Primary Preventive Services Question And Answers

Primary Preventive Services Definitions

Pit and fissure sealants

They are defined as ” a cement or a resin which is introduced into unprepared occlusal pit and fissures of caries susceptible teeth forming a mechanical & physical protective layer against the action of acid-producing bacteria & their substrates”

Primary Preventive Services Important Notes

1. Disclosing agents

• Erythrosine red dye – common disclosing agent
• Bismark brown – plaque component of the Ramjford index uses this solution
• Two-tone solution – Stains mature plaque as green and immature plaque as red
• Mercurochrome
• Malachite green

2. Pit and fissure sealants

• They mainly act by physical obstruction of pits and grooves
• This prevents the penetration of fermentable carbohydrates so the remaining bacteria cannot produce acid
• Types:

Indications:

• Presence of deep occlusal pits and fissures
• Presence of lingual pits or palatal pits in relation to upper lateral incisors and molars
• Presence of incipient lesion in pit and fissure
• Children and young people with medical, physical, and mental impairment with high caries risk
• Children and young people with signs of higher caries activity and coming from nonfluoride areas

Contraindications:

• Presence of shallow pits and fissures
• An open occlusal caries lesion with extension into the dentin
• Presence of large occlusal restoration
• Presence of interproximal lesions and rampant caries
• Partially erupted tooth where in isolation is a problem
• Uncooperative children

3. Interdental cleaning aids

It is selected depending on the relative size of the embrasure

4. Lactobacillus colony test

• It is the oldest and most widely used microbiological method for assessing the caries activity
• Measures the number of aciduric bacteria in the patient’s saliva

5. Swab test

• Developed by Grainger et al
• In it no collection of saliva is necessary
• It is valuable in evaluating caries in very young children

Procedure:

• Swab the buccal surfaces of the teeth with a cotton applicator
• Incubate the sample in a media
• The change in pH over 48 hours of incubation is noted on a pH meter.

Interpretation:

6. Snyder test 

• It measures the ability of the salivary microorganism to form organic acids from a carbohydrate media
• Media contains bromocresol green dye which changes color from green to yellow in the range of pH 5.4 to 3.8
• Color observations

7.Salivaiy reductase test (or) Salivary Reductase Test.

It measures the activity of the reductase enzyme present in salivary bacteria

8. Alban’s test

• It is a simplified substitute for the Snyder test
• Can be used for routine dental office use
• At the time of the test, the patient is asked to spit unstimulated saliva directly into the tube and it is incubated for 4 days.

Primary Preventive Services Short Essays

Question 1. Bisbiguanides/ Chlorhexidine.
Answer:

Bisbiguanides

Chlorhexidine gluconate & alexidine are the most effective biguanides

Bisbiguanides Chlorhexidine Gluconate:

Bisbiguanides Indications:

• As an adjunct to mechanical methods
• Immediately after pack removal
• After oral surgical procedures
• In patients with fixed appliances

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• For handicapped patients
• Drug-induced gingival enlargements
• Medically compromised patients
• Acute infections
• As prophylactic rinse

Bisbiguanides Adverse Effects:

• Staining of teeth
• Burning sensation
• Impaired taste sensation
• Rarely, parotid swelling

Bisbiguanides Mechanism:

• In low concentrations- bacteriostatic
  • Cationic molecules of chlorhexidine bind to the anionic molecules of bacterial cell wall
  • Interferes with membrane transport
  • Results in leakage of the substance
• In high concentrations- bacteriocidal
  • Penetration of chlorhexidine into the cell
  • Precipitation of cytoplasm

Bisbiguanides Effective Concentration:

10 ml of 0.2%

Question 2. Caries vaccine
(or) Describe the routes of immunization of dental caries vaccine.
Answer:

Caries vaccine

It is a suspension of an attenuated or killed microorganism administered for the prevention, amelioration or treatment of infectious diseases

Caries vaccine Mechanism Of Action:

• When the tooth erupts serum antibodies i.e. IgA stimulate opsonization & phagocytosis
• These antibodies have an inhibitory effect on glucosyl transferase & on acid production
• It results in the inhibition of the metabolic activity of S.mutans on teeth

