(2) sensible dietary advice;
(3) use of fluorides;
(4) fissure sealants;
(5) regular dental checks with appropriate radiographs.
All of these measures need to be co-ordinated and supervised by the dental team and
reinforced with good patient and parental motivation.
6.4.1 Plaque control and toothbrushing
There are a number of plaque disclosing tablets and solutions available. Children need
close supervision when using these agents and appropriate advice should be given to
parents and guardians. Plaque charts can be used to monitor progress and to identify
areas where cleaning is not ideal. It is customary to report the percentage number of
clean surfaces so that patients aim to achieve as close to 100% clean as possible. After
demonstrating the plaque disclosing procedure (243HFig. 6.13) and performing the charting
it is initially advisable to instruct patients to use the disclosing agent prior to
toothbrushing. After 1 week it is advisable for patients to brush first and then disclose
in order to identify areas that are being missed.
Toothbrushing
Advise regular toothbrushing with an appropriate concentration of fluoride toothpaste.
Toothbrushing should become a routine and on at least two occasions every day.
There are numerous types of brushes (manual and electric) and toothpastes available.
Many brushes and pastes have cartoon characters etc., which can be good motivators
for many children. Both manual (preferably with a small head) and electric brushes
are equally effective for plaque removal. However, the cost of brushes and pastes can
be prohibitive for some low socio-economic groups wherein reality toothbrushing has
become a low priority. This is where community and school-based programmes are
needed to ensure provision of oral health measures. Young children under 5 years
need help with toothbrushing (244HFig. 6.14). Children do not have the manual dexterity to
brush their teeth effectively until they can tie their own shoelaces (about 7 years of
age). However, even after this children should still be supervised to establish a regular
routine and to ensure a good oral health practice. Only a small smear of fluoride
toothpaste should be used up to 6 years of age. Fluoride is cleared quickly from the
oral cavity that many advise to swish the toothpaste saliva slurry around the mouth
and not to rinse with water in order to maintain elevated intra-oral fluoride levels for
longer periods of time. A simple message for patients is 'brush your teeth first thing in
the morning and last thing at night'.
As dental caries is caused by bacteria in plaque fermenting dietary carbohydrates to
acids which dissolve enamel, it is logical to prevent caries by removing plaque from
teeth, usually with a toothbrush. Unfortunately, many investigations indicate that
caries reduction is not brought about by improved toothbrushing alone. However, it
must be said straight away that, first, toothbrushing is a very important way of
controlling gingivitis and periodontal disease and, second, that toothbrushing with
toothpaste is a very important way of conveying fluoride to the tooth surface.
The results of the few studies to investigate the effect of flossing on dental caries are