INTENTION OF PREVENTION

 EASE OF USE MATTERS

Fluoride varnish (Figure 4) has been used in the United States for caries (as "off-labeled") since 1991 (Table). The primary reason for its wide acceptance is the easy, safe, convenient, and well-accepted application procedure, especially for young children. With fluoride varnishes, the amount of fluoride exposure to patients can be better controlled and less chair time is required. It covers the teeth with an adherent film for a prolonged period of time, thereby enhancing the uptake of fluoride ions into the tooth structure. Even though fluoride varnishes contain higher concentration levels of fluoride, 22,600 ppm of NaF, studies have shown lower levels of fluoride in blood plasma. Because the amount of fluoride ingestion is minimal, due to its adhesive nature, fluoride varnish can be applied to very young children.
The ADA Council on Scientific Affairs recently suggested the use of fluoride varnish as often as 4 times per year, for children and adults identified as high-risk.

KNOWLEDGE OF OTHER PRODUCTS AND BENEFITS MATTER
ACP—is inorganic amorphous calcium phosphate, made by combining soluble salts of calcium and phosphorous, and it consists of the same minerals contained in hydroxyapatite crystals. ACP speeds up remineralization by rapidly delivering calcium and phosphate ions to the tooth. ACP technology is found in Arm & Hammer Enamel Care with Liquid Calcium as well as their Age Defying Toothpaste, and Mentadent Replenishing White Toothpaste, Discus Dental’s Zoom 2 DayWhite and NiteWhite with ACP (Figure 5), Discus Dental’s Relief ACP sensitivity relief product, and Premier Dental Products’ Enamel Pro from and 5% NaF varnish.
Casein Phosphopeptide (CCP)-ACP—a 7.4-pH, milk-derived protein that releases bio-available calcium and phosphate ions when a patient’s saliva becomes acid challenged. When using CPP-ACP in the mouth, it binds to biofilm, plaque, bacteria, hydroxyapatite, and soft tissues. Elevating the level of fluoride further enhance its effects since fluoride requires a good source of calcium and phosphate for remineralization of enamel with the more acid-resistant fluorapatite. Recaldent CPP-ACP can be delivered to the teeth by Trident XtraCare gum with Recaldent, and MI Paste and MI Paste Plus manufactured by GC America.
Calcium Sodium Phosphosilicate compound (NovaMin)—is a tradename for bioactive glass. It is made from elements which are naturally found in the body. NovaMin particle delivers an ionic form of calcium, sodium, phosphorus, and silica, which bind to the tooth surface. When exposed to saliva or water, it instantly reacts, releasing sodium, calcium, and phosphate ions, which then interact and result in the formation of a crystalline hydroxycarbonate apatite layer that is chemically and structurally similar to enamel and bone. Products Containing NovaMin include: NUPRO Sensodyne Prophylaxis Paste, Sensodyne NUPRO Professional Toothpaste with NovaMin, Sensodyne Repair & Protect, NuCare Prophylaxis Paste with NovaMin and NuCare Root Conditioner with NovaMin, SootheRx, Dr. Collins Restore Toothpaste, and Burt’s Bees Natural Toothpaste.
Xylitol—is a naturally occurring sugar (alcohol) sweetener that is used as a sugar substitute. There is a considerable amount of evidence that the use of gum or candy with xylitol prevents dental caries in the permanent teeth when used several times daily. (The effectiveness varied between 30% and 60% when compared to controls without the gum use.) According to the NIH Consensus Statement on the Diagnosis and Management of Dental Caries, the evidence for xylitol is strong as the primary prevention of dental caries. The preventive effect of xylitol seems to derive from the remineralization of decalcified surfaces of teeth, replacement of fermentable dietary sugars and reduction of the amount of dental plaque or the amount of S mutans in plaque and saliva.
The most significant effect demonstrated so far in caries reduction is its ability to reduce the growth and acid production of S mutans, the primary bacteria responsible for caries. Growth retardation of S mutans is thought to result from an energy-spending "futile xylitol cycle" and impaired glucose uptake and metabolism 
With regard to plaque, several studies have shown xylitol to reduce the amount, adhesiveness, and acidogenic potential of the bacterial colonies. Xylitol has the ability to reduce the number of S mutans in plaque and to loosen the plaque and bacteria binding to the tooth surface.
Caries prevention seeks to prevent the onset of carious lesions, arrest progression, and even to repair them. Prevention can be successfully carried out both by eliminating contributory factors of caries and by improving the resistance of teeth to caries attacks.
Dental products containing xylitol include Xylishield Comprehensive Dental Care System (Ultradent Products) (Figure 6), TheraGum and TheraMints (Godwin and Miller), BreathRx (Discus Dental), Spry (Xlear), Biotene, Dentiva (Nuvora), Natural Dentist (Caldwell Consumer Health), Supersmile Professional Whitening Gum, Trident Gum, and Spiffies.

THE POWER OF INTENTION
Studies have shown the beneficial effect of fluoride varnish in preventing progression of dental caries and the effect of using xylitol in reducing salivary S mutans levels. They have shown how the use of ACP, CCP-ACP, and NovaMin all help in the remineralization process These products may offer an efficacious and cost-effective caries prevention strategy, which may greatly improve the quality of oral health.

IN CLOSING: INTERVENTION FOR PREVENTION
By carefully evaluating techniques and using the appropriate materials, one can consistently obtain a predictable, practical, preventive program that works.