mixed. Daily flossing of the teeth of young children reduced caries in one study but
no preventive effect was observed in older children who flossed their own teeth.
Twenty-five years ago, in Kalstaad, Sweden, caries increments were virtually
eliminated in children who had fortnightly prophylaxes and intensive preventive
advice by dental hygienists. Other workers have tried to reproduce those sensational
results (96% caries reduction compared with a control group) but have failed to do so,
illustrating the difficulty of extrapolating findings of trials from one country to
another.
Plaque growth can be prevented by twice-daily rinsing with chlorhexidine but because
of the intra-oral side-effects of chlorhexidine (changed taste sensation, poor taste, and
tooth staining), it is usually recommended for short-term use only to aid periodontal
care.
245H
Fig. 6.13 Plaque disclosure of upper
and lower dentition.246H
Fig. 6.14 Parent assisting
toothbrushing of their young child's
teeth.6.4.2 Nutrition and diet in caries control
We are constantly eating and snacking and it is very important to be able to give
sensible practical advice regarding diet and dental caries. Some consider that there
are 'good foods' and 'bad foods' while others consider that there are 'good diets' and
'bad diets'. Further, some consider sugar to be the arch villain and enemy of dentistry.
Caries has declined despite increased sales and consumption of sugars. However, the
literature is controversial and there are many conflicting views and opinions regarding
sugar consumption. The COMA report classified sugars as being either intrinsic
(sugar within cell membrane, for example, fruits) or extrinsic (readily available
sugars, for example, refined sugars). Are intrinsic sugars converted to extrinsic sugars
on chewing? This is probably irrelevant, as bacteria need a fermentable source of
carbohydrate to produce acid. The review paper of Burt and Pai (2001) summarizes
the conflict in opinions on sugar. However, we should concentrate on giving sensible