Caries vaccine Route Of Administration:

• Oral route
  • Increases stimulation of IgA antibodies
• Systemic route
  • Subcutaneous administration of s.mutans led to an increase in IgG, IgM & IgA antibodies
  • Active gingival-salivary route
  • Localizes the immune response by using gingival crevicular fluid as a route
• Active immunization
  • Synthetic peptides
    • Derived from glucosyl transferase enzyme
• Coupling with cholera toxin subunits
  • Coupling of the protein with a nontoxic unit of cholera toxin suppresses colonization of S. mutans
• Fusing with avirulent strains of salmonella
  • Liposomes- increases IgA antibodies
• Passive immunization
  • External supplements are included
  • Bovine milk & whey
  • Egg yolk
  • Transgenic plants

Question 3. Preventive resin restoration.
Answer:

Preventive resin restoration

It utilizes the invasive & non-invasive treatment of borderline or questionable caries

Preventive resin restoration Indications:

• Deep pit & fissure
• Minimal/small carious lesion » Isolated carious lesion

Preventive resin restoration Advantages:

• Conservative technique
• Cessation of tooth destruction
• Can be replaced easily

Question 4. Chemical plaque control.
Answer:

Chemical plaque control Uses:

• As adjunct
• Prevents recurrence of disease
• It may involve the prevention of plaque formation
• Removal of existing plaque
• Inhibition of calcification of existing plaque
• Altering the pathogenicity of plaque

Classification of Chemical plaque control:

• First generation
  • Reduces plaque score by 20-50%
  • Example: Antibiotics
• Second generation
  • Reduces plaque score by 70-90%
  • Example: Bisbiguanides
• Third generation
  • Effective against specific organisms

Chemical plaque control Chemical Used:

• Antibiotics
• Erythromycin
• Penicillin
• Enzymes
• Lipase
• Amylase
• Quaternary ammonium compounds
• Benzalkonium chloride
• Bisbiguanide
• Chlorhexidine
• Metallic salts
• Copper
• Zinc
• Herbal extracts
• Phenols
• Hydrogen peroxide
• Fluorides
• Others
• Triclosan

Question 5. Anti caries mouth rinses.
Answer:

Anti-caries mouth rinses

• Formulated at
• 0.2% concentration- for weekly use
• 0.05% concentration- for daily use
• Preparation
• Prepared by dissolving 200 mg sodium fluoride tablet in 5 teaspoons of fresh clean water « It can be used for 4 members (2 adults & 2 children)
• Mechanism
• Fluoride forms fluorapatite from hydroxyapatite
• Fluoride inhibits bacterial metabolism & plaque acid formation
• Indications
• If the concentration of fluoride in drinking water is 0.3 ppm or less
• Patients with increased caries risk
• School fluoride programs
• Advantages
• 30-40% reduction in caries incidence

Question 6. Pit & fissure sealants
(or)Classify pit and fissure sealants. Write about indications and contra-indications.
Answer:

Pit & fissure sealants

They are defined as ” a cement or a resin which is introduced into unprepared occlusal pit and fissures of caries susceptible teeth forming a mechanical & physical protective layer against the action of acid-producing bacteria & their substrates”

Pit Indication:

• Children of less than 4 years of age
• Newly erupted teeth
• Stained pits & fissures

Pit Contraindication:

• Low carious risk patients
• Wide pit & fissure
• Partially erupted teeth

Pit Classification:

• Based on polymerization
• Self-activation
• Light activation
• Resin systems
  • BIS-GMA
  • Urethane acrylate
  • Clear or tinted

Pit Ideal Requisites:

• Easily flowable into the deep pit & fissure
• Easy & quick to apply & cure
• Should result in prolonged retention
• Must have cariostatic properties
• Must be nonirritant
• Should have wear resistance property

Procedure:

• Surface cleanliness of the tooth
• Dryness of the tooth surface
• Preparing the tooth for sealant application
• Application of the sealant

Question 7. Lactobacillus test.
Answer:

