Hygiene and prevention in pedodontics
EDUCATIONAL OBJECTIVES
-Intercept oral pathologies affecting children
– Implement the necessary preventive measures to avoid the appearance or worsening of oral pathologies
1- Introduction
Prevention plays a key role in pediatric dentistry because it allows dental interventions to be avoided or reduced as much as possible.
2- Definitions
2-1 Prevention: all the means implemented to avoid the appearance, expansion or worsening of caries.
2-1 Prophylaxis: the set of treatment protocols aimed at preventing caries disease
3- The different levels of prevention
3-1 Primary prevention ( before the onset of the disease): This includes all actions intended to reduce the INCIDENCE of a disease.
3-2 Secondary prevention ( at the very beginning of the disease): It is based on education and motivation but also on systematic screening and prophylactic interventions.
3-3 Tertiary prevention ( Once the disease has set in): This includes all actions intended to reduce the PREVALENCE of chronic disabilities or recurrences in a population,
4- The different types of prevention
4-1 Mass collective prevention : focuses on the general public. The first step in this prevention is the education and information of the population.
4-2 Targeted collective prevention : aimed at specific groups of the population.
4-3 Individual prevention at the dental office : concerns the patient and their dentist, it is based on preventive examinations to put in place a treatment in the face of a problem.
5- Individual caries risk
5-1 definition
RCI is defined as the probability of an individual developing carious lesions reaching a given stage of the disease over a certain period of time, with exposure to risk factors constant during this period.
5-2 Assessment of individual caries risk
Risk factors help define individuals at high risk of caries
• Lack of daily brushing
• regular sugary ingestions outside of meals
• long-term use of sugary medications or medications that cause hyposialia;
• cracked grooves at the level of the molars;
• presence of cavities
• sweetened bottle
The presence of a single individual risk factor is sufficient to classify an individual as high RCI
6- Preventive measures in pediatric dentistry
6-1 Pregnancy:
During pregnancy, it is recommended:
– to assess the caries risk of pregnant women,
– to treat existing oral pathologies and prevent the appearance of other pathologies due to pregnancy,
– to prescribe xylitol chewing gum to pregnant women with high RCI to prevent early transmission of streptococcus mutans to the future newborn.
– to inform the pregnant woman of the risks of self-medication which must be avoided to limit any risk to the fetus.
Antibiotics of the cycline family can cause dental discoloration and inhibit bone growth; other drugs (benzodiazepines) can promote cleft palate formation when administered for a long time.
6-2 Breastfeeding:
Studies have shown that human milk and cow’s milk are less cariogenic than other infant formulas and that children exposed to long-term breastfeeding up to 12 months of age have a reduced caries risk.
6-3 – Oral hygiene and mechanical plaque control:
- Qualities that a toothbrush should have:
• have a size adapted to the patient’s age
• have nylon or polyester bristles
• have soft hair
The average lifespan of a toothbrush is about 2 months.
- Appropriate techniques:
The brushing method depends on age and periodontal health.
-From 6 months to 2 years
A wet compress or a finger toothbrush can be used. Toothpaste ≤ 500 ppm.
Horizontal method: 20 round trips per sector. 2 times/day.
-From 2 years old to 6 years old
The horizontal technique: The brush head is positioned perpendicular to the external surface of the tooth and horizontal movements are applied to the handle; the occlusal, lingual and palatal surfaces are brushed with the mouth open and the vestibular surface with the mouth closed.
The Boubou technique: It is always performed with the mouth open; all the teeth are brushed, using a back-and-forth movement on the occlusal surfaces, brushing the maxillary and mandibular teeth separately.
-For 6-9 year olds:
The intermediate method : For the occlusal surfaces, a back-and-forth movement, one dial at a time. For the vestibular surfaces of the anterior teeth, a rotary brushing is performed from the gum towards the tooth. For the palatal and lingual surfaces of the anterior teeth, they are brushed vertically with a movement from the gum towards the tooth.
-From 10 years old:
ROLLER Method: It is performed with the mouth open. For the vestibular and buccal surfaces, the head of the toothbrush has an oblique position in the apical direction. After initial pressure on the marginal gingiva, a rotating movement is performed.
Bass technique: This involves positioning the brush head at 45 degrees to the crown of the tooth, with the bristles covering the marginal gum and the cervical part of the tooth, but above all penetrating into the sulcus (about 0.5 mm). An anteroposterior movement is performed
BROS Method : For occlusal surfaces, the teeth are cleaned in an anteroposterior motion. For the vestibular and buccal surfaces, the toothbrush makes a 45° rotational motion from the gum towards the occlusal edge.
6-4- Increase in the resistance of the hard tissues of the tooth: fluoridation
6-4-1 the effects of fluoride
-formation of fluoroapatite, thus reducing the permeability of the dental structure
-inhibition of demineralization and stimulation of remineralization,
-inhibition of bacterial metabolism and the formation of dental plaque.
6-4-2 Sources
6-4-2-1 Waters
- Drinking water
The maximum fluoride content permitted in tap water is set at 1.5 mg/L.
