ART Manual - Chapter 8

Manual for the ART approach to control dental caries

Introduction

Chapter 1. Mouth, teeth and dental caries

Chapter 2. ART: What one should know

Chapter 3. What to do before applying ART

Chapter 4. Restoring one-surface cavities using ART

Chapter 5. Restoring multiple-surface cavities using ART

Chapter 6. Glass-ionomer used as a sealant

Chapter 7. Monitoring ART restorations and sealants

Chapter 8. ART: What not to forget

Chapter 9. List of essential instruments and materials

Chapter 8 - ART: What not to Forget

Restoration of decayed teeth is part of a total package of oral care which should always be based on preventive measures, health education and health promotion activities.

Prevention

Prevention of diseases is most important for developing and maintaining good health. Unfortunately, prevention alone is not always sufficient. If people have a disease, they like to be cured because the disease bothers them. After being cured people may be willing to listen to preventive advice.

That means prevention and cure should go hand in hand. In other words, neither prevention nor cure should be presented to the people separately.

This manual emphasises ART as a combined preventive and curative oral care procedure.

Treating dental caries using the ART approach without emphasis on preventive measures is a job only half done. It is important to explain to people how they can prevent dental caries from affecting other teeth. Prevention of dental caries is based on the following elements:

1. removal of plaque,

2. counselling on proper diet,

3. application of fluorides,

4. application of antimicrobial agents.

5. application of sealants

Many people are not aware of how to take care of their teeth properly and have come to you for the treatment of a painful tooth. What can you do after the tooth has been treated The answer is: give oral health education. Instruct the patient how best to take care of the teeth. If toothpaste with fluoride is available and affordable, advise them to use it. Inform them about food which is good and which is bad for teeth. Apply fluorides, sealants or antimicrobial agents when indicated and available.

1. Removal of Plaque

Tooth cleaning not only helps in preventing dental caries, it is essential in preventing gum diseases. Proper tooth cleaning is very important but it may also be difficult for some people. They need clear instructions and demonstrations: Clean your teeth either by tooth brush or chewing stick at least once a day, preferably twice. If only once a day is a realistic goal, then advise them to clean before going to bed. The teeth are thus plaque free for a long period of time. A good cleaning once a day is better than a poor job several times a day.

2. Diet Counselling

People should eat a well-balanced diet, high in fibres and rich in vitamins. A lot of luxury and convenience foods and drinks contain sugars. These and the refined table sugars are the main reason for getting tooth decay. Eating sugar in small quantities and only two or three times a day, will limit the harm caused to the teeth.

But, if a lot of sugar is consumed, on many occasions over the day, dental caries is very likely to develop.

If this happens daily over a long period, it is almost certain that cavities will be formed.

If sugary foods or drinks are to be taken, people should be advised to do this at a particular moment of the day. For example, before a meal, not after. Also inform them about food that is low in sugar.

3. Use of Fluorides

Fluorides make the enamel stronger. It stops the growth of bacteria which causes dental caries and helps in stopping early tooth decay. Fluoride is often incorporated in toothpaste. So toothpaste with fluoride should be recommended for cleaning teeth. Fluoride gel or varnish is recommended for tooth surfaces which are not indicated for sealants. For example the buccal/palatal/lingual smooth surfaces.

Fluoride mouthrinsing reduces dental caries. This can be done at school. Try to find out whether it is possible to introduce fluoride mouthrinsing programmes at schools.

4. Use of Antimicrobial Agents

There are many antimicrobial agents but fluoride is most accepted. The next best known antimicrobial is chlorehexidine which is available as a solution, a gel and as a varnish. However, there is some reservation against the use of chlorehexidine amongst professionals. The reasons are to do with the bad taste, the chance of staining the teeth black and the fact that its effect on preventing tooth decay is not conclusive.

Consult dental professionals in your region regarding the use of antimicrobial agents.