Prevention in children

Better to educate than to cure

It’s a long process of education that begins at a young age, because brushing your teeth isn’t enough. Make the right decisions, aside from your toothbrush, remember to use a toothbrush or floss when needed.

*The first step to achieving the goal is learning how to brush your teeth.

*Second step: Choose a toothbrush based on the child’s age and don’t hesitate to change it frequently!

*Finally, remember to use a toothpaste with fluoride in the correct dose adapted to the child’s age and, if necessary, to use fluoride supplements.

The different types of prevention

Primary prevention: through education, motivation and information,

Secondary prevention: early screening and treatment.
Tertiary prevention fights against recurrences and fights against subsequent deteriorations

II/EARLY DIAGNOSIS

The practitioner must systematically check all tissues in the area for which he is responsible. In addition to classic diagnostic instruments, such as mirrors, probes, intraoral and panoramic radiographs, two of the most effective diagnostic instruments are quantitative laser fluorescence and transluminescence.

The dentist must consider all the tissues of the mouth, health, color,

consistency, condition and position of teeth, mucous membranes and periodontium.

Caries risk assessment

An important element is the determination of caries risk based on the presence of plaque and the patient’s caries history. This assessment will determine the necessary frequency of oral examinations.

Initial Lesions

The examination can only be carried out in a clean mouth and with appropriate lighting.

Any trace of plaque calls for proper oral hygiene education.

The mouth is a privileged environment for direct and immediate observation. This is not a reason to limit the examination to the superficial.

Any point noted during the examination must be noted (or dictated).

The Mucous Membranes

Inspection of the mucous membranes will be systematic . Any lesion or change in color or surface should arouse attention. The condition of the mucous membrane is a symptom of many problems, from a small injury due to poor brushing to

malignant lesion, including gingivitis, abscess or periodontitis.

If there is the slightest doubt, further observation or a shared opinion is necessary.

The Teeth

Direct visual examination of teeth allows the location of numerous observations, losses, destruction, lesions and colorations.

The risk of caries

Physiological or behavioral risks

Failure to comply with food hygiene rules: snacking, consumption of

sodas between meals, food eaten after dinner or during the night.

Falling asleep with a bottle containing something other than pure water.
Insufficient or absent tooth brushing.
History of caries in the child or parents.

Environmental risks

Low socio-economic level of the family environment.
Child’s illness or disability causing difficulty brushing.
Wearing orthodontic appliances.
Long-term use of sugary medications.

III/THERAPEUTIC STRATEGY

A/Advice on oral hygiene

Oral hygiene is essential after every meal (morning, noon and evening) and must be carried out meticulously.

a./ THE PRODUCTS

/ PRE-BRUSHING SOLUTIONS: …

They are not essential, but they are an effective supplement for dissolving grease and plaque. Rinse your mouth with the solution for 15 seconds before brushing your teeth.

/ TOOTHPASTE: Today, a good toothpaste has an effective effect on teeth and gums. Some are more specific (for sensitive teeth, for example).
/ RINSE LIQUIDS AFTER BRUSHING.

They are generally a complement to toothpaste and can be used systematically. They provide an extra boost by delivering the active ingredient of the toothpaste after brushing, so at a time when the gum-tooth contact is very clean, and therefore very accessible.

/ MOUTHWASHES.

These are medications. They should not be used continuously without medical advice.

b/ INSTRUMENTS

The 4 essential complementary instruments are:

1/ MANUAL TOOTHBRUSHES:

They should be nylon, not too thick, and medium-sized unless otherwise indicated. They should be changed regularly, as soon as they appear to be damaged at the bristle level. Effective brushing is done by rotating (twisting) or vertically.

2/ ELECTRIC TOOTHBRUSHES.

Highly effective. Guaranteed vertical brushing. A very profitable short-term investment.

3/ INTERDENTAL BRUSHES:

Essential as soon as the gum has undergone resorption which allows passage for the brush,

and especially for wearers of crowns, bridges or… implants.

NB children and adolescents should not use interdental brushes unless specifically instructed by the practitioner).

4/ WATER PROPELLERS:

Allows a final cleaning of all inaccessible pockets and crevices and performs a tonic massage of the gums.

Use if possible once a day with lukewarm water with a few drops of antiseptic added

c/ – METHODS.

1/ BRUSHING YOUR TEETH

Brushing teeth should not be done “mechanically”, but methodically.

brushing in order:

All interior surfaces of the mandible (lower jaw)
All interior surfaces of the upper jaw
All outer surfaces of the mandible
All external surfaces of the maxilla

And of course, trying to reach all accessible sides of the teeth on both arches.

The part that needs to be maintained most seriously is the contact: gum/tooth, particularly on the lingual or palatal surfaces.

2/ INTERDENTAL BRUSHES:

Be careful not to apply excessive force or poke the gum towards the roots of the tooth. They must pass perpendicular to the axis of the teeth in the spaces where passage is possible. If bleeding occurs, it is a sign of inflammation.

3/ THE HYDROPULSEUR:

It is used with the mouth open above the sink with the jet directed perpendicular to the axis of the teeth, paying particular attention to the interdental spaces.

