Dental Puplic Health

Lecture 1

Define :-
1-Health :
According to WHO: a state of complete physical, mental and social well-being and not merely the absence of a
disease.
Recent WHO definition: “Health is the extent to which an individual or group is able on the one hand to realize
aspirations and satisfy needs; and on the other hand to change or cope with the environment".

2- Puplic Health :
It is the art and science of preventing disease, prolonging life and promoting physical and mental efficiency
through organized community effort.

3- Dental Puplic Health :

It is defined by ADA as the art and science of preventing and controlling dental diseases and prompting
dental health through organized community efforts, i.e. it serves the community, as a patient rather than
the individual

4- Preventive Dentistry :
It is a philosophy of dentistry.It comprises the various procedures used by dentists, dental hygienists, physicians, nurses,
teacher, and other to develop scientific oral health knowledge and habits

5- Caries activity tests :

Number of tests which aim at predicting caries activity in an individual.

6- Dip Slide method :

The dip slide test is a practical method to quantitate lactobacilli or streptococci

Give Reason:-
1- Prevention is the main goal of puplic health .
- Cuz prevention is better & cheaper than cure , prevention can be performed through a mass of population through
puplic health

2- Cheese is recommended as a caries preventive food .

- Cuz it cause : a- Strong stimulation of salivary flow.
b- Raises calcium concentration in plaque.
c- Raises oral pH to 7.5 within 3 minutes following ingestion which favors remineralization.

3- Xylitol is used in confectionary & toothpastes .

- less cariogenic than sorbitol & sucrose
- It inhibits certain strains of streptococci

4- The caries activity increase with increase in clearance time.

- Cuz carbohydrates stay for longer time incontact with the teeth.

5- Alternate the ( sucrose , glucose , fructose ) with artificial sweeteners like ( aspartame ,
saccharin , maaitol ).
-Cuz they reduce the cariogenicity of food.
Complete:-
1- Dental Puplic Health serves the community as a patient rather than the individual

2- Tools of dental puplic health divided into preventive dentistry and epidemiology

3- Puplic health methods must depend on biostatistics

4- Levels of prevention divided into prepathogenesis and pathogenesis

5- Primary level of prevention ( True prevention ) divided into health promotion and specific protection

6- Tertiary level of prevention divided into disability limitation and rehabilitation

7- Dental caries is the number one problem in dentistry

8- The causes of tooth decay tooth surface , sugar in your diet , plaque bacteria on the tooth surface and time

9- Diet has great influence on oral health divided into pre-eruptive effect and post-eruptive effect

10- Increasing the amount & frequency of CHO result in increasing caries activity

11- Carbohydrates should not be completely restricted from the diet , but dietary recommendations can be given

12- Sorbitol sweetened chewing gums & candies are less cariogenic than sucrose

13- Xylitol is used in confectionary & toothpastes

14- Xylitol is less cariogenic than sorbitol & sucrose

15- Dip Slide method divided into Dip-slide method for lactobacillus count and Dip- slide method for S.mutans count

Compare:-
Prepathogenesis Pathogenesis
- Primary level of prevention ( True Prevention ) - Secondry level of prevention ( Early )
- Tertiary level of prevention ( Late )

Health Promotion Specific Protection

- Health education in oral hygiene. - Good oral hygiene.
- Good standard of nutrition. - Fluoridation of public water supplies.
- Diet planning. - Topical fluoride application.
- Periodic inspection. - Avoidance of sticky foods, particularty between meals.
- Tooth brushing after eating.
- Dental prophylaxis.
- Treatment of highly susceptible but uninvolved areas
in highly susceptible persons.
- Prevention orthodontics.

Disability Limitation Rehabilitation

- Treatment of well- developed lesions. - Replacement of lost tooth structure by appliances
- Pulp capping. (bridges, partial dentures, implants...)
- Root canal therapy.
- Restoration of natural teeth.
- Extraction.
- Orodontic treatment.
 Pre-eruptive Effect
- Before birth through placental circulation from mother
to fetus, this provides calcium and vitamin D for proper
development of teeth.
- After birth through general nutrition where the
essential nutrients are carried by the blood stream from
the digestive tract
Post-eruptive Effect
- After tooth has erupted into the mouth, the diet has a
local effect by controlling the lodgment of freely
fermentable carbohydrates which accumulate around
the teeth

