What are the management and prevention strategies for dental cavities?

From the Guidelines

Effective management and prevention of dental cavities requires a combination of good oral hygiene practices, dietary modifications, and professional dental care, with a focus on fluoride use as recommended by the Centers for Disease Control and Prevention 1. To manage and prevent dental cavities, it is essential to:

• Brush teeth twice daily with fluoride toothpaste, as frequent exposure to small amounts of fluoride each day will best reduce the risk for dental caries in all age groups 1
• Floss once daily to remove plaque between teeth
• Use antimicrobial mouthwash to reduce harmful bacteria
• Limit consumption of sugary and acidic foods and beverages, as these contribute to enamel erosion and cavity formation
• Visit the dentist every six months for professional cleanings and check-ups, which allow for early detection and treatment of cavities Some key points to consider:
• Professional fluoride treatments, typically applied as a gel, foam, or varnish containing a high concentration of fluoride (9,000-22,500 ppm), can strengthen enamel and prevent decay 1
• Dental sealants, thin plastic coatings applied to the chewing surfaces of back teeth, provide a physical barrier against bacteria and food particles
• For existing cavities, treatment options include fillings (amalgam, composite, glass ionomer), crowns for larger cavities, root canal therapy for infections reaching the pulp, and extraction for severely damaged teeth
• Fluoride works by remineralizing weakened enamel and making teeth more resistant to acid attacks from bacteria and sugars, and its use is widely recommended by health organizations 1
• Maintaining a neutral pH in the mouth through adequate saliva production also helps prevent cavities, as saliva contains minerals that help repair early tooth decay It is also important to note that:
• Persons at high risk for dental caries might require additional fluoride or other preventive measures to reduce development of caries 1
• The cost-effectiveness of professionally applied fluoride methods, such as gel and varnish, is unclear and may depend on the target population and setting 1 Overall, a comprehensive approach to managing and preventing dental cavities should prioritize good oral hygiene practices, dietary modifications, and professional dental care, with a focus on fluoride use and regular check-ups. The most effective way to prevent dental cavities is to brush teeth twice daily with fluoride toothpaste and visit the dentist every six months for professional cleanings and check-ups 1.

From the FDA Drug Label

Topex Fluoride Foams are indicated for topical application to teeth to aid in the prevention of dental caries. The management and prevention strategies for dental cavities include:

• Topical application of fluoride foams to teeth
• Professional application in trays
• Treatment frequency not to exceed 4 treatments per year
• Precautions to minimize ingestion of product, such as using a saliva ejector during treatment
• Post-treatment instructions to refrain from drinking, eating, or rinsing for 30 minutes after treatment 2 2 Key points:
• Fluoride foams are used to prevent dental caries
• Treatment should be done by a professional
• Patient should follow post-treatment instructions to minimize ingestion of product

From the Research

Management and Prevention Strategies for Dental Cavities

• Regular toothbrushing with fluoride toothpaste is the principal non-professional intervention to prevent caries, with higher concentrations of fluoride associated with increased caries control 3
• The daily use of fluoride toothpaste is seen as the main reason for the overall decline of caries worldwide over recent decades 4
• A dose-response effect was observed for D(M)FS in children and adolescents, with 1000 to 1250 ppm or 1450 to 1500 ppm fluoride toothpaste reducing caries increments when compared with non-fluoride toothpaste 3
• In the adult permanent dentition, 1000 or 1100 ppm fluoride toothpaste reduces DMFS increment when compared with non-fluoride toothpaste in adults of all ages 3

Anatomic and Examination Considerations

• Patients often present to their physician with complaints of dental and/or oral pain, and it is important for physicians to understand the complexities of oral anatomy and how to perform a basic clinical examination of this area 5
• The general assessment and extra oral examination of the dental patient can identify undiagnosed or undisclosed medical conditions, such as malignancies, endocrine conditions and signs indicating raised cardiovascular or cerebral vascular risk 6
• History taking and clinical examination are two of the most important aspects of the patient assessment process, and complement each other to such an extent that it is impossible to build a satisfactory treatment plan without combining and collating information from the two procedures 7

Risk Factors and Classification

• Dental caries is a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues 4
• The balance between pathological and protective factors influences the initiation and progression of caries, and underpins the classification of individuals and groups into caries risk categories 4
• The choice of fluoride toothpaste concentration for young children should be balanced against the risk of fluorosis 3