CARIES

PREVENTION IN
CHILDREN
drg. Septriyani K., MDSc., Sp. KGA
FKG UMS
 CARIES
ETIOLOGICAL
PHATOGENESIS?
FACTOR?

HOW TO PREVENTION ?
DIAGNOSE ?
BASIC CONCEPT CARIES ETIOLOGY
The main features of the caries
process are:
(1) fermentation of carbohydrate to organic acids by micro-organisms
in plaque on the tooth surface;
(2) rapid acid formation, which lowers the pH at the enamel surface
below the level (the critical pH) at which enamel will dissolve;
(3) when carbohydrate is no longer available to the plaque micro-
organisms, the pH within plaque will rise due to the outward
diffusion of acids and their metabolism and neutralization in
plaque, so that remineralization of enamel can occur; and
(4) dental caries progresses only when demineralization is greater
than remineralization. The realization that demineralization and
remineralization is an equilibrium is key to understanding the
dynamics of the carious lesion and its prevention.
CRITICAL pH
Key Points : Dental caries
• occurs in plaque-covered areas frequently exposed to dietary
carbohydrates;
• the initial lesion is subsurface before the thin surface layer
collapses;
• the initial or pre-cavitation lesion is reversible;
• saliva plays an essential part in caries prevention;
• if all plaque is removed from the surface the carious process
stops.
The stages in caries diagnostic
process
Detect

Diagnose

Record
 DETECTION OF CARIES
• Conventional
• using sharp instruments like exproler and probe
• ause more harm by breaking the enamel rods when forced into an
incipient carious lesion.
• Condition:
• Decay is difficult to detect in radiographs unless larger than 2 mm to
3 mm deep into dentin
• Early caries lesion is pre-cavitation: white lesion or brown lesion
• At this early stage of caries remineralization should be considered.
• The problem is detecting the initial stage of caries.
• Minimaly invasive dentistry
• Caries detection devices are another tool aiding in the diagnosis of
caries along with conventional diagnostic tools and good professional
judgment.
• They can be used to monitor the progression of caries and aid in the
decision to prevent, remineralize, or restore.
Diference between white spot
and fluorosis
Fluoresence
The mainstay of preventive
measures are:
(1) plaque control and regular tooth brushing with a fluoride
toothpaste;
(2) sensible dietary advice;
(3) use of fluorides;
(4) fissure sealants;
(5) regular dental checks with appropriate radiographs.
 PLAQUE CONTROL
- To maintain proper and healthy oral environment
- Methods:
1. Mechanical plaque control
a. Toothbrush : manual, electric
b. Interdental tools: dental floss, triangular tooth pick
2. Chemical plaque control
a. First generation
- Reducing plaque 20-50%
- Ex: antibiotic, phenol
b. Second Generation
- reducing plaque 70-90%
- Ex: Bisbiguanid, chlorhexidine
c. Third generation
- Block binding microorganism
- Ex: enzyme (dekstranase, lactoperoxidase), povidon iodine
Plaque Control Procedure in
dental clinic
1. Plaque identification
2. Show the plaque to patients
3. Plaque scoring: OHI, PHP
4. Show the patients that plaque is easily removed
5. Show the patients to brush properly
6. Advice patient to use disclosing solution in daily oral hygiene
procedure
7. Fluor suplement if needed
8. Recomend patient to use fluoride containing dental paste
9. Do prophylaxis to remove remaining plaque
PHP
• Syarat: gigi desidui/permanen yang telah erupsi minimal ¾
• Gigi secara imajiner dibagi menjadi 5 area (skor 0: tidak ada plak, 1:
ada plak)
a. A : 1/3 gingiva dari area bagian tengah
b. B : 1/3 tengah dari area bagian tengah
c. C : 1/3 oklusal/incisal dari area bagian tengah
d. D : Area distal
e. E : Area mesial
• Gigi indeks yang diperiksa
a. Gigi paling posterior kwadran kanan atas
b. Gigi kaninus kanan atas
c. Gigi molar pertama desidui atau premolar pertama kiri atas
d. Gigi paling posterior kwadran kiri bawah
e. Gigi kaninus kiri bawah
f. Gigi molar pertama desidui atau premolar pertama kanan bawah
 DIET CONTROL
Eat more variety
meals especially water
Varieties containing food like
fruits and vegie

