Preventive Dentistry
Chapter 15
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Introduction
The goal of preventive dentistry is to
have a healthy mouth for a lifetime.
To achieve this goal, new and recurring
disease must be prevented.
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What Is Preventive Dentistry?
• Patient education
• Fluorides
• Dental sealants
• Proper nutrition
• Plaque control program
• Optimum oral health can
become a reality.
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Guides for Patient Education
• Listen carefully: Each patient will have
different needs.
• The initial instruction: Explain the relationship
of plaque to dental disease.
• Assess the patient’s motivations and needs:
Combine the patient’s motivating factors with
the patient’s needs.
• Select the home cleaning aids: Select a toothbrush,
toothbrushing method, interproximal cleaning aids
such as dental floss, and a toothpaste.
• Keep the instruction simple: Comment positively
on the patient’s efforts.
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Fig. 15-1 The mother lifts the child’s lip and
looks for early signs of decay.
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Fig. 15-2 The intraoral camera is a
valuable tool in patient education.
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Dental Sealants
• Dental sealants are used as a means of protecting the
difficult-to-clean occlusal surfaces of the teeth from
decay.
• A dental sealant is a plastic-like coating that is applied
over the occlusal pits and grooves of the teeth.
• Sealants cover the occlusal pits and fissures where
decay-causing bacteria can live.
• Dental sealants are an important component in
preventive dentistry.
• In several states, the application of dental sealants
is delegated to the dental assistant as an expanded
function.
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Fig. 15-3 This molar is protected from decay with a dental sealant.
(Courtesy 3M ESPE, St Paul, MN.)
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Fluoride
• Fluoride has been our primary weapon to combat
dental caries for more than 40 years.
• Fluoride slows demineralization and enhances
remineralization of tooth surfaces.
• Fluoride is a mineral that occurs naturally in food
and water.
• A supply of both systemic and topical fluoride must
be available throughout life to achieve the maximum
cavity prevention benefits.
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Ways of Receiving Fluoride
• Prescription-strength fluorides that are
applied in the dental office
• Nonprescription-strength over-the-counter
products for at-home use
• Fluoridated water, either bottled or
community water
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Ways of Receiving Fluoride-cont’d
• Systemic fluoride is ingested in food, beverages,
or supplements.
– The required amount of fluoride is absorbed through
the intestine into the bloodstream and transported to
the tissues where it is needed.
– Excess systemic fluoride is excreted by the body through
the skin, kidneys, and feces.
• Topical fluoride is applied in direct contact with the
teeth through the use of fluoridated toothpaste,
fluoride mouth rinses, and topical applications of
rinses, gels, foams, and varnishes.
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Fig. 15-4 Various forms of topical fluoride
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How Does Fluoride Work?
• Pre-eruptive development: Before a tooth erupts,
a fluid-filled sac surrounds it. Systemic fluoride
present in this fluid strengthens the enamel of the
developing tooth and makes it more acid resistant.
• Posteruptive development: After eruption, fluoride
continues to enter the enamel and alter the structure
of the enamel crystals. These fluoride-enriched
crystals are less acid-soluble than the original
structure of the enamel.
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Fluoridated Water
• For more than 40 years, fluoride has been safely
added to the communal water supply.
• Most major cities in the United States have
fluoridated water, and there are continuing efforts
to fluoridate water in other communities.
• From a public health standpoint, fluoridation of
public water supplies is a good way to deliver
fluoride to lower socioeconomic populations that
may not otherwise have access to topical fluoride
products such as fluoridated toothpaste and
mouthrinses.
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Fluoridated Water-cont’d
• Until recently, it was believed that water fluoridation
was effective in preventing tooth decay by systemic
uptake and incorporation into the enamel of
developing teeth.
• It has now been proved that the major effects of
water fluoridation are topical and not systemic.
• Topical uptake means the fluoride diffuses into the
surface of the enamel of an erupted tooth rather than
being incorporated into unerupted teeth during
development.
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Fluoridated Water-cont’d
• Approximately one part per million (ppm) of fluoride
in drinking water has been specified as the safe and
recommended concentration to aid in the control of
dental decay.
• This is approximately equivalent to one drop of
fluoride in a bathtub of water.
• The levels of fluoride in controlled water fluoridation
are so low that there is no danger of ingesting an
acutely toxic quantity of fluoride.
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Safe and Toxic Levels of Fluoride
• Fluorides used in the dental office have been proved
to be safe and effective when used as recommended.
