Preventive Materials, Methods, and Programs, Vol 4

ISBN: 0-86715-364-4 

656 pp; 607 illus (514 color) 

Contents
Preface
1. Plaque Control: The Key to Preventive Dentistry
2. Mechanical Plaque Control by Self-care
3. Professional Mechanical Toothcleaning
4. Chemical Plaque Control
5. Use of Fluorides 
6. Use of Fissure Sealants
7. Integrated Prevention and Control of Dental Caries in Children and Young Adults
8. Oral Health Promotion and Needs-Related Preventive Programs
9. Analytical Computerized Oral Epidemiology for Quality Control of Preventive Programs and Treatment
References
List of Abbreviations
Index 

Preface
The etiology of dental caries and periodontal diseases is well understood, and we now have developed efficient methods for prevention, treatment, arrest, and control of these diseases. For example, over the last 25 years in the county of Värmland, Sweden, large-scale implementation of our preventive programs for children has led to an increase in the percentage of caries-free 3-year-old children from 30% to 97%, as well as a reduction in caries prevalence in 12-year-old children from an average of 25 to less than 0.5 decayed or filled surfaces, with 85% of children in this age group caries free. 

In our 30-year longitudinal study in adults, the mean number of lost teeth was only about 0.5 per subject per 30 years, and the periodontal attachment level was unaltered irrespective of age. Large-scale implementation of the study’s methods in the preventive programs for our adult population has led to an increase of more than 15% in the number of remaining teeth in 65-year-old adults, as well as a reduced loss of periodontal support by more than 20% during only a 10-year period and a reduction in the percentage who were edentulous from 17% to 7%. 

According to the principles of lege artis, all members of our profession are obliged to offer treatment based on the most current scientific and clinical knowledge available. We must therefore continue to concentrate our efforts on preventing, controlling, and arresting the development of dental caries and periodontal diseases. However, needs-related preventive programs must be cost-effective and should be based on information derived from comprehensive diagnoses, histories, and risk predictions at group, individual, and tooth-surface levels. For quality control and evaluation of such programs, computer-aided analytical epidemiology, using relevant variables, should be introduced. 

The aim of this book, the fourth of a five-volume series of textbooks and atlases, is to provide the reader with updated information about various preventive materials and methods, needs-related preventive programs, and analytical epidemiology for quality control. Each chapter contains clear, concise text as well as numerous illustrations describing how to use the materials and methods addressed, supplemented with schedules showing how they should be used on a needs-related basis, according to the state of the art and based on evidence from recent research. Thus, the volume should act as a preventive dentistry "cookbook.” 

The first chapter focuses on the rate and pattern of plaque formation, which represents the etiology of dental caries and periodontal diseases. Because some microorganisms are more cariogenic and aggressive periopathogens than others, daily mechanical cleaning of all tooth surfaces is the most rational and efficient method for prevention and control of periodontal diseases and dental caries. Thus, chapter 2 presents the most cost-effective approach, mechanical toothcleaning by self-care, describing in detail the associated materials and methods, as well as principles for successful establishment of needs-related self-care habits based on self-diagnosis. Chapter 3 presents efficient materials and methods for professional mechanical toothcleaning (PMTC), as well as evidence-based effects of PMTC with and without oral hygiene education on dental caries, gingivitis, and periodontal diseases. 

Combinations of mechanical and chemical plaque control by self-care, supplemented with needs-related intervals of PMTC and professional application of chemical plaque control agents, are the most successful methods for prevention and control of periodontal diseases, as well as dental caries. Therefore, chapter 4 provides a supplementary comprehensive presentation of chemical plaque control agents for self-care and professional application, as well as a schedule for needs-related use of such products based on risk prediction. A unique chemical caries-preventive material, fluoride has been shown to exert almost 100% of its effect posteruptively. The caries preventive mechanisms of fluoride, as well as materials and methods for rational use of fluorides by self-care and professionals are presented in chapter 5. 

Almost 100% of all occlusal caries lesions are initiated in the distal and central fossae and related fissures of the permanent molars during the extremely long period of eruption (12 to 18 months). Without functional wear, cariogenic plaque biofilms reaccumulate extremely quickly and remain undisturbed on such key-risk surfaces. Therefore, if fissure sealants and other methods of intensified caries prevention are used until full eruption, the risk of developing fissure caries can be avoided altogether, as discussed in chapter 6. 

Because of the multifactorial nature of dental caries, several caries-preventive methods must be integrated in needs-related caries-preventive programs. Chapter 7 discusses principles for integrated caries prevention, as exemplified by a 20-year longitudinal needs-related caries-preventive program for children and young adults. Preventive dental programs also must be related to the oral health status and socioeconomic conditions of the population, as well as available dental care resources. In countries with high prevalence of dental diseases, low socioeconomic standards, and limited dental care resources, so-called population-based preventive programs should be implemented. However, in industrialized countries with high socioeconomic standards and well-developed dental care resources, more individualized preventive programs based on predicted risk for dental caries and periodontal disease are recommended from a cost-effectiveness point of view. New principles for oral health promotion and needs-related preventive programs are presented and discussed in chapter 8. In addition, schedules for preventive materials and methods related to predicted caries and periodontitis risk in different age groups are presented. Finally, chapter 9 presents the rationale and methods for periodical evaluation of the effect of such programs by relevant diagnostic variables in computer-aided analytical epidemiology at clinic and population levels. 

This project could not have been completed without the assistance and support of my family, friends, and colleagues. I offer my deepest thanks to my wife, Ingrid, and my daughter, Eva; my son, Torbjörn; and their families, as well to all my other relatives and friends, for their patience and understanding throughout the last 7 years, in which I have spent almost every night, weekend, and vacation preparing the material for these five volumes. I also wish to thank my wonderful staff at the Department of Preventive Dentistry, Public Dental Health Service, county of Värmland, for all their services, and particularly my assistant, Pia Hird Jonasson, who typed most of my manuscript. I owe special thanks to Art Director Fredrik Persson and Dr Jörgen Paulander, for their excellent support with computer-aided illustrations and to Associate Professor Joan Bevenius for her work in checking my English manuscript. 

I am grateful to all my colleagues and friends around the world and to several publishers (Munksgaard International, The American Academy of Periodontology, S. Karger Medical and Scientific Publisher, FDI World Dental Press, and WHO Oral Health Unit), who have generously permitted me to use their illustrations (about 30% of the total). Last but not least, the excellent cooperation of the publisher is gratefully acknowledged. 

Per Axelsson, DDS, Odont Dr 
Professor and Chairman 
Department of Preventive Dentistry 
Public Dental Health Service 
Karlstad, Sweden