UDC 616.314-053.2

Prevention of dental diseases: Textbook. manual for students of the Faculty of Dentistry, interns / V. I. Kutsevlyak, V. V. Nikonov, A. V. Samsonov and others; ed. V. I. Kutsevlya-ka.-Kharkov: KhSMU, 2001.- 217 s-Rus. lang.

Represented modern concepts occurrence of dental caries, periodontal disease, dentoalveolar anomalies. Traditional methods and the latest achievements in the prevention of major dental diseases are considered.

Submitted the current concept of vindication of Kapiecy teeth, periodontal disease, dentoalveolar anomalies. The traditional methods and innovations in the prevention of major dental diseases are reviewed.

Tab. 9. Ill. 51. Bibliography: 34 titles.

Reviewers: R. N. Dychko, head. Department of Dentistry

children's age of Dnepropetrovsk State Medical University, dr honey. sciences, prof.

L. A. Khomenko, head. Department of Pediatric Therapeutic Dentistry and Prevention of Dental Diseases of the National Medical University. acad. A. A. Bogomolets, Dr. med. sciences, prof.

© Kharkov State

medical university, 2001

2.6. Methods of primary prevention of major dental diseases in children

Prevention of dental diseases:

1) primary - the use of various methods and means to prevent the occurrence of dental diseases. The initial signs of tissue damage during preventive measures may stabilize or undergo regression;

2) secondary- the use of traditional methods of treatment to stop the developed pathological process and preserve tissues. Includes treatment of dental caries (filling, endodontic procedures), therapeutic and surgical treatment of periodontal diseases and other diseases of the oral cavity;

3) tertiary- replenishment of the anatomical and functional integrity of the dental system. It provides for the use of funds necessary to replace missing organs and tissues, and the rehabilitation of patients, bringing their condition as close as possible to normal.

Primary prevention methods include:

Individual oral hygiene;

Professional oral hygiene;

Endogenous use of fluoride preparations;

The use of local prophylaxis;

Dental education.

Individual oral hygiene. The leading component of the prevention of dental diseases is oral hygiene. Systematic brushing of teeth, removal of soft dental deposits contribute to the physiological process of maturation of tooth enamel. Biologically active components that are part of the hygiene products enrich the tissues of the tooth and periodontium with phosphate, calcium salts, trace elements, vitamins, and increase their resistance to harmful effects. Regular massage of the gums when brushing your teeth helps to activate metabolic processes, improve blood circulation in periodontal tissues.

Individual hygiene - careful and regular removal of dental deposits from the surfaces of the teeth and gums by the patient using various means.

Toothbrushes - the main tool for removing deposits from the surfaces of teeth and gums. There are now many models of toothbrushes designed to remove plaque from smooth, occlusal and proximal surfaces of teeth. The development of a new design of brushes is carried out using a computer.

Toothbrushes are:

head size;

fiber properties;

The shape of the brush field of the head and the arrangement of the bundles;

Rigidity;

Handle design.

Toothbrush head size. Currently (both adults and children) it is recommended to use brushes with a small head, which can be easily manipulated in the mouth and clean hard-to-reach surfaces of the teeth. The size of the head of a children's toothbrush should be 18-25 mm.

fiber properties. Synthetic fibers are predominantly used in the manufacture of toothbrushes. At the same time, brushes made from natural bristles are still on sale. This material, of course, is inferior to synthetic fibers in quality. Its disadvantages are the presence of a median canal filled with microorganisms, the difficulty of keeping the brush clean, the impossibility of perfect processing of the ends of the bristles, and the difficulty of imparting a certain rigidity to it.

The shape of the brush head. In the lateral projection, several profiles of the toothbrush head can be distinguished - flat, concave, convex, multi-level. With a brush with a concave shape of the working part of the head, it is better to clean the vestibular surfaces of the teeth, while with a convex one - the lingual ones. Brushes with bristles located on different levels, more effectively than flat ones, remove plaque, especially from the proximal surfaces of the teeth.

Location of fiber bundles. In the brush head, the bristles are arranged in tufts, usually arranged in 3 or 4 rows. This arrangement allows you to better clean all surfaces of the teeth. Bunches of setae, as a rule, have different heights: longer (softer) along the periphery, shorter ones in the center. Each group of beams contributes to a more thorough removal of plaque in a particular area of ​​the dentition. Straight high fibers clean plaque in the interdental spaces; short - in fissures. Fiber bundles located in an oblique direction, penetrating into the periodontal sulcus, remove plaque from the cervical area.

