Dental caries prophylaxis

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3Prevention of dental caries

Dental caries prevention is necessary before teeth have even erupted. The dental health of the mother impacts the child’s dental health. A child’s teeth develop during pregnancy, so correct nutrition and oral hygiene habits are essential for preventing maternal dental diseases and for the development of healthy and strong dentition for the child. Moreover, mother’s dental health is important throughout pregnancy. Dental check-ups are necessary during both the first as well as the second half of pregnancy; dental caries must be eliminated. Untreated carious lesions increase the amount of caries-inducing microorganisms in the oral cavity, and the latter can be easily transferred to the newborn. A neonatal caries infection creates a situation where caries-inducing microorganisms are present in the oral cavity even before the eruption of deciduous teeth. Weakly calcified teeth will be infected immediately after eruption. Therefore, an environment has been created for early childhood caries, also known as baby bottle caries, to form, which affects deciduous dentition overall. Dental problems of pregnant women and new mothers must be treated without delay for prevention. Sharing eating utensils between mother and baby and the mother inserting the dummy into her own mouth before giving it to the infant must also be avoided.

The deciduous dentition period

The deciduous dentition period is an important stage for the prevention of dental caries in the deciduous teeth and developing permanent dentition. The first visit to the dentist should occur after the eruption of the first tooth. If the tooth structure is normal, it is sufficient to start with tooth brushing. Using a soft rubber baby toothbrush, the infant’s teeth should be brushed with lukewarm water. Later, when the child can spit and rinse her mouth, a switch to a soft child’s toothbrush and toothpaste can occur. Designated children’s toothpastes in child-friendly flavors and an appropriate amount of fluoride are available. The child should go to sleep with clean teeth. Nighttime feeding must be avoided. Long-lasting breast feeding as well as providing sweetened drinks must be avoided because the food residues on the teeth create a favorable environment for dental caries formation.

When the oral cavity is healthy, gums are pink and teeth are white. Deciduous teeth begin to erupt at the age of 6-12 months. By the age of 24-30 months, all the deciduous teeth should already have erupted.

3- 5-year-old children

The parent should brush the child’s teeth twice a day: after breakfast in the morning and before bedtime in the evening. If the fluoride level in the drinking water is insufficient, fluoride-containing toothpaste should be used. Only a pea-sized amount of toothpaste should be placed onto the toothbrush.

Children 6 years old and older

Teeth must be brushed twice a day. The parent should help with tooth brushing until the child turns 8 years old. The first permanent molars will erupt during this period. Dental check-ups are mandatory and include local prophylactic procedures like removing plaque. The fissures in the molars should be sealed with fluoride-containing gels and varnishes (i.e. sealants) and topical fluoride must be applied to the upper incisors’ contact points. Teaching flossing techniques, etc., should also be done at this point.

Children 12 years old and older

Teeth must be brushed twice a day with fluoride-containing toothpaste and teeth must be flossed once a day. It is necessary to limit frequent snacking and the eating of sweet, carbohydrate-rich foods and to maintain a protein- and mineral-rich diet for the child.

Summery

Prevention of dental caries begins during pregnancy: dental check-ups are necessary and carious lesions must be treated without delay. Infecting the infant with caries-inducing microorganisms must be avoided, which means not sharing eating utensils and the mother inserting the dummy into her own mouth before giving it to her baby. Tooth brushing must begin immediately after the first deciduous tooth erupts. Designated children’s fluoride-containing toothpaste should be used. Erupted permanent teeth should be covered with fluoride-containing gels, varnishes or sealants. Parents should regulate the child’s mealtimes, encourage the consumption of vegetables, and prevent excessive snacking and consumption of sweets. Dental check-ups should be conducted twice a year.

Dental caries and its treatment

Dental caries is a major oral health problem, affecting approximately 80% of the population. Dental caries can contribute to loss of teeth throughout life. Dental caries can cause significant pain and inflammation of the jaw bone, which can damage the whole body. Dental caries is a disease induced by microorganisms that cause teeth to decompose. Due to this process, the tooth structure becomes damaged and loose, and breaks down. Thereafter, the carious defect (the cavity) forms. The destruction progresses if damaged tissue is not eliminated in a timely manner and the cavity is not filled. First, in the outer layer of enamel, a white or brown pigmented spot will be detected as the start of the carious process. At the so-called macular stage, it’s still possible to stop the further progress of caries, in other words, to stabilize the process! Macular stage carious lesion treatment does not require drilling. Fluoride-containing gels and varnishes are applied to the damaged surface of the tooth to treat the spot. These procedures must be repeated, especially for children with recently erupted permanent teeth. Timely detection of early decay is important. Dental check-ups must be conducted and necessary procedures performed at least twice a year for children and once per year for adults.

Carious lesions (D) can be distinguished into 4 different stages according to clinical appearance: D1 – a superficial defect, approaching the center of the enamel; D2 – the defect penetrates the enamel layer; D3 – an average-size defect entering the tooth structure, that is, the dentine and D4 – a deep, carious defect has penetrated almost as far as the dental pulp (occasional tooth ache).

Dental caries treatment

Treatment of dental caries depends on the extent of the defect and its location on the tooth’s surface. Thus, one or more tooth surfaces can be damaged, but gradually comprehensive decomposition of the tooth crown becomes a problem. The treatment of dental caries consists of removing the damaged tissue either by hand or with a rotating instrument and filling the defect with the appropriate type of filling material. In today’s dental clinics, caries are removed with dental tissue-friendly high-speed drills that are equipped with a water-cooling system. The anatomy of the tooth will be restored with esthetically appropriate and tissue-friendly high-quality filling materials. Light-curing composite materials are the most popular and match most colors of teeth. (Filtek from 3M, Heraeus Kulzer and Densply, etc.). Glass-ionomer cements (Fuji, CeramFil, etc.) are also used mostly for the treatment of deciduous teeth in small children, as they are easily placed in the cavity and not as sensitive to moisture. Particular attention has to be paid to the treatment of deep carious defects, where it is often necessary to address the pulp. Temporary fillings (IRM, etc.) with antibacterial and tooth-strengthening capabilities will be used for this purpose. A dual session treatment (a step-by-step treatment) will be indicated for deep caries and can also be applied to newly erupted permanent teeth. Caries lesions on small children (up to 3 years of age) can be removed exclusively with hand instruments. This procedure is called ART-atraumatic restorative treatment. Metal or celluloid matrix bands (rings) will be used to prevent adhesion of filling material while restoring the contact surfaces of the teeth. Treatment of dental caries can be considered completed if a filling has been placed into a previously prepared cavity, tooth anatomy has been restored and the outer surface polished.

Summery

Treatment of dental caries must be started as early as possible. The macular stage of carious lesion does not require drilling. Old worn-out and deformed fillings must be replaced. Treatment of dental caries must not be delayed because the process worsens and more dental tissue will be damaged. Caries-damaged teeth can be esthetically and functionally restored with fillings. A dental check-up must be conducted at least once per year.