Preventive Dentistry and Early Caries Detection
Conventional and recent ways in caries prevention and detection
Published on: Mar 4, 2016
Transcripts - Preventive Dentistry and Early Caries Detection
& Early Caries
Presented By : -Ghida Lawand
Methods to reduce
Methods to increase
Conventional Prevention of Dental caries
improve flow and
quantity of saliva
tooth surface or
Use of pit
Methods to reduce demineralizing factors
1) Dietary Measures
A) Provide substitutions for cariogenic foods
consumed by the patient ,mainly the ones
containing fibers such as raw fruits and vegetables
Intake of raw fruits
Removal of food debris
phosphates, phytates and
They do not stick to teeth
the frequency of
2) Methods to improve the oral hygiene:
A) Tooth brushing:
Most reliable means of controlling plaque and providing clean tooth
A Keep the bristles in gingival sulcus at 45 to the
long axis of the tooth
B Brushing on palatal surface
C Brushing on posterior
B) Interdental cleaning:
(Used with normal proximal contacts)
Methods to increase protective factors
1) Methods to Improve Flow and Quantity of Saliva
Saliva plays a major role in prevention of caries. Increasing the
salivary flow rate and its buffering capacity play an important role
1) Prescription of salivary stimulants
like (pilocarpine - cevimeline)
considered useful in case of patients
having Xerostomia (dry tongue) with
functional salivary glands.
This can be done by:
2 teaspoons of
8 oz of water
2) Baking soda helps in neutralizing the acids and this is
why it must be used with patients who have low salivary
2) Chemicals altering the tooth surface or tooth structure
Fluoride can reach the enamel in two ways:
Through blood supply of
Through direct contact of
fluoride on teeth surfaces
Examples: fluoride drops,
tablets, or treated water
Examples: dentifrice, mouth
B) Antimicrobial agents
2) Xylitol and soduim hypochrite :
1. Enhances the remineralization process
2. Decreases streptococcus mutans presence
1) Non fermentable
2) Non cariogenic sugar
3) Anti-caries effects (reduces: plaque formation, bacterial
Xylitol is recommended for pregnant
mothers. Studies showed that when the
mother chews xylitol gums during her
pregnancy, lower caries formation is
detected in her child.
1. Has anti cariogenic properties
2. Releases calcium and phosphate ions to convert to apatite
enhancing remineralization of the tooth structure.
3. Enhances the stability of the pH of saliva and reduces the
sensitivity of teeth.
3) Amorphous calcium phosphate (ACP)
A supersaturation of saliva with ACP is achieved by the addition
of a protein called Casein phosphopeptide (CCP).
After eating, it is recommended to chew xylitol or ACP
containing gums ,lozenges, and topical solutions to reduce
the acidogenecity of plaque, and increase salivary flow.
3) Use of Pit and fissure sealants
Material applied to the pits and fissures of teeth to prevent or arrest
caries that may continue to develop.
Advantages of pit and fissure sealants
Seals pits and fissures making them more resistant to food impaction
Make pits and fissures self-cleansable
Arrest incipient carious lesion
1.Bonded to enamel
by acid etching
Types of sealants
1.Bond chemically to dentin
and enamel along with active
fluoride release into the
2.Can’t be used when moisture
control is difficult
Resin sealant placement technique
Tooth preparation Etching of the prepared
Cleaning and drying the
Application of the resin sealant Light curing of the sealant
Genetically modified food
Current Methods in caries prevention
What is the aim of it?
The aim is to prevent tooth decay by modifying food
How is this modification done?
Incorporation of antagonist peptides in food that work against
glycosol transferase (catalyze to form glycoside caries)
To Whom are they important?
Patients with ‘high caries risk’
1) Genetically Modified Foods
• Vaccine is an immunological material created to form a
specific protection against a given disease.
• It stimulates production of protective antibody and other
No commercial vaccine was made till now
Streptococcus mutans is the main causative agent of human
dental caries vaccines should be derived from it
Immunizing Sreptococcus mutans tempts to do an
immune response stops organisms from settling on the
tooth surface stops carious deterioration.
