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Dental caries is the most common dental disease all

over the world. For the primary dentition, 28 % of


children between 2 to 5 years of age had one or
more carious primary teeth ,and 51 % of children
aged between 6-11 years had one or more primary
carious teeth.



In the permanent dentition, 10 %of children between
6 to 8 years were affected by dental caries, and 51%
of children were affected by age 12 to 15. Dental
caries affected 96 % of adults aged between 50 to 64
years.
Root caries affected about 8 % of adults aged 20 to
34 years and 21 % of adults aged 50 to 64 years.
Prevention and control of dental caries
Non fluoridated
agents
Fluoridated
agents

Based on high-quality evidence, fluoride, is the first
choice for prevention and control of dental caries. It
is relatively economical and can be administered
through a number of cost-effective routes to large
number of at caries risk population.
Fluoride has multiple modes of action, as:
inhibition of tooth demineralization
promotion of incipient lesion remineralization
antibacterial effects on cariogenic bacteria.
However, fluoride has many drawbacks. First,
fluoride has a profound effect on the level of caries
prevalence, but it is far from a complete cure. There
is no fluoride concentration which can eliminate
caries totally
The second reason is that its effect is more limited
on pit and fissure caries, which is the dominant type
of caries in the developing countries.
In addition, fluoride toxicity problems increase with
inadequate nutrition or when used with immune
compromised patients. Also, there is some evidence
that there are no additional benefits gained from
fluoridated water.
Researches started to search for non-fluoride agents
for the prevention of dental caries, whether these
products can work alone or can be synergistic to the
effect of the fluoride in the prevention of dental
caries at the community level.


1- Sugar free chewing gum
2- Other Xylitol forms
3- chlorhexidine
4- triclosan
5- Remineralizing agents
6- iodine
7- sialogogues
8- ozone
9- Fissure sealants
10- Caries vaccines
11- probiotics
12- Future prospects


Xylitol is a commonly used sugar substitute that
increases salivary flow rate and enhances the
protective properties of saliva. The

sugar-free gum
containing xylitol produces superior
remineralization.
Sorbitol is another sugar substitute. The remineralizing
ability of xylitol and sorbitol on early enamel caries
is almost the same. Adding Isomalt to a
demineralizing solution has shown to significantly
reduce tooth mineral loss.

The ADA panel for evidence based dentistry reported that
there is moderate evidence that in children aged 5 16
years, supervised consumption of chewing gum sweetened
with sucrose-free polyol (xylitol only or polyol
combinations) for 10 20 minutes after meals marginally
reduces incidence of caries
.


ADA panel concluded that evidence is low that:
xylitol in dentifrices, lozenges or hard candy
reduces incidence of coronal caries in children
There is insufficient evidence that xylitol syrup
prevents caries in children under 2 years of age.
it is available in many vehicles. It has been reported
that a varnish causes the most Mutans streptococci
persistent reducing effect, followed by gels and
mouthwashes. CHX-containing sprays, chewing
gums and dentifrices are also available on the
market.
There is moderate evidence that the professionally
applied 10 to 40 % CHX varnish does not reduce
the incidence of coronal or root caries in children
and adults.
There is low certainty in concluding that: I n children up
to 15 years, application of a 1:1 mixture of CHX/thymol
varnish does not reduce the incidence of coronal caries.
while, the evidence is moderate that it reduces the
incidence of root caries in adults and elderly people

Regarding the rinse, the panel concluded with high
certainty that, using 0.05 to 0.12 percent CHX rinse
does not reduce the incidence of coronal or root
caries in children and adults.

For the CHX gel, THE ADA panel concluded that:
there is insufficient evidence that professionally
applied 1 % chlorhexidine gel reduces the
incidence of coronal caries in 3-15 years children,
or the root caries in adults and eldery.

It is a broad-spectrum antimicrobial agent which is
widely used in dentifrices. Alone, it has only
moderate anti-plaque properties, but when used in
conjunction with other compounds its activity may
be enhanced.

The panel concluded that: There is insufficient
evidence that triclosan lowers incidence of caries.