Lactobacillus test

Described by Hadley in 1933

Lactobacillus test Principle:

It estimates the number of acidogenic bacteria in a patient’s saliva by counting the number of colonies appearing on agar

Lactobacillus test Procedure:

• Collect paraffin-stimulated saliva (5-10 ml)
• Dilute to 1:10 dilution by pipetting 1 ml of saliva into a 9 ml tube of sterile saline solution
• Similar again to 1:100 dilution using a 1:10 diluted sample
• Mix thoroughly
• Spread 0.4 ml of each dilution over agar plates
• Incubate for 3-4 days at 37° C
• Count the number of colonies

Result:

Lactobacillus test Disadvantages:

• Inaccurate
• Require complex equipment
• Time-consuming
• Tedious

Question 8. Self-control of plaque.
Answer:

The self-control of plaque Measures:

The self-control of plaque Toothbrush:

• The self-control of plaque ADA’S specification
  • Tooth head should be
  • 1-11/4* inch in length
  • 5/16- 3/8 inches in width
  • 2-4 rows of bristles
  • 5-12 tufts per row
  • Soft- 0.007-0.009 rows
  • 80-86 bristles per tufts
• The self-control of plaque Types
  • Based on the diameter of the bristles
    • Soft- 0.007-0.009 inches
    • Medium- 0.010-0.012 inches
    • Hard- 0.013-0.014 inches
    • Extra hard- 0.015 inches
• The self-control of plaque Based on the use
• Frequency of brushing
  • Every 12 hours
• The self-control of plaque Frequency of change of brush
  • Every 3 months
  • Length of brushing time
    • Initially 10-20 minutes
    • Later 3-5 minutes
• The self-control of plaque Dentrifices
  • Used in the form of powder, paste, or gels
  • Interdental cleansing aids
  • Used in periodontally-involved patients
  • Used in open embrasures
  • Various aids
  • Dental floss o Interdental brushes
  • Wooden tips
  • Yams, gauze strips
  • The self-control of plaque Gingival massage
    • Device used
    • Toothbrush
    • Rubber tip stimulator
    • Interdental cleaning device
• The self-control of plaque  Effects
  • Epithelial thickening
  • Increased keratinization
  • Increased mitotic activity
• The self-control of plaque  Oral irrigation
  • Clean non
  • adherent bacteria debris
  • Disrupt & detoxify subgingival plaque
  • Delivers anti-microbial agents into the periodontal pocket

Question 9. Erythrosine dye.
Answer:

Erythrosine dye

It is a cherry-pink synthetic agent

Erythrosine dye Uses:

• Food coloring agent
• In printing inks
• Biological stain
• Disclosing agent
• Radiopaque medium
• Sensitizer
• Used in sweets, in cakes decorating gels

Erythrosine dye Concentration:

• For rinsing
  • Red no 3- 6.0 g
  • Water to make: 100 ml
  • For topical application
  • Erythrosine: 0.8 g
  • Distilled water-100 ml
  • Alcohol 95%-10 ml
  • Peppermint oil: 2 drops
• Erythrosine dye Tablets
  • Red no 3 -15 g
  • Sodium chloride- 0.747 %
  • Sodium sugary: 0.747 %
  • Calcium stearate: 0.995%
  • Soluble saccharin: 0.186%
  • White oil: 0.124%
  • Flavoring: 2.239%
  • Sorbitol

Erythrosine dye Purpose:

• Patient’s education
• Evaluate the effectiveness of the treatment
• Evaluate plaque indices
• Self-evaluation

Question 10. Toothbrush.
Answer:

Toothbrush Ada’s Specification:

• Tooth head should be
• 1-11/4^ inch in length
• 5/16-3/8 inches in width
• 2-4 rows of bristles
• 5-12 tufts per
• Soft- 0.007-0.009 rows
• 80-86 bristles per tufts

Toothbrush Types:

