Plaque control and dental caries

Question 1

What sites are caries most common?

Answer 1

1) Fissure
2) Proximal surfaces
3) Lingual and smooth surfaces
4) Margins of restorations

Question 2

How does toothbrushing effect caries rates?

Answer 2

Toothbrushing without fluoride does not appear to be effective in reducing caries
Evidence supporting toothbrushing independent of fluoride effects is lacking
Toothbrishing WITH fluoridated toothpaste DOES reduce caries rates

Question 3

Why is toothbrushing ineffective without fluoride?

Answer 3

Bristles do not reach the major caries-prone sites

Question 4

How often should brushing occur?

Answer 4

Twice a day is more effective than once a day lowers caries incidence
Plaque removal every other day is sufficient to prevent gingivitis

Question 5

When should you brush?

Answer 5

Some evidence that fluoride before meals reduces acid production
Brushing before bed provides long-term fluoride benefits
Advise patients to brush before bed and then some other time throughout the day

Question 6

How much toothpaste should be used?

Answer 6

Amount doesn’t matter

Higher concentrations of fluoride is more effective

Question 7

How does rinsing behavior effect caries?

Answer 7

Volume of water and vigor of rinsing both affect caries experience
Advise patients to rinse minimmally

Question 8

At what age should patients start brushing?

Answer 8

Earlier commencement of brushing (before the age of 1) seems to correlate with lower caries experience
Get a flavor kids will like

Question 9

What type of manual toothbrush is the best?

Answer 9

• Toothbrushes with filaments arranged at different heights and angles have been demonstrated to be significantly more effective in plaque removal and reducing gingivitis
• No data on caries

Question 10

Are powered toothbrushes better than manual?

Answer 10

Powered toothbrushes with a rotation oscillation action reduce plaque and gingivitis more than manual toothbrushing

Question 11

What kind of powered toothbrushes are the best?

Answer 11

The action of oscillating/rotating/pulsating toothbrushes (Oral-B and Sonicare) have been found to be the most effective

Question 12

What is the most effective method to brush?

Answer 12

Studies indicate that no method is superior
Patients rarely exceed 60 sec (that’s not good)
Emphasize to patients the need to reach all surfaces

Question 13

What effect does flossing have on caries rated?

Answer 13

Interproximal flossing by trained assistants reduced incidence of proximal caries by 40%
Daily home flossing has no effect
This is probably due to technique and/or frequency

Question 14

How often do prophylaxis’ need to occur to have an effect on caries rates?

Answer 14

Every two weeks (semi-annual has no effect)
There is little evidence to support that Professional Mechanical Plaque removal without Oral Hygiene instruction is valuble

Question 15

What is the optimum frequency of Profesisonal Mechanical Plaque Removal?

Answer 15

Not been investigated

Question 16

Why can’t antibiotics be used to prevent caries?

Answer 16

Resistance will develop

Beneficial species will be eliminated

Question 17

What agent is more effective than Fluoride?

Answer 17

Nothing (some are effective against gingivitis - but nothing compares when it comes to caries)

Question 18

T/F - Rinses are effective against subgingival problems such as periodontitis

Answer 18

False - rinses don’t enter the sulcus

Question 19

Chlorohexidine

Answer 19

Available as a rinse or varnish
Adds little to the effects of fluoride
-no good evidence for reduction of caries increment
Side effects include
-staining
-calculus
-taste alteration
-tissue irritation

Question 20

Casein phosphopeptide

Answer 20

Milk proteins bound to amorphous calcium phosphate
Binds to plaque
Supplies calcium and phosphate during acid attack
Some evidence for efficacy in toothpaste and food

Question 21

Quaternary ammonium compounds (such as cetyl pyridiunium chloride)

Answer 21

May reduce plaque

Their effectiveness in preventing caries has not been studied

Question 22

Triclosan

Answer 22

Found in Colgate tooth paste
Toothpastes with triclosan and fluoride are slightly more effective against root caries than fluoride alone
Effective against gingivitis
Might be carcinogenic

Question 23

Essential oils

Answer 23

Thymol, Eucalyptol, Methyl salicylate, menthol
Effective against gingivitis
Some evidence for protection against caries

Question 24

Prebrushing rinses

Answer 24

Not any more effective than a placebo

Question 25

Sanguinarine (herbal remedy)

Answer 25

May reduce plaque

Not considered safe - causes precancerous lesions

Question 26

What are some agents currently under research?

Answer 26

Natural products such as berry and herbal extracts made by other microbes
Targeted antimicrobial peptides (to kill only S. mutans)
Non-acidogenic replacement strains of S. mutans
“Keep 32”