• Chronic overexposure to fluoride, even at low
concentrations, can result in dental fluorosis in
children younger than 6 years with developing teeth.
• Acute overdosing of fluoride can result in poisoning
or even death.
• Acute overdosing is very rare.
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Fluoride Precautions
• To prevent patients from receiving too much
fluoride:
– Evaluate the patient’s current fluoride intake.
– Perform a fluoride “Needs Assessment.”
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Fig. 15-5 A, Mild fluorosis
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Fig. 15-5 B, Moderate fluorosis
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Sources of Systemic Fluoride
• Foods and beverages: Many processed foods and
beverages are prepared with fluoridated water.
• Prescribed dietary fluoride supplements may be
prescribed by the dentist for children ages 6 months
to 16 years.
• NOTE: Toothpaste and mouth rinses: Toothpaste
and mouth rinses containing fluoride should not be
a source of systemic fluoride because with proper
use any excess is spit out and never swallowed.
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Fig. 15-6 Preventive dentistry
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Fig. 15-7 Fluoride rinse and fluoride dentifrice
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Fig. 15-8 Children must be carefully supervised while brushing
to avoid swallowing fluoride-containing toothpaste.
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Fig. 15-9 Training toothpaste for young children
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Fig. 15-10 Various chemotherapeutic products available to consumers.
(Courtesy Oral-B Laboratories.)
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Sources of Topical Fluoride
• Toothpaste containing fluoride is the primary
source of topical fluoride.
• Fluoride mouth rinses
– Prescription
– Nonprescription
• Brush-on fluoride gel
• Professional topical fluoride applications
• Fluoridated water
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Nutrition and Dental Caries
• Without dietary sugars, dental caries will not occur.
• Sucrose has a greater decay-causing potential than
other sugars, but maltose, lactose, glucose, fructose,
and their combinations do have high cariesproducing abilities.
• Flour and starches are not usually decay-causing,
but when starch is used in conjunction with sugar,
i.e., in cookies and so on, the potential for caries
increases.
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Sugar Substitutes
• Increasing use of less fermentable and
noncariogenic (caries-causing) artificial sweeteners.
• Artificial sweeteners are an alternative to sucrose:
– Saccharine (“Sweet and Low”)
– Aspartame (“Nutrasweet” and “Equal”)
– Sorbitol
– Xylitol
– Mannitol
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Sugar Substitutes-cont’d
• Of these sugar substitutes, saccharine, aspartame,
sorbitol and mannitol are noncariogenic—which
means that they do not cause dental caries,
• Xylitol is the only one of the artificial sweeteners that
actually prevents caries (anticariogenic).
• Products that contain xylitol are significantly better;
however, they are also more expensive than products
with other types of artificial sweeteners.
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Fig. 15-11 Ford “Extreme Xylitol” gum and “Sugarfree Dental Care”
gum containing xylitol and sorbitol
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Dietary Analysis
• A dietary analysis is done to determine the patient’s
current food intake to assess the need for dietary
counseling.
• The patient maintains a food diary that includes
everything consumed each day for 1 week.
• The listing includes all meals, supplements, gum,
snacks, and fluoridated water.
• It can then be used to reveal any dietary habits that
are likely to have an adverse effect on the patient’s
oral health.
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Plaque Control Program
• Plaque can be kept under control by brushing,
flossing, interdental cleaning aids, and
antimicrobial solutions.
• A goal of the program is to remove plaque at least
once daily.
• The techniques that are selected must be based
on the needs and abilities of the individual patient.
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Fig. 15-1 Disclosing solution shows heavy plaque
formation throughout the mouth.
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Oral Hygiene Aids and Methods
• There are a wide variety of oral hygiene products
on the market today.
• It is important for dental assistants to remain current
on the newest products on the market so that they
can advise patients, make recommendations, and
answer their questions.
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The Toothbrush
• The two basic types of toothbrushes are:
– Manual
– Automatic
• When used properly, both types are
effective in the removal of dental plaque.
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Fig. 15-12 Examples of manual toothbrushes
(From Daniel SJ and Harfst SA: Mosby’s dental hygiene: concepts, cases, and competencies, St. Louis, 2002, Mosby.)
Copyright © 2005 by Elsevier Inc. All rights reserved.
Fig. 15-13 The proper adaptation of the
brush head of a powered toothbrush
(From Daniel SJ, Harfst SA: Mosby’s dental hygiene: concepts, cases, and competencies, St. Louis, 2002, Mosby.)
