Stopping and managing dental caries in sufferers can fall underneath many classes. These are:

• Stopping new caries lesions from showing

• Stopping present lesions from advancing additional

• Preserving tooth construction with

• Non-operative care at extra preliminary levels

• Conservative operative care at extra intensive caries levels

• Managing caries threat components

• Being alert to modifications at each tooth and affected person threat ranges by means of periodic monitoring

• Enhancing well being consequence for sufferers 

Enhancing the oral well being routine and food regimen

Each affected person ought to be educated in how you can care for his or her enamel and gums. The dental crew ought to be answerable for serving to sufferers perceive what’s concerned in an efficient day by day routine. ¹

This contains oral hygiene practices reminiscent of toothbrushing with a 1450ppm fluoride toothpaste very last thing at night time and at one different day through the day. Sufferers also needs to be inspired to wash in between their enamel interdentally as soon as a day. ¹

For these sufferers at larger threat of caries, a fluoride mouthwash could also be suggested. Sufferers ought to be urged to make use of mouthwash as soon as a day, at any time in between brushes. ¹

Affected person teams at excessive threat of caries, or with earlier historical past of caries also needs to be suggested to cut back the quantity and frequency of sugar (carbohydrate) consumption. ¹ This contains limiting sugar consumption to mealtimes and being discouraged from unhealthy snacking.

One other behaviour behavior that may assist sufferers at elevated threat of caries embody chewing sugar free gum with xylitol. This might help promote saliva move. ²

Excessive fluoride toothpaste

Prescription excessive fluoride toothpaste is an easy, evidenced-based means for serving to forestall dental caries in adolescents and adults. ^{3, 4, 5} It’s significantly suggested for sufferers in danger from a number of caries (coronal and/or root caries). ^{4, 6} 

Excessive fluoride toothpaste is an evidenced-based technique of early intervention. ¹

It’s a proactive resolution for these sufferers at a number of caries threat ^{4, 5, 6} which have had interrupted care because of lockdown, to assist keep away from caries deterioration.

Public Well being England’s ‘Delivering Higher Oral Well being’ advises prescription excessive fluoride toothpaste at 5000ppm for sufferers over 16 years outdated at excessive threat of caries, both at current or sooner or later. ¹

Study extra about prescribing excessive fluoride toothpaste right here.

Excessive fluoride varnish

Fluoride varnish 2.2% NaF (sodium fluoride) remedies are extra typically utilized to kids who’re susceptible to caries, or who’ve energetic caries. Nevertheless, many peer reviewed research present that caries in adults is akin to that of younger individuals. ⁷

Consequently, Delivering Higher Oral Well being recommends using professionally utilized topical fluorides for all ages.  Adults with apparent present energetic caries, dry mouth, these with particular wants, or with different caries threat components, are all suggested to undertake twice-yearly fluoride varnish remedy. ¹

Fluoride varnish is without doubt one of the greatest choices for growing the provision of topical fluoride, whatever the ranges of fluoride within the water provide. There may be additionally high-quality proof of the caries-preventive effectiveness of fluoride varnish in each everlasting and first dentitions. ¹

Any affected person who has been recognized with decay over the past 24 months ought to be thought-about at elevated threat for caries and might be thought-about for top fluoride varnish remedy. ⁸

Clinicians ought to be conscious that there are a lot of fluoride varnishes in the marketplace that will not be licensed for caries management, though they could have related formulations. This ought to be considered with respect to prescriber’s obligations. ¹ Colgate® Duraphat® Varnish is the one medically licensed (Prescription Solely Drugs, POM) varnish which has been clinically confirmed for the prevention of caries. ⁹

Pit and fissure sealants

Dental sealants had been launched within the Nineteen Sixties to assist forestall dental caries, primarily within the pits and fissures of occlusal tooth surfaces.  Sealants act to forestall micro organism development that may result in dental decay. ³

A sealant is a protecting composite coating, which is utilized to occlusal surfaces of molars. The sealant types a tough protect that retains meals and micro organism from stepping into the tiny grooves within the enamel and inflicting decay. ¹⁰

It is strongly recommended that pit and fissure sealants be utilized to reasonable or excessive caries threat kids. ³

You possibly can inform sufferers which enamel are being sealed after you may have examined them and checked whether or not the fissures are deep sufficient for sealing to assist. Some enamel naturally have deep grooves which can should be sealed; others have shallow ones which won’t want sealing. ¹⁰

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Sources

1. Public Well being England (2017) ‘Delivering higher oral well being: an evidence-based toolkit for prevention’, Third Version, UK.
2. Newton JT, Awojobi O, Nasseripour M, et al. A Systematic Assessment and Meta-Evaluation of the Position of Sugar-Free Chewing Gum in Dental Caries. JDR Scientific & Translational Analysis. 2020;5(3):214-223. doi:10.1177/2380084419887178
3. Ahovuo-Saloranta A, Forss H, Walsh T, Nordblad A, Mäkelä M, Worthington HV. Pit and fissure sealants for stopping dental decay in everlasting enamel. Cochrane Database Syst Rev. 2017 Jul 31;7(7):CD001830. doi: 10.1002/14651858.CD001830.pub5. PMID: 28759120; PMCID: PMC6483295.
4. Colgate-Palmolive (U.Okay.) Ltd (2020) ‘Abstract of Product Traits’, Duraphat 5000ppm fluoride toothpaste. On-line at https://mhraproducts4853.blob.core.home windows.web/docs/993ca2d10345c940c4649fd8c98042f68fe00d51
5. Colgate-Palmolive (U.Okay.) Ltd (2014) ‘Duraphat® 5000ppm Fluoride Toothpaste’, Package deal Leaflet: Info for the consumer, on-line at https://mhraproducts4853.blob.core.home windows.web/docs/f7686217b083fc71959d19152bb6eab6ea5dad82.
6. Colgate-Palmolive (U.Okay.) Ltd (2020) ‘Abstract of Product Traits,’ Duraphat 2800ppm fluoride toothpaste. On-line at https://mhraproducts4853.blob.core.home windows.web/docs/c0e452136f37b21ae14dae330bc55c62b0e931fb
7. Thomson WM. Dental caries expertise in older individuals over time: what can the big cohort research inform us? Br Dent J. 2004;196(2):89-92.
8. ADA Scientific Panel points evidence-based scientific suggestions: Sufferers at elevated threat for creating cavities profit from making use of topical fluoride. American Dental Affiliation web site. https://www.ada.org/en/press-room/news-releases/2013-archive/november/ada-scientific-panel-issues-evidence-based-clinical-recommendations. Revealed November 01, 2013.
9. Colgate-Palmolive (U.Okay.) Ltd (2020) ‘Colgate® Duraphat® Varnish 50mg/ml Dental Suspension’, on-line at https://www.colgateprofessional.co.uk/merchandise/products-list/colgate-durphat-varnish-50-toothpaste, accessed October 2020.
10. Oral Well being Basis (2020) ‘Pit and fissure sealants’, on-line at https://www.dentalhealth.org/pit-and-fissure-sealants, accessed October 2020.