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influencing biofilm formation and growth, or modifying the dissolution process of tooth enamel, or both (Kidd and Fejerskov 2003), which needs some adjustments in patient’s dietary pattern, oral hygiene habits, and fluoride usage as appropriate (Elderton 1996). Treatment strategies, dominated by restorative approaches, have been shown to be ineffective in diminishing the burden of oral diseases (Elderton 1993, Nadanovsky and Sheiham 1995, Sheiham 1997). In fact restorative treatment, per se, does not cure the dental Dentists and Preventive Oral Health Care 211 caries (Elderton 1996, Kidd and Fejerskov 2003, Ericson 2007). Unfortunately, operative intervention has been seen by many patients, dentists, and health decision-makers as the way to manage and control dental caries. But it is well understood that the placement of initial restoration in a tooth will increase the risk of future restorations in that tooth (Elderton 1996, Luan et al. 2000) each being more invasive than the previous one. In this stage the tooth has been entered into the repeat restoration cycle (Elderton 1990). It has been shown that 65% of restorative care of dentists were replacement of previous restorations with the secondary caries being as the most common reason for replacement. (Anusavice 1995, Forss and Widstrom 2004). Research on the longevity of restorations clearly shows that making the first restoration often leads to an irreversible cycle of subsequent restorations (Deligeorgi et al., 2001), which may finally result into tooth removal (Qvist et al. 1990, Mjör et al. 2000; 2005; Tyas 2005). 4.2 Preventive/non-operative caries treatment Dental caries is the result of mineral loss in tooth tissues due to the bacterial metabolism of plaque biofilm accumulated on tooth surface. A range of factors determine the extent and rate of the mineral loss which include composition of bacterial biofilm, quality and quantity of saliva, the presence of carbohydrate, and the concentrations of minerals (especially fluoride) in oral fluids (Kidd and Fejerscov 2003). By influencing each element of the process, caries initiation and progression can be actively modified and the disease, therefore, be controlled (Baelum and Fejerscov 2003). The following measures may influence caries process: dental plaque removal, chemical modification of plaque, use of fluorides, modification of diet, influencing the composition and flow of saliva (Kidd and Fejerscov 2003). 5. Strategies for caries prevention Dental caries is a multifactorial disease meaning that it has many risk factors. Since people are different in their risk to dental caries, setting strategies for caries prevention is worthwhile. Preventive strategies attempt to reduce the risk of disease by influencing its determinants (Daly et al. 2002). Strategies for preventing dental caries may be designed at different levels; at the individual level (for patients referring to dental practices) or at the population level (as an oral health care policy for the whole population or some particular subgroups of the population). 5.1 At the individual level To succeed in caries control at the individual level, there are some aspects to be considered: assessment of the current caries activity and risk of future caries progression, using the information to classify patients in risk groups, selection of the appropriate treatment among the available preventive non-operative treatments, setting follow-up visits. Caries risk assessment, as a major part of dental practice, will provide valuable information for dentist to focus on treatments according to each patient’s need, to recognize particular risk factors for each individual, to define recall interval (since dental care would never complete with one course of treatment), and to inform patients about their relative risk for developing new lesions or progression of current lesions (so that patients get encouragement to keep on recall visits and become active in their preventive care) (Kidd and Fejerskov 2003). Oral Health Care – Prosthodontics, Periodontology, Biology, Research and Systemic Conditions 212 Oral self-care practices have been proved to be effective preventive measures at individual level for maintaining good oral health (Bratthall et al., 1996; Downer 1996; Loe 2000; Axelsson et al., 2002). Moreover, due to common risk factors with general health, oral health behaviours such as oral hygiene practices, limiting sugar use, restricting smoking would help the improvement of general health as well (Sheiham and Watt 2000, Petersen 2003a, Sanders et al. 2005). Preventive measures at the individual level emphasize plaque control, use of fluoride, and diet modification. Selecting each of these measures depends on the particular conditions of each patient and there is no single pre-written caries preventive recommendation suitable for all patients (Kidd and Nyvad 2003). Plaque control is the cornerstone of preventive caries treatment since carious lesion is the result of metabolic activity of dental plaque at tooth surface. Plaque control includes tooth brushing, interdental cleaning and professional tooth cleaning. For an effective plaque removal, teeth should be brushed at a regular basis at least once a day with fluoridated toothpaste. Twice-a-day tooth brushing, however, have shown to be more effective and, therefore, is more recommended (Adair 2006, Davies 2003). Interdental cleaning is needed especially when there are signs of active proximal lesions. There are different interdental cleaning aids as the form of floss, tape or brush which can be used according to each specific site in the mouth. In case of caries-active patients, it may be necessary to support the patient with additional plaque control in the form of professional tooth cleaning (Kidd and Nyvad 2003). All individuals should use fluoride toothpaste, containing 1000-1500 ppm fluoride ion, as a basic caries-preventive measure (Kidd and Nyvad 2003, Twetman et al. 2003). Caries-active patients will need additional fluoride therapy in form of home use fluoride moth-wash (Marinho et al. 2003b) or professionally-applied fluoride containing products (American Dental Association Council on Scientific Affairs 2007) until the situation is under the control (Kidd and Nyvad 2003). Diet change may not be necessary in caries-inactive patients. However, patients must be informed about the role of diet in the process of dental caries. For patients with multiple active lesions, diet analysis is always needed (Kidd and Nyvad 2003) and diet change might be unavoidable. Recall intervals should be set according to existing caries situation of each individual. Therefore, it may vary widely during the course of treatment. Examining the condition of whole mouth regarding the caries status and quality and flow of saliva, and assessment of patient’s compliance at recall visits are of major importance (Kidd and Nyvad 2003). 5.2 At the population level Strategies employed for the control of dental caries at the population level fundamentally depends on risks, determinants, and distributions of caries in different populations (Sheiham and Fejerskov 2003). These strategies may aim at the whole population which is known as the whole-population approach, or target at certain sections of the population which is named the risk approach. Based on the subdivision of the population identified, the