:

A-Calcium containing agents:
1 % calcium lactate mouth-rinse
Calcium carbonate
Amorphous calcium phosphate (ACP)
Sodium calciumphosphosilicate (bioactive glass):
Calcium carbonate carrier - SensiStat
B- phosphorous containing
agents:

inorganic salts as sodium and potassium or the
complex polyphosphates
Organic phosphates such as glycerophosphate and
phytate
The trimetaphosphate ion (TMP)
Alpha-tricalcium phosphate
Dicalcium phosphate dehydrate (DCPD)
C-Nano hydroxyapatite
10% of carbonate hydroxyapatite nanocrystals,
having size, morphology, chemical composition, and
crystallinity comparable to that of dentin, are said to
remineralize enamel. Hydroxyapatite has been used
in toothpastes (as fillers) and pit-and-fissure sealants
D
-
Casein Phosphopeptides
(CPP):
They are the latest entry into preventive dentistry.
They are used alone or as CPP-ACP (casein
phophopeptides with amorphous calcium phosphate)
or CPP-ACFP (casein phophopeptides with
amorphous calcium fluoride phosphate).
The main function of casein phosphopeptides is to
modulate bioavailability of calcium phosphate levels
to increase remineralization. It is also believed to
have an antibacterial and buffering effect on plaque
and interfere in the growth and adherence of
Streptococcus mutans and Streptococcus sorbinus.
The ADA panel concluded that: There is
insufficient evidence from clinical trials that use of
agents containing calcium and/or phosphates with
or without casein derivatives lowers incidence of
either coronal or root caries.

6- Iodine:
It is reported that 10% povidone-iodin reduce
Streptococcus mutans concentrations in plaque
biofilm and saliva. However, the panel concluded
that There is insufficient evidence that use of
iodine lowers incidence of coronal caries.



The panel found no published reports that evaluated
the use of sialogogues (for example, pilocarpine,
cevimeline) for caries prevention.

Ozone therapy is proposed to stimulate
remineralization of incipient caries following
treatment for a period of about 6 to 8 weeks.

Sealants are placed to prevent caries and to arrest
caries progression by providing a physical barrier
that inhibits microorganisms and food particles from
collecting in pits and fissures. The addition of
remineralizing agents such as fluorides and CCP-
ACP can further enhance remineralization.

ADA panel reported : The placement of resin-based
sealants on the permanent molars of children and
adolescents is effective for caries reduction. The
percentage of reduction ranges from 86 %at one
year to 78.6 %at two years and 58.6 %at four years.

Placement of pit-and-fissure sealants
significantly reduces the progress of noncavitated
carious lesions in children, adolescents and young
adults up to five years after sealant placement.

A successful vaccination directed against S.mutans
could be a valuable adjunct to other caries
preventive measures. If clinical trials prove their
efficiency and safty, then dental caries vaccine can
be given at the time of regular immunization
schedule of a child.
Dental caries vaccine has some limitations: other
microorganisms rather than S.mutans can initiate
caries like, S.sobrenus and vaccination against all is
not possible. Also if we contain these organisms,
another will become the potential agents for causing
caries.



The term probiotics refers to the living micro-
organisms, which, when administered in adequate
amounts, provides a health benefit to the host
Classic probiotic strains, such as those belong to
Lactobacillus and Bifidobacterium, have been
tested. This also includes the application of S.
mutans types that cannot produce acids, or other
bacteria that interfere with the pathogenic effects of
S. mutans.


synthetic carbonate-hydroxyapatite biomimetic
(CHA) nanocrystals have been investigated
regarding the possibility of obtaining an in vitro
remineralization of the altered enamel surfaces.
Smart molecules against specific bacteria, passive
immunization with animal or plant derived
antibodies against cariogenic bacteria, and peptide-
and DNA-based vaccines aimed at pathogens
colonization proteins are now under development.

In light of good supportive evidence, the panel
reminds clinicians that professional and home-use
fluoride products, including fluoridated
toothpastes and dental sealants, remain the
primary interventions effective in preventing caries