Prevention in Restorative Dentistry

Question 1

Describe “Prevention v Cure” approaches to healthcare

Answer 1

• Greater emphasis on prevention and reduction of inequalities
• Giving advice, provision of support to change behaviour and evidence informed actions
• Advice and support given to all patients

Question 2

What are 3 pillars of prevention in dentistry?

Answer 2

1. Oral hygeine instruction
2. Diet
3. Fluoride

Question 3

Describe 5 components of toothbrushing advice for all adult patients

Answer 3

1. Regular toothbrushing with fluoride toothpaste
2. Start as soon as first primary tooth erupts
3. Twice daily as a minimum, at least once before bed for two minutes each time
4. Spit and don’t rinse
5. Brushing with small headed toothbrush with medium texture bristles

Question 4

What may be used to give the patient a visual aid for toothbrushing?

Answer 4

Disclosing tablets to highlight areas where plaque is left

Question 5

Describe fluoride’s role in preventative dentistry

Answer 5

• Reduces caries levels in individuals and communities
• Works topically
• Higher concentrations should be balanced with risk of fluorosis

Question 6

What type of patient would be of higher concern to suffer from fluorosis?

Answer 6

Children as their teeth are still developing

Question 7

Name 4 vehicles of fluoride delivery

Answer 7

1. Water / milk fluoridation
2. Fluoride toothpaste
3. Fluoride varnishes / rinses
4. Fluoride tablets

Question 8

Why are fluoride tablets not used often as a vehicle of fluoride delivery?

Answer 8

They have a high association with fluorosis

Question 9

What is the recommended amount of fluoride in toothpaste?

Answer 9

> 1000ppm (usually 1450ppm)

Question 10

Why may fluoride varnish be used?

Answer 10

• Two or more applications a year reduce caries by around 40%
• Can arrest existing lesions
• Sodium fluoride 22,600ppm varnish used

Question 11

Describe 2 contraindications of duraphat varnish

Answer 11

1. Stomatitis

2. Ulcerative colitis

Question 12

What are 2 strengths of prescription only high fluoride concentration toothpastes?

Answer 12

1. 2800ppm

2. 5000ppm

Question 13

What 3 types of patients may have 2800ppm high fluoride toothpaste prescribed?

Answer 13

1. High caries risk patients aged 10+
2. Patient with caries and ortho appliances
3. Patients with cariogenic diet or medication

Question 14

What 4 types of patients may have 5000ppm high fluoride toothpaste prescribed?

Answer 14

1. High caries risk patients aged 16+
2. Present or potential root caries
3. Patients with caries and ortho appliances or overdentures
4. Patients with cariogenic diet / medication

Question 15

Describe the uses of fluoride rinses

Answer 15

• Must be over age 8 and have ability to spit
• Rinse for 1 minute and spit out
• Used in conjunction with brushing at different time of day
• Concentration of 225ppm

Question 16

Why is it important to spit out fluoride rinse?

Answer 16

Ingestion leads to increased risk of fluorosis

Question 17

Name 3 components of diet advice provided to patients in preventative dentistry

Answer 17

1. Avoid sugar containing foods at bedtime
2. Eat a range of foods in line with Eatwell Guide
3. Reduce amount and frequency of consuming food and drinks with high sugar content

Question 18

Describe 3 pieces of information which may help to assess overall pattern of patient’s eating

Answer 18

1. Number of intakes of food and drinks per day
2. Number of intakes which consume free sugars and how many consumed between meals
3. Any intakes containing sugar where within one hour of bedtime

Question 19

What is a useful tool to gain an overall picture of someone’s diet?

Answer 19

Diet diary

Question 20

Describe what should be recorded in a diet diary

Answer 20

• Recorded for 3 days including one weekend and two week days
• Include what time going to bed
• Quantities of food taken at which time

Question 21

What is a caries risk assessment?

Answer 21

Assessment of probability of carious lesions developing

Question 22

What are 3 advantages of caries risk assessments?

Answer 22

1. Allows understanding of why patient has disease activity
2. Enables creation of personalised caries management plan
3. Helps patients engage and understand

Question 23

Describe 4 components of prevention of caries given to adult patients with high risk of caries

Answer 23

1. Apply fluoride varnish twice yearly
2. Prescribe fluoride rinses for those with active caries
3. Prescription of high fluoride toothpaste for active caries
4. Investigate diet

Question 24

What is tooth wear?

Answer 24

Loss of tooth structure involving mechanical and chemical factors leading to attrition, abrasion and erosion

Question 25

What is mechanical wear?

Answer 25

Involved physical contact with another material or object such as brush or an opposing surface leading to attrition or abrasion

Question 26

What is erosion of teeth?

Answer 26

Chemical loss of hard tissue through exposure to acids which are of non-bacteria origins

Question 27

Name 3 professional actions for high risk tooth wear patients

Answer 27

1. Diet advice - Avoid intake of acidic food / drinks
2. OHI and Fluoride
3. Facilitate patients in seeking medical assistance for GORD or eating disorders

Question 27

Name 3 professional actions for high risk tooth wear patients

Answer 27

1. Diet advice - Avoid intake of acidic food / drinks
2. OHI and Fluoride
3. Facilitate patients in seeking medical assistance for GORD or eating disorders