INTENTION OF PREVENTION

[Drsumitra]

INTRODUCTION

As preventive health care providers, what is our intention for prevention beyond the scope of providing hygiene therapy and giving oral hygiene instructions?
This article is not about the science of saving enamel or the dynamics of the dental caries process. It is intended to assist the everyday working hygienist in understanding the practical and predictable options for prevention. The intention is to help you become more knowledge about innovative and effective preventive products and the benefits that they provide.

THE MYSTERY IS IN THE HISTORY
Dental caries is an infectious disease. Streptococcus mutans and Lactobacillus produce organic acids when consuming carbohydrates, causing the pH to drop below 5.5. The acid dissolves the carbonated hydroxypatite, the main component of enamel, and demineralization begins. Thirty minutes later, the sugar is gone, and the mineral loss can be recovered (remineralization begins) from ions dissolved in the saliva. Dental caries result when the rate of demineralization exceeds the rate of remineralization and the latticework is destroyed.
Prevention of dental caries, especially in early childhood, is important with respect to its future progression, to improve the quality of life, and to reduce the costs of restorative treatments throughout a patient’s lifetime. Efficacious, safe, feasible, and cost-effective caries prevention methods for children are essential.

Figure 2. Clinical flouride application (Profluorid L [VOCO America]) placement.	Figure 3. Application of fluoride using a tray for delivery.
Figure 4. Clinical application of a fluoride varnish (Flor-Opal Varnish [Ultradent Products]).	Figure 5. Zoom 2 Day White and Nite White with ACP (Discus Dental).

MOVING BEYOND GOOD INTENTIONS
Everyday experience tells us that good intentions are often simply not enough. The use of traditional prophy pastes and fluoride foams and gels is no longer the only option we have.
Today our intention is to discuss different methods and products of prevention, such as fluoride varnish; amorphous calcium phosphate (ACP), a special milk-derived phosphopeptide that binds calcium and phosphate to tooth surfaces, plaque, and the surrounding soft tissues (Recaldent MI Paste [GC America]) (Figure 1); calcium sodium phosphosilicate (NovaMin [Sultan Healthcare]); and use of xylitol products into your practice.

TIMING MATTERS
The key to an effective preventive program is the appropriate mix at the appropriate time. In order to prevent primary caries, early intervention is important. To achieve lifelong caries prevention, fluorides, and other products must be made available during all stages of enamel development in both pre-eruption and posteruption. When ingested systemically through infant fluoride drops, fluoridated vitamins, and fluoridation, fluoride strengthens developing enamel. When applied topically via topical fluoride treatments, prescription fluorides, and toothpastes, fluoride not only strengthens posterupted enamel but also reverses incipient lesions and helps arrest the decay process.

Figure 6. Xylishield Comprehensive Dental Care System (Ultradent Products).

CONCENTRATION MATTERS: PROFESSIONALLY APPLIED FLUORIDE COMPOUNDS
No longer does anyone question the efficacy of fluoride. In the United States, dental clinicians have been applying highly concentrated fluoride compounds directly to patients’ teeth for more than 50 years. Application procedures were developed based on the research that the fluoride would be incorporated into the crystalline structure of the enamel and would help develop a well-crystallized and more acid-resistant apatite in the enamel surface when the pH in the mouth drops (Figure 2).
Studies report that fluoride uptake by enamel increased in an acidic surrounding. Fluoride gel is often formulated to be highly acidic, consisting of a pH of 3.5 which can result in a bitter taste. The 3 professional strength fluoride products approved by the US Food and Drug Administration and ADA contain higher levels of concentration in both strength and acidity. Sodium fluoride (NaF) and stannous fluoride concentration both range between 9,000 ppm and 19,000 ppm, 9 mg and 19 mg of fluoride per mL. where as acidulated phosphate fluoride contains 12,300 ppm or 1.23 mg of fluoride per mL of product with a phosphoric acid pH of approximately 3.5. The at home self-applied NaF gels contain 5,000 ppm and stannous fluoride contains 1,000 ppm of fluoride per mL of product.

