PARTIE II – PRISE EN CHARGE (Dentisterie Minimale)
48. Miller C, Morvan C, Parmentier P, Boukpessi T, Lasfargues Jj. Nutrition et santé bucco-dentaire: rôle du chirurgien-dentiste. Sciences, 3 : 40-43. 2005.
49. Parmentier P, Morvan C, Miller C, Lasfargues JJ. Nutrition et Odontologie; Enquête auprès d’un échantillon de chirurgiens dentistes. Information Dentaire 4:155-158, 2006.
50. American Academy of Pediatric Dentistry. Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. Pediatr Dent. 2013 Sep-Oct;35(5):E148-56.
51. Cortelli SC, Costa FO, Rode Sde M, Haas AN, Andrade AK, Pannuti CM, Escobar EC, Almeida ER, Cortelli JR, Pedrazzi V. Mouthrinse recommendation for prosthodontic patients. Braz Oral Res. 2014;28
Different reasons can contribute to classifying dental prosthesis wearers as high-risk individuals in relation to dental biofilm accumulation. These include a past history of oral disease, age and additional retentive areas. Other common complaints include inflammation and halitosis. Moreover, prosthesis replacement and prosthetic pillar loss are generally associated with caries and periodontal disease recurrence. Therefore, the present study undertook to make a critical review of the literature, aiming at discussing the main aspects related to chemical agent prescriptions for dental prosthesis wearers. Most of the articles were selected based on relevance, methods and availability in regard to the specific subject under investigation, without considering publication year limitations. Different types of prostheses and their impact on teeth and other oral tissues were reported. It was demonstrated that there is greater biofilm buildup and increased inflammatory levels in the presence of different types of prostheses, suggesting that additional measures are required both on population-wide and individual levels in order to control these factors. Mechanical control consists of a combination of manual or electric toothbrush and toothpaste, as well as specific devices for interdental cleaning. Although many chemical agents exhibit antimicrobial benefits when used for prosthesis disinfection, only a few agents can be used safely without causing damage. Regarding the selection of antiseptics by the overall population, chlorhexidine is the most indicated in the short term and in sporadic cases. The most indicated adjuncts to overcome the deficiencies and limitations of daily mechanical biofilm control are products containing essential oils as active ingredients.
52. Ellwood RP, Cury JA. How much toothpaste should a child under the age of 6 years use? Eur Arch Paediatr Dent. 2009 Sep;10(3):168-74.
Dental fluorosis is dependent on local fluoride levels in the extra cellular fluid surrounding the tooth during its development. These fluoride levels are determined by the plasma concentration that in turn is a function of the daily intake of fluoride. Fluoride released from bone during remodelling may also contribute to fluoride levels in the tissue. There is evidence to suggest that the effects of fluoride resulting in fluorosis prior to eruption of the tooth are cumulative and dependent on the amount and duration of exposure rather than a specific window of vulnerability. In contrast to dilution of ingested fluoride in the large volume of plasma, dilution of toothpaste in oral fluids is relatively small. Hence, for a given dose of fluoride, higher fluoride levels can be achieved in the oral environment using small amounts of toothpaste with higher fluoride concentrations rather than larger amounts with lower fluoride concentrations.
It is concluded that for young children fluoride ingestion needs to be carefully controlled during the first six years of life and the best balance between risk and efficacy might be achieved by using small amounts of high fluoride toothpaste under close supervision from parents.
53. McGrath C, Zhang W, Lo EC. A review of the effectiveness of oral health promotion activities among elderly people. Gerodontology. 2009 Jun;26(2):85-96
Thirteen thousand nine hundred and four papers were retrieved and 17 studies (18 papers) met the criteria for the review: 13 were randomised controlled studies, three were quasi-experimental studies and one was a pre-/post-single group intervention study. According to the Levels of Evidence, 11 studies could be categorised as 1b and six studies could be categorised as 2b. The quality of the evidence of the 17 studies ranged from 12 to 19; 13 of the studies had a score of 15 or above; four of the studies ranged from 12 to 14. Evidence from oral health promotion activities aimed at preventing caries, improving periodontal health and altering oral health behaviours were reviewed. The use of fluoride, antimicrobial agents and health-care provider education has important roles within oral health promotion activities for elderly people. Studies have tended to be of short-term duration and rely on surrogate outcome measures of oral health.