Copyright © 2005 by Elsevier Inc. All rights reserved.
Toothbrushing Precautions
• The patient should be cautioned about damage that
may be caused by vigorously scrubbing the teeth
with any toothbrush.
• Over time this may cause abnormal abrasion (wear)
of the tooth structure, gingival recession, and
exposure of the root surface.
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Fig. 15-14 Observing toothbrushing technique
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Fig. 15-15 Improper brushing techniques can result in abrasion
of the tooth surface and can cause gingival recession.
(Courtesy Dr. Robert Meckstroth.)
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Toothbrushing Methods
• There are several methods of toothbrushing:
– Bass method
– Modified Bass
– Charter’s method
– Stillman method
– Fones method
• The dental professional will recommend the
method best suited to the patient’s needs.
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Dental Floss
• Dental floss or tape removes bacterial plaque
and thus reduces interproximal bleeding.
• Dental floss is circular in shape and dental tape
is flat.
• Floss and wax can be purchased in various
colors and flavors.
• Floss and tape are available in waxed or
unwaxed varieties.
• Research has shown that there is no difference
in the effectiveness of waxed or unwaxed floss
for plaque removal.
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Fig. 15-16 The dental assistant assists the patient in learning to floss.
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Interdental Aids
• End-tuft brushes
• Bridge cleaners
• Automatic flossers
• PerioAid
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Fig. 15-18 A and B, End-tuft toothbrush
for anterior and posterior teeth
A
B
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Fig. 15-19 Bridge cleaner and dental floss
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Fig. 15-20 Automatic flosser
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Fig. 15-21 PerioAid
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Fig. 15-22 Denture and denture brush
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Dentifrice (Toothpaste)
• Dentifrice (toothpaste) contains ingredients designed
to help remove food residue and abrasives to help
remove stain.
• Highly polished tooth surfaces will stain less readily
and remain clean longer.
• Most brands of toothpaste now contain fluoride. They
also contain flavoring agents to give the mouth a fresh
and clean feeling.
• Some toothpaste now contains a compound that
reduces calculus formation when it is used regularly
following a dental prophylaxis.
– It will not remove existing calculus.
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Fig. 15-23 Marketing toothpaste for children
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Fig. 15-24 Mouthrinses.
A, Two prerinses (left) and several non–alcohol-containing mouthrinses (right).
B, Familiar brands of mouthrinses containing alcohol ranging from 8% to 27%.
(Courtesy Dr. W.B. Stilley II, Brandon, Miss. From Daniel SJ, Harfst SA: Mosby’s dental hygiene concepts, cases, and competencies–2004 update, St. Louis, 2004, Mosby.)
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Fig. 15-25 Irrigator. Unit is shown with supragingival and marginal irrigation tips and two reservoirs.
The larger reservoir is on top of the unit and is designed for water. The smaller reservoir is designed
for chemotherapeutic agents (for example , chlorhexidine) and is tinted to reduce light degradation.
(Courtesy Waterpik Technologies, Fort Collins, Colo.)
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General Guidelines for Home Care Products
• The ADA Council on Dental Therapeutics conducts an
independent review of the scientific evidence of the
research claims and evaluation of home care products.
• When a product meets the appropriate standards, it is
given the ADA Seal of Acceptance. The ADA's Seal of
Acceptance provides a quality assurance guarantee for
consumers and professionals.
• Check the ADA's web site at http://www.ada.org to
receive current information on toothbrushes,
dentifrices, interproximal aids, and products for the
prevention of gingivitis and caries.
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Fig. 15-26 The American Dental Association’s Seal of Acceptance
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MouthRinses
• Many patients like the feeling of freshness provided
by a mouthrinse.
• There is a wide variety of mouthrinses on the market
today, and some also contain fluoride.
• Recovering alcoholics should select a mouthrinse
that does not contain alcohol.
• Rinsing the mouth with water is recommended after
meals and snacks when toothbrushing and
interdental cleaning are not possible.
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Irrigation Devices
• Oral irrigators deliver a pulsating stream of water
or chemical agent through a nozzle to the teeth and
gingiva.
• Oral irrigation can be applied at home by the patient
or in the dental office.
• Oral irrigation helps to keep the subgingival bacterial
levels at a minimum.
• For selected patients, oral irrigation can supplement
other oral hygiene techniques.
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