opportunity to discuss the type of toothbrush and toothpaste. Some patients are more
likely to develop dental caries than others, and these patients need more aggressive
preventive advice and therapy. Effective toothbrushing with an appropriate fluoride
toothpaste is an essential first goal. Other forms of fluoride therapy should be
considered, as outlined above: drops/tablets (if the drinking water is fluoride
deficient), mouth rinses, and topical applications of solutions, gel or varnish. Dietary
habits should be investigated using a 3-day diet diary and appropriate advice given
that is personal, practical, and positive. As toothbrushing, rinsing, and dietary control
all require changes in life-style especially at home, continuous encouragement is
essential. Fissure sealing is likely to be sensible, in line with the guidelines set out
above.
The order in which the various carious preventive measures are scheduled in the
treatment plan is of some importance. It is sensible to investigate toothbrushing early,
as it is a good bridge between the home and the dental surgery and it gives proper
emphasis to this vital preventive measure. If done first, it allows you to work on clean
teeth. As investigation of diet and dietary advice requires at least three visits, it is
sensible to introduce this at an early appointment. Fissure sealing can be commenced
early in the treatment plan as a relatively easy procedure giving emphasis to
prevention rather than restoration, while topical fluoride therapy could be carried out
after fissure sealing. If fluoride dietary supplements and/or mouth rinses are going to
be recommended, it is sensible to introduce them on the first or second appointment
so that continuous encouragement in their use might be given at later appointments.
The above intensive preventive therapy is for patients 'at risk' of developing caries.
This begs the question on how to predict future caries development. There has been
much work on this topic with many risk factors or markers of caries risk proposed.
Overall, the findings are not encouraging. The most successful are: past caries
experience, saliva properties (flow rate, buffering power, and microbiological
content), and social status. These can be used in combination to increase
discriminatory power. Despite much work, one large American investigation showed
that the best predictor of future caries increment in children was 'intuition of the
dentist'.
6.6 SUMMARY
- Dental caries is caused by dietary carbohydrates being fermented by plaque
bacteria to acid. - Caries detection and diagnosis requires a meticulous systematic approach.
- The pre-cavitation lesion is a danger sign indicating the need for prevention.
- The four practical pillars to caries prevention are: toothbrushing, diet, fluoride, and
fissure sealing. - Preventive advice must be to parent and child and should be appropriate to the age
and circumstances of the child. - Motivation and continuous encouragement is essential if prevention is to be
successful.