Preventive and/or non-invasive dentistry
I-Definition:
Preventive and/or non-invasive dentistry is the set of interventions and methods which aim to reverse, stop or even delay the progression of a non-cavitary carious lesion (Koch and Poulsen 2009)
II-Prevention of carious disease by modification of the biofilm
1-Mechanical control of bacterial plaque
Brushing teeth with either manual or motorized toothbrushes is the most common method of oral hygiene in most countries. It is most often performed using a plastic toothbrush in combination with toothpaste.
- a-Rotation method: It consists of circular movements, carried out on the dental surface, the brush forming a 90° angle with the teeth. The vestibular surfaces of the teeth are thus brushed at the same time as the marginal gingiva.
- b-Bass method: The head of the brush is placed at 45° to the axis of the tooth. The end of the bristles should reach the sulcus and the interdental spaces, without pressure. Then, small rotary movements are made with the handle.
- c-Charters method : The brush should be inclined at 45° to the dental axis, with the end of the bristles pointing towards the occlusal edge. Using light pressure, the end of the bristles is gently introduced into the interdental spaces. From this position, the brush is made with small back-and-forth movements.
- d-Stillman method: The brush is placed so that the end of the bristles extends about 2 mm beyond the marginal gingiva, the angle formed with the dental axis being 45°. While the edges of the brush press on the gingiva, a light, mesio-distal movement is made.
- e-Brushing of interproximal areas: In interproximal areas, brushing alone is not sufficient to remove dental plaque especially in patients with periodontal disease.
- It must be completed by interdental brushing using:
- Interdental floss
- Toothpick: harmful to the gums
- Interdental brush
2-Chemical control of bacterial biofilm
- A-Chlorhexidine : In the case of high RCI, it may be necessary to combine antibacterial agents and remineralization agents. In the context of orthodontic treatments with bonded devices, the combination of chlorhexidine with fluoride toothpaste and gel protocols may prove effective in limiting the development of “white spots”.
- B-Xylitol : It is a non-cariogenic sugar alcohol with antimicrobial properties; it can be administered in chewing gum or in the form of lozenges.
- c-Triclosan: Triclosan is a hydrophilic nonionic antimicrobial agent with hydrophobic properties. Triclosan has a broad antimicrobial spectrum, with activity against both Gram-positive and Gram-negative microorganisms and fungi.
Oral microorganisms such as mutans, streptococci, S. sanguinis and Streptococcus salivarius are sensitive to low concentrations of triclosan.
- d-Essential Oil (Listerine ): Listerine is a hydroalcoholic solution of thymol, menthol, eucalyptol and methyl silicate. It is one of the oldest mouthwashes and is very popular
- e- metal ions : Metal ions such as Cu2+, Zn2+, and Sn2+ exhibit antimicrobial effect by interacting with anionic groups of bacterial enzymes and thus can inhibit bacterial metabolism.
3-Biological control of bacterial biofilm
a-Anti-caries vaccine
Two main approaches were considered:
- To elicit a serum IgG-like response from an injectable vaccine using Streptococcus mutans bacterial wall proteins as antigens.
- Promote a salivary IgA response through the mucosal digestive system using an oral vaccine, absorbed at the intestinal level.
b-probiotic
The paradigm shift is underway toward an ecological plaque; a hypothesis that supports new treatment strategies. The rationale for the probiotic approach is “to administer live microorganisms that confer a health benefit to the host.
c-engineering of bacterial adhesion antibodies
Recently, local passive immunization has raised a safe procedure in the prevention of dental caries. New technology for antibody engineering makes possible the production of immunoglobulins in transgenic animals and plants (Nicotiana tabacum). Murine IgG1 has been isolated and is effective against streptococcal cell surface adhesion, which mediates the attachment of bacteria to the salivary pellicle.
Preventive and/or non-invasive dentistry
d.Nanotechnology: (Dendrimers-Antimicrobials/Antiadherents)
- Nanotechnology has given us dendrimers that can be used as nanotherapeutics.