In the last 10 years, increasing attention has been paid to oral health promotion activities among the elderly population and high quality evidence has emerged. However, there is a need for even higher-quality research to provide more definitive guidelines on oral health promotion practices for elderly people.
54. Pitts N, Duckworth RM, Marsh P, Mutti B, Parnell C, Zero D. Post-brushing rinsing for the control of dental caries: exploration of the available evidence to establish what advice we should give our patients. Br Dent J. 2012 Apr 13;212(7):315-20.
Post-tooth brushing rinsing behaviours have the potential to either reduce or enhance the effectiveness of fluoride toothpaste and show wide variation in the general population. There is a lack of high-quality evidence to support definitive guidance in this area. However, the currently available international guidelines provide consistent recommendations despite the limited evidence. To explore the available evidence base and recommendations on optimal post-brushing rinsing behaviour relating to the use of both water and mouth rinses, a meeting was held between the authors and other experts. This paper reports the consensus views of those present at the meeting concerning what advice we should give our patients. A full list of meeting attendees is provided at the end of this article.
55. Prahlad Gupta, Nidhi Gupta, Atish Prakash Pawar, Smita Shrishail Birajdar, Amanpreet Singh Natt, and Harkanwal Preet Singh. Role of Sugar and Sugar Substitutes in Dental Caries: A Review. ISRN Dent. 2013; 2013: 519421
Dental caries is a chronic disease which can affect us at any age. The term “caries” denotes both the disease process and its consequences, that is, the damage caused by the disease process. Dental caries has a multifactorial aetiology in which there is interplay of three principal factors: the host (saliva and teeth), the microflora (plaque), and the substrate (diet), and a fourth factor: time. The role of sugar (and other fermentable carbohydrates such as highly refined flour) as a risk factor in the initiation and progression of dental caries is overwhelming. Whether this initial demineralization proceeds to clinically detectable caries or whether the lesion is remineralized by plaque minerals depends on a number of factors, of which the amount and frequency of further sugars consumption are of utmost importance. This paper reviews the role of sugar and sugar substitutes in dental caries.
56. Chou R, Cantor A, Zakher B, Mitchell JP, Pappas M. Preventing dental caries in children < 5 years: systematic review updating USPSTF recommendation. Pediatrics. 2013 Aug;132(2):332-50. doi: 10.1542/peds.2013-1469. Epub 2013 Jul 15.
There is no direct evidence that screening by primary care clinicians reduces early childhood caries. Evidence previously reviewed by the US Preventive Services Task Force found oral fluoride supplementation effective at reducing caries incidence, and new evidence supports the effectiveness of fluoride varnish in higher-risk children.
57. Courson F, Assathiany R, Vital S. Prévention bucco-dentaire chez l’enfant : les moyens dont on dispose. Arch Pediatr 2010 ; 17:776-777
58. De Visschere LM, van der Putten GJ, Vanobbergen JN, Schols JM, de Baat C. An oral health care guideline for institutionalised older people. Gerodontology. 2011 Dec;28(4):307-10
Institutionalized older people are prone to oral health problems and their negative impact due to frailty, disabilities, multi-morbidity, and multiple medication use. Until recently, no evidence-based oral health care guideline for institutionalized older people has been available. For that reason, the Dutch Association of Nursing Home Physicians developed the Oral health care Guideline for Older people in Long-term care Institutions (OGOLI), meeting the requirements of the AGREE instrument for assessing a guideline’s quality. This short report presents the keynotes and the content of the Oral health care Guideline. Most recommendations are based on expert opinions. Only 4 recommendations (education, pneumonia, use of an electric toothbrush, and fluoride rinsing in case of a sudden increase of oral plaque amount) are based on evidence level A2 conclusions. This emphasizes the need for further research on oral health of institutionalized older people.
59. Espelid I. Caries preventive effect of fluoride in milk, salt and tablets: a literature review. Eur Arch Paediatr Dent. 2009 Sep;10(3):149-56.
