouth rinses, varnish…)
A) Fluoride
B) Antimicrobial agents
1) Chlorhexidine
2) Xylitol and soduim hypochrite :
1. Enhances the remineralization process 2. Decreases streptococcus mutans presence
Importance: 1) Non fermentable 2) Non cariogenic sugar 3) Anti-caries effects (reduces: plaque formation, bacterial adherence…)
Xylitol is recommended for pregnant mothers. Studies showed that when the mother chews xylitol gums during her pregnancy, lower caries formation is detected in her child.
1. Has anti cariogenic properties2. Releases calcium and phosphate ions to convert to apatite
enhancing remineralization of the tooth structure.3. Enhances the stability of the pH of saliva and reduces the
sensitivity of teeth.
3) Amorphous calcium phosphate (ACP)
A supersaturation of saliva with ACP is achieved by the addition of a protein called Casein phosphopeptide (CCP).
Chewing gums/tablets
Toothpastes
After eating, it is recommended to chew xylitol or ACP containing gums ,lozenges, and topical solutions to reduce the acidogenecity of plaque, and increase salivary flow.
Mouthwashes
3) Use of Pit and fissure sealants Material applied to the pits and fissures of teeth to prevent or arrest caries that may continue to develop. Advantages of pit and fissure sealants Seals pits and fissures making them more resistant to food impaction Make pits and fissures self-cleansable Arrest incipient carious lesion
Resins
1.Bonded to enamel by acid etching
technique2.Most durable
Types of sealants
Glass ionomer Cement
Compomer
1.Bond chemically to dentin and enamel along with active
fluoride release into the surrounding enamel
2.Can’t be used when moisture control is difficult
Similar Properties to resin
Resin sealant placement technique
Tooth preparation Etching of the prepared surface
Cleaning and drying the surface
Application of the resin sealant Light curing of the sealant
What is the aim of it?The aim is to prevent tooth decay by modifying food
How is this modification done?Incorporation of antagonist peptides in food that work against glycosol transferase (catalyze to form glycoside caries)
To Whom are they important?Patients with ‘high caries risk’
1) Genetically Modified Foods
• Vaccine is an immunological material created to form a specific protection against a given disease.
• It stimulates production of protective antibody and other
immune mechanism. No commercial vaccine was made till now
Streptococcus mutans is the main causative agent of human dental caries vaccines should be derived from it Immunizing Sreptococcus mutans tempts to do an immune response stops organisms from settling on the tooth surface stops carious deterioration.• Vaccine should be given prior to the eruption of primary
teeth
2) Caries vaccine
Problems in development of caries vaccine
1. Caries etiology is still not completely known so the effectiveness of this vaccine is not ultimate.
2. Cross reactivity of Streptococcus mutans cell antigens is found in the muscles of the heart.
Visual-tactile method
Radiographic methods
Electrical conductance measurement
Early Caries detection Tools
Lasers
Visual-tactile method
Conventional Methods
Advances in visual method
Tactile examination
Visual examination
Illumination
Dyes
a) Fiber optic trans illumination (FOTI)
b) Digital imaging FOTI (DIFOTI).
Tactile examination
• If the probe sticks in its place, roughness in the surface and a lesion may be possible.
• Advanced smooth surface caries and root caries feels soft upon penetration of the probe.
Dental probe:
1. Pits and fissure caries are examined tactilely as softness, but mechanical binding of an explorer in
the pits or fissures may be due to noncarious causes (shape of the fissure, sharpness of the
explorer, force of application…)
Disadvantages
3. Not effective for interproximal detection of caries
2. Transfer of cariogenic bacteria from the tip of the probe to other
uninfected pits and fissures
Visual examination
Cavitation
Early caries lesion
Discoloration
White lesions
Cavitated carious lesion
Conventional Methods of Radiography Bitewing Radiographs • Estimation of the proximal tooth surfaces before
they are detected clinically.• Detect incipient lesions at contacts of the teeth.
Radiographic methods of diagnosis
Digital imaging uses the conventional radiology
technique where the film is used in recording the image
and then final image is exposed to digital
processing to harvest the final result.
Recent Methods of Radiography
1) Digital Radiography
Advantages• Readily manipulated• Better stored• Better quality • Includes the logicon system :contains in its database radiographic
patterns of sound teeth.
Bitewing radiograph of a suspected interproximal area
is taken
System will compare it to the
sound tooth radiographic
pattern
Informs the operator whether it
is sound, decalcified or
cavitated.
• Depends on measuring light induced fluorescence of the tooth.
• Fluorescence of tooth structure is due to the presence of chromophores within the enamel.
• Intra-oral camera with software for image capture and storage called Spectra camera is used.
• The caries activity is determined on a scale of 0 to 5.
Significance of colors seen:• Green color: Normal tooth structure• Blue color: Shows demineralization or incipient
lesions• Red Color: Appear in caries and plaque indicating the
bacterial presence
• The technique is called “quantified laser fluorescence”. It is based on measuring the differential refraction of light passing through tooth structure.
• The fluorescent light of lower frequency indicates the presence of a carious lesion.
• Requires a clean dry operating field
Tooth Decay
Tip of probe is too small to
reach decay Can’t detect it
until cavity becomes larger
DIAGNOdent Cavity may
be treated when the
cavity is too small
Value Indication Restorative suggestion014 No caries No treatment other than
preventive1520 Histological caries within
the enamelPits and fissure sealant
2199 Histological dentinal caries
Risk
>30 Cavity Operative treatment
Changes detected in initial carious lesions include:Microporosity of enamel structure which will alter
transmission of light. Defects and color changes visible throughout enamel and dentin.
Visible Light
Fiber optic transillumination
(FOTI)
Digital imaging fiver optic transillumination
(DIFOTI)
1. Differentiate between sound tooth structure and carious tooth.
2. Promote detection of small carious lesions.
Fiber Optic Transillumination (FOTI)
Depends on the propagation of light
from the source (fiber optic handpeice) to the non-illuminated tooth
surface
No Shadow High index of light transmission No Lesion
Darkened shadow low index of light transmission Carious lesion
Digital Imaging Fiber Optic Transillumination (DIFOTI)
Early caries detection without using ionizing radiation.
The light from the DIFOTI probe is positioned on the
tooth
Tooth is illuminated
Images are captured by a
digital electronic charged coupled device camera
(CCD)
Sent to a computer Analyzed using branded sequence
Optical Coherence Tomography (OCT)
• Uses reflections of infrared light with considerable penetration into tissue without biological effect.
• Determine not only the occurrence of decay but also the depth of caries progression.
Electrical Conductive measurement device:
Porosity of the
affected tooth
surface
Cause soaking
(wetting) of saliva
Increase the
electrical conductivit
y of the tooth
Shows a differential
conductivity of AC between
sound and carious tooth surface
Alternating Current Impedance Spectroscopy
Consists of an application of multiple electrical frequencies for the diagnosis of both occlusal and smooth surface caries through a device called “CarieScan PRO”.
Allows to detect the state of the tooth structure:
-Sound-Early stages of demineralization-Badly decayed state.
Dyes For Detection Of Caries
It binds to carious lesion which then is disclosed with the fluorescence.
Enamel Caries Dyes
Procion Calcein Zyglo ZL-22Brilliant blue
Dentin Caries Dyes
1% acid-red 52 in propylene glycol baseIodine