QUANTITY MATTERS: HOW MUCH IS TOO MUCH
The toxic nature of fluoride makes it necessary to establish prudent monitoring for professional strength fluoride treatments delivered within the dental office. Naturally, an area of concern includes professional strength topical fluoride treatments on children less than age 6 years, since this age group has the greatest incidence of inadvertently swallowing fluoride because of their immature swallowing reflex. The variables that directly affect fluoride ingestion by patients in the dental office include applying fluoride to the teeth with a cotton swab, dispensing the inappropriate quantity of fluoride, selecting the inaccurate size and shaped tray, or clinicians altering the fluoride tray (Figure 3) being used, thus making fluoride varnishes the fluoride of choice.

        

[Drsumitra]

 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.

 

        

[drmithila]

Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride.[2] Fluoridated water operates on tooth surfaces: in the mouth it creates low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes and increases the rate at which it remineralizes in the early stages of cavities.[3] Typically a fluoridated compound is added to drinking water, a process that in the U.S. costs an average of about $1 per person-year.[2][4] Defluoridation is needed when the naturally occurring fluoride level exceeds recommended limits.[5] A 1994 World Health Organization expert committee suggested a level of fluoride from 0.5 to 1.0 mg/L (milligrams per litre), depending on climate.[6] Bottled water typically has unknown fluoride levels, and some domestic water filters remove some or all fluoride.[7]
Dental caries remain a major public health concern in most industrialized countries, affecting 60–90% of schoolchildren and the vast majority of adults.[8] Water fluoridation prevents cavities in both children and adults,[9] with studies estimating an 18–40% reduction in cavities when water fluoridation is used by children who already have access to toothpaste and other sources of fluoride.[2] Although water fluoridation can cause dental fluorosis, which can alter the appearance of developing teeth, most of this is mild and usually not considered to be of aesthetic or public-health concern.[10] There is no clear evidence of other adverse effects.[11] Moderate-quality studies have investigated effectiveness; studies on adverse effects have been mostly of low quality.[11] Fluoride’s effects depend on the total daily intake of fluoride from all sources. Drinking water is typically the largest source;[12] other methods of fluoride therapy include fluoridation of toothpaste, salt, and milk.[13] Water fluoridation, when feasible and culturally acceptable, has substantial advantages, especially for subgroups at high risk.[8] The U.S. Centers for Disease Control listed water fluoridation as one of the ten great public health achievements of the 20th century;[14] in contrast, most European countries have experienced substantial declines in tooth decay without its use, primarily due to the introduction of fluoride toothpaste in the 1970s.[3] The use of topical fluorides (such as in toothpaste) to prevent caries among people living in both industrialized and developing countries may help supplant the need for fluoridated water.[3] Fluoridation may be more justified in the U.S. because of socioeconomic inequalities in dental health and dental care.[15] Public water fluoridation was first practiced in the USA,[16] and has been introduced to many other countries to varying degrees[17] with many countries having water that is naturally fluoridated to recommended levels and others, such as in Europe, using fluoridated salts as an alternative source of fluoride.[18]
The goal of water fluoridation is to prevent a chronic disease whose burdens particularly fall on children and on the poor.[19] Its use presents a conflict between the common good and individual rights.[20] It is controversial,[21] and opposition to it has been based on ethical, legal, safety, and efficacy grounds.[22] Health and dental organizations worldwide have endorsed its safety and effectiveness.[3] Its use began in 1945, following studies of children in a region where higher levels of fluoride occur naturally in the water.[23] Researchers discovered that moderate fluoridation prevents tooth decay,[24] and as of 2004 about 400 million people worldwide received fluoridated water.[

 

        

[drmithila]

The value of recommending and dispensing a professional fluoride toothpaste is undeniable! However, patient compliance is our foremost challenge; patients must use it consistently to be effective. Philips Oral Healthcare created Fluoridex with this in mind. Not only does it contain four times more fluoride than over-the-counter toothpastes, but it also offers the same look, taste, and feel of the most popular consumer toothpaste brands, so your patients are more likely to use it on a routine daily basis. There are four patient-friendly formulas — 1) Sensitivity Relief combines maximum strength fluoride to enhance remineralization with 5% potassium nitrate. This is ideal for patients with sensitivity caused by gum recession, enamel abrasion, and abraded dentin. 2) Daily Defense is ideal for patients with root caries, xerostomia-induced caries, and high to extreme caries risk. This formula offers your patients maximum professional strength fluoride and aids in remineralization. 3) Sensitivity Relief SLS Free provides maximum fluoride protection with 5% potassium nitrate and no sodium lauryl sulfate (SLS) to irritate the oral mucosa. SLS is a foaming agent that can irritate sensitive skin and cause cell sloughing. Studies have shown that using SLS-free toothpaste may be beneficial for people with recurrent aphthous ulcers, reducing outbreaks. 4) Enhanced Whitening is the first professional strength fluoride toothpaste to provide the additional benefit of whitening to keep patients’ teeth healthy and beautiful.
Order Fluoridex to deliver compliance-friendly formulas and fluoride protection for your patients by visiting http://www.philipsoralhealthcare.com/en_us/oral_hygiene/fluoridex.php for more information