• Based on the diameter of the bristles
  • Soft- 0.007-0.009 inches
  • Medium- 0.010-0.012 inches
  • Hard-0.013-0.014 inches
  • Extra hard- 0.015 inches
• Based on use
  • Manual
  • Automatic
  • Sonic & ultrasonic
  • Ionic
• Frequency of brushing
  • Every 12 hours
• Frequency of change of brush
  • Every 3 months
• Length of brushing time
  • Initially 10-20 minutes
  • Later 3-5 minutes

Toothbrush Objectives Of Brushing:

• To clean teeth & interdental space
  • To prevent plaque formation
  • To remove plaque
  • To stimulate & massage gingival tissue
  • To clean tongue

Toothbrush Parts:

• Handle
  • Head
  • Tufts
  • Brushing plane
  • Shank

Question 11. Bass technique.
Answer:

Bass technique Synonym:

Sulcus cleaning method

Bass technique Indications:

• Open interproximal areas
• Routine technique
• Exposed root surfaces

Bass technique Technique:

• Place the bristles at a 45° angle to gingival
• Move in small circular motions
• Cover 3 teeth at a time
• Repeat around 20 strokes
• For occlusal surfaces
• Press the bristles firmly against pits & fissures
• Activate the bristles
• For lingual surfaces of the anterior place the brush vertically

Bass technique Advantages:

• Easy
• Effective
• Stimulate gingiva

Bass technique Disadvantages:

• Can cause gingival injury
• Time-consuming
• Require dexterity

Question 12. Classification of dental caries.
Answer:

Classification of dental caries Clinical:

• According to the stage of lesion progression
  • Non cavitated
  • Cavity
• According to the severity of the disease
  • Acute
  • Chronic
  • Stabilized
• According to clinical manifestation
  • White spot lesion
  • Superficial caries
  • Medium caries
  • Deep caries
  • Secondary caries

Classification of dental caries Anatomical:

• According to anatomical depth
  • Enamel caries « Dentinal caries
  • Cementum caries
• According to location
  • Coronal caries
  • Occlusal caries
  • Smooth surface caries
  • Approximal caries
  • Root caries

Question 13. Caries activity tests.
(or) Synder’s test
Answer:

1. Synder’s Test:

It is used for lactobacillus count

Caries activity tests Procedure:

1. Paraffin-stimulated saliva is collected in test tubes
2. It is inoculated into glucose & agar media
3. pH 4.7-5.0 is maintained along with color indicator bromocresol green
4. The color change indicates pH change & is compared to the standardized color chart & scored
5. Recordings are carried out at the end of 24 hours, 48 hours & 72 hours

Result:

2. Lactobacillus Test:

Described by Hadley in 1933

Caries activity tests Procedure:

• Collect paraffin-stimulated saliva [5-10 ml)
• Dilute to 1:10 dilution by pipetting 1 ml of saliva into a 9 ml tube of sterile saline solution
• Similar again to 1:100 dilution using a 1:10 diluted sample
• Mix thoroughly
• Spread 0.4 ml of each dilution over agar plates
• Incubate for 3-4 days at 37° C
• Count the number of colonies

3. Swab Test:

Caries activity tests Procedure:

• The oral flora is sampled by swabbing the buccal surfaces of the teeth with a cotton applicator
• It is subsequently incubated in the medium
• The change in pH following a 48-hour incubation period is read on a pH meter

Interpretation:

Question 14. Modified bass technique.
Answer:

Bass technique

• Placement of the head of the brush
  • 45° to the long axis of the teeth
  • Initial from most posterior teeth
• Method
  • Place the brush covering 3 most posterior teeth
  • Exert gentle pressure
  • Use short back & forth motions complete 20 strokes
  • Sweep the bristles occlusal
  • Repeat it for remaining teeth both buccally & lingually
  • For occlusal surfaces, press bristles into pits & fissures & exert strokes
  • For lingual surfaces of the anterior, place the brush vertically

Primary Preventive Services Short Question And Answers

Question 1. Interdental cleansing aids.
Answer:

Interdental cleansing aids Uses:

• Used in periodontally-involved patients
• Used in open embrasures
• Removes plaque & debris adherent
• Polishes the surfaces
• Massage the inter-dental papillae
• Reduces gingival bleeding
• Contribute to general oral sanitation
• Controls halitosis
• Various Aids:
• Dental floss
• Interdental brushes
• Wooden tips
• Yarns, gauze strips