Some toothbrush models have a power ridge to better clean the molars, especially the distal surfaces of the last molars, and deep penetration into the interdental spaces.

Often toothbrushes are equipped with an indicator - two rows of fiber bundles dyed with multi-colored food coloring, which discolor with use. The signal to replace the brush is the discoloration of the bristles by half of its height. This usually occurs after 2-3 months with daily brushing twice a day.

Rigidity brush depends on the composition of the fiber, the diameter and length of the bristles, as well as the number of bristles in the bundle.

There are several degrees of hardness of toothbrushes: very hard, hard, medium, soft, very soft.

Recommendations to patients on the use of a toothbrush of varying degrees of hardness are purely individual. The most widely used brushes are of medium hardness. Typically, children's toothbrushes are made from very soft or soft fiber.

Handle design. The shape of the handle of toothbrushes can be straight or curved at different angles, but its length should be sufficient to provide maximum comfort when brushing your teeth. Children's toothbrushes "Oral-B", "Disney Mickey Mouse L-10" (for children from 2 years old) and "Squish Grip" (from 4 years old) are very soft, with a small head, indicator bristles and a comfortable non-slip handle.

You can teach a child to brush their teeth properly with the help of toothbrushes, in which, when brushing their teeth (within 2-3 minutes), the initial color of the handle changes. The same property is possessed by toothbrushes, in which a rattle is mounted in the handle. With correct (vertical) movements of the brush, a sound is made, and with horizontal (incorrect) movements, the toothbrush is “silent”.

Interdental brushes. Special toothbrushes are designed for cleaning interdental spaces, cervical areas of teeth, spaces under fixed orthodontic structures. Usually they are small in size, their working part may consist of a single bundle of fibers trimmed in the form of a cone or several bundles placed in one row. With such brushes, replaceable brushes of different sizes are used.

Electric toothbrushes. This type of toothbrush is now used quite widely. An example is the electrical Toothbrush Braun Oral-B Plak Control 3D. This brush has 3 types of bristles: soft FlexiSoft with a spongy structure, higher - "power ledges", indicator. The small brush head pulsates at a frequency of 20,000 vibrations per minute, which loosens plaque, and reciprocates at a frequency of 7,600 vibrations per minute, which removes plaque even from hard-to-reach surfaces. Simultaneously with cleaning, the gums are massaged.

For children, special children's electric toothbrushes have been developed.

Teeth brushing methods.Cleaning milk teeth from the moment of eruption. From the moment the first milk teeth erupt, they must be cleaned at least once a day with a special toothbrush that parents put on their finger.

From 1 year old, a child can brush his teeth 2 times a day with a soft children's toothbrush, from 2-2.5 years old - 2 times a day, using a soft toothbrush and gel-like children's toothpaste. Monitoring the correctness of brushing teeth in all age periods should serve as the absence of visible plaque.

Circle methodPhones. Using this method, the vestibular surfaces of closed teeth are first cleaned in a circular motion, excluding the marginal part of the gum, then the mouth is opened and cleaned with small rotational movements oral surfaces, horizontal or rotational movements - occlusal surfaces of the teeth. This method is recommended for both children and adults.

Standard Teeth Brushing Method(G.N. Pakhomov). The dentition is conditionally divided into several segments. Toothbrushing begins with a site in the region of the upper right chewing teeth, sequentially moving from segment to segment. In the same order, teeth are cleaned in the lower jaw.

When cleaning the vestibular and oral surfaces of molars and premolars, the working part of the toothbrush is placed at an angle of 45 ° to the tooth and cleansing movements are made from gum to tooth, while simultaneously removing plaque from the teeth and gums. The chewing surfaces of the teeth are cleaned with horizontal (reciprocating) movements, while the brush fibers penetrate deep into the fissures and interdental spaces.

The vestibular surface of the frontal group of teeth of the upper and lower jaws is cleaned with the same movements as molars and premolars. When cleaning the oral surface, the brush handle is placed perpendicular to the occlusal plane of the teeth, while the fibers are at an acute angle to them and capture not only the teeth, but also the gums.

Finish cleaning all segments in a circular motion.

Dental floss (floss). Flosses are designed to thoroughly remove plaque and food debris from hard-to-brush contact surfaces of teeth. They are made from a special synthetic fiber. They can be waxed or unwaxed, round or flat, sometimes menthol-coated. In addition, there are super floss- threads with one-sided thickening. This thread has a stiff tip and a combination of unwaxed fragments with wider nylon fibers. It allows you to clean the contact surfaces of the teeth, and also contributes to a more thorough removal of food debris and plaque from orthopedic and orthodontic structures in the oral cavity.