Reduce high sucrose

containing food
Amount

Frequency Less frequent is better

 FLUORIDE
• Food containing fluor: vegetables, tea, fish
• Metabolism:
a. Absorbtion: 30-60 min after ingestion, mostly by intestinum
mucosa
b. Distribution: peak concentration in an hour, normal after 4 hour
0,1-0,15 ppm
c. Eksretion: by urine (90-95%), feces (5-10%) and sweat
d. Storage : bone and teeth bounded
Mechanisme: ion substitution between fluor from extracelular fluid and
hidroxil from hidroxiapatit form fluorapatit
e. Toxixity: acute and death ( single dose 2,5-5 gr sodium fluoride)
a. 2-8 ppm  mottled tooth enamel
b. 8-20 ppm  osteosklerosis
c. 50 ppm  growth depression
d. 5-10 gr  death
AKSI FLUOR
Dapat mereduksi karies dengan cara:
a. Meningkatkan stabilitas kristal email
b. Meningkatkan remineralisasi
c. Menghambat sistem enzim bakteri yang mengubah gula
menjadi asam
d. Efek antibakteri secara langsung
 HOW TO GIVE
1. Fluoridasi sistemik
1. Water Fluoridation : < 2 years, Concentration 1 ppm
2. Fluor tablet and lozenges
3. Fluor containing salt
4. Fluor containing milk
2. Fluoridasi Lokal
1. Pasta gigi berfluoride
2. Kumur-kumur larutan fluor
3. Gel berfluor
4. Topikal aplikasi fluor
Daftar Pemberian Suplemen
Fluor (dalam mg/hari)

