Prevention
It has long been known that preventing diseases is easier and less costly than treating them. That is why the dentist–patient partnership has come to understand that more attention must be devoted to prevention. Prevention means all the measures put in place to avoid the onset, spread or worsening of diseases. In other words, prevention is the set of measures by which the factors that predispose to a decline in dental health are removed or reduced.
In the case of the oral cavity, dental diseases arise as a result of the presence of three main predisposing factors:
- the infectious factor – represented by the microbes or bacteria located in dental plaque. Their presence in the oral cavity leads sooner or later to disease of the teeth and of the adjacent tissues (gums, bone, ligaments);
- the dietary factor – represented by the influence of the foods consumed by each person. Because carbohydrates are a good source of food for bacteria, the more carbohydrates are introduced into and retained in the oral cavity, the more dental conditions appear;
- the host terrain – represented by the quality of the dento-periodontal tissues of each person. Consequently, the harder the enamel and dentine, the lower the risk of dental diseases.
The methods of dental prevention aim to reduce and remove these predisposing factors – accordingly, we have preventive methods that will seek to influence the infectious factor, methods that will act on the dietary factor, and methods that will influence the terrain, more precisely the quality of the dental tissues.
Prevention targeting the infectious factor:
Personal oral hygiene – the most important and easiest preventive method, in the sense that without correct oral hygiene all the other preventive methods no longer make sense. It is carried out by each person individually, by removing dental plaque through thorough brushing at least twice a day.
Professional cleaning – dental brushing performed with the help of special mechanical instruments (rotary brushes) whose role is to remove dental plaque. This is done at the dental practice. Following this procedure, the teeth remain glossy and future deposits of plaque and calculus are delayed. Even so, given that dental plaque is deposited after every meal, mechanical brushing must be accompanied by correct oral hygiene.
Scaling – a simple procedure using special ultrasound-based instruments intended to break up and remove the deposits of calculus (tartar or calcium salts) from the surface of the teeth (especially on the tongue side), from the interdental spaces and from the roots of the teeth. This procedure is recommended approximately twice a year. Many people are unaware that they have calculus deposits on their teeth because of their yellowish-white colour, or do not want to have such a treatment because they believe that these calcium deposits keep the teeth in place. Neither of these reasons is worth taking into account: even though in the initial stage calculus is yellowish-white, its colour changes to brown or black as a result of the consumption of food or tobacco, and as regards the stabilisation of the teeth, calculus in fact only loosens them further because of the gradual deterioration of the tissues that hold the teeth in the bone (periodontium). Even though the procedures are simple and available in any practice, many patients do not consider them necessary or try to remove the calculus "in the quiet of their own home" with various improvised instruments or acidic substances. Such methods will not make the calculus disappear; on the contrary – they will further damage the enamel of the teeth and the surrounding soft tissues.
Sealing of the grooves and pits is the method by which the occlusal surface of the teeth is protected from the onset of dental caries. Every time we eat, because of the masticatory forces exerted by the jaws and the consumption of foods that are often hard, the occlusal surface (the surface on which we chew) of the teeth, especially of the molars, is subjected to trauma. Every tooth has small elevations (cusps) on its occlusal surface, separated by grooves and pits that can crack during chewing or, in many cases, cannot be cleaned adequately precisely because of their specific shapes, thus leading to the onset of caries. To prevent this, from the moment the teeth have fully erupted, that is around the age of 12–14 years, the very sharp angles can be rounded off (where appropriate) to allow the toothbrush to reach into all the corners, followed by a sealing of these forms of dental relief. These sealings are done with composite materials of low viscosity, therefore very flowable, which penetrate deep into the grooves and pits that they fill and, at the same time, create on the occlusal surface of the teeth a very thin film that does not allow the bacteria to reach the enamel of the teeth. Such materials have a varied chemical composition, the best being those that, in addition to the ability to seal the surface of the teeth, can also maintain them by releasing fluoride over a long period of time. So, just as we protect the objects around us with the help of lacquers and paints, we can in the same way effectively protect the teeth too.
Fluoridation and desensitisation – the method for preventing dental cracks and caries; it helps to strengthen the enamel and should begin as early as childhood, through diet, brushing with fluoride toothpaste and medicinal supplements where appropriate. If the fluoride deficiency is significant, the dentist can carry out a more extensive fluoridation by applying, over the entire surface of the teeth in a tray, a gel rich in topical fluoride.
Dental desensitisation – the set of methods that lead to a reduction in the sensitivity of the teeth. Dentinal sensitivity manifests as a sharp, short-lived pain on contact with hot, cold, sour or sweet foods or with pressure. Teeth are made up of dentine, which is the sensitive layer of the teeth and through which run small tubules leading to the nerve and blood vessels inside the teeth. This dentine is covered by cementum at the level of the roots and by enamel at the level of the crown. So, on a brief examination of the preceding statements, we realise that the sensitivity is in fact due to the outer opening of these small tubules, through which heat, cold or certain substances can reach the dental nerve and irritate it. The causes that lead to dental sensitivity are usually: recession of the gums, dystrophy or absence of the enamel, bruxism, secondary caries resulting from poorly marginally adapted fillings, cracking or fracture of the teeth and, not least, deficient or excessive hygiene. To prevent and treat sensitivity, the dentist–patient team have different but interwoven "duties": the dentist finds the true cause of this sensitivity, treats it where appropriate and educates the patient to continue with maintenance techniques at home. Thus, the treatments usually consist of covering the roots with composite, correct treatment of primary and secondary caries, sealing of the cracks and, not least, fluoridation of the dental surface.
