Prevention via plaque control and diet

Question 1

Understand the theoretical considerations of Plaque control in caries prevention

Answer 1

• There is an additive effect of brushing the teeth with fluoride toothpaste
• Individuals who either neglect mechanical removal and/or use of a fluoride toothpaste may not experience the maximum protection against dental caries
• Poor oral hygiene cannot be compensated for the intensive use of fluorides

Question 2

Understand the biological effect of plaque control

Answer 2

• A perfectly clean tooth free from bacteria is difficult to achieve
• Residual biofilm maintains the ability to elicit a moderate pH drop
• Plaque will often be retained in surface irregularities, areas that are difficult to reach: e.g. approximal surfaces

Question 3

Understand the clinical effect of plaque control

Answer 3

• Brushing is effective when it is supervised, done twice daily and 1500ppm Fluoride is used
• A 1 cm ribbon of 1000 ppm F = approx 0.8-1mg Fluoride: reduces caries incidence by 24%
• There is an additional 8% additional caries inhibiting effect per 1000 ppm increase in the F concentration
• A toothpaste called neutraflour has 5000 ppm F. A 1 cm ribbon of 5000 ppm F = 1mg Fluoride because the diameter of the nozzle has been reduced
• An additional 14% additional caries inhibiting effects per extra brushing occasion

Question 4

Understand the effect of professional intervention on plaque control

Answer 4

• Treatment of caries by restorative care alone does not reduce caries risk
• Successful caries control must include measures to reduce the bacterial challenge by either mechanical plaque control, or chemical control, or both
• Caries is treated by (1) home care; twice daily toothbrushing with fluoride toothpaste and care to reduce between-meal snaking on sugar-containing products and (2) non-invasive professional intervention.

Question 5

Understand and demonstrate understanding of the potential for controlling caries risk by reducing sugar exposure

Answer 5

• Risk of caries increases significantly with increasing levels of biofilm at all levels of sugar consumption
• When sugar consumption is high – biofilm removal can control the development and the progression of lesions
• Eating cheese following consumption of a sugary snack prevented the depression of plaque pH. • This research gave rise to the focus on the milk product casein and, subsequently, to the development of casein phospho-peptide amorphous calcium phosphate, CPP-ACP, as a remineralisation agent
Remember: sugar, critical pH, frequent snacking = demin

Question 6

Understand the interrelated risk factors associated with dental caries prevention

Answer 6

• Pathological factors: acid-producing bacteria, frequent eating/drinking of fermentable carbohydrates and sub-normal saliva flow and function
• Protective factors: saliva flow and its components, fluoride/ calcium and phosphate for remineralisation, antibacterials; chlorhexidine and xylitol