Depending on the country, the fluoride content of water is 0.6 to 1.1 mg/L.
This variation in fluorine content depends on many factors such as flow rate, pH, porosity, solubility or the nature of the rocks.
Bottled natural mineral waters contain varying amounts of fluoride ranging from less than 0.1 to 9 mg/L.
However, Afssaps has set a limit value for fluoride in bottled mineral water, below which infants and children can consume mineral water without risk of developing fluorosis. This limit is set at 0.5 mg/L in the absence of systemic fluoride supplementation and at 0.3 mg/L in the case of supplementation.
- Spring water
Their fluoride content varies greatly. The quality limit for fluoride is identical to that of public water distribution networks: 1.5 mg/L.
- Food
– Fluoride salts : The salt is supplemented with fluoride at a rate of 250 mg/kg of fluorides, in the form of potassium fluoride.
In practice, children consume very little salt before the age of two.
After two years, the average dose of fluoride absorbed through fluoridated salt during meals is estimated at approximately 0.25 mg/day.
-Other foods : Generally speaking, foods provide little fluoride. However, sea fish are relatively rich in fluoride (1 to 3 mg/100 g), as is tea (about 0.5 to 1.5 mg/L). It is also found in dates.
6-4-3 Systemic medications
There are approximately fifty pharmaceutical specialties containing fluorides indicated for the prevention of dental caries and administered in oral form (tablets, oral solution/drops).
6-4-4 Topics
-Low fluoride (<150 mg/100 g or <1500 ppm fluoride) generally have cosmetic status and are available over the counter. This is the case for many toothpastes and most mouthwashes.
-High fluorine content ( >150 mg/100 g or > 1500 ppm)
Fluoride toothpastes, gels and varnishes
A distinction must be made between materials used for preventive purposes (varnishes and fissure sealants) and those intended for the restoration of dental tissues (fluorinated silver amalgams and glass ionomer cement-type materials with or without composite resin).
6-5- furrow sealing (sealants)
Indications
-prevention of caries in teeth without caries but at risk (high or moderate RCI).
-Treatment of carious lesions limited to the enamel.
– concerns the occlusal surface of the 1st and 2nd permanent molars in patients under 20 years of age.
-Currently any tooth with irregular grooves can be sealed
Contraindications
Cavities that have reached the dentin
Implementation : we distinguish two cases:
1-A placement without opening the furrows
2-A setting up with opening of the furrows in the following cases:
-Cleaning the surface of the tooth to be sealed using a dry brush
-Isolation using a waterproof surgical drape
-Etching carried out with phosphoric acid (35-37%) of pits and fissures for 15 to 20 seconds
-Rinsing time equivalent to etching
-Application of the material and passage of the probe in the pits and cracks to eliminate bubbles and improve the spreading in low thickness of the resin .
-Waiting 15-20s before photopolymerization improves the penetration of the material into pits and cracks
-Photopolymerization, 20 s,
6-6- Antibacterial agents in caries prevention
Chlorhexidine in various forms (toothpaste, mouthwash, varnish, gel) is used daily or periodically by a dental professional. Due to its side effects, chlorhexidine should not be used for extended periods of more than a few weeks.
Triclosan : is another antimicrobial agent Contained in many cosmetics, it is a broad-spectrum synthetic agent with bactericidal and partially virucidal and fungicidal properties.
6-7 Probiotics
WHO: Defines them as live microorganisms which, when administered in adequate quantities, have the capacity to compete with pathogenic bacteria for adhesion sites, exert antagonism towards these pathogens and modulate the host response.
6-8 – Xylitol
It is a substitute sugar whose sweetening power is equal to that of sucrose, which would inhibit the metabolism of bacteria.
6-9 Milk proteins: Casein phosphopeptide amorphous calcium phosphate (CPP-ACP)
– improve the buffering capacity of the acquired film
– prevent demineralization and induce remineralization
-thus they may even possess a certain anticariogenic potential.
– This milk derivative, combined with calcium and phosphate ions in an amorphous form, would delay the formation of oral biofilm.
6-10- control visits
They are essential in any prevention program. These check-ups should be carried out every 3, 6 or 12 months depending on the assessment of the patient’s risk factors.
7- Conclusion
Prevention means taking the necessary measures to avoid illness.
This means intercepting potential diseases before they manifest or are still in their early stages, when they are easiest to treat.
8- Bibliographies
1- Marysette Folliguet: Prevention of dental caries in children before 3 years old, 2006.
2- French Society of Pediatric Odontology. Recommendations on the prescription of fluorides from birth to adolescence
3- AFSSAPS Update Use of fluoride in the prevention of dental caries before the age of 18 October 2008
4- Chahrazed SELLAF, Fatima Zohra SENOUCI BEREKSI & Fadia HADJ SLIMANE final year dissertation: DESCRIPTIVE STUDY OF STRUCTURAL ENAMEL DEFECTS IN SCHOOL CHILDREN AGED 6 TO 15 YEARS OLD; 2017.
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