Lecture 8

Management of dental caries ( Cont. )

There are three types of sugars:

1- Conventional sugars: sucrose, lactose, glucose, fructose ( ‫) موجود في العسل‬
2- Nutritive sugars: caloric ( calories ‫) بيزود ال‬
Sugar alcohols : xylitol, sorbitol, mannitol
3- Intense sweeteners (Non caloric synthetic sugars): aspartame, neotame, saccharine

Sugar substitues
Nutritive sweeteners :
may be referred to as caloric or bulk sweeteners and include sugars and sugar alcohols
Non-nutritive sweeteners :
may be referred to as non caloric or intense sweeteners offer no energy and can sweeten with
little volume

Nutritive sweeteners
‫ زي العصير و اللبان‬sugar free products ‫موجودين في كل ال‬
Xylitol :
xylitol is the best nutritive sucrose substitute with respect to caries prevention. It has been
shown to be nonacidogenic and therefore noncariogenic
‫ مش بتعمله‬streptococcus mutans ‫ و ال‬modification of diet ‫ و هشتغل عليه‬high caries risk ‫مع بيشنت عنده‬
fermentation
Sorbitol :
The dental interest in sorbitol results from its use in so-called sugar-free gum, which has been
claimed to be noncariogenic
Mannitol :
This sweetener is metabolized very slowly by oral microorganisms and has virtually no
cariogenic potential

Anti cariogenic effect of Xilitol :

Non fermentable :
• Inhibits enamel demineralization
Direct effect on bacteria :
• Reduces bacterial adherence
Increases salivary flow :
• Neutralize plaque acidity
Non-nutritive sweeteners
1- Saccharin
* 300 times sweeter than sucrose
* Saccharin is compatible with most food and drug ingredients
* Its major deterrent, a metallic aftertaste
2- Aspartame
* It is approved as a free-flowing sugar substitute for table use, and for use by manufacturers
in over 100 products.
* It is void of an unpleasant aftertaste
* In diet pepsi & 7UP
Factors affecting diet :
1- Nature : sticky or fibrous
2- Frequency : intermediate or constant
3- Consistency
Dietary Guidance for Prevention of Dental Caries
1- Eat a diet that is low in retentive carbohydrates (ex; sticky food).
2- Reduce the frequency of eating and drinking fermentable carbohydrates
3- Do not eat cariogenic snacks.
4- Include foods of firm and hard texture for better clearance and low adherence on tooth
surface. ( ‫ تاكل جزر‬snickers‫) يعني بعد‬
5- Choose fats in the diet wisely to reduce the risk of chronic disease yet still benefit from
fat adherence to tooth surface.
6- Chew sugarless gum after eating for 15-20 minutes to increase salivary benefits.
7- Only eat candies with noncariogenic sweeteners such as Xylitol and Maltitol.
Snaking Habit
Avoid Snack on
Sugar Fresh fruits and vegetables
Honey Breads or crackers with margarine or peanut butter
Corn Syrup cuz it is fatty so non cariogenic
Candies Low fat ( or filled milk ) cheese
Jellies Lean meats
Jam Skimmed milk
Sugared breakfast cereals
Cakes
Sugared chewing gum
Sucrose sweetened drinks
Sweetened fruit juice
Fruit - flavored drinks

Caries management by modifying the biofilm :

