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Preventive programs for patients with hyposalivation and xerostomia
29-03-2010
Preventive programs for patients with hyposalivation and xerostomia For such high-caries-risk patients, most preventive measures, self-administered as well as professional, must be optimized. The following regimens are recommended. Plaque control and self-administered fluoride Patients with impaired salivation are extremely fast plaque formers (Plaque Formation Rate Index scores 4 and 5). Therefore, not only the frequency but also the quality of combined mechanical and chemical plaque control by self-care has to be optimized, and all tooth surfaces must be targeted. To reduce the risk of demineralization resulting from a fall in plaque pH during meals, mechanical removal of plaque, with a fluoride toothpaste that contains antiplaque agents, is recommended before every meal. Directly after the meal, one stick each of fluoride and chlorhexidine chewing gum should be chewed for 20 minutes. In patients with xerostomia and very sensitive oral mucosa, use of a fluoride toothpaste that does not contain sodium lauryl sulfate is recommended, as is application of a chlorhexidine-fluoride gel in customized trays for 5 minutes per day. The diet should be mild, without spicy flavoring, and the patient should be advised to drink copious amounts of water. Sweets, sweet drinks, and confectionery should be sweetened with sugar substitutes. Professional plaque control and use of fluorides Needs-related intervals of professional mechanical toothcleaning are essential. After PMTC, the caries-susceptible tooth surfaces should be treated with slow-release fluoride and chlorhexidine varnishes. In a recent study, application of a 1:1 mixture of chlorhexidine varnish (Cervitec: 1% chlorhexidine and 1% thymol) and a fluoride varnish (Fluorprotector: 0.1% fluoride) significantly prolonged the depression of approximal mutans streptococci compared to the application of Cervitec alone (Twetman and Petersson, 1997). Although this effect is probably attributable to the superior retention of the fluoride varnish, for optimal prevention, the supplementary effect of slow fluoride release is essential (for reviews on saliva, see Edgar et al, 1994; Lagerlof and Oliveby, 1994; Pearce, 1991; Sreebny et al, 1992; Tenovuo, 1997; Tenovuo and Lagerlof, 1994; Tenovuo and Lumikari, 1991).
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Comments
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Articles for theme “caries”:
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29-03-2010
Symptomatic therapyIn the absence of natural salivation, it is essential to try to protect the oral hard and soft tissues by salivary substitution. Saliva substitutes, also called artificial salivas, are frequently recommended for patients complaining of dry mouth (xerostomia). Although many studies suggest that saliva substitutes are useful in the management of xerostomia, clinical experience has shown that these products are not well accepted by patients. Most patients do not continue to use the substitutes regularly, relying instead on water or other fluids to relieve their symptoms.
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29-03-2010
Salivary stimulation and substitution in patients with hyposalivation and xerostomia – Stimulation of salivaRecognition of the key role of saliva in maintaining normal oral function has stimulated research on its protective properties against caries and on the treatment of xerostomia and salivary hypofunction. Salivary clearance, buffering power, and degree of saturation with respect to tooth mineral are the major protective properties (for review, see Sreebny et al, 1992; Tenuvuo, 1997), their effect increasing with salivary stimulation: The saliva stimulated by consumption of fermentable carbohydrates reduces the fall in plaque pH that could lead to demineralization andincreases the potential for remineralization.
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29-03-2010
Formation and functions of pellicleSaliva is seldom in direct contact with the tooth surface but is separated from it by the acquired pellicle, defined as an acellular layer of salivary proteins and other macromolecules, approximately 10 um thick, adsorbed onto the enamel surface. It forms a base for subsequent adhesion of microorganisms, which under certain conditions may develop into dental plaque. The pellicle layer, although thin, has an important role in protecting the enamel from abrasion and attrition, but it also serves as a diffusion barrier.
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29-03-2010
Antimicrobial and other protective propertiesThe saliva contains many different proteins and some other small organic proteins that together protect the oral cavity (the soft tissues as well as the teeth) from frictional wear, dryness, erosion, pathogenic bacteria, and so on (see Box 12). Lubrication and other protective properties. Almost all salivary proteins are glycoproteins; that is, they contain variable amounts of carbohydrates linked to the protein core. Glycoproteins are often classified according to their cellular origin and subclassified on the basis of their biochemical properties.
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29-03-2010
Demineralization and remineralization of tooth surfacesThe physicochemical integrity of dental enamel in the oral environment is entirely dependent on the composition and chemical behavior of the surrounding fluids: saliva and plaque fluids. The main factors governing the stability of enamel apatite are pH and the free active concentrations of calcium, phosphate, and fluoride in solution, all of which can be derived from the saliva (see Box 12). The development of a clinical carious lesion involves a complicated interplay between a number of factors in the oral environment and the dental hard tissues.
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