Wuhan University

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Wuhan University
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Caries Prevention

• School of Stomatology,
• Wuhan University
• Jiang Han

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Caries definition infectious, transmissible
diseaseclinical features of caries colour,
shape, structureharm of caries loss of tooth
structure, pain, tooth loss, acute systemic
infection
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Etiology of dental caries

• ? Chemico-parasitic theory1889 Miller
• ? Proteolytic theory1947 Gottlieb
• ? Proteolysis-chelation theory1955 Schatz
• ? Amylon theory1959 Egydi sugar intake? ?,the
  Amylon in the tooth tissue ?

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Etiology of Dental Caries
The theory of four factors
Microbial
Host Caries
Diet
Time
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Risk factors of dental caries
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Cariogenic bacteria in human

• Streptoccus mutans group
• FirstS.mutans SecondS.sobrinus
• Lactobacillus
• L.casei L.acidphilus
• Actinomyces
• A.naoslundii genspecies
• others

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Cariogenic bacteria

• ? Mutans Streptococci
• G ??,????,?????????????????,???,???
  ????
• ?????????????????????a- h ?????

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the golden marker of Mutans Streptococci by
Colloid
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• ? ?????(Actiomycetes)
  G ?,
  ????????????, ? ? ??????????????????????
• ?????(A.Viscosus)
  ????? (A.Naselundilli)
  ????? ( A. Iseral)
  ?????(
  A.Odontolyticus)

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• ?????( lactobacilli )
• G ??,???????30????????????
• ??????,??????????

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The virulence effect of the cariogenic bacteria

• ? Adhere
• ? Acidogenic
• ? Aciduric

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Dental plaque

• ? Dental plaque in the smooth surface
• ? Dental plaque in the pit and fissure surface

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Diet
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Sugar and caries

• ? Types of sugar and caries
• Monosaccharide Glucose?Fructose? Galactose
• Disaccharide Sucrose?Maltose?Lactose
• Polysaccharide Starch
• ? Power of cariogenic Sucrosegt Glucosegt
  Maltose?Lactose?Fructose gt Starch

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• ?viscosity of eating sugar and caries
• ? Way of eating sugar and caries
• ? Frequency of eating sugar and caries

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Host
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Teeth

• ? Anatomic form pit and fissure
• ? Tissue of tooth enamelaplasia
• ? Alignment malocclusion

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Factors from physician

• Secondary caries??
• Crown
• Orthodontic treatment
• Pit and fissure sealant

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Pathological factor

• Exposed root
• Attrition
• Turner teeth

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Saliva

• ?Component Organics?Inorganics
• ? Flow rate Xerostomia
• ? Buffer capacity HCO3-/H2CO3,HPO42/H2PO4
• ? MineralizationpH?, Demineralization pH?,
  Remineralization

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Demineralization, Remineralization
recently cleaned front teeth with signs of
demineralization and gingivitis
after some weeks remineralization has taken
place and the gingivitis is healed
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Socio-behavioural risk factor

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Question 1
Which of the following statement, if any, are
correct?

• 1. Usually dental plaques exhibit uniform
  structures composition, and properties.
• 2. It usually takes several days before the
  acquired pellicle is reformed after a
  prophylaxis.
• 3. Plaque is found only on the smooth surfaces
  of the enamel.

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Question 2
Which of the following statement, if any, are
correct?

• 1. Plaque removal requires instrumentation by
  a dentist or a dental hygienist.
• 2. The critical PH for enamel demineralization
  ranges between 6.0 to 5.5.
• 3. Salivary glycoproteins are a major source
  of organic materials in the acquired pellicle.
• 4. Refined carbohydrates alone provide
  sufficient nutrition for cariogenic bacteria.

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Caries Activity Test

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• ? ??????????????????????????

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Caries Activity Test of oral bacteria

• Count of Lactobacillus Hardly, 1933
• ? ????????????????,????????????????????(Rogosa),3
  7 ?, ??3?,??????

