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Caries Management and Prevention —— —— John D.B. Featherstone

Caries Management and Prevention —— —— John D.B. Featherstone University of California San Francisco. Disclaimer. Any products referred to in this presentation are given as examples and illustrations only by the presenter.

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Caries Management and Prevention —— —— John D.B. Featherstone

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  1. Caries Management and Prevention —— —— John D.B. Featherstone University of California San Francisco

  2. Disclaimer • Any products referred to in this presentation are given as examples and illustrations only by the presenter. • There is no implied endorsement of any of the examples given. • There are other brands and manufacturers of each of the products that are used as illustrations

  3. “White spot” lesion Protective Factors

  4. Protective Factors Frank occlusal cavity

  5. Early Childhood Caries Protective Factors

  6. The Caries Balance • Protective Factors • Saliva flow and components • Fluoride - remineralization • Antibacterials:- • chlorhexidine, xylitol, new? • Pathological Factors • Acid-producing bacteria • Frequent eating/drinking of • fermentable carbohydrates • Sub-normal saliva flow and • function Caries No Caries Featherstone, Community Dent Oral Epidem, 1999

  7. Protective Factors Often a delicate balance

  8. The Caries Imbalance • Risk Factors • Acidogenic • bacteria • Frequent • carbohydrates • Sub-normal • saliva • Protective • Factors • Saliva • Fluoride • Antibacterials • Disease Indicators • Cavities/dentin • Enamel lesions • Restorations < 2 yr • White spots Caries Progression No Caries

  9. Caries Risk Assessment – High-Risk One or more disease indicators Cavities, radiographic lesions to dentin, recent restorations, white spots And/or multiple risk factors Coupled with little or no protective factors

  10. High-Risk Indicator in Infants

  11. Placing restorations does not reduce the bacterial challenge Increase fluoride for remineralization Decrease bacterial challenge by antibacterial therapy Balance pathological factors with protective factors Guiding Principles for Caries Management for High-Risk Individuals

  12. Fluoride Works Primarily Through Topical (Surface Mechanisms) - Inhibits demineralization and enhances remineralization Therefore products applied to the mouth are the most effective Fluoride products are effective for adults as well as children of all ages

  13. Brushing twice daily with a fluoride-containing dentifrice is one of the most effective ways to control dental decay. High bacterial challenge overcomes the therapeutic effects of fluoride.

  14. Children under 6 years of age: Pea sized amount twice daily Children 6 years and older: Brush at least 2X daily with a fluoride toothpaste -> major caries reduction High risk: use 5000 ppm F toothpaste Fluoride Toothpaste

  15. High concentration 5000 ppm fluoride toothpaste/gel for high-risk patients from age 6 years upwards.

  16. Evidence-based Clinical Recommendations: Professionally Applied Topical Fluoride American Dental Association: May, 2006 Fluoride gel applied for 4 minutes or more is effective Fluoride varnish applied every 6 months is effective Two or more applications of fluoride varnish per year are effective in high caries risk individuals Office topical applications no added benefit for low-riskindividuals

  17. Weintraub et al, J Dent Res, 2006. Fluoride varnish in infants (approx 2 years old at start). Percent with decay vs treatments Protective Factors

  18. Fluoride Varnish 2-3 X a year for high-risk children and adults

  19. Antibacterial Therapy-Age 6 Years Up Chlorhexidine gluconate 0.12% • Rinse 10 ml daily for one week • Repeat every month for 6 months and reassess • Continue until cariogenic bacteria are controlled • Must be used together with fluoride therapy

  20. Xylitol Gum, Mints Xylitol • Noncariogenic sweetener • Inhibits transfer of bacteria from mother to child • Can reduce loading of cariogenic bacteria in the mouth

  21. Placing restorations does not reduce the bacterial challenge Increase fluoride for remineralization Decrease bacterial challenge using antibacterial therapy Balance pathological factors with protective factors Guiding Principles for Caries Management for High-Risk Individuals

  22. Fluoride toothpaste at least 2x daily Increase the fluoride to 5000 ppm toothpaste for age 6 years through adult Fluoride varnish 2-3 x annually Xylitol for mothers and caregivers of 0-5 year olds Chlorhexidine (1x daily, 1 week, each month) and xylitol for age 6 years through adult Therapeutic Summary - High Caries Risk

  23. Calcium phosphopeptide paste with fluoride (MI paste plus) Sealants Glass ionomer restorations/sealants Minimally invasive restorations Additional Therapy

  24. California Dental Association Journal www.cdafoundation.org/journal October/November 2007 Acknowledgements

  25. Disclosure: I have no personal financial interest in any company relevant to this presentation. I consult for, have consulted for, or have done research funded or supported by: Arm and Hammer, Beecham, Cadbury, GSK, KaVo, Novamin, Omnii Oral Pharmaceuticals, Oral B, Philips Oralcare, Procter and Gamble, Wrigley, and the National Institutes of Health.

  26. Mothers and caregivers transmit bacteria to children Children can transmit to children Treat the caregivers to reduce the transmission Where do the cariogenic bacteria come from in children?

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