www.metdental.com

Quality Resource Guide

MetLife designates this activity for

1.0 continuing education credit

for the review of this Quality Resource Guide

and successful completion of the post test.

Educational Objectives

Following this unit of instruction, the practitioner should be able to:

Understand the factors creating risk for caries.

Assess a patient’s caries risk level.

Understand the caries preventive action of fluorides.

4. Identify different modalities of fluorides as well as their appropriate dosages.

5. Appropriately apply topical fluorides.

6. Educate patients on appropriate application of self-applied topical fluorides.

7. Understand the benefits and side effects of systemic fluorides.

Introduction

“D

ental

caries is the dissolution of

mineralized tissues, enamel, dentine,

and cementum, caused by metabolic

events in the oral biofilm”.

In addition to the metabolic

events, the distribution and severity of caries are

affected by genetic, biological, social and extra-

oral environmental factors. A more recent focus of

researchers has been on the social determinants of

oral diseases (including dental caries) at the individual,

family, and community levels.

Certain microorganisms,

present in the oral biofilm or plaque and collectively

known as cariogenic bacteria

(

mutans streptococci,

streptococcus sobrinus, lactobacillus acidophilus

and

actinomyces viscosus

; the last organism is mostly

implicated in the etiology of root caries), ferment the

carbohydrate in the oral cavity and form acids resulting

in a decreased pH in the oral cavity. When the resultant

pH reaches 5.5, enamel or cementum begins to dissolve

or demineralize and minerals such as calcium and

phosphate are lost from tooth structure.

Demineralization

is a dynamic process alternating with remineralization

depending on the pH level in the oral cavity and the

equilibrium between caries determinants, protective and

risk factors.

With lower pH and dominant caries risk

factors, demineralization overwhelms remineralization

and vice versa. More common risk factors for dental

caries include: visible lesions; fillings during the last three

years; heavy plaque; sugar snacks more than three

times/day; inadequate salivary flow (<1.0 ml/minute);

appliances (orthodontic, prosthetic); factors that reduce

salivary flow (certain medications, radiation therapy);

systemic conditions (Sjogren’s syndrome); exposed

roots; developmental defects, and; recreational drugs.

Protective factors of dental caries are: optimal fluoride

exposure; adequate flow of saliva (> 1.0 ml/minute);

good oral hygiene, and; infrequent exposure to sugary

products (less than three times/day).

Assessing the risk level for dental caries is a cornerstone

for successful dental caries management in clinical

practice.

Different caries risk assessment protocols

have been developed recently including those created

by the

Caries Management by Risk Assessment

(CAMBRA)

coalition,

3,4

the

American Dental

Association

(ADA)

5-7

and the

Caries Assessment

Tool

developed by the A

merican Academy of

Pediatric Dentistry

(AAPD)

While the protocols

from the first two organizations have a protocol for

children aged less than six years and another for

those six years or older, the

AAPD

has developed

three protocols based on age groups: 0-3 years, 3-5

years, and greater than or equal to six years. While

CAMBRA

protocol classifies an individual’s caries

risk into four levels (low, moderate, high, and extremely

high), the

ADA

’s protocol includes only three levels

FIRST EDITION

The following commentary highlights

fundamental and commonly accepted

practices on the subject matter. The

information is intended as a general overview

and is for educational purposes only. This

information does not constitute legal advice,

which can only be provided by an attorney.

New York, NY. All materials subject to

this copyright may be photocopied for the

noncommercial purpose of scientific or

educational advancement.

Published March 2016.

Expiration date:

December 2018.

The content of this Guide

is subject to change as new scientific

information becomes available.

MetLife is an ADA CERP Recognized Provider.

ADA CERP is a service of the American

Dental Association to assist dental

professionals in identifying quality providers of

continuing dental education. ADA CERP does

not approve or endorse individual courses or

instructors, nor does it imply acceptance of

credit hours by boards of dentistry.

Concerns or complaints about a CE provider

may be directed to the provider or to ADA

CERP at www.ada.org/goto/cerp.

Accepted Program Provider FAGD/MAGD

Credit

11/01/12 - 12/31/16

Address comments to:

dentalquality@MetLife.com

MetLife Dental

Quality Initiatives Program

501 US Highway 22

Bridgewater, NJ 08807

Author Acknowledgements

Sena Narendran, BDS MSc DDPH

Associate Professor

Department of Community Dentistry

School of Dental Medicine

Case Western Reserve University

Cleveland, Ohio

Dr. Narendran has no relevant financial

relationships to disclose.

Contemporary Use of Fluorides in Dental Practice