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Count of Lactobacillus

• _________________________________
• Lactobacillus/ ml
  caries activity
• 0 100
  low or normal
• 1,000
  mild
• 10,000
  moderate
• 100,000
  high
• _________________________________

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Count of Streptococcus mutans

• ????? ?1 ml ??,??????????????????MSB,37
  ????2-3?,?????
• CFU / ML ?? ?????
  
• lt 104
  ?
• 5 104
  ?
• 105
  ?
• 2.5 106
  ?

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Count of Streptococcus mutans

• MSBB
• Dentocult SM test
• Resazarin disc test
• PCR

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Caries Activity Test of saliva

• Salivary flow rate (?????? )
• Volume 1-3ml 5-minute period.
• unstimulated saliva 0.1ml/min, abnormal
  0.05ml/min extremely low
• stimulated saliva 0.7 ml/min abnormal 0.5
  ml/min extremely low

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• Salivary viscosity (?????? )
• If the saliva appears to have a ropy
  appearance, high salivary viscosity should be
  suspected, especially when the stimulated flow
  rate is low.
• Salivary viscosity ----water?
• Method 5 ml water and salivary
  viscosity,
• Relative viscosity (RV) time required for
  the saliva/time required for the water
• normal viscosity 1.5

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• Salivary buffer capacity (???????? )
  
• The buffering capacity of saliva and flow
  rate
• The buffering capacity of saliva and inverse
  relationship to caries
• Level low, intermediate and high-buffer
  capacity
• Dentobuff system
• Dentobuff PH

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Acid production capacity(????????)

• Synder test
• ???????????????????, ????PH???(PH
  5.0),???????????????????
• ?? ?????????????0.2ml,
  ??Synder??,??,???????
• 24 h
  48h 72h
• ? ? ? ? ? ?
  ? ?
• ????? ?? ?? ?? ?? ? ?

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Tooth sensibility examination

• ? Visual examination
• ? Enamel biopsy
• ? Intraoral cariogenicity test, ICT
• ? Electrical resistance

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???????????
?? ?? ?? ?? ???? ???? CFU/ml ????? CFU/ml ???? ml/mi ????
??? ???,?????? ? ? lt104 lt 104 2-3 ?
???? ??????,???? ? ????? gt3 105 104 lt0.7 ?
???? ???,???? ?? ?????? ???? gt 106 gt 105 lt 0.7 ?
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Question 4
Which of the following statement, if any, are
correct?

• 1. Caries activity tests are indicative of a
  patients
• vulnerability at the time of the test.
• 2. A risk assessment strategy is most
  important in
• communities with high caries prevalence.
• 3. A valid test can be both accurate and
  reliable.

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Question 5
Which of the following statement, if any, are
correct?

• 1. A useful caries predicator should have a
  strong and stable association to caries
  prevalence.
• 2. Caries risk assessment for the individual
  
• gather data from case history, clinical
  examination, and laboratory tests.

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Mothod of caries prevention
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Primary Preventive Dentistry. 5th ed
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Dental Caries

• ? Primary Prevention prevent, arrest , reverse
  fluoridation US0.5 sealants 35
• ? Secondary Prevention terminate disease
  process, restore tissues. US50,
• ? Tertiary Prevention replace lost tissue,
  rehabilitate patients US500,

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Question 6
Which of the following statement, if any, are
correct?

• 1. An amalgam restoration that is placed in a
  carious occlusal pit of a molar is an excellent
  example of tertiary prevention.
• 2. The avoidance of an etiologic factor for a
  specific disease is an example of primary
  prevention.
• 3. Preventive dentistry, in its broadest sense,
  embodies primary, secondary and tertiary
  prevention.

