Non fluoride preventative modalities

Question 1

Which % of 5 y/o have 50% of disease?

Answer 1

9%

Question 2

Which % of 14 y/o have 50% of disease?

Answer 2

6%

Question 3

Which % of 5 y/o have obvious decay with dmft of 3.0?

Answer 3

31%

Question 4

What are the 6 non fluoride preventative modalities?

Answer 4

• Diet modification
• Fissure sealants
• Oral hygiene and dental health education
• Sugar free medicines
• Chewing gums
• Chlorhexidine

Question 5

Which type of sugar is worse for your teeth, intrinsic or extrinsic?

Answer 5

Extrinsic sugars

Question 6

What did the COMA report in 1989 show?

Answer 6

That caries is related to the frequency and amount of non milk extrinsic sugar consumption (therefore we should decrease this and replace with fruit, veg and starch)

Question 7

What are the different classifications for sugars?

Answer 7

Intrinsic sugars

Extrinsic sugars -> Non milk extrinsic sugars and milk sugars

Question 8

What are intrinsic sugars?

Answer 8

Sugars inside the cell already e.g. raw fruit = natural

Question 9

What are extrinsic sugars?

Answer 9

Not inside the cell e.g. added to the food

Question 10

Which type of sugars are the worst?

Answer 10

Non milk extrinsic sugars

Question 11

Name some non milk extrinsic sugars:

Answer 11

Fruit juice, pulps, puree and honey
Recipe sugar = added by cook or manufacturer
Table sugar = discretionary

Question 12

What was the hope wood house study?

Answer 12

No sugar in diet, oral hygiene not great but no caries

lower caries than state schools but still huge increase age 15 when left house, but still lower than state schools

Question 13

What was the vipenholm study?

Answer 13

A mental institution
= divided into 3 groups:
- original diet w/ 300g sugar in drink (least cariogenic)
- original diet w/ 50 g sugar in bread
- in between meal given sugary toffee and candy (most cariogenic)

Question 14

What did the hope wood house study and vipenholm study show us?

Answer 14

• Restrict sugar intake to

Question 15

Why is selection of non cariogenic food difficult?

Answer 15

• Sugar content labelling is not always clear
• Access to healthy foods difficult in socially deprived areas
• sugar industry spends more time marketing and advertising that the government has to spend on the provision of dental health in children
• few families stick to 3 x meals daily, tend to graze
• school tuck shops tempting
• not everyone can/will cook

Question 16

What is advised by delivering better oral health?

Answer 16

• frequency of consumption of sugar = caries
• diet advice important for all = should reinforce at every recall visit
• limit sugar intake to max 4 x daily
• sugars should be

Question 17

How long should we get them to do the diet diary for?

Answer 17

3 days (weekend + other day)
or 24 hour recall

Question 18

What do we look at when analysing the diet diary?

Answer 18

Amount of sugar intake
Frequency of sugar intake
Frequency of snacking
How food and drink are consumed

Question 19

When reviewing the diet diary what is it important to remember?

Answer 19

That they may not be accurate
Ask the pt/parent to identify problems
Offer alternative non cariogenic foods (must fit with family style)

Question 20

What are the different types of fissure sealant?

Answer 20

Resin
Compomer
GIC
Fluoride containing
Opaque/clear

Question 21

What did the cochrane review say about fissure sealants?

Answer 21

= 78% less occlusal caries if fissure sealed (2 yrs) and 60% less (4-4.5 y/o)
= some evidence (Hirri 2000) that pit and fissure sealants are superior to fluoride varnishes in preventing occlusal caries

Question 22

What is a fissure sealant?

Answer 22

A flowable resin or GIC placed in the pits and fissures of teeth to prevent the development of caries (cochrane approved)

Question 23

How do we select a patient for fissure sealant?

Answer 23

Children and young people with impairments and caries in primary teeth

Question 24

How do we select a tooth for a fissure sealant?

Answer 24

Deep fissures (susceptible to caries and sufficiently erupted for good moisture control)
If occlusal caries affects 1 6 fissure seal the other 6’s
Only really fissure seal permanent teeth (but sometimes posterior teeth of high risk children)

Question 25

Which teeth do we fissure seal?

Answer 25

Molars and premolars & palatal pits of lateral incisors

Question 26

What do we do for defective sealants?

Answer 26

Replace them

Question 27

What do we need to do once a sealant is placed?

Answer 27

Regular monitoring clinically and radiographically

Question 28

Whats the technique for placing a fissure sealant?

Answer 28

1. investigate (radiographically or with probe) stained fissure and isolate tooth
2. Etch (30-40% phosphoric acid for 20-40s)
3. wash and dry tooth
4. place fissure sealant
5. cure for 20 seconds

Question 29

When should oral hygiene and dental health education be carried out?

Answer 29

Should be taught to all ages

Question 30

Educate parents…

Answer 30

Start brushing teeth from 6 months when start eating food

Question 31

What is the scientific evidence for toothbrushing?

Answer 31

Little scientific evidence showing toothbrushing presents caries (inevitably leaves plaque inn fissures and stagnation areas = caries) BUT use of fluoride toothpaste with toothbrush = obvious benefit

Question 32

What is the advice on sugar free medicines?

Answer 32

Should prescribe sugar free medicines wherever possible, and recommend the use of sugar free non prescription medicines

Question 33

What is the advice r.e. chewing gum?

Answer 33

Encourage the use of sugar free = xylitol and sorbitol have anti-caries properties -> xylitol is more effective (finland study shows substitution for sugar decreased caries)

Question 34

When should chlorhexidine be used?

Answer 34

Prophylaxis = rinse, gel or paste = average decrease in caries by 46% (varnish also an option for prevention)