Dr. Poorva Gharpure, Smile Care, Nasik.

New technologies have given us a better insight into different approaches in dentistry. Regular dental checkup is the first step towards prevention of dental decay. Preventive measures suggest interception done best at earliest or initial stages. Parents are encouraged to be active in making decisions along with dentists for their child’s dental therapy.

Based on caries risk assessment of a child, protection from cavities can be achieved through :

1. Topical and systemic fluorides
2. Remineralization toothpastes/chewing gums
3. Dental sealants

Topical and systemic fluorides :

Topical fluorides: Professionally applied fluorides are used in a gel or varnish form, main constituent being acidulated phosphate fluoride or stannous fluoride. Biannual application of such topical fluorides has proven to be effective especially in kids having high risk of caries and for newly erupted permanent molars. Fluoride gels or foams are applied in soft application trays for a period of 4 minutes as against fluoride varnishes that are painted onto teeth and left on. Other topical fluoride means are fluoride mouth rinses and dentifrices, to be used under professional guidance.

Systemic fluorides: Fluorides that are delivered through ingestion account for systemic fluorides. Different food sources or dietary supplements like tablets or lozenges can increase fluoride levels in blood. Fluoridated water supply also provides for systemic intake.

Remineralization toothpastes/chewing gums :

Incipient chalky lesions and undetectable subsurface lesions suggestive of decay can be reversed through application of remineralization pastes or consumption of chewing gums containing amorphous calcium phosphate-casein phosphopeptide complexes or calcium sodium phosphphosilicate which are clinically proven to aid in remineralization of dental enamel.

Dental sealants :

Anatomical variations in the form of deep occlusal pits and fissures in molars and rarely premolars render teeth susceptible to dental decay. Newly erupted permanent first molars are more susceptible to decay since they are one of the first teeth to erupt in the oral cavity. Sealants are plastic like flowable resin materials which when applied over preconditioned teeth and subjected to light of specific spectrum, harden over the surfaces applied. Food deposition and accumulation reduces considerably in these areas, thereby minimizing possibility of decay.

Preventive orthodontics :

Preventive orthodontics focuses on maintaining integrity of normal developing dentition. Problems regarding discrepancy of occlusion in forms of premature shedding or over retained milk teeth, thumb sucking or tongue thrusting habits, crowding, spacing and other tooth size-jaw size abnormalities can be identified and evaluated for the need of treatment at an early stage when the permanent teeth start erupting, by the age of 7 years. Sometimes, a wait and watch approach in mixed dentition stage is useful to assess whether discrepancy is self correcting. Dental appliances like habit breaking, space maintainers or others which aid in guided jaw growth, help in correction of minor problems which may complicate at a later stage.

Before determining the treatment modalities for the child, it is necessary to evaluate the age, previous exposure to fluorides, water fluoridation levels, dental eruption pattern and decay rate of the child. Caries risk assessment by a dental professional, effective communication & co-operation with parent will allow the child to receive proper dental care to maintain healthy teeth in the long run.