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Plaque Control
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Mechanical Plaque Removal

• ? Tooth brushing
• ? Mouth rinsing
• ? Dental floss
• ? Interdental brush
• ? Toothpick

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Chemotherapeutic Method

• Chlorhexidine
• Triclosan

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Chlorhexidine

• ? ???(Hibitine) ????????????????,?G,G- ????????
• ? ??????????????,??????????,??????,????????????
• ? ?????,??,????
• ? ?????,????????

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• A two-year clinical trial of chlorhexidine
  varnish on dental caries in Chinese preschool
  children.
• Published in Journal of Dental Research in
  2006

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• ABSTRACT
• Objective To assess the effect of six- monthly
  professional applications of chlorhexidine
  varnish on prevention of dental caries in the
  primary dentition in Chinese preschool children.
• Material and MethodsIn a double-blinded,
  randomised, placebo- controlled clinical trial,
  334 children aged 4-5 years were randomly divided
  into two groups. Children in the test group
  received six-monthly chlorhexidine varnish
  applications in the kindergarten and the control
  group children received a placebo varnish. Caries
  status of the children were assessed by two
  calibrated examiners at baseline and after 24
  months according to criteria recommended by the
  World Health Organization.
• ResultsThe 2- year mean caries increments in the
  test and the control group children were 1.0 and
  1.6 dmfs respectively, a 38 reduction (t- test,
  p0.036).
• Conclusion It was concluded that six-monthly
  applications of chlorhexidine varnish was
  effective in reducing the incidence of dental
  caries in primary teeth.

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• ? ???????? Traditional Chinese Medicine
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Healthy diet habitCleaning and Protective
foods
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Sugar Substitutes

• ? ?????
• ? ?????
• ? ?????
• ? ???????
• ? ????

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• caloric sweeteners
• Xylitol chewing gum
• Sorbitol
• Mannitol

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• Noncaloric sweeteners
• 
  
• Stevia sugar 200-300
• Saccharin 300-500
• Aspartame 200, 75 countries using
  
• Acesulfam-K 200

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Diet Counselling

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  ????????,????????,??,?????????,???????????????????
  
• ? ????????????,??????????,????????????????????????
  ??,????????,??,????????????????

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  ????????,???????????
• ????????????????,?????????

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  ,???????,??,???????????
• ???,?????????????????????????????????????,???????
  ???????????????????,?????,???????????????

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  ,??????????????????????
• ?????????????????,???????????????????,?????????,?
  ??????????????,?????????????????????,????????????
  ????????????

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  ?????
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  ,??????????????,????????????

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Strengthening host ability to Anti-caries
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1 Strengthening teeth ability to Anti-caries

• ? Fluoride
• ? Pit and fissure sealant
• ? Laser against dental caries
• 2 Strengthening bodies ability to Anti-caries
  Immunization against dental caries

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????

• ? ?? ?????????????????,????????????,???????
• ? ?? ??????CO2???Nd-YAG??

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?? Strengthening host ability to Anti-caries
vaccine of preventing caries

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• 1?????
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• 2?????
• ??? ?? ?? ??(Ab)??

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• 1?????? ?????
• 2??????? ????????????????????
• ? ??????
• 1?McAb?????????
• 2?S.mutans?McAb?????
• 3? S.mutans?McAb??,?????????????????????

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Replacement therapy

• ????????????????????????,???????????

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Five measures of anti-caries

1. Plaque control
2. Using Fluoride
3. Controlling consumption of Sugar
4. Pit and fissure sealants
5. Oral health education and promotion

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Question 7
Which of the following statement, if any, are
correct?

• 1. Xylitol is the best nutritive sucrose
  substitute with respect to caries prevention.
• 2. The development of dental caries depends on
  four essential factors 1) diet, 2) inherent
  factors of host resistance, 3) bacteria, and 4)
  time.

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Question 8
Which of the following statement, if any, are
correct?

• 1. Sweetness is related to cariogenticity.
• 2. The five general areas that form the basis
  for primary prevention of dental diseases are 1)
  plaque control, 2) fluorides, 3) sealants, 4)
  restorations and 5)education and patient
  compliance.