Prevention of the carious diseases constitutes the preliminary
step of caries therapies. It takes place prior any clinical intervention
on dental tissues. Preventive options are divided into
primary (pit and fissure sealants, and topically applied fluorides
including toothpastes and varnishes), secondary and tertiary
prevention, involving the patient and professionally.
Prevention implies a clear understanding of the characteristics
of enamel disorders. It includes the identification of acidproducing
bacteria, diet-counseling comprising a long list of
fermentable carbohydrates, and host factors, involving teeth
and saliva as well.
During the last 30 years, 70 per cent of children aged 5 to 11
years were caries-free, whereas 70 per cent of the 12-17 yearold
still had caries. Prevention suggests also an effective
role for enamel remineralization. In this context, fluorides play
role as key factors for caries treatments. Initial carious lesions
of dental enamel may be identified even they may be undetectable.
Dental caries processes consists in a bacterial film
that produces acids as a byproduct of its metabolism.
The acidsdiffuse through the whole thickness of the dental plaque.
Modern methods allow identifying the initial carious decay.
For years, following Black’s classification, mechanical rules
were applied to teeth preparations. Small area of subsurface
demineralization occurs beneath the dental plaque. Drilling
creates large cavities prepared according to geometrical requirements.
This is required imperatively for the stabilization
of the cavity, prophylactic extension, and preparation of horizontal
or vertical walls. Mutans streptococci, S. sobrinus and
lactobacilli produce lactic acid and appear in plaque before
any caries could be clinically observed. Recent spectacular
evolutions of dental materials, namely the adhesive properties of resins and glass ionomers, have modified the general
concept. As a consequence, this is leading to Minimal Intervention
Dentistry. However, different available concepts are
determining the rules of Minimal Adhesive Restorations or
what is sustaining the preventive concepts implicated in carious
diseases.
Bacteria are responsible for acid production of dental caries.
Dietary fermentable carbohydrates contribute to the dissolution
of enamel hydroxyapatite. Due to fluoride intake or to
crystal remineralization, the prevention or development of
dental caries constitutes a major step for dental caries prevention.
Since the pioneer work of GV Black on operative dentistry,
carious lesions are anatomically classified in five classes.
The shape and preparation of cavities are related to the anatomical
localization of the lesion.
Class I concerns exclusively occlusal fissures. Class II develops
in the proximal aspects of molars and involves also the occlusal
surfaces. Class III affects the proximal surfaces of incisors
and canine. Class IV is a mixture of the two previous classes
in single-rooted teeth. Cervical lesions, identified as Class V
are developing in the collar of teeth, at the junction between
enamel, cementum and dentin.
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