How to use dental floss A thread 35-40 cm long is wound around the first phalanx of the middle fingers of both hands. Then, a stretched thread is carefully inserted (with the help of index fingers - on the lower jaw and thumbs - on the upper jaw) along the contact surface of the tooth, trying not to injure the gingival papilla. With a few movements of the thread, all soft deposits are removed. Consistently clean the contact surfaces of each tooth.

Children can use floss on their own from the age of 9-10. Before this age, it is recommended for parents to clean the contact surfaces of the teeth in children.

Toothpaste. Since the 30s of the XX century, toothpastes have become widespread, which have significant advantages over powders and are more convenient and mass media hygiene. Their effectiveness in the prevention of dental caries and periodontal disease is generally recognized.

The use of toothpastes significantly contributes to a decrease (by an average of 25-30%) in the frequency of caries in permanent teeth, an improvement in the hygienic state of the oral cavity (by 24-46%), and a decrease in inflammation in periodontal tissues (by 33-58%).

Toothpastes should be good at removing soft plaque,

leftover food; be pleasant in taste, have a pronounced deodorizing and refreshing effect and not give side effects: locally irritating and allergenic.

The main components of toothpastes:

Abrasives - provide a cleansing and polishing effect (chemically precipitated chalk, dicalcium phosphate, silicon dioxide, aluminum hydroxide, etc.);

Binders - ensure the stability of the toothpaste composition (natural and synthetic hydrocolloids);

Moisturizing agents - contribute to the preservation of moisture in the paste, obtaining a plastic homogeneous mass (polyhydric alcohols);

Foaming agents (alizarin oil, sodium lauryl sulfate);

Flavors and sweeteners - provide organoleptic properties of toothpaste (peppermint, sweeteners).

AT recent times found application gel toothpaste, obtained on the basis of silicon oxide compounds and have a high foaming ability. Such pastes are pleasant in taste, have different colors due to added dyes, however, the cleaning power of some of them is lower than pastes containing a chalk base or dicalcium phosphate.

Gel toothpastes provide a milder cleansing effect without damaging the enamel of milk teeth, so they are also recommended for use in preschool and primary school children.

Toothpastes may contain biologically active ingredients, which allows them to be used

the main means of preventing dental caries and periodontal disease.

The most popular therapeutic and prophylactic agent are anti-caries fluoride-containing toothpastes. Sodium and tin fluorides, sodium monofluorophosphate, sodium fluoride acidified with phosphates, and, more recently, organic fluorine compounds (aminofluorides) are introduced into the composition of toothpastes as anticaries additives.

Fluorides increase the resistance of teeth to acids formed by plaque microorganisms, enhance enamel remineralization and inhibit the metabolism of plaque microorganisms. According to WHO recommendations (1984), the optimal concentration of fluoride in toothpastes should be 0.11%. In the composition of children's toothpastes, fluoride compounds are in small quantities - up to 0.023%.

For complete mineralization of hard tissues of the tooth and increase their resistance to caries, in addition to fluorides, other inorganic elements are also needed.

Toothpastes containing potassium and sodium phosphates, calcium and sodium glycerophosphates, calcium gluconate, zinc oxide have a pronounced anti-caries effect. A similar effect is also given by toothpastes containing chitin and chitosan derivatives. These substances have an affinity for proteins and are able to inhibit the adsorption of Streptococcus mutans, mitis, sanguis on the surface of hydroxyapatite. The use of anti-inflammatory toothpastes is a simple and affordable form of prevention and treatment of periodontal disease. Biologically active substances are introduced into their composition - medicinal herbs, salts, antiseptics, enzymes, vitamins, microelements.

Toothpastes with the addition of medicinal herbs have an anti-inflammatory effect: chamomile, St. John's wort, cloves, yarrow, calamus, calendula, sage, ginseng root extract. These pastes help reduce gum bleeding, have analgesic, anti-inflammatory and regenerating effects.

To accelerate the regenerative processes of the mucous membrane, biologically active components are introduced into toothpastes - enzymes, oil solutions of vitamins A and E, carotenoline. To reduce the amount of plaque and inhibit the growth of calculus crystals, sodium or potassium pyrophosphates, zinc citrate are also included in toothpastes, which, without affecting the activity of fluorides, are able to inhibit the formation of hard dental deposits.

The components that make up some toothpastes, such as remodent, calcium glycerophosphate, synthetic hydroxyapatite, help reduce enamel hypersensitivity by closing the inlets of the dentinal tubules.