Very few studies of good quality were identified in general. Two studies on fluoridated milk were tabulated and seven studies dealing with fluoride tablets/ drops were analysed. One study showed a 78% reduction in caries in newly erupted permanent teeth among 8 year olds after 3 years with fluoridated milk. For primary teeth one study showed 31% caries reduction. The differences between fluoride-group and control were statistically significant. The reduction in caries prevalence in the fluoride tablet group compared with a negative control varied from 81% (carious surfaces in permanent teeth erupted in the study period) to 49% in DMFS for all permanent teeth. No RCT studies on fluoridated salt were identified. There is limited evidence that F tablets and drops are effective, and compliance is a key factor. There are good reasons to believe that fluoride in different applications and formulas does work as caries preventive agents under supervision. There is a need for new, well-designed studies within this field, but the use of negative controls without any fluoride exposure is difficult due to ethical reasons. In particular new research is needed concerning possible caries preventive effect of fluoridated milk and salt.
60. European Academy of Paediatric Dentistry. Guidelines on the use of fluoride in children: an EAPD policy document. Eur Arch Paediatr Dent. 2009 Sep;10(3):129-35
The EAPD strongly endorses that the daily use of fluoride should be a major part of any comprehensive preventive program for the control of dental caries in children. Regardless of the type of program, community or individually based, the suggested use of fluoride must be balanced between the estimation of caries risks and the possible risks for toxic effects of the fluorides. Such a preventive program should be re-evaluated at regular intervals and adapted to a patient’s needs and risks. For the majority of European communities, the EAPD recommends the use of appropriate fluoride toothpaste in conjunction with good oral hygiene to be the basic fluoride regimen.
61. Muller-Bolla M, Courson F, Sixou JL. Faut-il revoir nos habitudes de prescription des dentifrices chez l’enfant ? Information Dentaire, 2010 ; 93 : 14-18
62. Rugg-Gunn A, Bánóczy J. Fluoride toothpastes and fluoride mouthrinses for home use. Acta Med Acad. 2013 Nov;42(2):168-78
To provide a brief commentary review of fluoride-containing toothpastes and mouthrinses with emphasis on their use at home. Toothpastes and mouthrinses are just two of many ways of providing fluoride for the prevention of dental caries. The first investigations into incorporating fluoride into toothpastes and mouthrinses were reported in the middle 1940s. Unlike water fluoridation (which is ‘automatic fluoridation’), fluoride-containing toothpastes and fluoridecontaining mouthrinses are, primarily, for home use and need to be purchased by the individual. By the 1960s, research indicated that fluoride could be successfully incorporated into toothpastes and clinical trials demonstrated their effectiveness. By the end of the 1970s, almost all toothpastes contained fluoride. The widespread use of fluoride- containing toothpastes is thought to be the main reason for much improved oral health in many countries. Of the many fluoride compounds investigated, sodium fluoride, with a compatible abrasive, is the most popular, although amine fluorides are used widely in Europe. The situation is similar for mouthrinses. Concentrations of fluoride (F), commonly found, are 1500 ppm (1500 μg F/g) for toothpastes and 225 ppm (225 μg F/ml) for mouthrinse. Several systematic reviews have concluded that fluoride-containing toothpastes and mouthrinses are effective, and that there is added benefit from their use with other fluoride delivery methods such as water fluoridation. Guidelines for the appropriate use of fluoride toothpastes and mouthrinses are available in many countries.
Fluoride toothpastes and mouthrinses have been developed and extensive testing has demonstrated that they are effective and their use should be encouraged.
63. Scottish Intercollegiate Guidelines Network. Dental interventions to prevent caries in children. Edinburgh: publication no. 138. 2014 March
64. Vaishnavi Bhaskar, Kathleen A McGraw, and Kimon Divaris. The importance of preventive dental visits from a young age: systematic review and current perspectives. Clin Cosmet Investig Dent. 2014; 8: 21–27
Four manuscripts met the inclusion criteria and were included in the review. All studies were conducted in the US and employed a retrospective cohort study design using public insurance-claims data, whereas one study matched claims files with kindergarten state dental surveillance data. That study found no benefit of EPDVs in future clinically determined dental caries levels in kindergarten. The other three studies found mixed support for an association of EPDVs with subsequent more preventive and fewer nonpreventive visits and lower nonpreventive service-related expenditures. Selection bias and a problem-driven dental care-seeking pattern were frequently articulated themes in the reviewed studies.
