Primary Prevention

• Health promotion:
  • Oral hygiene instruction
  • Dietary counseling
  • Fluoride exposure
• Specific protection:
  • Sealants
  • Antimicrobials

Secondary Prevention

• Early diagnosis (bitewings, DIAGNOdent)
• Prompt treatment (incipient lesions)

Tertiary Prevention

• Restorative treatment
• Rehabilitation
• Recall maintenance

Goal: Focus on primary prevention to avoid disease initiation

Varnish Technique

1. Clean and dry teeth
2. Apply thin layer to all surfaces
3. Patient avoids eating/drinking 30 min
4. No brushing for 4-6 hours

Safety Considerations

• Acute toxic dose: 5mg F/kg
• Chronic overexposure: Fluorosis
• Storage out of children's reach
• Supervise children <6 years

Clinical Evidence

• 78% reduction in occlusal caries at 2 years
• 60% reduction at 4 years
• Sealed teeth have 50% lower risk of restoration
• Effectiveness maintained if intact

Retention Factors

• Operator skill
• Moisture control
• Tooth eruption stage
• Material selection

Maintenance

• Inspect at recall visits
• Reapply if partially lost
• Monitor for caries under sealant

Contraindications

• Visible caries
• Well-coalesced pits/fissures
• Non-carious tooth
• Allergy to components

Toothbrushing

• Bass technique:
  • 45° angle to gingiva
  • Short vibratory strokes
  • Focus on sulcus
• Modified Stillman:
  • For recession
• Frequency:
  • 2x/day minimum
  • After meals ideal

Toothbrush Selection

• Soft bristles
• Small head
• Replace every 3 months
• Powered brushes may be more effective

Toothpaste

• Fluoride-containing
• 1000-1500 ppm F for adults
• Smear for <3 years
• Pea-sized for 3-6 years

Special Considerations

• Orthodontic patients
• Prosthesis wearers
• Xerostomia
• Dexterity challenges

Flossing

• Technique:
  • C-shape against tooth
  • Gently below gingiva
  • Clean both proximal surfaces
• Types:
  • Waxed/unwaxed
  • PTFE (Glide)
  • Superfloss (for bridges)

Interdental Brushes

• For open embrasures
• Size appropriately
• Gentle insertion
• Replace when worn

Other Aids

• Wooden sticks:
  • Stimulate gingiva
  • Remove plaque
• Water flossers:
  • Good for ortho, implants
  • Doesn't replace flossing
• Tongue cleaners:
  • Reduce halitosis

Patient Education

• Demonstrate on models
• Have patient return demo
• Provide written instructions
• Motivate with disclosing solution

High Risk Factors

• Biological:
  • Active caries
  • High S. mutans levels
  • Low saliva flow
• Behavioral:
  • Frequent snacking
  • Poor oral hygiene
  • No fluoride exposure
• Environmental:
  • Low socioeconomic status
  • Limited dental access

Assessment Tools

• CAMBRA:
  • Caries Management by Risk Assessment
  • Comprehensive questionnaire
• CAT:
  • Caries Assessment Tool
  • Simplified version
• ADA Caries Risk Forms

Clinical Indicators

• White spot lesions
• Restoration history
• Plaque accumulation
• Bleeding on probing

Protective Functions

• Cleansing:
  • Removes food debris
• Buffering:
  • Bicarbonate system
  • Neutralizes acids
• Remineralization:
  • Calcium/phosphate ions
• Antimicrobial:
  • Lysozyme, lactoferrin
  • Secretory IgA

Xerostomia Management

• Stimulate flow:
  • Sugar-free gum
  • Pilocarpine (Rx)
• Saliva substitutes:
  • Carboxymethylcellulose
• Preventive care:
  • High-fluoride products
  • Frequent recalls
  • Avoid alcohol rinses

Testing Salivary Flow

• Unstimulated: <0.1 ml/min = low
• Stimulated: <0.7 ml/min = low
• Spit into cup for 5 minutes

Chlorhexidine

• Properties:
  • Gold standard antimicrobial
  • Substantivity (12h retention)
• Forms:
  • 0.12% rinse (30 sec 2x/day)
  • Gel
  • Varnish
• Side effects:
  • Staining
  • Taste alteration

Essential Oils

• Listerine (thymol, eucalyptol)
• 30 sec rinse 2x/day
• Less effective than CHX
• Better taste