Most whitening toothpastes contain a high concentration of silicon dioxide as an abrasive, as well as polishing components and substances that prevent the formation of hard dental deposits. It is not recommended to use whitening pastes in children during the eruption of permanent teeth.

Chewing gum. Chewing gums, which are now recommended for use by children, are among the means to improve the hygienic state of the oral cavity.

Chewing gum, acting on the tissues of the oral cavity, contributes to:

Increasing the rate of salivation;

Stimulation of saliva secretion with increased buffer capacity;

Neutralization of dental plaque acids;

Strengthening saliva washing of hard-to-reach areas of the oral cavity;

Normalization of clearance of sucrose from saliva;

Removal of food debris.

Currently, chewing gums made on the basis of sweeteners are used, as they have an anti-caries effect. Sweeteners give chewing gum a sweet taste, but unlike sugar, they decompose to acids very slowly. Some chewing gums contain anti-caries and anti-inflammatory additives: fluorine compounds, calcium lactate, chlorhexidine. Chewing gum should be used after each meal and sweets for no more than 10 minutes. Uncontrolled, repeated use of chewing gum during the day is not recommended.

dentalelixirs designed to rinse the mouth after brushing your teeth or eating. They improve the cleaning of the surfaces of the teeth, prevent the formation of plaque, and deodorize the oral cavity. The composition of elixirs may include biologically active components: sodium fluoride, extracts of medicinal plants, triclosan and ksidifon, which prevent the formation of tartar.

Professional oral hygiene. Occupational hygiene is a set of measures that eliminate and prevent the development of dental caries and inflammatory periodontal diseases by mechanical removal of supra- and subgingival dental deposits from the surfaces of the teeth.

Professional hygiene includes:

Motivating the patient to fight dental diseases;

Patient education in individual oral hygiene;

Removal of supra- and subgingival dental deposits;

Polishing of the tooth surface (including the root);

Elimination of factors contributing to the accumulation of plaque.

Professional oral hygiene as one of the main components of the prevention of dental diseases should be carried out for children and adolescents strictly individually and after a certain time.

The duration of the intervals between visits to the dentist depends on:

Hygienic condition of the oral cavity;

The intensity of dental caries;

The presence of gingivitis;

The severity of periodontitis;

Degrees of teething.

Controlled brushing- this is teeth cleaning, which the patient performs independently in the presence of a specialist (dentist, hygienist, etc.). First, the patient's teeth are treated with a staining agent and IG is determined. Then the patient brushes his teeth in his usual manner, and his IG is again determined. The specialist uses a mirror to show the patient which surfaces he does not clean enough. At subsequent visits, supervised brushing is repeated, assessing the patient's skills.

The doctor should explain to the child and parents the causes of the onset and development of dental caries and periodontal diseases, the formation of dental deposits containing bacteria and their metabolic products, and methods for controlling their formation. Recommendations should also be given on the use of preventive and hygiene products (toothbrushes, pastes, dental floss, brushes for cleaning interdental spaces, tongue, toothpicks, gels, rinses, etc.) and the rules for using them.

Professional teeth cleaning as a component of the program for the prevention of caries and inflammatory periodontal diseases was proposed by P. Axelsson et al. in 1970 in the so-called "Karlstadt model" (Sweden). This comprehensive prevention program included regular dental education, professional cleaning, topical fluoride, and nutritional advice. Professional cleaning was carried out by specially trained dental personnel at regular intervals (every 2 weeks). The idea of ​​carrying out the procedure for the complete removal of plaque was based on research data showing that in the presence of dense plaque, signs of gingivitis and initial caries develop in 2-3 weeks, provided that sucrose is periodically present in the plaque.

Despite excellent results, the "Karlstadt Program" proved to be expensive, so over the next decades, researchers tried to work out optimal intervals between patient visits in order to maintain the positive effect of preventive programs and at the same time reduce their cost. One example is the Nexo program (Denmark) and its modification implemented by I.N. Kuzmina (1996) in the Solntsevsky district of Moscow. A feature of these programs is the planning of intervals between professional teeth cleaning, depending on the individual characteristics of the child.

At the same time, the interval between professional teeth cleaning was determined on the basis of the following factors:

Interest of parents and children in the program;

The susceptibility of teeth to caries in a patient;

The degree of eruption (especially the first and second permanent molars) and the presence of caries on the chewing surfaces of the permanent molars.