1- Mechanical 2- Chemical
How to evaluate patients teeth brushing ?
Make him chew disclosing tablets and see the amount of plaque
The bristle tooth brush appeared about the year of 1600 in China and later was patented in
America in 1857 ( ‫) العرب كانوا بيستخدموا المسواك في الوقت دا‬
Tooth brushing :
1- Manual : is effective as electric
2- Electric : with old age , children & physically disable to brush
- Professional care :
Remove calculus & plaque and polish teeth with contra
Mechanical biofilm control :
1- Grap brush in 45º towards gingival sulcus and brush buccal / labial surface in one
direction towards occlusal surface ( vertical or horizontal cause damage to gingiva )
2- Brush lingual / palatal surfaces in one direction towards occlusal surface
3- Brush occlusal surfaces
4- Scraping of tongue to avoid bad odor
Ideal Properties of a Tooth Brush
1- Should remove all the calculus and plaque.
2- Should access all the surfaces of the tooth.
3- Should not injure the gingiva.
4- The bristles should be soft to avoid abrasion (mechanical wear ot tooth )
5- The bristles should not deteriorate/ or should have long working life.
Tips for high caries risk patient to gain good oral hygiene protocol :
1- Brush your teeth twice a day WHY??
‫ بيتكون بعد نص ساعه من االكل فغسيل االسنان هيقلل الفتره اللي هيحصل فيها‬plaque ‫ممكن تكون مش بتاكل بليل بس ال‬
maturation
2- Brush your teeth after meals WHY??
‫ يبقي كدا‬.. ‫ هتغسل اسنانك بعدين هتفطر و تروح الكلية‬plaque on cervical areas ‫لما بتصحي الصبح من النوم بتالقي‬
‫ علي اسنانك‬food stagnation ‫ اللي اتكون طول الليل لكن عملت‬plaque ‫معملتش حاجة انت شيلت ال‬
3- Avoid excessive force to avoid avrasion
4- Use medium tooth brush not soft or hard … to avoid tooth brush abrasion
5- Reduce rinsing … to get benefit from fluoride in paste
6- Replace tooth brush every three months
7- Brushing time : not less 2min and maximum 6 min
‫ لقوا‬percentage of caries reduction ‫ دقايق و قاسوا ال‬6 ‫ اتعملت بين ناس بتغسل دقيقتين و ناس‬studies ‫فيه‬
not effective in caries reduction ‫ بيكون‬2 ‫ لكن اقل من‬6 ‫ ل‬2 ‫مش بتفرق من‬

: How do tooth pastes fight dental caries

1- Before demineralization ( at risk ) caries ‫لسه محصلش‬
- Fluoride containing toothpastes → hardens enamel
- Xylitol containing toothpastes
2- After demineralization ( initial stage )
In white spot lesion , incipient lesion , chalky white appearance
- minerals ( remineralization of white spot lesion )
 fluoride is toxic ‫ الن‬toxicity ‫ علشان ميبقاش فيه‬pea size ‫ هتحط معجون اسنان‬-
‫ علشان سهل يبلعوه‬rice size ‫و في األطفال‬
: Interdental cleaning aids
interdental tooth brush or floss ‫ فهحتاج‬interproximal surface ‫فرشاه االسنان مش بتوصل لل‬
... interdental floss ‫ و الصورة اللي علي الشمال‬interdental brush ‫الصورة اللي علي اليمين‬
interdental brush ‫ ال‬area ‫ و بيوصل لكل ال‬more effective ‫ال‬
‫ مش بيوصلها‬floss ‫ ال‬critical areas in concavity of proximal surface ‫ فيه‬interdental floss ‫الن ال‬

: Advantages of interdental brush

Very effective in cleaning under the implant -1
Very effective in cleaning under braces ( in orthodontic appliances ) -2
Reach triangle space between gums in gingival embrasure -3
‫ و نشيل االكل بين االسنان‬gingival embressure ‫بنحطها في ال‬

permanent damage in interdental papilla ‫ بيكونوا وحشين جدا علشان بيعملوا‬wooden / plastic tooth pics ‫ال‬
wide interdental space ‫ او‬gingival recession ‫ و مقدرش استخدمهم اال لما يكون عندي‬abusive use ‫مع ال‬

... different sizes & tips ‫ و بتكون ب‬/ water jet air ‫ بيشتغل ب‬oral irrigating devices ‫احسن حاجة ال‬
‫ بسبب ال‬depth of the pocket ‫ مش بتوصل لل‬floss & interdental brush ‫ علشان ال‬pockets ‫مفيدة اكتر للي عندهم‬
alveolar bone

Streptococcus mutans : 1- acidogenic & aciduric

facultative : can live in aerobic & non aerobic -2