Caries-Prone Patients: Prevention, Assessment, and Intervention _____________________________________
• Floss or use an interdental cleaner daily to remove bacteria between teeth and under the gum line. • Limit snacking and eat a balanced diet. • Develop a customized at-home oral hygiene regimen that includes the use of prescription- strength fluoride gels or toothpastes. • Establish a dental recall schedule that reflects the patient’s ability to maintain ideal oral hygiene. ORAL HYGIENE INSTRUCTION Since the average patient brushes for less than one minute and few adults floss daily, it is important to review the ADA guidelines with patients at dental visits. To increase patient acceptance and understanding of oral hygiene instructions, it is advantageous for the dental professional to give patients the opportunity to demonstrate oral hygiene techniques. This allows the patient to receive feedback and gain confidence. Power toothbrushes may be advisable for some patients because they are better than manual toothbrushes at reducing dental plaque levels and can be an exceptional oral hygiene tool for orthodontic patients and those with limited manual dexterity [16]. Timers may also be recommended to ensure that patients are brushing for a full two to three minutes. CARIOUS DIETS In order to decrease caries through nutritional counseling, the dental professional must understand the most common caries-promoting behaviors and diet choices among the population. Poor nutrition can promote the development of carious lesions and can also have an adverse effect upon the structural integrity of the gingival tissues, the oral mucosa, and the periodontium [17]. SNACKING Snacking is a common habit in the United States, with 90% of U.S. adults reporting one or more snacks per day—which accounts for approximately 22% of their daily energy intake [18]. Snacking promotes caries for a number of reasons. First, patients do not often brush or floss after eating snacks, leaving food debris and dental plaque biofilm in the mouth for extended periods. Second, most snack foods either have elevated sugar content or—like potato chips and crackers—are high in fermentable carbohydrates, allowing for acid formation from oral bacteria. Third, snacks are usually eaten throughout the day, permitting oral bacteria to produce acid and lower the salivary and plaque biofilm pH multiple times in a relatively short period. Snacking habits have changed over the years, making it important for dental professionals to stay abreast of healthy options and nutritional evaluation techniques. Over a span of 35 years—between 1977 and 2012—there was a significant increase in per capita energy intake from snacking. The snack foods and beverages consumed were typically sugar-sweetened
CARIES LESION DETECTION METHODS
Caries lesions are detected a number of ways [3; 12; 13; 14]: • Visual examination is employed for diagnosing large pit and fissure, root surface, and facial and lingual smooth surface caries lesions. • Inspection with a blunt explorer or probe over the surfaces of teeth is the tactile method of detecting caries lesions. This exploration is especially effective around margins of existing restorations. • Using the air/water syringe to visualize teeth wet and dry is helpful. Demineralized surfaces will look dull, chalky, and irregular when dry. • Radiographs can be used to identify interproximal caries before they can be detected visually or tactilely, allowing for diagnosis when they are small or incipient. • Transillumination is the technique of shining light through the teeth with a dental light and mirror or with fiber-optic equipment. Various lasers for caries detection are available from dental equipment manufacturers. These methods allow tooth examination without risking cavitation of decalcified tooth surfaces, as may occur with the use of dental instruments. Employing a combination of these methods increases the prob- ability of finding carious lesions in early stages when restorative treatment can be minimal or may even be avoided. A thorough dental examination helps the dental professional to determine a patient’s caries risk level because any caries activity, including the presence of white spots or demineralization, automatically places a patient at high risk for caries development [15]. ORAL CARE HABITS The role of plaque biofilm in the caries process necessitates the teaching and frequent reviewing of proper oral hygiene with patients. It is possible to distinguish patients who are at increased risk for dental caries by recognizing patients with poor oral care habits. AMERICAN DENTAL ASSOCIATION RECOMMENDATIONS To prevent tooth decay, the American Dental Association recommends the following oral hygiene behaviors [16]: • Brush teeth twice a day. • Brush for two to three minutes. • Use a fluoride toothpaste that is ADA-accepted. • Replace the toothbrush every three to four months, or more frequently if bristles are fraying.
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