Question 2. ADA’s specification of the toothbrush.
Answer:

ADA’s specification of the toothbrush

• Tooth head should be
  • 1-1 l/4th inch in length o 5/16-3/8 inches in width
  • 2-4 rows of bristles
  • 5-12 tufts per
  • Soft- 0.007-0.009 rows
  • 80-86 bristles per tufts

Question 3. Disclosing agents.
Answer:

Disclosing agents

• They are prepared in liquid, tablet, or lozenge form that contains a dye or other coloring agent
• It is used to identify bacterial plaque for instruction, evaluation & research

Disclosing agents Purpose:

• Patient’s education
  • Evaluate the effectiveness of the treatment
  • Evaluate plaque indices
  • Self-evaluation

Disclosing agents Requirements:

• Color should contrast with the normal color of the oral cavity
  • It should not rinse off immediately
  • It should not cause any irritation
  • It should be thin enough

Disclosing agents Agents

• Iodine containing preparation
  • Bismarck brown
  • Merbromin
  • Erythrosine
  • Fast green
  • Two-tone

Question 4. Synder’s test.
Answer:

Synder’s test

It is used for lactobacillus count

Synder’s test Procedure:

• Paraffin-stimulated saliva is collected in test tubes
• It is inoculated into glucose ft agar media
• pH 4.7-5.0 is maintained along with color indicator bro- mo cresol green
• The color change indicates pH change it is compared to the standardized color chart ft scored
• Recordings are carried out at the end of 24 hours, 48 hours & 72 hours

Question 5. Dental floss.
Answer:

Dental floss Types:

• Twisted or non-twisted
• Bonded or non bonded
• Waxed or unwaxed
• Thick or thin

Dental floss Technique:

• Wrap the dental floss around the fingers
• Stretch it between the forefinger ft thumb
• Pass interproximal through each contact area in the back ft forth motion
• Move the floss along the tooth apically upto sulus
• Repeat it

Dental floss Functions:

• Removal of adherent plaque ft debris interdentally
• Polish tooth surface
• Stimulate ft massage interdetnal papilla
• Help to locate
• Subgingival calculus
• Proximal caries
• Overhanging margins
• It is a vehicle to apply polishing / therapeutic agents

Question 6. Charter’s method.
Answer:

Charter’s method Method:

• Place the bristles 45° angle to the long axis of teeth pointing coronally
• Flexed against the gingiva
• Back ft forth vibratory motions are given

Charter’s method Indication:

After surgery

Charter’s method Effect:

• Gingival stimulation
• Interproximal cleansing

Question 7. Chlorhexidine.
Answer:

Chlorhexidine Indications:

• As an adjunct to mechanical methods
• Immediately after pack removal
• After oral surgical procedures
• In patients with fixed appliances
• For handicapped patients
• Drug-induced gingival enlargements
• Medically compromised patients
• Acute infections
• As prophylactic rinse

Chlorhexidine Adverse Effect:

• Staining of teeth
• Burning sensation
• Impaired taste sensation
• Rarely, parotid swelling

Chlorhexidine Mechanism:

• In low concentrations- bacteriostatic
  • Cationic molecules of chlorhexidine bind to the
  • ionic molecules of bacterial cell wall
  • Interferes with membrane transport
  • Results in leakage of the substance
• In high concentration-bacteriocidal
  • Penetration of chlorhexidine into a cell i
  • Precipitation of cytoplasm

Chlorhexidine Effective Concentration:

10 ml of 0.2%

Question 8. Active immunization for dental caries.
Answer:

• As an adjunct to mechanical methods
• Immediately after pack removal
• After oral surgical procedures
• In patients with fixed appliances
• For handicapped patients
• Drug-induced gingival enlargements
• Medically compromised patients
• Acute infections
• As prophylactic rinse

Question 9. Roll on technique.
Answer:

Roll on technique Synonym:

• ADA method
• Sweep method

Roll-on technique Indications

• Preparatory for modified Stillman method
• Children
• Adults with limited dexterity

Roll on technique Technique:

• Place the bristles at a 45° angle to tooth surfaces
• Lightly roll over it occlusal

Roll on technique Advantage

Massage & stimulate gingiva

Roll-on technique Disadvantage:

• Lacerate alveolar mucosa
• Ineffective for the cervical third of the tooth & interproximal areas
• May produce punctuate lesions

Question 10. Dentrifices.
Answer:

Dentrifices

• It is a substance used with a toothbrush for the purpose of
• cleaning the accessible surfaces of teeth
• Used in the form of powder, paste, or gel

Dentrifices Functions:

• Minimize plaque build-up
• Anticaries action e Removal of stains
• Mouth freshener

Dentrifices Composition

• Abrasive
  • Calcium carbonate
  • Calcium phosphate
• Humectants
  • Maintains moisture
  • Glycerine, sorbitol
• Preservatives
  • Benzoic acid
• Thickening agents
  • Methylcellulose
• Foaming agents
  • Sodium lauryl sulfate
• Flavoring agents
• Mint
• Sweetening agents
  • Mannitol, saccharine
• Desensitizing agents
  • Sodium fluoride
• Anticalculus agent
  • Pyrophosphates

Question 11. Uses of chlorhexidine.
Answer:

Uses of chlorhexidine

• As an adjunct to mechanical methods
• Immediately after pack removal
• After oral surgical procedures
• In patients with fixed appliances
• For handicapped patients
• Drug-induced gingival enlargements
• Medically compromised patients
• Acute infections
• As prophylactic rinse

Question 12. Caries vaccine.
Answer:

Caries vaccine

It is a suspension of an attenuated or killed microorganism administered for the prevention, amelioration or treatment of infectious diseases

Caries vaccine Mechanism Of Action:

• When the tooth erupts serum antibodies i.e. IgA stimulate opsonization & phagocytosis
• These antibodies have an inhibitory effect on glucosyl transferase & on acid production
• It results in the inhibition of the metabolic activity of S.mutans on teeth

Question 13. Indications of a powered toothbrush.
Answer:

Indications of a powered toothbrush

• Young children
• Handicapped patients
• Individuals lacking manual dexterity
• Patients with prosthodontic or endosseous implants
• Orthodontic patients
• Institutionalized patients including the elderly who are dependent on care providers
• Patients on supportive periodontal therapy

Question 14. Salivary reductase test.
Answer:

Salivary reductase test Procedure:

• Paraffin-stimulated saliva is collected in a collection tube
• It is then mixed with the dye Diazo-resorcinol
• The caries conduciveness reading or color change is done after 15 minutes

Question 15. Spool method of flossing.
Answer:

Spool method of flossing

• About 12-18 inches long floss is taken and about 4 inches from each end is wound around the middle finger of each hand
• In both hands, the last three fingers are folded and closed and both hands are moved apart
• In this way, about 1-2 inches of floss is held tightly between the index fingers of both the hands

Primary Preventive Services Viva Voce

1. Fredick Tornberg was the first to design the powered toothbrush
2. The circular method of toothbrushing technique is called the Fones technique
3. The vertical method of brushing technique is called the Leonard method
4. Smith method is a physiological method of toothbrushing
5. The bristles in the bass method are placed at a 45-degree angle to the gingiva
6. Dental floss is indicated to remove plaque from type I gingival embrasure
7. Furcation areas are difficult to access with a dental floss
8. The spool method of flossing is used in adults with good manual dexterity
9. Waxed floss makes a squeaking noise when passed interproximal
10. Gingival physiotherapy results in better gingival health through increased blood flow
11. The bound chlorhexidine is slowly released in the active form for a period of 12-24 hours
12. Triclosan is a phenol derivative present as an antiplaque agent
13. Brown staining of chlorhexidine is due to the precipitation of salivary melanoidin’s
14. Humectant present in toothpaste helps in reducing loss of moisture
15. Sodium lauryl sulfate is the detergent present in toothpaste