• Vaccine should be given prior to the eruption of primary
2) Caries vaccine
Problems in development of caries vaccine
1. Caries etiology is still not completely known so the effectiveness
of this vaccine is not ultimate.
1. Cross reactivity of Streptococcus mutans cell antigens is found in
the muscles of the heart.
Early Caries detection Tools
a) Fiber optic trans
b) Digital imaging FOTI
• If the probe sticks in its place, roughness in the surface and a lesion
may be possible.
• Advanced smooth surface caries and root caries feels soft upon
penetration of the probe.
1. Pits and fissure caries are examined tactilely as
softness, but mechanical binding of an explorer in
the pits or fissures may be due to noncarious
causes (shape of the fissure, sharpness of the
explorer, force of application…)
3. Not effective for interproximal
detection of caries
2. Transfer of cariogenic bacteria
from the tip of the probe to other
uninfected pits and fissures
Early caries lesion
Cavitated carious lesion
Conventional Methods of Radiography
• Estimation of the proximal tooth surfaces before they
are detected clinically.
• Detect incipient lesions at contacts of the teeth.
Radiographic methods of diagnosis
Digital imaging uses the
technique where the film is
used in recording the image
and then final image is
exposed to digital
processing to harvest the
Recent Methods of Radiography
1) Digital Radiography
• Readily manipulated
• Better stored
• Better quality
• Includes the logicon system :contains in its database radiographic
patterns of sound teeth.
Bitewing radiograph of a
suspected interproximal area
compare it to the
operator whether it
Qualitative Laser Fluorescence(QLF)
Light induced fluorescence
• Depends on measuring light induced fluorescence of the
• Fluorescence of tooth structure is due to the presence of
chromophores within the enamel.
• Intra-oral camera with software for image capture and
storage called Spectra camera is used.
• The caries activity is determined on a scale of 0 to 5.
Significance of colors seen:
• Green color: Normal tooth structure
• Blue color: Shows demineralization or incipient
• Red Color: Appear in caries and plaque indicating the
• The technique is called “quantified laser
fluorescence”. It is based on measuring the
differential refraction of light passing through
• The fluorescent light of lower frequency
indicates the presence of a carious lesion.
• Requires a clean dry operating field
Tip of probe is
too small to
Can’t detect it
cavity is too
Value Indication Restorative suggestion
014 No caries No treatment other than
1520 Histological caries within
Pits and fissure sealant
2199 Histological dentinal
>30 Cavity Operative treatment
Changes detected in initial carious lesions include:
Microporosity of enamel structure which will alter
transmission of light. Defects and color changes visible
throughout enamel and dentin.
Digital imaging fiver
1. Differentiate between sound tooth
structure and carious tooth.
2. Promote detection of small carious
Fiber Optic Transillumination (FOTI)
Depends on the
propagation of light
from the source (fiber
optic handpeice) to the
No Shadow High index of light transmission No Lesion
Darkened shadow low index of light transmission Carious lesion
Digital Imaging Fiber Optic
Early caries detection without using ionizing radiation.
The light from the
DIFOTI probe is
positioned on the
captured by a
Sent to a computer
Optical Coherence Tomography (OCT)
• Uses reflections of
infrared light with
into tissue without
• Determine not only the
occurrence of decay but
also the depth of caries
Electrical Conductive measurement device:
y of the
conductivity of AC
between sound and
Alternating Current Impedance Spectroscopy
Consists of an application of multiple
electrical frequencies for the diagnosis
of both occlusal and smooth surface
caries through a device called
Allows to detect the state of the
-Early stages of demineralization
-Badly decayed state.
The severity of the carious lesion is determined by
both color and numerical scales.
Dyes For Detection Of Caries
It binds to carious lesion which then is disclosed with the fluorescence.
Enamel Caries Dyes
Dentin Caries Dyes
1% acid-red 52 in
propylene glycol base