Usia < 0,3 ppm F 0,3-0,6 ppm F > 0,6 ppm F

Lahir- 6 bulan 0 0 0
6 bulan- 3 tahun 0,25 mg 0 0
3-6 tahun 0,50 mg 0,25 mg 0
6 tahun- 16 tahun 1 mg 0,50 mg 0
 TOPIKAL APLIKASI FLUOR
- Terdapat 3 bahan: Sodium fluoride, Acidulated Phosphat fluoride,
dan stannous fluoride
A. Sodium fluoride
1. Teknik Knutson
a. Profilaksis dengan pasta pumice menggunakan pointed brush dan
rubber cup
b. Isolasi dengan cotton roll
c. Keringkan
Aplikasi NaF 2% biarkan selama 3 menit agar kering
d. Tiap perawatan memerlukan 4 kali aplikasi dengan interval satu minggu,
profilaksis hanya dilakukan di kunjungan pertama
e. Perawatan dilakukam pada usia 3,7,11 dan 13 tahun
2. Teknik Bibby
a. Tahap a-c sama
b. Aplikasi NaF 0,1 %, dijaga tetap basah dengan larutan selama 7-8 menit
c. Perawatan 3 kali dalam 1 tahun
B. Acidulated Phosphat fluoride
- Merupakan campuran dari sodium fluoride, hydrofluoric acid
dan phosphoric acid.
- Konsentrasi untuk topikal adalah 1,23% berbentuk gel atau
larutan
- Teknik:
a. Profilaksis
b. Isolasi gigi
c. Keringkan
d. Aplikasi APF, jaga agar tetap basah selama 4 menit
e. instruksikan untuk tidak makan dan minum selama 30 menit
f. Perawatan dilakukan tiap 6 bulan/ 1 tahun
C. Stannous fluoride
- Konsentrasi 8%
- Teknik
a. Profilaksis dengan pasta prophy yang mengandung SnF2
b. Isolasi gigi
c. Keringkan
d. Aplikasi SnF2 pada permukaan gigi, jaga tetap basah
e. Prosedur rutin setiap 6 bulan/ 1 tahun sekali
f. Instruksi: jangan makan dan minum selama 30 menit setelah
perawatan
Fluor Keberhasilan Keuntungan Kerugian
NaF Efektif untuk pH netral, rasa lebih bisa Berbahaya jika tertelan dalam
anak yang diterima dibanding SnF2, tidak jumlah besar
tinggal di ada pengaruh terhadap
daerah rendah restorasi
fluor, Larutan bersifat stabil
konsentrasi
anjuran 2%
dalam bentuk
gel atau larutan
APF Rasa lebih bisa diterima Merusak restorasi porselen,
dibanding SnF2, tidak berbahaya jika tertelan dalam
menyebabkan staining atau jumlah besar
pigmentasi, dapat
diaplikasikan di RA dan RB
secara bersamaan, larutan
stabil
SnF2 Tidak menyebabkan rasa tidak enak, sebabkan
pengetsaan pada restorasi pigmentasi pada lesi awal
porselen karies, iritasi gingiva, larutan
tidak stabil, pigmentasi pada
restorasi silikat, bahaya jika
tertelan
Bahan lain yang digunakan…
Silver Diamine Fluoride
Casein phospopeptide amorphous calcium phosphatase
(CPP-ACP), Tri-calcium phospate
FISSURE SEALANT
 Indikasi
Pit dan fissure yang dalam dan retentif
Pit dan fissure yang mengalami
dekalsifikasi minimal/ pewarnaan
Adanya restorasi atau karies pada pit
dan fissure gigi desidui/permanen
lainya
Tidak ada tanda karies interproximal
yang memerlukan restorasi
Memungkinkan isolasi gigi secara
memadai
Erupsinya kurang dari 4 tahun
Anak-anak dengan disabilitas
Kontraindikasi
Pit fissure yang memungkinkan self
cleansing
Terdapat karies proksimal yang perlu
direstorasi
Terdapat banyak karies dan tidak ada
tindakan preventif lain
Gigi baru erupsi sebagian, tidak
memungkinkan isolasi
Pit dan fissure yang tetap bebas karies
selama lebih dari 4 tahun
Fissure sealing technique
• Prophylaxis before etching does not enhance retention but is
advisable if abundant
• plaque is present. A dry brush should be used rather than
paste as these are retained in the depths of the fissures
preventing penetration of the resin.
• Isolate the tooth surface,
• Etch for 20-30 s with 37% phosphoric acid,
• Wash and dry the surface maintaining isolation,
• Apply the resin,
• Cure,
• Check for adequacy.
Application of glass ionomer
sealants
• Clean the surface
• Isolate the tooth
• Run the glass ionomer into the fissures
• Protect the material during initial setting
• Apply unfilled resin, petroleum jelly, or fluoride varnish to
protect the material.
• For anxious patients application can be done with a gloved
finger until the material isset.
Patient selection
1. Children with special needs. Fissure sealing of all occlusal
surfaces of permanent teeth should be considered for those
who are medically compromised, physically or mentally
disabled, or have learning difficulties, or for those from a
disadvantaged social background.
2. Children with extensive caries in their primary teeth should
have all permanent molars sealed soon after their eruption.
3. Children with carious-free primary dentitions do not need to
have first permanent molars sealed routinely; rather these
teeth should be reviewed at regular intervals.
Tooth selection
1. Fissure sealants have the greatest benefit on the occlusal
surfaces of permanent molar teeth. Other surfaces should
not be neglected, in particular the cingulum pits of upper
incisors, the buccal pits of lower molars, and the palatal pits
of upper molars.
2. Sealants should normally be applied as soon as the selected
tooth has erupted sufficiently to permit moisture control.
3. Any child with occlusal caries in one first permanent molar
should have the fissures of the sound first permanent
molars sealed.
4. Occlusal caries affecting one or more first permanent molars
indicates a need to seal the second permanent molars as
soon as they have erupted sufficiently.
 SUMMARY

1. Dental caries is caused by dietary carbohydrates being

fermented by plaque bacteria to acid.
2. Caries detection and diagnosis requires a meticulous
systematic approach.
3. The pre-cavitation lesion is a danger sign indicating the need
for prevention.
4. The four practical pillars to caries prevention are:
toothbrushing, diet, fluoride, and fissure sealing.
5. Preventive advice must be to parent and child and should be
appropriate to the age and circumstances of the child.
6. Motivation and continuous encouragement is essential if
prevention is to be successful.