The basic principles of professional teeth cleaning for a particular patient:

All teeth are stained with a dye (usually erythrosin). The doctor shows the patient the places of the greatest accumulation of plaque. Training in brushing teeth is carried out taking into account the individual characteristics of the hygienic state of the oral cavity;

The remaining plaque is removed using an abrasive fluoride-containing polishing paste, where silicon dioxide is mainly used as an abrasive. Removal of plaque from the chewing surfaces of the teeth is carried out with rotating brushes, and from smooth surfaces - with soft rubber caps filled with polishing paste. Both brushes and caps are driven by a mechanical handpiece micromotor. The proximal surfaces of the teeth are cleaned of plaque with dental floss;

After cleaning all surfaces of the teeth, it is necessary to control the thoroughness of the procedure performed. For self-monitoring of the quality of brushing teeth at home, the patient can be recommended the use of plaque-staining tablets.

A comprehensive system for the prevention of dental diseases plays important role in the fight against diseases of the oral cavity. These are urgent measures, because the percentage of dental diseases among the population is very high.

A set of measures to prevent dental diseases is divided into three stages:

• Primary prevention by eliminating the causes of diseases prevents them. At this stage, measures are taken to increase resistance to adverse environmental factors.
• Secondary prevention of dental diseases is aimed at preventing recurrence and complications of diseases.
• Tertiary prevention is used when it is no longer possible to prevent the disease at the first, second stage. Here, dentists try to preserve the function of lost teeth with the help of replacement.

The primary task is to preserve the health of the patient, prevent diseases of the oral cavity (example: prevention (prevention of development) of dental caries). If this was not achieved, and the disease began to develop, then secondary task- cure the patient of the disease, prevent complications and recurrences from appearing (example: the development of pulpitis and periodontitis - the progression of caries). At the last stage, dentists are engaged in the restoration of lost tooth functions. Most often, orthopedic replacement of lost teeth is used (example: the treatment of periodontitis and its complications did not bring results, it was necessary to remove the tooth, and replace the empty space with a prosthesis).

Features of the prevention of dental diseases in pregnant women

During pregnancy, teeth and gums are the first to suffer. This is due to the fact that developing child picks up most calcium, which enters the body of the expectant mother. If few nutrients enter the female body, then teeth, nails, and hair suffer. Therefore, during pregnancy and lactation, a woman should take special vitamins. Also, blood circulation in the gums worsens, changes chemical composition saliva. All this increases the risk of caries and gum disease, so it is especially important to pay attention to preventive measures. Oral diseases are more effective and best treated at the stage of primary prevention of dental diseases. This will avoid further complications. Primary prevention is divided into two types: antenatal and postnatal.

• Antenatal prophylaxis of dental diseases is a set of measures that is carried out in pregnant women in order to prevent pathologies of organs and tissues of the oral cavity in the fetus.
• Postnatal prophylaxis is a set of measures that is carried out after the birth of a child in order to prevent the development of pathology of the organs and tissues of the oral cavity.

• You need to visit the dentist regularly
• Keep your mouth clean
• Massage the gums
• brush your tongue
• Healthy food
• Receive required amount ultraviolet

Prevention of dental diseases in young children

Parents should begin hygienic care of the child's oral cavity from the moment the first milk tooth appears. As long as there are no teeth, the oral cavity can be cleaned with special wipes. By the time the child erupts 8-10 teeth, parents should brush their children's teeth twice a day with a soft children's toothbrush without the use of toothpaste. Wherein Special attention should be given to teeth that are in the process of eruption. When all teeth appear, you can gradually introduce soft toothbrushes and gel toothpaste suitable for age. Poor oral hygiene, frequent night feedings and constant drinking of sugary drinks between main feedings provokes the appearance of early tooth decay. AT early age it is desirable to be shown to the dentist once a year from the moment the first teeth appear. The control of proper brushing of teeth in all age periods should be the absence of visible plaque on them.

Diagnosis and prevention of dental diseases in preschool children

Between the ages of 3 and 7, help your child brush their teeth. You need to check the quality of brushing your teeth and the amount of paste used. It is important to brush your teeth in the morning and in the evening. Especially great attention should be given to brushing your teeth before going to bed. There are factors that can trigger the appearance of caries: poor dental care, frequent consumption of sweets, wrong mode food, a large number of carbohydrate foods. AT preschool age It is recommended to visit the dentist 2-3 times a year.

Prevention of dental diseases in school-age children

At this age, children already brush their teeth on their own. It is necessary to pay great attention to the condition of the gums. Teach children how to use dental floss and toothpicks. If a child wears braces, brushing, caring for the teeth and the braces system must be given great attention. After all, food particles can get stuck between structures, provoke the development of caries, they must be thoroughly cleaned. From the age of twelve, you can take your child for hygienic cleaning of the teeth to the dentist.