Evidence-Based Preventive Strategies for Caries Management in Pediatric Dentistry: A Review of Mechanical, Chemical, and Dietary Interventions.

Reducing a patient’s susceptibility to dental disease begins with effective management of dental plaque biofilm. Research has shown that disrupting the biofilm through mechanical brushing with fluoridated toothpaste is an effective method for controlling caries lesion development (Peters et al., 2010). However, many patients struggle to adequately remove plaque from high-risk areas (Fontana & Cabezas, 2012). In pediatric patients, the horizontal brushing technique is recommended (Ceyhan et al., 2018), with parental supervision advised until the age of seven, as per the American Academy of Pediatric Dentistry (AAPD) recommendations (2016).

Dietary Counseling:

The metabolism of dietary sugars by anaerobic bacteria leads to the production of organic acids, which are the primary cause of tooth demineralization (Bang et al., 1972). Moynihan et al. (2014) reported a higher incidence of caries in individuals with sugar intake exceeding 10% of total energy consumption compared to those with lower intake. However, due to increased fluoride exposure, Fontana et al. (2012) noted that the direct correlation between sugar consumption and caries has become less distinct. Nevertheless, the World Health Organization (WHO) recommends limiting sugar intake to below 10% of total energy and, when possible, below 5% (Moynihan, 2016).

A diet diary serves as a valuable tool for high-risk patients, allowing clinicians to assess dietary habits contributing to oral disease (Watt et al., 2003). However, Arheiam et al. (2018) highlighted potential parental resistance to diet diaries, citing concerns about blame and embarrassment, which may affect compliance.

Sugar Substitutes:

Xylitol has been suggested to reduce caries risk by stimulating salivary flow (Janket et al., 2019) and inhibiting the growth of Streptococcus mutans (Bradshaw et al., 1994). However, Rethman et al. (2011) noted that the quality of research supporting xylitol’s caries-reducing benefits remains low, necessitating further investigation

Chlorhexidine:

Chlorhexidine, one of the most commonly prescribed antiseptics in dental practice, is highly effective when used alongside mechanical oral hygiene measures (Varoni et al., 2012). The application of chlorhexidine varnish every 3–4 months has demonstrated moderate efficacy in caries inhibition; however, its effect diminishes after two years (Zhang et al., 2006). Walsh et al. (2015) found insufficient evidence in the Cochrane Library to either confirm or refute its effectiveness in caries prevention, making its role in caries management inconclusive.

Ozone Therapy:

Ozone, a tri-atomic form of oxygen with antimicrobial properties, has shown potential in arresting dental caries (Brazzelli et al., 2006). Dähnhardt et al. (2006) reported increased tactile hardness of occlusal caries lesions treated with ozone at 4, 6, and 8 months, whereas untreated lesions showed no improvement. Similarly, Atabek et al. (2011) found that 90% of ozone-treated lesions remineralized, with an even higher success rate when combined with remineralizing agents.

However, Duggal et al. (2012) found no additional benefit of ozone therapy compared to existing remineralization treatments. Moreover, the National Institute for Health and Care Excellence (NICE) advises against its use in caries management due to insufficient evidence. Despite some studies supporting its safety (Erkmen et al., 2013), the overall efficacy of ozone therapy remains controversial, warranting further high-quality research (Srinivasan & Amaechi, 2019).

Fissure Sealants:

Pits and fissures serve as prime sites for biofilm accumulation and caries initiation (Simonsen et al., 2011). The AAPD (2016) endorses the use of pit and fissure sealants as an effective preventive measure, with sealed teeth demonstrating lower caries incidence compared to unsealed teeth.

Studies have found that resin-based sealants offer greater longevity than glass ionomer sealants (Locker et al., 2003). However, Leal (2014) cautioned that resin-based materials require strict moisture control during application. A recent study by Feifei et al. (2020) found no statistically significant difference in caries prevention between fluoride varnish and sealants.

Fluoride Therapy:

Fluoride strengthens hydroxyapatite crystals in enamel, increasing resistance to acid-induced demineralization (Doumit et al., 2017). Historically, systemic fluoride intake was believed to enhance pre-eruptive enamel resistance (Fejerskov, 2004), but subsequent research suggests that fluoride primarily exerts its anticariogenic effect post-eruptively through topical contact (CDC, 1991).

Water fluoridation remains a widely adopted public health measure, with over 25 countries maintaining optimal fluoride levels in drinking water (~0.7 ppm) to reduce caries prevalence (Armfield, 2010; U.S. Public Health Service, 2015). However, concerns regarding fluoride’s ethical implications, potential effects on IQ, and risk of dental fluorosis have led to opposition in some countries (Council of Europe, 1997; GMC, 2008).

Topically applied fluoride is available in various forms, including toothpaste, gels, foams, and rinses. The AAPD (2013) recommends using a pea-sized amount of fluoridated toothpaste (0.25 mg fluoride) for children aged 3–6 years and a smear-sized amount (0.1 mg fluoride) for children under 3, given that young children swallow 80–100% of toothpaste while brushing (Cochran et al., 2004).

Professional fluoride applications, such as varnishes and gels, have demonstrated strong potential in caries prevention (Marinho, 2003). Delbam & Cury (2002) found that acidulated phosphate fluoride (APF) gel increased enamel fluoride uptake and enhanced remineralization. The American Dental Association (ADA) recommends fluoride varnish applications every 6 months for moderate-risk patients and every 3 months for high-risk patients (ADA, 2006).

Silver Diamine Fluoride (SDF):

SDF (38%) is an effective non-invasive treatment for arresting caries, with silver ions providing antimicrobial effects and fluoride ions promoting remineralization (Zhao et al., 2018). Studies show an arrest rate of 70% following SDF application (AAPD, 2018).

Advantages of SDF include its affordability, ease of use, and ability to reduce hypersensitivity. However, disadvantages include black discoloration of carious lesions, metallic taste, and potential irritation (Mei et al., 2016). Recent reviews suggest that potassium iodide application post-SDF may reduce staining in the short term (Roberts et al., 2020).

Conclusion:

Caries prevention in pediatric dentistry requires an integrated approach combining mechanical plaque control, fluoride applications, dietary modifications, and adjunctive therapies. While conventional methods like fluoridated toothpaste and sealants remain highly effective, emerging treatments such as ozone therapy and silver diamine fluoride show promise but require further investigation. High-quality clinical trials are essential to establish the long-term efficacy of newer interventions.

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