The lactobacillus count test Methyl red test

Estimation of the number of acidogenic and This method use water soluble methyl red pH indicator
Definition

aciduric baceria in the patient saliva by counting
the number of colonies appearing on Tomato
agar plates (pH 5.0) after inoculation with a
sample of saliva.
- Patient chews a piece of paraffin.
- Then the saliva get accumulated saliva sample
is diluted and incubated
Application
for disclosing areas of the tooth surface that develop pH
below 5.2 (Enamel dissolves at pH 5.2)
1- Apply the solution which is yellow is to all the teeth
and after 30 seconds, some areas of red coloration
appear indicting acid formation. The change in colour to

red will appear in the active carious areas in proportion

to their caries activities.
2- Rinsing with 1% sugar solution and after few minutes
apply MethyI red solution another time .
Further change in color to red is noted. Red areas which
are not already showing caries may suggest the sites of
future caries.
- Count over 10.000 → moderate to marked - Methyl red ( 0.216%) is a chemical indicator that
Indication

- Between 1000 and 10.000 → Slight to changes from yellow at PH 6 or above to deep red at PH
moderate 5.
- Below 1000 → Very slight or no caries activity

The Snyder test Alban test ( Modified Synder test)

This test measures the ability of oral microorganisms It is a simplified substitute for the Snyder test.
Def

to form acid from carbohydrates.

- A sample of 0.2ml of the saliva specimen obtained - Same as Synder test
by asking the patient to chew on a
Application

cube of paraffin wax first thing after getting up in the

morning and spit into sterile tube.
- The sample is inoculated into +a glucose agar
medium with + indicator→ Bromocresol green.

The change in color to yellow indicates a fall in pH or - A zero score indicates no cotor change.
acid formation. - Score 1 is a color change to yellow in the top 1/4 of
Indication

If the change occurs: the tube .

-Within 24 hours→ it indicates Harked caries activity. - Score 2 is to the halfway mark
-Within 48 hours→ it indicates Moderate activity. - Score 3 is to the 3/4 mark
-Within 72 hours→ it indicates Slight caries activity. - Score 4 is when the entire length of the agar
- Above 72 hours→ it indicates No caries activity. column has changed to yellow
 Dip-slide method for lactobacillus count
1- A special plastic slide is coated wich lactobacilli
selective agar.
2- Undiluted, paraffin-stimulated saliva is flowed
over the agar surface.
Technique
Dip-slide method for S.mutants count
1- A special plastic slide is coated with Mitis Salivarius
Agar, containing 20% sucrose.
2- Undiluted, paraffin- stimulated saliva is poured on
it.

3- The slide is then placed into sterile tube, which is
tightly closed and incubated at 37oC for 4 days. lt is
then removed.
4- The colony density is determined by comparing it
with a model chart.
3- The slide is then tighdy screwed into covered tube
and incubated at 37°C for 48 hours.
4- The density of Streptococcus Mutans colonies is
evaluated as follows:

-Reading of less than 1000 colonies/mI of saliva is - Low when the colonies are discrete less than 200
low. colony.
Indication

-Reading between 1000-10.000 colonies/ml of saliva - Medium when the colonies are more than 200
is medium. colony.
-Reading of more than 10.000 colonies/ml of saliva - High when the colonies are tiny and uncountable.
is high.

- Give account:-
Guidelines of dental puplic health.
1- It depends on teamwork.

2- It must be done in areas where group responsibility is recognized.

3- Public health workers should deal with healthy, apparently healthy as well as diseased people.

4- It should deal with all parts of problem; involving the host, population and environment.

5- Prevention is the main goal of public health.

6- Health education of the public and adaptation of public health programs to the community.

7- Public health methods must depend on biostatistics.

Objectives of dental puplic health.

1- It gives an accurate indication about dental diseases.
2- It takes into consideration the current social changes in the community that influence the prevalence of dental
diseases.
3- It provides the dentists with specialized skill and knowledge to plan dental health programs for large population.
4- It stresses the importance of prevention in the minds of public.

Objectives of preventive dentistry.

- It aims to prevent : 1- Factors which predispose to disease.
2- The disease itself.
3- Factors which evoke more severe manifestations of diseases.
4- Factors which tend to maintain disease in a chronic state.
5- Complications & sequelae of disease.
6- Factors which maintain disability resulting from disease.
7- Factors which interfere with rehabilitation.

Prevention of dental caries .

1- Dental caries continues to be number one problem in dentistry.
2- It should receive the major attention not only from the standpoint of restorative procedures, but more important
from the standpoint of preventive procedures designed to reduce the problem
Secondry level of prevention ( Early diagnosis & prompt treatment ) .
1- Periodic detailed oral examination with x-ray.
2- Prompt treatment of incipient lesions.
3- Extension for prevention.
4- Attention to developmental defects.
5- Compulsory examination of school children.