        

[Drsumitra]

Voters in Wichita, KS, have decided against water fluoridation, handing a victory to antifluoridation activists that has been difficult to attain in major cities this year.
Following the November 6 vote, the final tally was 74,788 in favor and 50,890 against, roughly a 60% to 40% split, the Wichita Eagle reported. Wichita voters have rejected water fluoridation in the past, with votes against winning in 1964 and 1978.

"From a political standpoint, the odds were against us," Jonathan Hall, spokesperson for Wichitans Opposed to Fluoridation, said during an interview with DrBicuspid.com. "The pro-fluoride group set the timeline and had over a year to plan and implement it. They petitioned city council members [to implement water fluoridation] before anyone knew what was going on, so we’re pleased with our quick response to their campaign."
Wichitans for Healthy Teeth, a fluoride advocacy group, called the results "disappointing but not surprising" in a post on its website. The group noted that the antifluoride leaders "pumped a lot of money" into robocalls, direct mail, and other messages that "misled and confused voters."

Local TV station KWCH Channel 12 examined three common arguments that were used to attack fluoridation and judged all three to be either "false or misleading," the organization added.

Meanwhile, opposition groups celebrated. In a post on its website following the vote, Wichitans Opposed to Fluoridation hailed voters’ majority decision as an informed one that "discarded the falsehoods and propaganda" disbursed by fluoridation advocates and called fluoridation "antiquated and unethical."

"The key to success was getting out and educating voters face-to-face," Hall said. "The majority of them that we spoke to were aware of the controversy but didn’t understand the ins and outs. They had a lot of questions."

Collaboration possible?

The opposition group also offered to collaborate with fluoridation advocates to improve access to dental care for low-income children. "We challenge those groups who have offered grants to pay for fluoridation start-up costs to use that same money for dental care for low-income children instead," the group added.

Cooperation may prove to be challenging, Hall admitted. "There were a lot of sour grapes between groups as you can imagine," he said. "It was hard to accomplish anything between them."

While a formal debate never took place, both sides used an array of tactics to communicate their messages. Fluoride Free Kansas’ official website — http://www.fluoridefreekansas.org — hosts YouTube videos and fact sheets drawn up by the organization describing the dangers of fluoridation. Meanwhile, fluoride advocates set up an eerily similar website of their own — http://www.fluoridefreekansas.com — with detailed information outlining the reasons for their support of water fluoridation and a link to the home page of Wichitans for Healthy Teeth.

And a "Fluoride Voter Guide" was issued by Wichitans for Healthy Teeth, the Wichita District Dental Society, the Medical Society of Sedgwick County, the Kansas Academy of Family Physicians, and the Kansas Chapter of the American Academy of Pediatrics. The Kansas Dental Association expressed its support for it.

However, fluoridation opponents had the support of the Kansas Republican Assembly and its president, Mark Gietzen, the Wichita Eagle reported. In the article, he stated that fluoridation would come to be viewed like asbestos or other materials that were once viewed as beneficial until negative consequences of their use were revealed over time.

Gietzen expressed ongoing support for the antifluoridation campaign, and stated that he intended to make it a core issue that he will take statewide.

Hall said that antifluoride groups had a meeting on November 8 to discuss their options. "We may try to implement a citywide ban on fluoride," he added.

 

        

[Anonymous]

A doctor of dental medicine, or dentist, cares for the mouth, gums and other areas near the mouth. Dentists complete many years of education before they are licensed.
pediatric dentist

        

[Author]

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