Tuesday 11 April 2017

Strategies for Caries Prevention

                                     http://mathewsopenaccess.com/dentistry-current-issue.html



Prevention of the carious diseases constitutes the preliminary step of caries therapies. It takes place prior any clinical intervention on dental tissues. Preventive options are divided into primary (pit and fissure sealants, and topically applied fluorides including toothpastes and varnishes), secondary and tertiary prevention, involving the patient and professionally. Prevention implies a clear understanding of the characteristics of enamel disorders. It includes the identification of acidproducing bacteria, diet-counseling comprising a long list of fermentable carbohydrates, and host factors, involving teeth and saliva as well. During the last 30 years, 70 per cent of children aged 5 to 11 years were caries-free, whereas 70 per cent of the 12-17 yearold still had caries. Prevention suggests also an effective role for enamel remineralization. In this context, fluorides play role as key factors for caries treatments. Initial carious lesions of dental enamel may be identified even they may be undetectable. Dental caries processes consists in a bacterial film that produces acids as a byproduct of its metabolism. 

The acidsdiffuse through the whole thickness of the dental plaque. Modern methods allow identifying the initial carious decay. For years, following Black’s classification, mechanical rules were applied to teeth preparations. Small area of subsurface demineralization occurs beneath the dental plaque. Drilling creates large cavities prepared according to geometrical requirements. This is required imperatively for the stabilization of the cavity, prophylactic extension, and preparation of horizontal or vertical walls. Mutans streptococci, S. sobrinus and lactobacilli produce lactic acid and appear in plaque before any caries could be clinically observed. Recent spectacular evolutions of dental materials, namely the adhesive properties of resins and glass ionomers, have modified the general concept. As a consequence, this is leading to Minimal Intervention Dentistry. However, different available concepts are determining the rules of Minimal Adhesive Restorations or what is sustaining the preventive concepts implicated in carious diseases.

 Bacteria are responsible for acid production of dental caries. Dietary fermentable carbohydrates contribute to the dissolution of enamel hydroxyapatite. Due to fluoride intake or to crystal remineralization, the prevention or development of dental caries constitutes a major step for dental caries prevention. Since the pioneer work of GV Black on operative dentistry, carious lesions are anatomically classified in five classes. The shape and preparation of cavities are related to the anatomical localization of the lesion. Class I concerns exclusively occlusal fissures. Class II develops in the proximal aspects of molars and involves also the occlusal surfaces. Class III affects the proximal surfaces of incisors and canine. Class IV is a mixture of the two previous classes in single-rooted teeth. Cervical lesions, identified as Class V are developing in the collar of teeth, at the junction between enamel, cementum and dentin. 

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