- These very low molecular weight artificial proteins can penetrate cells and they can also be functionalized. In other words, you can attach to a dendrimer, an antimicrobial, an antimetabolite, an anti-inflammatory, etc. Then, depending on
- The dendrimer can also attach to surface apatite by altering the surface charge or acting as an antibacterial agent,
III-Dietary advice
Advise the patient:
- Reduce the intake of sugary foods
- Prefer sugar substitutes
- Promote the ingestion of foods with anticariogenic potential: e.g. cereals (rich in glyceryl acid), dairy products (rich in calcium, phosphorus and casein)
IV-Remineralization of non-cavitary lesions
1-Professional application of fluoride
- Fluoride varnishes: These preparations promote prolonged contact of fluoride with the enamel surface, allowing better incorporation. There also appears to be a reduction in the solubility of the enamel surface where the varnish has been applied.
- Fluoride gels
- The gels are used in single-use trays. The method is simple, fast and widely accepted by patients.
- The recommendations are to leave the trays in place for 4 minutes and the patient should not rinse or drink for 1 hour or 1.5 hours after applying the fluoride gel.
- Aqueous solutions
- Topical application of the aqueous solution is done using an applicator or brush on clean, dry teeth that are properly isolated from the salivary environment.
2-Individual application of fluoride
- Fluoride toothpastes: their use explains the reduction in cavities.
- Mouthwashes : are the most common method to combat caries, the preparations are based on NaF in a concentration of 0.05% for daily use and 0.2% for weekly use,
- Fluoride tablets and chewing gum: this represents another form of self-application of fluoride.
3-Other remineralization agents
- CPP-ACP and CPP-AFCP : More recently, specialties based on CPP-ACP (casein phosphopeptide – amorphous calcium phosphate) and CPP-AFCP (casein phosphopeptide – amorphous fluoride calcium phosphate) have been introduced. These molecules prove to be promising in the non-invasive management of carious lesions by promoting phosphocalcic remineralization.
V- Therapeutic techniques for non-cavitary lesions
- Sterilization of the dentinal wound (Ozone therapy):
Application of ozone to the initial caries using a handpiece with a single-use applicator. Once the surface is cleaned, fluoride varnish is applied to fill in surface irregularities.
Preventive and/or non-invasive dentistry
- The laser:
The application of the Er:YAG laser on an initial carious lesion allows:
- Selective removal of damaged tissues
- It makes enamel more resistant to acid demineralization
- Sealing of occlusal fissures
Sealants occupy a prominent place in the therapeutic arsenal in Minimal Intervention and are, in fact, indicated in the case of occlusal non-cavitary carious lesions but also for sealing open margins on the edge of old restorations.
indicated in:
- a prophylactic framework for carious lesions
- Enamel lesions with enamel breakage
Contraindications
- Extensively decayed teeth, with one or more crown lesions
- poor oral hygiene
- highly fluoridated teeth.
Protocol;
- Deepening of the groove and dimples using a diamond ball cutter mounted on a very small diameter turbine, or using ultrasonic or air abrasion diamond inserts
- Sealing the groove with a flowable composite after etching and application of adhesive or sealing with a CVI
- Polishing and occlusion control
- Infiltration of initial caries
The Icon® infiltration product exists for initial caries, the tooth substance is preserved as much as possible because there is no drilling
Operating protocol:
- Cleaning and polishing the surface using a rubber cup
- Etching enamel
- Rinse + dry the surface
- Depositing Icon® resin using a specific syringe
- Photo polymerization
VI- Cavity approach
1. Site 1 (occlusal):
Stage 1:
- For sites 1, there is no predetermined shape. At best, the teardrop shape allows minimal access to remove all infected dentin while preserving the maximum amount of enamel surface.
- Separate cavities should not be connected.
- The cavity should not be extended to the furrow
- The creation of a beveled or rounded chamfer is not recommended at this stage of the lesion .
Stage 2:
- The shape of the cavity is rounded
- The preparation extends to the infiltrated furrows
- Separate cavities should not be joined
- Preserve the overhanging enamel
2. Site 2 (proximal):
- Tunnel Preparation :
It is an occluso-proximal cavity made in such a way as to respect the integrity of the marginal ridge as much as possible; it is called a closed tunnel when the proximal enamel is not destroyed and it is called an open tunnel when the latter is collapsed.
3. Site 3 (cervical):
- No specific form
- The form of preparation follows the configuration of the lesion.
Preventive and/or non-invasive dentistry
Deep cavities may require root canal treatment.
Interdental brushes effectively clean between teeth.
Misaligned teeth can cause chewing problems.
Untreated dental infections can spread to other parts of the body.
Whitening trays are used for gradual results.
Cracked teeth can be repaired with composite resins.
Proper hydration helps maintain a healthy mouth.