6.4.0 Introduction
The dramatic improvement in dental health, especially in children, in many
developed countries during the past 20 years is proof that prevention works. Dental
caries is not inevitable; the causes are well known, discouraging caries development
and encouraging caries healing are realities to be grasped. Failure to do so is, at least,
to provide second-class dental care.
There are four practical pillars to the prevention of dental caries: plaque control/
toothbrushing, diet, fluoride, and fissure sealing. Each of these will be considered in
turn before being brought together in treatment planning and in relation to caries-risk.
Prevention of caries is so easy in theory but in practice involves many skills. The
main reason for this is that control of the aetiological agents⎯plaque and fermentable
carbohydrates⎯involve a change in behaviour. The value of fluoride is that it can be
delivered in a variety of ways, some of which require minimal action by the patient.
There is no 'magic bullet' that can be applied to teeth which will render them totally
resistant to caries. Fissure sealants come close to this but they are expensive to apply,
some fall off, and they only prevent caries of pits and fissures.
In dentistry there is no doubt that prevention is better than cure. Prevention of dental
caries underpins all dental care provided to children. All children require preventive
input. The type of input depends on the child and their caries risk. Forming a
comprehensive treatment strategy, tailored to the needs of each individual child, is an
essential component of all paediatric treatment planning.
Despite dental caries being a preventable disease epidemiological surveys in children
in many countries have shown that the distribution of dental caries has become
'bimodal', with 80% of the disease present in only 20% of the child population.
Consequently two approaches are required to improve dental health. This strategy
will involve maintaining good dental health in those without dental decay, and
secondly targeting resources to those that are at risk of developing decay. This means
targeting the 'high caries-risk' groups comprising:
- the caries prone⎯especially early childhood caries (nursing bottle caries).
- the handicapped⎯medical and physical.
- the socially deprived, that is, low socio-economic groups.
- ethnic minority groups usually residing in inner city areas.
Low caries-risk children are those who are caries-free or have well-controlled caries,
have good oral and dietary habits, are highly motivated and attend their dental
appointments regularly.
It is thus important to institute effective preventive measures for children and advice
for their patients. This is best achieved at treatment planning prior to commencing any
restorative work (other than emergency and stabilizing procedures). It is also
important to clarify what constitutes high and low caries-risk children (242HChapter 3).
The mainstay of preventive measures are:
(1) plaque control and regular toothbrushing with a fluoride toothpaste;