Dietary advice for caries prevention

Question 1

What are the factors that cause caries?

Answer 1

Bacterial plaque, tooth surface, refined carbohydrates (NMES) and time.

Question 2

What are the stages in the development of caries?

Answer 2

Salivary pellicle formed (buffer), microorganisms colonise (large proportion of steptococcus, strep sanguis, strep oralis). In 1-14 days the streptococcus dominated plaque changes to actinomyces dominated plaque.

Question 3

What are the specific sites of a tooth at a higher risk of developing caries?

Answer 3

Pits and fissures of occlusal surfaces, approximal surfaces and margins of restorations.

Question 4

What is the characteristic surface of an early initial lesion?

Answer 4

Chalky

Question 5

What are extrinsic sugars?

Answer 5

Sugars added to food

Question 6

How many days should a diet sheet be used for?

Answer 6

4 days including the weekend

Question 7

Who is at high risk of caries?

Answer 7

Toddlers using bottles, reduced salivary flow patients, increased carbohydrate intake due to medical problem, recreational drug users, athletes taking sports drinks, those on liquid medications, those with language and cultural barriers, socially deprived.

Question 8

What would you do with a patient at high risk?

Answer 8

Plaque control and regular brushing with duraphat 2800-5000ppm toothpaste. Diet advice to modify cariogenic food, use of fluorides and fissure sealants, regular radiographs. Monitor and review, plaque scores, OHI, topical fluoride, family history, fissure sealants, PRR’s, restore cracked restorations and chairside instruction.

Question 9

What is the dietary advice for children?

Answer 9

Confectionary at meal times, milk and water in a feeder cup, reduce soft drinks at meal times, use straw, do not use honey jam or comforter and do not give any sugary sweetened drinks at bedtime.

Question 10

What should the frequency of sugar be?

Answer 10

4 times a day at meal times with non sugar sweeteners and non cariogenic snacks where possible.

Question 11

Tooth brushing advice

Answer 11

Use interdental brushes before brushing, F toothpaste 1450ppm, chlorhexidine and fluoride rinses if needs be.

Question 12

Bitewing radiograph intervals according to risk groups

Answer 12

Low - every 2 years, mod - every 1 year, high - 2x a year

Question 13

What is the brushing advice for children under 3?

Answer 13

Smear of toothpaste no less than 1000ppm, parents should brush their teeth up to 7 years old. Sugar should not be consumed over 4 times a day.

Question 14

Brushing advice for 3-6 year olds?

Answer 14

Pea sized amount of toothpaste at 1350ppm-1500ppm. Fluoride varnish 2.2% applied every 3-6 months if siblings have history of caries.