B/ FLUOROTHERAPY

Fluorine is a mineral of the halogen family, chemically very reactive, which combines with many elements and gives very stable compounds which are: fluorides (amine fluorides, tin fluorides, sodium fluorides).

Fluoride can be used either systemically to increase the stability of the enamel crystal structure during amelogenesis, or topically post-eruptively to strengthen the surface enamel structure against acid attack during the caries process.

Mechanism of action

* A double cariostatic effect : in fact, fluorides limit demineralization and facilitate remineralization: in the oral environment, calcified dental structures are permanently subjected to cycles of demineralization and remineralization. The demineralization phase is the result of a drop in salivary pH by the acids produced by bacteria following their metabolism of dietary carbohydrates. Then, remineralization and crystalline restructuring of the enamel occurs. If the acid pH persists below the critical pH, due to prolonged intake of carbohydrates or salivary deficit, there is a disruption of the demineralization-remineralization balance in favor of demineralization, which is the origin of the formation of the initial carious lesion of the enamel.

-Fluoride ions intervene in the process by limiting the phases of the

demineralization and promoting remineralization During remineralization there is the formation of hydroxyapatite crystals, fluoride at high concentration, fluoride ions can also precipitate in the form of very labile microcrystals of calcium fluoride, on demineralized dental surfaces These crystals constitute a reservoir of fluoride and calcium in the event of drops in pH.

* Inhibition of the metabolism of cariogenic bacteria:

At an acidic pH, fluoride ions are found in the form of HF (hydrofluoric acid), the form in which they enter the bacterial cell. Once inside the cell, they find a near-neutral pH and will dissociate into F- and H+ ions. This has the following consequences:

-Decrease in intracellular pH under the effect of H+ ions

-F- ions inhibit the extrusive H+/ATPase pumps which prevents the rise of intrabacterial pH.

These different blockages disrupt the bacteria’s energy metabolism and limit acid production.

*Fluoride on dental tissue Before tooth eruption

Fluorides act mainly on:
- the cellular metabolism of ameloblasts
- the cellular metabolism of odontoblasts (involved in the formation of dentin).

After tooth eruption

The enamel is exposed to saliva, food and bacterial plaque. In this

in this case, fluorides:

limit demineralization and promote remineralization,
slow down the metabolism of bacteria that cause cavities.

Forms of administration

1/Topical forms

Topical forms for personal use

* Toothpastes : They are composed of sodium fluorides, sodium monofluorides, tin fluorides and amine fluorides. For pediatric toothpastes, the fluoride concentration is 250 to 1000 ppm. Its use, according to a proper technique, 3 times a day for a 2-minute brushing ensures effective prevention against cavities. For adults, rinsing should be moderate, to keep the fluoride in contact with the tooth surface after brushing.

* Mouthwashes : They are composed of sodium fluorides, combined with flavoring agents (leaving the mouth feeling clean).

* Chewing gums : with a concentration of 45 ppm, they are recommended to stimulate salivary secretion, while constituting a fluoride supplement.

Topical forms for professional use

* Varnishes : They are composed of a synthetic resin, with an alcoholic solution containing the active agent which is sodium fluoride, or calcium fluoride or difluorosilane. This action is important during the first 3 weeks after their application

* Highly concentrated gels : with a concentration of 20,000 ppm, applied on the chair for 10 minutes 2 to 4 times per year in patients at high risk of caries.

*Acidulated fluorophosphate foams : These have a fluoride concentration of 12,300 ppm, a pH of 3 to 4.5, and are flavored. Their main advantage is a consistency that is better tolerated and accepted by patients and a lower risk of ingestion.

* Polishing pastes with a concentration of 5000 ppm are mainly used for professional prophylactic cleaning of dental surfaces.

2/systemically :

Zymafluorine: 1 mg or ¼ mg in tablet form and even oral drops.

in children aged 1 to 3 years: ¼ mg of Cp every other day (preferably at night).
in children aged 5 years: ¼ mg of Cp every evening.
in children aged 6 years: ½ mg of Cp every evening or 1 Cp every other day.
in children aged 8 to 9 years: 1 mg per day.

This treatment can be continued even up to 13 years with the same dosage of 1 mg/day.

This treatment is also indicated for pregnant women.

NOTICED :

If a child consumes a lot of tea (rich in fluoride), the dosage should be reduced [1/4 mg every two days], as excess fluoride is very dangerous.

C/FURROW SEALING

Fissure sealants provide a watertight barrier between the enamel and the oral environment . It is a primary and secondary prevention procedure (sealing of initial lesions) of choice, the effectiveness of which has been demonstrated. To prevent the development of caries (primary prevention), its indication depends on the RCI. Fissure sealants placed on permanent molars in subjects with low RCI are of no interest unless they have an anfractious anatomy that increases the risk at the tooth level. The French Society of Pediatric Odontology (SFOP) has broadened the scope of indications to permanent premolars in cases of high RCI and to temporary teeth, particularly in young children with medical, physical or intellectual disorders (at-risk populations). Materials based on light-curing resin should be preferred because they have a better retention rate over time. If the installation conditions are not optimal (insufficient insulation conditions), a temporary solution with a glass-ionomer cement-based material or a fluoride varnish may be recommended.