Dental caries is the most common dental disease all over the world.

For the primary dentition, 28 % of children between 2 to 5 years of age had one or more carious primary teeth ,and 51 % of children aged between 6-11 years had one or more primary carious teeth.

 In the permanent dentition, 10 %of children between

6 to 8 years were affected by dental caries, and 51%

of children were affected by age 12 to 15. Dental

caries affected 96 % of adults aged between 50 to 64

years.

Root caries affected about 8 % of adults aged 20 to

34 years and 21 % of adults aged 50 to 64 years.

Prevention and control of dental caries

Fluoridated agents

Non fluoridated agents

 Based on high-quality evidence, fluoride, is the first choice for prevention and control of dental caries. It is relatively economical and can be administered through a number of cost-effective routes to large number of at caries risk population.

Fluoride has multiple modes of action, as:

inhibition of tooth demineralization promotion of incipient lesion remineralization antibacterial effects on cariogenic bacteria.

 However, fluoride has many drawbacks. First, fluoride has a profound effect on the level of caries prevalence, but it is far from a complete cure. There is no fluoride concentration which can eliminate caries totally

 The second reason is that its effect is more limited

on pit and fissure caries, which is the dominant type

of caries in the developing countries.

 In addition, fluoride toxicity problems increase with inadequate nutrition or when used with immune compromised patients. Also, there is some evidence

that there are no additional benefits gained from

fluoridated water.

 Researches started to search for non-fluoride agents for the prevention of dental caries, whether these products can work alone or can be synergistic to the effect of the fluoride in the prevention of dental caries at the community level.

 1- Sugar free chewing gum 2- Other Xylitol forms

3- chlorhexidine 4- triclosan 5- Remineralizing agents 6- iodine

 7- sialogogues 8- ozone
9- Fissure sealants 10- Caries vaccines 11- probiotics 12- Future prospects

 Xylitol is a commonly used sugar substitute that increases salivary flow rate and enhances the protective properties of saliva. The sugar-free gum containing xylitol produces superior

remineralization.

Sorbitol is another sugar substitute. The remineralizing

ability of xylitol and sorbitol on early enamel caries

is almost the same. Adding Isomalt to a

demineralizing solution has shown to significantly

reduce tooth mineral loss.

 The ADA panel for evidence based dentistry reported that there is moderate evidence that in children aged 5 16 years, supervised consumption of chewing gum sweetened with sucrose-free polyol (xylitol only or polyol combinations) for 10 20 minutes after meals marginally reduces incidence of caries .

 ADA panel concluded that evidence is low that:

xylitol in dentifrices, lozenges or hard candy

reduces incidence of coronal caries in children

There is insufficient evidence that xylitol syrup

prevents caries in children under 2 years of age.

 it is available in many vehicles. It has been reported that a varnish causes the most Mutans streptococci persistent reducing effect, followed by gels and

mouthwashes. CHX-containing sprays, chewing

gums and dentifrices are also available on the

market.

 There is moderate evidence that the professionally

applied 10 to 40 % CHX varnish does not reduce

the incidence of coronal or root caries in children

and adults.

 There is low certainty in concluding that: In children up to 15 years, application of a 1:1 mixture of CHX/thymol

varnish does not reduce the incidence of coronal caries.

while, the evidence is moderate that it reduces the

incidence of root caries in adults and elderly people

 Regarding the rinse, the panel concluded with high

certainty that, using 0.05 to 0.12 percent CHX rinse

does not reduce the incidence of coronal or root

caries in children and adults.

 For the CHX gel, THE ADA panel concluded that: there is insufficient evidence that professionally applied 1 % chlorhexidine gel reduces the

incidence of coronal caries in 3-15 years children,

or the root caries in adults and eldery.

 It is a broad-spectrum antimicrobial agent which is widely used in dentifrices. Alone, it has only moderate anti-plaque properties, but when used in conjunction with other compounds its activity may be enhanced.

 The panel concluded that: There is insufficient evidence that triclosan lowers incidence of caries.

