Prevention of Dental Caries-Measures beyond Fluoride

Dental caries is one of the most common preventable childhood disease; people are susceptible to this ailment throughout the lifetime [1]. Data from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2004 revealed that 28 percent of children ranging from 2 to 5 years of age had one or more primary tooth affected by dental caries and 51 percent of children had one or more primary tooth affected by age 6 to 11. In the permanent dentition, 10 percent of children aged 6 to 8 had dental caries and 51 percent of children were affected by age 12 to 15 [2]. The preventive care providers have the intention for prevention beyond the scope of providing hygiene therapy and oral hygiene instructions. Dental decay is mainly due to demineralization which is caused by acids produced by bacteria, particularly mutans Streptococci and possibly lactobacilli that ferment dietary carbohydrates. This occurs within a bacteria-laden gelatinous material called dental plaque that adheres to tooth surfaces and becomes colonized by bacteria. Thus, caries results from the interplay of three main factors over time: dietary carbohydrates, cariogenic bacteria within dental plaque, and susceptible hard tooth surfaces [3]. The use of fluoridated toothpastes [4], other topically applied fluorides [5], fluoridated municipal water [6] and pit and fissure sealants [7,8] along with dietary improvement remain mainstays of caries management. These modalities, which are based on high quality evidence, are the first choice for prevention and control of dental caries. Fluoride’s anti-caries efficacy is well-proven and may arise from multiple modes of action, i.e., inhibition of tooth demineralization, promotion of incipient lesion remineralization, and perhaps, antibacterial effects on cariogenic bacteria [9]. Clinical evidence would suggest that increasing the concentration of fluoride above the conventional level of 1000 or 1500 ppm in dentifrices will give an increased benefit although there would appear to be something of a law of diminishing returns [10]. Although fluoride is highly effective on smooth-surface caries, its effect would seem to be more limited on pit and fissure caries, and these lesions tend to dominate the caries experience of developed countries currently enjoying the benefits of fluoride. Apart from fluoride, dental health education programme, diet counselling, oral hygiene measures like dentifrices, different brushing technique are also used in prevention of dental caries. Various anti plaque agents, and other agents like enzymes have been effectively used as prevention of dental caries. From the 1930‘s when the researches came to know the anti-caries effect of the fluoride, many gargantuan water fluoridation program have been implicated, but these programs has shown to be successful only in attaining a 50% caries reduction but none of them was able to contain the caries process [11]. Since 1970‘s researches started to search for non-fluoride agents for the prevention of dental caries [12]. Non-fluoride agents may serve as adjunctive therapeutics for preventing, arresting or even reversing dental caries. The objective of this paper is to present a complete review of recent advances of various non-fluoridated caries preventing agents.