Preventive Dentistry and Dental Public Health
Risk assessment and prevention
Caries risk assessment combines diet, plaque, fluoride exposure, salivary flow, past caries experience and medical factors. Fluoride acts topically: it enhances remineralisation, inhibits demineralisation and has antibacterial effects. Toothpaste of 1,350–1,500 ppm for adults, about 1,000 ppm for children under six (smear or pea-sized), and 5,000 ppm for high-risk adults; professional varnish 5% NaF (22,600 ppm) two to four times yearly for high-risk patients. Place pit-and-fissure sealants on permanent molars with early or no caries. Reducing sugar frequency matters more than total amount; xylitol gum is an adjunct.
Public health
Distinguish prevalence (proportion with disease) from incidence (new cases). DMFT/dmft measures past and present caries; ICDAS adds activity and severity detail. Prevention levels are primordial, primary, secondary and tertiary. The Ottawa Charter (1986) frames health promotion as healthy public policy, supportive environments, community action, personal skills and reorientation of services. In Gulf states the public supply is desalinated with negligible fluoride, so community water fluoridation is not the vehicle - school programmes, varnish, supervised brushing and toothpaste promotion carry the preventive load. Fluorosis risk follows excessive ingestion during enamel formation.
Worked example
A community of 12-year-olds with DMFT 4.5 and no water fluoride: a school-based supervised brushing and varnish programme addresses the population, while high-risk individuals still need clinical recall and sealants.
Traps
- Confusing prevalence with incidence.
- Believing systemic fluoride is the main mechanism - it is topical.
- Applying adult fluoride concentrations to preschool children.
- Treating sealants as a substitute for fluoride and dietary control.