Xylitol

• Mechanism:
  • Non-fermentable sweetener
  • Disrupts S. mutans metabolism
• Forms:
  • Gum (6-10g/day)
  • Mints
  • Toothpaste
• Dosage:
  • 5-10g/day in 3-5 exposures

Probiotics

• Lactobacillus strains
• Bifidobacterium
• Early evidence promising
• Not yet standard practice

Calcium Phosphate Technologies

• CPP-ACP (Recaldent):
  • Casein phosphopeptide-amorphous calcium phosphate
  • Available in gum, toothpaste, cream
  • 30-50% remineralization improvement
• TCP (Tri-Calcium Phosphate):
  • In some fluoride toothpastes
  • Enhances fluoride uptake
• HAp (Hydroxyapatite):
  • Biomimetic
  • Nano-HAp more effective

Other Agents

• Arginine:
  • Alkalinizing effect
  • In some toothpastes
• Stannous Fluoride:
  • Antimicrobial + remineralization
  • May cause staining
• Bioactive Glasses:
  • Release Ca, P, F ions
  • Form hydroxycarbonate apatite

Clinical Application

• Early white spot lesions
• Orthodontic patients
• Xerostomia
• High caries risk

Early Childhood Caries (ECC)

• Definition:
  • ≥1 cavitated/non-cavitated lesion
  • Age <6 years
• Risk factors:
  • Nighttime bottle feeding
  • Frequent sugary snacks
  • Maternal caries
  • Low socioeconomic status
• Prevention:
  • First dental visit by age 1
  • Wean from bottle by 12-14 months
  • Brush with fluoride toothpaste

Preventive Strategies

• Fluoride varnish:
  • 2-4x/year based on risk
  • From tooth eruption
• Sealants:
  • Primary molars if deep fissures
  • Permanent molars ASAP
• Diet counseling:
  • Limit juice to 4-6 oz/day
  • No bottle in bed
• Anticipatory guidance:
  • Teething
  • Thumb sucking
  • Injury prevention

Age-Related Challenges

• Root caries:
  • From gingival recession
  • Higher in xerostomia
• Periodontal disease:
  • Chronic inflammation
  • Attachment loss
• Dexterity issues:
  • Arthritis
  • Parkinson's
• Medication effects:
  • Xerostomia
  • Gingival hyperplasia

Preventive Approaches

• High-fluoride products:
  • 5000 ppm F toothpaste
  • Daily fluoride rinse
• Adaptive aids:
  • Electric toothbrushes
  • Floss holders
  • Three-sided brushes
• Caregiver training:
  • For dependent elderly
• Frequent recalls:
  • 3-4 month intervals
  • Professional fluoride

Challenges

• Plaque retention:
  • Around brackets/wires
  • Under bands
• Demineralization:
  • White spot lesions
  • 50% prevalence
• Gingivitis:
  • From poor hygiene

Pre-Treatment

• Caries risk assessment
• Seal all susceptible teeth
• Restore active lesions
• Oral hygiene instruction

During Treatment

• Specialized brushes:
  • Interproximal
  • End-tuft
• Fluoride:
  • 5000 ppm F toothpaste
  • Weekly fluoride rinse
  • Varnish at adjustments
• Antimicrobials:
  • CHX rinse 1x/day
• Diet:
  • Avoid sticky/sugary foods

Challenges

• Physical limitations:
  • Dexterity issues
  • Wheelchair transfers
• Cognitive impairments:
  • Understanding instructions
  • Cooperation
• Medical conditions:
  • Medication effects
  • Seizure risks

Preventive Strategies

• Adaptive aids:
  • Electric toothbrushes
  • Floss holders
  • Toothbrush grips
• Caregiver training:
  • Positioning techniques
  • Daily care protocols

Clinical Approaches

• Behavior guidance:
  • Tell-show-do
  • Positive reinforcement
• Preventive treatments:
  • High-frequency fluoride
  • Sealants
  • Antimicrobial rinses
• Sedation options:
  • Nitrous oxide
  • Oral sedation
  • General anesthesia

Common Conditions

• Cerebral palsy
• Down syndrome
• Autism spectrum
• Developmental delays

Plaque Control

• Bass technique:
  • Focus on sulcular cleaning
• Interdental aids:
  • Floss
  • Interdental brushes
  • Rubber tips
• Powered brushes:
  • More effective for many

