Caries: Prevention

Prevention and prophylaxis include assessing the individual caries risk. For this purpose, previously collected data from medical history and findings are used:

  • Anamnesis
  • Findings
  • Periodontal diseases (diseases of the periodontium).
  • X-ray findings
  • Oral hygiene and plaque index
  • Previous caries experience
  • Social environment
  • Saliva and microorganisms
  • Nutritional data

Based on these data, an individualized prevention plan is created for the patient. Prevention requires different measures, depending on the condition of the individual patient:

  • Primary prevention attempts
    • Delay an infection of the child as long as possible, by already the pregnant mother is intensively cared for and as far as possible treated and educated.
    • Prevent new cases (oral hygiene, nutrition, fluoridation).
  • Secondary prevention aims at early diagnosis of the disease and prevention of manifestation to limit the loss of tooth structure
  • Tertiary prevention: treatment and elimination of damage and measures to prevent recurrence.

The four supporting pillars of caries prevention are:

  • Oral hygiene measures
  • Application of fluoride-containing cariostatic agents (caries inhibitors).
  • Nutritional counseling and conversion
  • Fissure sealing

Oral hygiene measures

It is almost impossible for the patient to remove plaque from all teeth in just one brushing. Therefore, it is advised to brush teeth after every meal and to perform extra intensive dental care at least once a day (preferably in the evening before going to bed). It is important to follow a systematic approach to brushing in order to clean all teeth equally. It is not possible to remove plaque and food residues from the interdental spaces with a toothbrush alone. Here, dental floss or interdental brushes should be used. Aids:

  • Manual toothbrush or electric toothbrush.
  • For denture wearers: special denture toothbrush for cleaning the denture.
  • Fluoride-containing toothpaste; for young children, a fluoride-reduced toothpaste should be used
  • Dental floss
  • Interdental brushes
  • Mouth rinse containing fluoride
  • If necessary, mouthwash Attention: endocarditis patients must not use a mouthwash, as this can lead to germ spread.

Regular professional dental cleaning (PZR) at the dentist is an indispensable complement to home oral hygiene. Not only are the structures cleaned, there should always be renewed consultations to improve oral hygiene.

Use of fluoride-containing cariostatic agents (caries inhibitors)

In addition to a fluoride toothpaste and fluoride mouth rinses, there are also gels that are highly enriched with fluoride, which can be used once a week for dental care as a supportive therapy. Your dentist also has high-dose fluoride preparations, but these should only be used selectively. Furthermore, it is possible to cook with fluoridated table salt. In addition, drinking water contains varying amounts of naturally occurring fluoride from region to region. Another source of fluoride is our daily food (fish, meat, vegetables, etc.). Particularly high fluoride content: green and black tea). For exact advice on the individually required amount of fluoride, you should talk to your dentist. Especially with small children, the correct dosage of fluoride causes confusion for many parents. In this case, it is also essential to consult the dentist treating the child so that all factors (fluoride content of drinking water, table salt, toothpaste, etc.) can be taken into account on an individual basis. Mechanisms of action of fluorides applied locally (“topically”):

  • Remineralizes the enamel that is thus more acid-resistant than the original healthy enamel.
  • Caries-inhibiting effect due to regular contact with the tooth surface.
  • Formation of a storage layer, remineralization and positive effects on the bacterial biofilm.

Note: Caries inhibition depends on the fluoride concentration acting; there is a dose-response relationship: a higher fluoride concentration is associated with better caries inhibition.

Nutritional counseling and conversion

Foods that are particularly cariogenic (= promote caries) include:

  • Short-chain carbohydrates
  • Sucrose
  • Glucose, maltose, fructose, lactose
  • Starch

z. E.g. sugar, potato chips, white bread, sugary fruit juices and sodas, sugary sweets, candy, dried fruit Attention! In young children, constant rinsing of the teeth with sugary drinks leads to massive milk tooth decay (so-called “nursing bottle syndrome”). Note: Even so-called “sugar-free fruit juices” contain natural fruit sugar (fructose) and fruit acid. The frequency of intake and, of course, the appropriate oral hygiene measures also play an important role. Sweet snacks in particular, which are a combination of high sugar content and frequent intake, are considered to be particularly caries-promoting. When buying sweets, for example, look for the so-called tooth man. This identifies sugar-free foods. Furthermore, a healthy and balanced diet is of course not only important with regard to healthy teeth. The whole body benefits from a conscious diet. The additional supply of vital substances (macro- and micronutrients) is also very helpful (see Prevention with micronutrients).

Fissure sealing

Particularly pits and fissures of the teeth are more susceptible to caries than other areas. The goal of sealants is to seal these areas from plaque and bacteria entry.