Introduction

Dental education and practice need to rise to modern day challenges and if fails to do so then changes will be forced on them while they are in a defensive position. There is a need to move wholeheartedly into the preventive era. The universal adoption of a preventive (evidence-based) approach to making of dental treatment decisions could be the most powerful factor in reducing the restorative burden of dental services.2 Dental caries and periodontal diseases are dynamic conditions, which need 'managing' with a focused blend of preventive and refined restoration care. Much more emphasis should be laid on the assessment of caries or periodontal lesions, with a view to implementing specific preventive measures and allowing the natural healing and arrest of disease processes to occur.3 The standard invasive dental treatments fail to address the fundamental bacterial nature of the diseases. In fact, these treatments rather readily start a totally unacceptable chain of events. This chain embraces many shortcomings, which themselves nurture what may be described as the repeat restorative cycle.
Bacteria's are responsible for dental caries and periodontal diseases and it is possible to prevent them from the beginning. But unfortunately they are not always prevented; rather, the forces leading to the diseases are allowed to remain in race with those that lead to dental health. In modern worod, but the services providing appropriate dental care to manage them remain outdated and fail to follow evidence-based approach.
Poor oral health, including caries, tooth loss, and periodontitis, is ubiquitous worldwide, and is potentially treatable and preventable.3 Like adverse oral health conditions, Alzheimer disease and related disorders are also very common among aging populations. Established risk factors for Alzheimer disease include cerebrovascular disease and its vascular risk factors, many of which share associations with evidence of systemic inflammation also identified in periodontitis and other poor oral health states. In this review, we present epidemiologic evidence of links between poor oral health and both prevalent and incident cognitive impairment, and review plausible mechanisms linking these conditions, including evidence from compelling animal models. Considering that a large etiologic fraction of dementia remains unexplained, these studies argue for further multidisciplinary research between oral health conditions, including translational, epidemiologic, and possibly clinical treatment studies.6 The current program of continuing dentistry is unnecessarily restricted by outdated conceptions of professionalism and learning; thus it fails to serve the needs of dentists today.

Caries

The dental caries is a chronic, diet microbial, site-specific disease caused by shifts from protective factors favoring tooth remineralization to destructive factors leading to demineralization. Dental caries results from complex interactions among the tooth structure, the dental biofilm, and dietary, salivary and genetic influences. The distribution of caries has changed in the last century. Relatively recent data indicate that about 90% of carious lesions occur in the pits and fissures of permanent posterior teeth and that molar teeth are most susceptible to caries.7 Throughout the 20th century, of all possible etiological organisms associated with dental caries, the Streptococci group captured the greatest interest. Researchers initially isolated Streptococcus mutans from human carious lesions, but it was not until much later, when researchers conducted animal studies, that the bacterial etiology of dental caries was established firmly. Children acquire some oral micro-organisms, such as S. mutans, from their mothers or primary caregivers early in life.
Therefore, caries is a microbial disease in which etiologic bacteria are normal constituents of the oral micro-biota that cause disease only when their proportions and pathogenicity change in response to environmental conditions. The key caries-associated microbial virulence traits include acidogenesis and acid tolerance, intracellular polysaccharide storage and extracellular glucan formation, which promote MS attachment and increases plaque's pH-lowering ability. Although S. mutans is one of the most researched cariogenic micro-organisms, it is only one of more than 500 species found in dental plaque.6 In studies using molecular identification of bacteria, investigators have reported that diverse bacterial communities, including some novel speciesare associated with dental caries and that S. mutans is notdetectable in 10 to 20% of people who have severe caries.Recent evidence also has supported the role of yeast (Candida albicans) as a member of the mixed oral micro-biota involved in caries causation.
These findings provide support for the ecological plaque hypothesis, which proposes that S. mutans is only one of many endogenous micro-organisms involved in the patho- genesis of caries. A challenge for researchers is to charact- erize this complex biofilm and subsequently identify micr- obial risk factors leading to caries activity, with a view tow- ard developing novel antimicrobial interventions. Dietary factors and host salivary and genetic factors also play an important role.
Dentistry needs new diagnostic tools and treatment metho- ds to support improved patient care. Future caries manage- ment must include risk assessment to enable clinicians to provide timely and cost-effective care to those most in ne- ed. We have made much progress in our knowledge of the biology, prevention, diagnosis and treatment of dental cari- es since the founding of the ADA 150 years ago. However, dental caries remains a significant problem for many Americans, and we look forward to the day when people of all ages and backgrounds view dental caries as a disease of the past.