The currently available evidence base supporting the effectiveness of EPDVs and the year 1 first dental visit recommendation is weak, and more research is warranted. The benefits of EPDVs before the age of 3 years are evident among children at high risk or with existing dental disease. However, EPDVs may be associated with reduced restorative dental care visits and related expenditures during the first years of life.
65. Bergstrand F, Twetman S. A review on prevention and treatment of post-orthodontic white spot lesions – evidence-based methods and emerging technologies. Open Dent J. 2011;5:158-62.
The findings consolidated the use of topical fluorides in addition to fluoride toothpaste as the best evidence-based way to avoid WSL. The mean prevented fraction based on 6 trials was 42.5% with a range from -4% to 73%. The recent papers provided the strongest support for regular professional applications of fluoride varnish around the bracket base during the course of orthodontic treatment. For the treatment of post-orthodontic WSL, home-care applications of a remineralizing cream, based on casein phosphopeptide-stabilized amorphous calcium phosphate, as adjunct to fluoride toothpaste could be beneficial but the findings were equivocal. For emerging technologies such as sugar alcohols and probiotics, still only studies with surrogate endpoints are available. Thus, further well-designed studies with standardized regimes and endpoints are needed before guidelines on the non-fluoride technologies can be recommended.
66. Featherstone JD, Doméjean S. The role of remineralizing and anticaries agents in caries management. Adv Dent Res. 2012 Sep;24(2):28-31.
The first ICNARA conference (International Conference on Novel Anticaries and Remineralizing Agents) was held in Chile in January, 2008, and the proceedings were published in Advances in Dental Research (Volume 21, 2009). That issue of Advances summarized the state of the science and set a research agenda for the future for two key components of caries management, namely, antibacterial agents and remineralizing agents. The second conference (ICNARA 2, January 2012) provided an update on science and new directions for research and clinical practice. Over the past decade, renewed efforts have been made across the world to establish proven methods of caries risk assessment and to provide direction for improved methods of caries management based upon risk levels. Evidence-based caries risk assessment tools are now available. The need for improved therapy to reduce the bacterial challenge that initiates the caries process, and to enhance remineralization, is now very clear. Fluoride therapy alone is insufficient to control the caries process in high-risk individuals. New remineralizing and anticaries products and new delivery systems are in development, and ICNARA 2 presents future technology for the management of dental caries.
67. Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E. Minimal intervention dentistry for managing dental caries – a review: report of a FDI task group. Int Dent J. 2012 Oct;62(5):223-43.
This publication describes the history of minimal intervention dentistry (MID) for managing dental caries and presents evidence for various carious lesion detection devices, for preventive measures, for restorative and non-restorative therapies as well as for repairing rather than replacing defective restorations. It is a follow-up to the FDI World Dental Federation publication on MID, of 2000. The dental profession currently is faced with an enormous task of how to manage the high burden of consequences of the caries process amongst the world population. If it is to manage carious lesion development and its progression, it should move away from the ‘surgical’ care approach and fully embrace the MID approach. The chance for MID to be successful is thought to be increased tremendously if dental caries is not considered an infectious but instead a behavioural disease with a bacterial component. Controlling the two main carious lesion development related behaviours, i.e. intake and frequency of fermentable sugars, to not more than five times daily and removing/disturbing dental plaque from all tooth surfaces using an effective fluoridated toothpaste twice daily, are the ingredients for reducing the burden of dental caries in many communities in the world. FDI’s policy of reducing the need for restorative therapy by placing an even greater emphasis on caries prevention than is currently done, is therefore, worth pursuing.
68. Girish Babu KL, Doddamani GM. Dental home: Patient centered dentistry. J Int Soc Prev Community Dent. 2012 Jan;2(1):8-12.
Early childhood dental caries occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in children in families belonging to the low-income group, where it is seen in epidemic proportions. Dental caries results from an overgrowth of specific organisms that are a part of normally occurring human flora. Human dental flora is site specific, and an infant is not colonized until the eruption of the primary dentition at approximately 6 to 30 months of age. The most likely source of inoculation of an infant’s dental flora is the mother, or another intimate care provider, shared utensils, etc. Decreasing the level of cariogenic organisms in the mother’s dental flora at the time of colonization can significantly impact the child’s redisposition to caries. To prevent caries in children, high-risk individuals must be identified at an early age (preferably high-risk mothers during prenatal care), and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications (oral hygiene and feeding practices), and establishment of a dental home by 1 year of age for children deemed at risk.
