The prevention of dental diseases, such as caries and periodontitis, is a subject of great interest and, for this reason, the scientific community is engaged in research related to safe and effective solutions.
Oral hygiene is the basis for oral health and dental hygienists are the professionals who are responsible for the prevention of oral diseases through motivating patients, teaching proper brushing techniques and the removal of plaque and tartar from teeth with hand instruments or ultrasonic tools.
Caries
According to the WHO, dental caries is a localised pathological process of bacterial origin, which appears after the eruption of the tooth and causes softening of the hard tissue, developing into the formation of a cavity.
Caries, along with periodontitis, is one of the most common chronic diseases. The dietary changes of the modern era have increased its prevalence. The high incidence of this disease began to decrease in the late 1970s and early 1980s. This is because of the fluoridation of drinking water systems that began in the 1960s, as well as the introduction and marketing of fluorinated oral hygiene products for use at home, following the discovery of the role fluoride plays in preventing tooth decay.
The principle recommendations for preventing tooth decay are:
- Reduce the consumption of food and beverages containing sucrose
- Practice oral hygiene at home
- Fluoridation of water
- Use of fluoride products
- Regularly taking fluoride in areas where there is not a sufficient amount of fluoride in the water systems
- Regular professional oral hygiene visits
- Frequent dental visits
- Sealing of dental dimples and pits
Periodontitis
Periodontitis is inflammation of the periodontium and causes the attachment of the tooth to be lost. Today, we know that only a few bacterial species are responsible for periodontitis. These bacterial species are exogenous, or are transmitted to the host through direct contamination (kissing, sharing the same toothbrush, cutlery, etc.).
In order to develop periodontitis, three factors must be present simultaneously:
- The presence of periodontal bacteria
- Biofilm, or rather bacterial plaque and organic residues in which periodontal bacteria can hide and proliferate. These bacterial species are, in fact, unable to bind to the surface of the tooth and, therefore, need what is clinically referred to as biofilm in order to replicate. The bacterial plaque basically ‘hide’ in the biofilm, protecting itself from aggressive agents in the oral cavity (saliva, secretory IgA). Thus, through their ability to inhibit the host’s defence mechanisms, they penetrate into the gingival sulcus and destroy the connective attachment of the tooth, leading to reabsorption of the alveolar bone.
- Family history
Once diagnosed with periodontitis, complete intraoral radiographic scans are made to record the status and the periodontal chart is filled in to record the extent of the loss of attachment of teeth.
The main tools used by the hygienist for professional dental care are:
- Ultrasound
- Curettes
- Brushes and rubber tips that are mounted on low-speed hand tools for polishing
- Diamond prophylaxis paste
- Hand tools that spray air/water to eliminate extrinsic discolouration
- Fluoride-based gel and masks for applying it in cases of dental hypersensitivity
Sealing Dimples and Pits
The anatomical part that presents the greatest risk with regard to the possibility of developing caries are dental dimples and pits. Sealing consists of applying a special material to these areas so that they are isolated from cariogenic bacteria.
The dimples and pits are part of the dental physiological morphology of the crowns of teeth. In some cases (molars), they are deep enough to not allow for proper cleaning with common brushing manoeuvres. For this reason, it is always advisable to seal the pits and dimples on permanent molars using composite resins or sealants directly following their eruption (around six years old).