Preventive dietary measures .

1- Reduction of the frequency of carbohydrate intake.
2- Sucrose substitutes.
3- Addition of caries inhibiting agent.

Reduction of the frequency of carbohydrate intake.

1- Oral clearance of carbohydrates.
2- Time of consumption of carbohydrates.
3- Amount and frequency of consuming carbohydrates.

Oral clearance of carbohydrates.

- Some of the carbohydrates take longer time to be cleared from the mouth i.e stick food & biscuits ,the caries
activity increase with increase in clearance time because carbohydrates stay for longer time incontact with the teeth.

Time of consumption of carbohydrates.

- CHO are consumed between meals increases the caries activity .
‫ هنا‬.. ‫ و بعد االكل بتغسل اسنانك ( طبعا انت معفن مبتعملش كدا ) او بتشرب مايه‬acidic media ‫ فبيبقي فيه‬drop ‫ بيحصله‬PH ‫ ال‬meal ‫ وقت ال‬-
Caries ‫ بيفضل طالع نازل فبيعمل‬PH ‫ و كدا ال‬.. ‫ ينزل تاني‬PH ‫ فبعدين بتاكل حاجة حلوة او اي حاجة فال‬alkaline ‫ او‬neutral ‫ بتبقي‬PH ‫ال‬
. activity

Dietary recommendations.
Carbohydrates should not be completely restricted from the diet, but dietary recommendations can be given. These
are:
1- CHO ≤ 𝟏⁄𝟐 dialy caloric intake.
2- Select soluble forms of CHO which quickly cleared from mouth & avoid sticky ones.
3- Consume carbohydrates at meals and avoid between meal snacks.
4- Substitute sticky sweets with raw fruit or vegetables or nuts for in between meal snacks.
5- Cheese is recommended as a caries preventive food.

Sucrose substitutes.
- Alternate the ( sucrose , glucose , fructose ) with artificial sweeteners like ( aspartame , saccharin , maaitol ) because
they reduce the cariogenicity of food.

Addition of caries inhibiting agents.

A- Fluorides:
Addition of fluoride to foods e.g. salt, milk, bread and flour. However, individual consumption of those foods varies
considerably.
B-Inorganic and organic phosphates:
Act primarily by forming a protective layer on the enamel surface.
C-Dextranase:
Reduces the adherence of bacteria to tooth surface.

Diet history analysis ( aim ) .

- Determination of individual eating habits when vague reports from patients make it impossible to determine
whether an adequate diet is being obtained
Diet history analysis ( importance ).
1- Helps the dentist to define to the patient his dental and dietary problem and to discuss solutions.
2- Enables the dentist to gie good dietary recommendations to change his patient's dietary habits.
3- Helps as a guide to improve the general nutritional level of patient.
4- Makes the parents actively involved in the problem by recording the diet history of their child.

Diet history analysis ( technique ).

1- Ask the parents to record on a diet sheet the exact food intake of their child for a period of 3 -7 days (at meals and
between meals).
2- Analyze the report for calories, carbohydrates, proteins, fats and important minerals and vitamins.
3- Compare the results with the recommended dietary allowances and the desirable distribution of food among the
four basic food groups.
4- Determine the total amount and type of carbohydrates consumed and the time of consumption (at meals or
between meals).
5- Accordingly, give dietary recommendations to improve the patient's dietary habits.

Strategies for caries prevention.

1- Modifying caries promoting ingredients of the diet (diet control).
2- Combating caries inducing microorganisms (plaque control).
3- Increasing the resistance of teeth to decay.

Caries activity tests ( aims ).

1- To identify individuals with a higher probability to develop denal caries.
2- To identify individuals in need for caries control measures.
3- To induce patient cooperation (by illustrating acid production).

Methyl red test benefits .

- This test is a convenient method to demonstrate to parents the role of freely fermentable carbohydrates in the
caries process and the value of immediate brushing and rinsing after the ingestion of carbohydrates.

Alban test ( Modified Snyder test ) benefits .

1- Ideal for patient's education motivation and cooperation.
2- Can be easily used in dental office.

Dip slide method components.

1- Special plastic slide coated with selective agar
2- Saliva is flowed over the agar surface
3- Slide is then placed into sterile tube , which is tightly closed and incubated
4- Colony density is determined by comparing it with a model chart

Dip slide method components.

1- Remove the slide
2- Apply the paddle against the surface or submerge in liquid
3- Replace the paddle in the tube and incubate
4- Check the results

Dip slide method components.

1- The dip slide method is simple, practical and inexpensive.
2- Can be used in a private dental office.