Transcript day diet
Caries prevention Caries prevention Reduce the numbers of cariogenic bacteria Preventive treatment methodes are designed to limit tooth demineralization caused by cariogenic bacteria • By limiting pathogen growth • Its metabolism • Increasing resistance of the tooth surface to demineralization Caries control • Are the operative methods used to : • stop the advance of individual lesions • prevent spread of pathogenic bacteria to other tooth surfaces • Cavitated lesions should be treated in short period of time • Fluoride treatment makes tooth surface more acid resistant, and in same circumstances can arrest active caries • Identify the patients with high caries risk • Consider the patient resistance to infection by cariogenic bacteria • Design appriopriate treatment plan • Reduce the numbers of cariogenic bacteria Identification of the patients with high caries risk Identification of the patients with high caries risk Identification of the patients with high caries risk Identification of the patients with high caries risk Identification of the patients with high caries risk Identification of the patients with high caries risk Patients resistance to the cariogenic bacteria The factors: • General health status • Function of immune system • Saliva production • Fluoride exposure history • • • • Diet Oral hygiene Use of antimicrobial agents Dental care General health status • Patients undergoing radiation or chemiotherapy treatment are immunocompromised • All patients with chronic illnesses, taking a lot of medications which idividually or in combination reduce salivary flow • Medications:Antispasmodic, antidepressants, antipsychotic, parkinsonian, arrhytmia medications, antihistamine, appetite depressants, anticonvusant, anxiolytic, antihypertensive, diuretic, skeletal muscle relaxants Patient with chronic diseases • • • • • • They shoud be examined for Plaque index ; for purpose of reducting high score Salivary flow; Oral mucosa; red glossy Gingiva; puffy, red Teeth with signs of demineralization Saliva production • • • • • Saliva is important in caries prevention Normal salivary flow is about 0.5-1 litre per day Stimulated salivary flow is about 1.0-3.0ml per minute Without stimulation is 0.25-0.35ml per minute Consultation with physician may be neccesery to identify alternate treatment with lower impact on salivary flow • Use of salivary stimulants:gums, paraffin waxes, saliva substitutes may be helpful diet • Dietary sucrose has two imporant effects on the plaque • 1.frequent ingestion of the sucrose provides stronger potential for coloniation by SM, enhancing the caries potential of plaque • 2. Mature plaque rapidly metabolizes the sucrose into the organic acids, which provide long pH drop • High frequency of ingested sucrose strongly stimulates the caries activity Xylitol gums • • • • • • • Xylitol is natural five-carbon sugar It keeps the sucrose molecule from binding with MS MS cannot metabolize xylitol Xylitol reduces MS by altering their metabolic pathways Enhences remineralization helps arrest caries It is recomended that patient chew a xylitol gum after eating or snacking for at least 5 minutes • Chewing stimulates salivary flow and enhances buffering of pH drop that occurs after eating Diet sheet • Dietary advice should be given based on a diet sheet • On that sheet the frequency of suger intake should be marked morning 8 am breakfast 9 am mid day meal 12 afternoon 14 pm Evening meal 18 Evening & night 21 Dietary modification • • • • Eat the sweets just at the end of the meal Have a sucrose brakes Have a sugerfree snacks Drink a lot of mineral water insted of drinking juices Oral hygiene • Plaque free surfaces do not decay • Daily removal of the plaque by brushing, flossing and rinsing is highly effective in caries prevention • Pits and fissures are not accessible becouse of the small diameter of their orifices, obturation of them by sealants is highly effective method • High-risk patients should perform plaque removal after every meal • Adults with low caries risk should remove the plaque twice a day Flossing • Persuade the patient that flossing should be the one of routine plaque control procedures • Handle the floss by winding it on the ring finger of the operating hand and ring finger of the other hand • Anchoring the ends by the second loop overlapping the first • The remaining lengh should be about 15 cm • The braced technique is necessary for passing the floss through contacts atraumatically • Each contact should be cleaned with fresh section of the floss Oral hygiene • Brushing with soft toothbrush with Bass method • The bristles are held at 45-degree angle to the tooth surface and vibrated into the gingival sulcus • Rinsing follows brushing and flossing fluoride • Increases the resistance of the tooth structure to demineralization • Reduces the caries activity • Is essential nutrient for humans that is required in small quantities Fluoride availability • Fluoridated community water systems, the most successful method • Diet • Toothpastes • Mouthrinses • Topical professional applications Fluoride doses • • • • • Optimal daily dose for fluoride ion is 1.5-2mg The food brings 0.2-0.5mg The water should have 1mgF\1litre so 1 part per milion The fluoride tablets contains 0.55mg ,0.25mg Zymafluor The indication for the fluoride systemic treatment is in children in regions where the fluoride contant in the water is below 0.7mg • for little children fluor drops are indicated Fluoride anticaries mechanisms • 1.Enhaces the precipitation into the tooth structure of the fluoroapatite from calcium and phosphate ions in saliva • Insoluble precipitate replaces soluble salts that were lost in demineralization process • The enamel becomes more acid resistant • Incipient caries non cavitated lesions become remineralized • 2. Antimicrobial activity:inhibition of enzymic production of glucosylotransferase • In high concentrations fluride is toxic to oral microorganisms:MS Best methods of fluoride application • Children with developing permanent teeth : • Systemic fluoride treatment through water supply • Dietary supplementation is indicated when water is not with fluoride • Semiannualy topical fluoride application • Adults at high caries risk also need semiannualy topical fluoride application Adults with high caries risk • Fluoride mouthrinses • Topical fuoride application • systemic fluoride treatment Fluoride mouthrinses • • • • High dose0.2%F\low frequency rinses used once a week Low dose0.05%F\high frequency rinese once a day Have similar effectiveness For patients who have high risk of caries & patients exibiting recently increase in caries activity Flouide varnishes • Provide high uptake of the fluoride ion into the enamel • Clinician applies a thin layer of the varnish directly on the teeth • Application time is several minutes • Patients are to avoid eating for several hours and than avoid brushing until next morning