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Getting Back to Basics: Part II

Prevention and Promotion Go Hand in Hand

Appropriate dental care is integral to the health and well-being of all members of society. Although not universally recognized, the impact of oral health status on systemic health is a popular area of current research. Part One of this series focused on the need for preventative dental services and a unified preventative philosophy for the dental office. Part Two continues to develop this concept as well as the need for early caries detection and implementation of nonsurgical treatment approaches.

Recent findings indicate a significant correlation between poor oral health and increased mortality—even when cardiovascular diseases, some of the most common primary causes of death, are eliminated from the analysis.1 Dental caries is the leading cause of tooth loss in adults. The increasing segment of aged patients has caused practitioners to pay special attention to the continued oral health for elders and, moreover, all segments of the population.

A vital aspect of oral disease control is proper risk assessment. In doing so, the existing dental status is used to help predict future dental complications. Individuals presenting with high levels of active dental caries are considered high risk and should be treated differently than moderate or low risk individuals. In assessing risk status, it is important to note other contributing indicators—aside from past caries history—and their potential for interaction. Such indicators include: inadequate fluoride exposure; certain disease states (eg, Sjogren’s disease) or treatments for diseases (eg, radiotherapy treatment for head and neck cancers); physical and mental disabilities; and existing restorations or oral appliances. In addition, increased fermentable carbohydrate consumption, decreased salivary production and flow rates, gingival recession in an elderly population, and lower socio-economic status are all risk indicators that, in concert with carcinogenic bacteria, may be associated with increased caries activity.2

The implementation of a definitive intervention program is imperative to investigate potential interactions in order to guard against initiation and progression of dental caries. Since noncavitated lesions are specifically amenable to remineralization, a program for nonsurgical treatment of early lesions should also be initiated. Caries is a multifactorial and multimodal disease and should be treated accordingly. The three stages of caries are infection, demineralization, and cavitation. Preventative strategies that work well in children and young adults may not be as effective in adults and elders. Research and published literature do not always provide qualitatively and quantitatively complete data, leaving the practitioner to rely on anecdotal nonevidence-based strategies. In general, the following research observations are made:

  • Fluoride-containing water, dentifrices, and varnishes are effective; rinses and gels show future promise.
  • Although chlorhexidine varnishes and gels show promise in caries reduction, data on chlorhexidine rinses is lacking.
  • Pit and fissure sealants are effective.
  • Combination treatment including sealants, chlorhexidine, and fluoride for caries control is effective.
  • Salivary enhancers should be considered for patients with Sjogren’s disease or radiation-induced xerostomia. There is no evidence to support the use of enhancers in individuals with low to normal salivary flow rates.

Practitioners must be able to recognize noncavitated lesions in the earlier stages and intervene in an effort to prevent caries progression. Dentists have been successful in promoting dental caries prevention even with the knowledge that less dental disease may have a negative economic impact. In a similar fashion, clinicians must also promote nonsurgical treatment of noncavitated lesions and incorporate alternative methods for detecting early caries with the same understanding of potential economic impact.


*Associate Professor, Director, Oral Medicine Residency Program, LSU Health Sciences Center, New Orleans, Louisiana.



  1. Jansson L, Lavstedt S, Frithiof L. Relationship between oral health and mortality rate. J Clin Periodontol 2002;29(11):1029-1034.
  2. NIH Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life. J Dent Educ 2001;65(10):935-1179.
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