69. Jurić H. Current possibilities in occlusal caries management. Acta Med Acad. 2013 Nov;42(2):216-22.
Dental caries is a multifactorial disease that affects most populations throughout the world and it is still the primary cause of oral pain and tooth loss. The occlusal surfaces of posterior teeth are the most vulnerable sites for dental caries due to their anatomy. Therefore, the aim of the following article is to summarize current knowledge on occlusal caries development and the possibilities of its prevention. Although the overall caries rate today has fallen for populations in industrialized countries, the rate of occlusal surface caries has not decreased. This may be explained with fact that topically applied fluorides and their mode of action prevent caries better on smooth than on occlusal surfaces. As we know, tooth decay of first permanent molars causes a great deal of different short and long term difficulties for patients. Therefore, there is a continuous need for implementation of programs for caries prevention in permanent teeth. Nowadays, we like to treat our patients by minimally invasive methods. A very important step in our effective preventive treatment is sealing pits and fissures as a cornerstone of occlusal caries management. Reliable assessment of caries activity is also very important for defining treatment needs and plans. A very important decision, which should be made during occlusal caries management, is the selection of restorative material according to the treatment plan.
70. Mm J, Nk B, A P. Minimal intervention dentistry – a new frontier in clinical dentistry. J Clin Diagn Res. 2014 Jul;8(7):ZE04-8.
Minimally invasive procedures are the new paradigm in health care. Everything from heart bypasses to gall bladder, surgeries are being performed with these dynamic new techniques. Dentistry is joining this exciting revolution as well. Minimally invasive dentistry adopts a philosophy that integrates prevention, remineralisation and minimal intervention for the placement and replacement of restorations. Minimally invasive dentistry reaches the treatment objective using the least invasive surgical approach, with the removal of the minimal amount of healthy tissues. This paper reviews in brief the concept of minimal intervention in dentistry.
71. Bain RE, Gundry SW, Wright JA, Yang H, Pedley S, Bartram JK. Accounting for water quality in monitoring access to safe drinking-water as part of the Millennium Development Goals: lessons from five countries. Bull World Health Organ. 2012 Mar 1;90(3):228-235A.
To determine how data on water source quality aﬀect assessments of progress towards the 2015 Millennium Development Goal (MDG) target on access to safe drinking-water. The criterion used by the MDG indicator to determine whether a water source is safe can lead to substantial overestimates of the population with access to safe drinking-water and, consequently, also overestimates the progress made towards the 2015 MDG target. Monitoring drinking-water supplies by recording both access to water sources and their safety would be a substantial improvement.
72. Poulsen S. Fluoride-containing gels, mouth rinses and varnishes: an update of evidence of efficacy. Eur Arch Paediatr Dent. 2009 Sep;10(3):157-61.
Four new studies were identified on fluoride-containing gels, one on fluoride mouth rinses and four on fluoride-containing varnishes. Prevented fractions obtained in the permanent dentition were consistent with the estimates found in previous reviews, while the effect obtained on caries in the primary dentition remains uncertain. The only study that compared the effect of different fluoride compounds, could not find any difference.
The effect of the three methods on caries in the permanent dentition is well described, while the effect on caries in the primary dentition remains to be determined. The effect of choice of fluoride compound is also not known.
73. Turner L, Mupparapu M, Akintoye SO. Review of the complications associated with treatment of oropharyngeal cancer: a guide for the dental practitioner. Quintessence Int. 2013 Mar;44(3):267-79.
We identified the most common complications associated with the treatment of oral cancers. Based on the information gathered, there is evidence that survival of OPC extends beyond eradication of the diseased tissue. Understanding the potential treatment complications and utilizing available resources to prevent and minimize them are important. Caring for OPC survivors should be a multidisciplinary team approach involving the dentist, oncologist, internist, and social worker to improve the currently stagnant 5-year survival rate of OPC. More emphasis on improved quality of life after elimination of the cancer will ultimately improve OPC survivorship.