Periodontal disease

Periodontitis is characterized by a progressive loss of bone around the teeth. Without proper oral hygiene among those at risk for the disease and if left untreated, the teeth loosen and are responsible for periodontitis. Until now, however, they did not know precisely which bacterium was to blame. “Identifying the mechanism that is responsible for periodo- ntitis is a major discovery,” said Jiao, lead author of the pa- per that recently appeared in the journal Cell Host and Mi- crobe. He said by using a mouse model to conduct the research “we were able to isolate the bacterium, NI1060, that normally lives in the oral cavity, but triggers tooth-supporting bone loss which leads to periodontitis.” Another major discovery was that a receptor, which lines the oral cavity, Nod1, is activated by the NI1060 bacterium.
Scientists have known that periodontitis is caused by mul- tiple bacteria and that some of them can damage the ging- iva, the tissue surrounding the teeth. “But they also know that gingival damage is not sufficient to trigger bone loss, and that unknown bacteria are responsible.11 Researchers have developed a way to induce damage to the gingiva bet- ween the molar teeth of mice. Over time, they discovered that the NI1060 bacterium accumulated at the damaged si- te. To prove NI1060 causes the disease, the bacterium was introduced into germ-free mice with gingival damage. This resulted in bone loss around the teeth. Genomic sequencing revealed that NI1060 is a bacterium that is related to bacteria associated with the development of aggressive periodontitis in humans. “Nod1 is a part of our protective mechanisms against bacterial infection. It helps us to fight infection by recruiting neutrophils, blood cells that act as bacterial killers. “It also removes harmful bacteria during infection.” However, in the case of periodontitis, accumulation of NI1060 stimulates Nod1 to trigger neutrophils and osteoclasts, which are cells that destroy bone in the oral cavity.

Developing Personalized Therapies

While these discoveries are important, it may take years for new therapies to be developed that dentists might be able to use in clinics to help patients with periodontal disease. The findings from this study underscore the connection between beneficial and harmful bacteria that normally reside in the oral cavity, how a harmful bacterium causes the disease, and how an at-risk patient might respond to such bacteria. This improved molecular understanding may help in developing more personalized therapies for patient management. Until then, regular checkups with a person's oral health care provider and practicing good oral hygiene to reduce the prevalence of bacteria will continue to play a crucial role in minimizing periodontitis.

Evidence Based Dentistry: A Step Ahead

National Institutes of Health consensus statement acknow- ledged that tooth restoration does not stop the caries proc- ess and emphasized the need for improved diagnosis, prev- ention and management of caries in its early (that is, noncavitated) stages.15 The early stages of the carious process are reversible by modifying or eliminating etiologic factors (such as plaque biofilm and diet) and increasing protective factors (such as fluoride exposure and salivary flow). This approach manages dental caries by means of prevention and cure, reserving surgical approaches for those whose disease severity and tissue loss leave no other option.
The early stage of periodontal disease is called gingivitis. It often results in gums that are swollen and bleed easily. The good news is that this stage is usually reversible. Regular check-ups are important. Even if the patient brushes and flosses on regular basis, the plaque may not be removed pro- perly, especially around the gum line. Once this plaque hardens it turns into calculus or tar-tar which can only be removed in a dental office by a professional.
Variations in practice patterns, difficulties in keeping current with the scientific literature, and providing students with knowledge, skills, and competencies necessary for contemporary practice are challenges that the health care professions are facing today, including dental hygiene. To address these problems, an evidence-based approach has been recommended by national organizations. National leadership will be needed to co-ordinate and prioritize research strategies, promote curricular changes, and improve access to clinically relevant information so that an EBDM approach can become the norm in practice.17 The application of knowledge is fundamental to human problem solving. In health disciplines, knowledge utilization commonly manifests through evidence-based decision making in practice.
Dental hygiene utilizes knowledge for practice from a variety of sources. Dental hygiene strengthen development of skilled researchers to study interventions leading to improved oral outcomes, and transferring that knowledge to practitioners. Intentional pursuit of knowledge for practice would lead to dental hygiene's eventual emergence as a professional discipline.19 Evidence-based practice is the application of the best available empirical evidence, including recent research findings to clinical practice in order to aid clinical decision making. Evidence based decision-making expose principles of cognitive function in general, and we speculate about the challenges and directions before the field. To provide evidence-based dental care, dental professionals have to integrate the best available evidence, their clinical experience and their patients' values; this paper should help to identify user-friendly sources of the best available evidence.

Oral hygiene aids

The dentists had the maximum knowledge of oral hygiene and oral hygiene aids. They not only practiced the oral hy- giene methods but also encouraged others to do so. Oral hygiene aids are much in demand among the population, but aids that are deleterious to the oral health are also ava- ilable over the counter.23 Motivation to follow instructions of a dentist, proper use of various oral hygiene aids, education given on oral health care and regular reinforcement are essential parts of prevention of oral diseases.24 The removal of interdental plaque is very important for the maintenance of gingival health, prevention of periodontal disease and the reduction of caries. Unfortunately, the toothbrush is rel- atively ineffective for the removal, and therefore patients need to resort to additional techniques. Options include fl- oss, woodsticks, rubber tips and interdental brushes, which represent the primary methods available for interproximal cleaning. Floss is the most widely used method of interdental cleaning. As such, there is a need for new techniques/ devices to be developed that will make interdental cleaning easier and improve patient motivation. It is essential that the dental profession breaks away from yesterday's conce- pts in favor of dental care aimed at optimizing oral health and maintaining the natural dentition in as intact a state as possible.

Conclusion

Routine, invasive dental treatments are in general not an ef- fective way to manage dental caries and periodontal disea- ses. Much more emphasis should be placed upon the asse- ssment of each and every carious and periodontal lesion with a view to allowing a possible natural arrest of the pro- cesses to occur, aided by specific preventive measures as appropriate. Indeed, the universal adoption of a preventive, evidence-based approach to treatment decisions could beby far the most powerful factor in reducing the restorative burden of dental practice. It is essential that as dentists, we lobby for a focus on prevention, not simply a “quick fix” for later. Putting funds into prevention saves future health care costs. In the world of lobbying and politics, organized dentistry plays a significant role.

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