:
A-Calcium containing agents: 1 % calcium lactate mouth-rinse Calcium carbonate Amorphous calcium phosphate (ACP) Sodium calciumphosphosilicate (bioactive glass): Calcium carbonate carrier - SensiStat

B- phosphorous containing agents:

inorganic salts as sodium and potassium or the complex polyphosphates Organic phosphates such as glycerophosphate and phytate The trimetaphosphate ion (TMP) Alpha-tricalcium phosphate Dicalcium phosphate dehydrate (DCPD)

C-Nano hydroxyapatite
10% of carbonate hydroxyapatite nanocrystals, having size, morphology, chemical composition, and crystallinity comparable to that of dentin, are said to remineralize enamel. Hydroxyapatite has been used in toothpastes (as fillers) and pit-and-fissure sealants

D Casein

Phosphopeptides

(CPP):
They are the latest entry into preventive dentistry. They are used alone or as CPP-ACP (casein phophopeptides with amorphous calcium phosphate) or CPP-ACFP (casein phophopeptides with

amorphous calcium fluoride phosphate).

 The main function of casein phosphopeptides is to modulate bioavailability of calcium phosphate levels to increase remineralization. It is also believed to

have an antibacterial and buffering effect on plaque

and interfere in the growth and adherence of

Streptococcus mutans and Streptococcus sorbinus.

 The

ADA

panel

concluded

that:

There

is

insufficient evidence from clinical trials that use of agents containing calcium and/or phosphates with or without casein derivatives lowers incidence of either coronal or root caries.

6- Iodine:
It is reported that 10% povidone-iodin reduce Streptococcus mutans concentrations in plaque biofilm and saliva. However, the panel concluded

that There is insufficient evidence that use of

iodine lowers incidence of coronal caries.

 The panel found no published reports that evaluated the use of sialogogues (for example, pilocarpine, cevimeline) for caries prevention.

 Ozone

therapy

is of

proposed incipient

to

stimulate following

remineralization

caries

treatment for a period of about 6 to 8 weeks.

 Sealants are placed to prevent caries and to arrest caries progression by providing a physical barrier that inhibits microorganisms and food particles from

collecting in pits and fissures. The addition of

remineralizing agents such as fluorides and CCP-

ACP can further enhance remineralization.

 ADA panel reported : The placement of resin-based sealants on the permanent molars of children and adolescents is effective for caries reduction. The

percentage of reduction ranges from 86 %at one

year to 78.6 %at two years and 58.6 %at four years.

Placement

of

pit-and-fissure

sealants

significantly reduces the progress of noncavitated

carious lesions in children, adolescents and young

adults up to five years after sealant placement.

 A successful vaccination directed against S.mutans could be a valuable adjunct to other caries preventive measures. If clinical trials prove their

efficiency and safty, then dental caries vaccine can

be given at the time of regular immunization

schedule of a child.

 Dental caries vaccine has some limitations: other microorganisms rather than S.mutans can initiate caries like, S.sobrenus and vaccination against all is

not possible. Also if we contain these organisms,

another will become the potential agents for causing

caries.

 The term probiotics refers to the living microorganisms, which, when administered in adequate amounts, provides a health benefit to the host

 Classic probiotic strains, such as those belong to Lactobacillus and Bifidobacterium, have been tested. This also includes the application of S.

mutans types that cannot produce acids, or other

bacteria that interfere with the pathogenic effects of

S. mutans.

 synthetic (CHA)

carbonate-hydroxyapatite nanocrystals have been

biomimetic investigated

regarding the possibility of obtaining an in vitro remineralization of the altered enamel surfaces.

 Smart molecules against specific bacteria, passive immunization with animal or plant derived

antibodies against cariogenic bacteria, and peptideand DNA-based vaccines aimed at pathogens colonization proteins are now under development.

 In light of good supportive evidence, the panel reminds clinicians that professional and home-use fluoride products, including fluoridated toothpastes and dental sealants, remain the primary interventions effective in preventing caries