Chemical Agents

• CHX:
  • Gold standard antimicrobial
• Essential oils:
  • Listerine
• Stannous fluoride:
  • Antiplaque effects

Professional Care

• Recall frequency:
  • 3-4 months for periodontitis
• Scaling/root planing:
  • Removes calculus
• Local antimicrobials:
  • Periochip
  • Arestin

Risk Factors

• Smoking
• Diabetes
• Genetics
• Stress
• Medications

Risk Factors

• Tobacco:
  • Smoking (7x risk)
  • Smokeless tobacco (4x risk)
• Alcohol:
  • Synergistic with tobacco
• HPV:
  • HPV-16 (oropharyngeal)
• Other:
  • Sun exposure (lip)
  • Poor diet

Prevention Strategies

• Tobacco cessation counseling
• Alcohol moderation
• HPV vaccination
• Sun protection
• Antioxidant-rich diet

Screening Protocol

1. Extraoral exam (nodes)
2. Intraoral soft tissue exam:
   • Lips
   • Buccal mucosa
   • Tongue
   • Floor of mouth
   • Palate
3. Palpate suspicious areas
4. Document findings

Warning Signs

• Non-healing ulcer (>2 weeks)
• White/red patches
• Lump or thickening
• Difficulty swallowing
• Persistent sore throat

Mouthguards

• Types:
  • Stock (least protective)
  • Boil-and-bite
  • Custom (best fit)
• Materials:
  • EVA copolymer
  • 3-5mm thickness ideal
• Benefits:
  • Prevents tooth fractures
  • Reduces concussion risk
  • Protects soft tissues

Indications

• Contact sports (football, hockey)
• Collision risk (basketball, soccer)
• Any athlete concerned about injury

Fabrication

1. Take alginate impressions
2. Pour stone models
3. Heat EVA sheet (160°C)
4. Vacuum form over model
5. Trim to 2mm beyond gingiva
6. Smooth edges

Other Considerations

• Fluoride:
  • For swimmers (pool water pH)
• Hydration:
  • Avoid sports drinks
  • Water preferred
• Emergency plan:
  • Tooth avulsion protocol

Water Fluoridation

• Benefits:
  • 20-40% caries reduction
  • Cost-effective ($0.50/person/year)
• Safety:
  • 0.7 ppm optimal
  • Monitored by EPA
• Controversies:
  • Opposition groups
  • Legal challenges

School-Based Programs

• Sealant programs:
  • Target high-risk schools
  • 78% caries reduction
• Fluoride rinse:
  • Weekly 0.2% NaF
• Education:
  • Classroom presentations
  • Poster contests

Public Health Initiatives

• WIC programs:
  • Nutrition counseling
  • Oral health education
• Head Start:
  • Dental screenings
  • Referral systems
• Teledentistry:
  • Rural access
  • School-linked

Global Prevention

• WHO oral health goals
• Salt fluoridation (alternative to water)
• Milk fluoridation programs
• ATLAS initiative (global caries prevention)

Motivational Interviewing

• Principles:
  • Express empathy
  • Develop discrepancy
  • Roll with resistance
  • Support self-efficacy
• Techniques:
  • Open-ended questions
  • Affirmations
  • Reflective listening
  • Summarizing

Stages of Change

1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance

Patient Education Tools

• Disclosing solutions:
  • Visualize plaque
  • Motivate brushing
• Models/diagrams:
  • Show disease progression
• Digital apps:
  • Brushing timers
  • Reminder systems

Positive Reinforcement

• Praise improvements
• Set achievable goals
• Use reward systems (especially children)
• Involve family members

Detection Advances

• Digital imaging:
  • DIAGNOdent (laser fluorescence)
  • Near-infrared imaging
• AI diagnostics:
  • Caries detection software
  • Radiograph analysis
• Salivary biomarkers:
  • Caries risk prediction
  • Periodontal disease markers

Prevention Innovations

• Smart toothbrushes:
  • Real-time feedback
  • Data tracking
• Probiotic therapies
• Antimicrobial peptides
• Gene therapy:
  • Modify bacterial virulence

Material Advances

• Nano-fluoride:
  • Enhanced bioavailability
• Bioactive composites:
  • Remineralizing restorations
• Self-healing materials:
  • Microcapsule technology

Digital Tools

• Teledentistry:
  • Remote monitoring
  • Preventive counseling
• AR/VR education:
  • Interactive learning
• Wearable sensors:
  • pH monitoring
  • Brushing verification