3/21: Cariology Flashcards
What is cariology?
The study of dental caries and cariogenesis
What are dental caries?
An infectious microbiologic disease of the teeth resulting in localized dissolution and destruction of calcified tissues
What are the three elements of caries formation?
Teeth
- without teeth, bacteria have no habitat
Bacteria
- streptococcus mutans
Substrate
- any type of carbohydrate will support some strain of bacteria
What is the Tldr; recipe for caries?
Tooth
Biofilm (plaque)
Food source
Caries is ____________
Multifactorial
What are the types of bacteria that can cause caries?
Streptococcus mutans
Streptococcus sangius
Streptococcus mitis
Bacteroides melaningenicus
What is Considered normal oral flora- presence can actually slow the growth of Strep mutans colonies?
Streptococcus mitis
What is bacteroids melaninogenicus?
◦ Obligate anaerobe
◦ Associated with periodontal disease
What is dental plaque?
Gelatinous mass of bacteria adhering to tooth surface
Biofilm
What is cariogenic bacteria metabolism?
Bacteria consume sugars, the waste product is acid
What do acids lower pH in mouth to?
below 5.5
What occurs at 5.5 pH?
Deminerlization of enamel begins to take place
Since enamel is stronger, what does it require?
Higher acidity than dentin
What pH does dentin demineralize at?
6.2
What pH does dentin remain at after each sugar exposure?
Below 5.5 for 20-60 min
What is the food source for caries?
Fermentable carbohydrates
- bacteria eats what we eat
What is the preferred type of source for mutans streptococci?
Carbs - sucrose
What are examples of simple carbohydrates and starches?
◦ Chips
◦ Soda
◦ Candy
◦ Cookies
◦ Chewing gum
◦ Fruit drinks
◦ Rice
◦ Trail mix
◦ Granola bars
What is the epidemiology of caries in the past 30 years?
-Younger children (2-8yrs) have had minor decrease in caries prevalence
-Caries prevalence has remained constant for older children
-Minority youth still most at risk for caries
-Lower income youth still most at risk for caries
What are some examples of things that have been introduced to DECREASE caries rates?
Fluoride toothpaste
Water
Water Pik
Electrical toothbrush
Why do you think caries rates have not decreased significantly in the last 30 years?
Because things like soda, candy, cookies, baby bottles, sippers, drug users and poor brushing habits are still around
What are sites for caries initiation?
Pits and fissures
Smooth surfaces
- interproximal contacts (Cl II and III)
- near gingiva (Cl V)
Root surfaces
Is a white spot lesion a clinical feature of caries?
NONcavitated
Are smooth surface caries a clinical feature of caries?
Cavitated
How can you see interproximal caries?
- clinically, but more often radiographs
What are clinical features of caries?
Smooth surface caries
Occlusal caries
Interproximal caries
Root surface caries
Describe pit and fissure caries
Class I caries
Occlusal surfaces of posterior teeth
Buccal surface of posterior molars
◦ Buccal pit
Lingual surface of lateral incisors
What is the most prevalent location for caries?
Pit and fissure caries
How can pit and fissure caries be prevented?
By sealants
How do you detect pit and fissure caries?
◦ NOT A STICK- use explorer to drag along surface to check for softness. Use
gentle pressure.
◦ Clinical visualization- shadowing
◦ Radiographs
◦ Only when large enough
What bacteria is present in pit and fissure caries?
Presence of high concentrations of mutans streptococci in pits or fissures is typically followed by a carious lesion in 6-24 months
When is it important to place sealants?
Shortly after eruption of teeth
What are types of smooth surface caries?
Buccal and lingual caries
Interproximal
Describe buccal and lingual caries
Class V
Diagnose visually
Describe interproximal caries
Class II
Difficult to diagnose visually
Diagnose with radiographs (bitewings, PA angulation = inaccurate)
How to take care of interproximal caries?
Begin gingival to contact and extend toward pulp
Progress more rapidly once reach dentin
What are smooth surface caries associated with?
High sugar intake
What are smooth surface caries prevalent in?
“soda sippers”
- easily restored (still a serious lesion)
Describe root surface caries
Comparatively rapid succession
Often asymptomatic
Closer to the pulp
More difficult to restore
What are recurrent/secondary caries?
Caries developed at margin of a restoration
What are ways of diagnosing caries?
Visual
Tactile
Radiographs
What are visual diagnoses of caries?
Color
Matte vs shiny
What are tactile features of caries?
Firm
Soft
- leathery
Within caries management, what are we moving away from?
“Caries prevention” and “caries treatment”
What are management ways of caries?
Surgical
Non-surgical options
Waht are factors to consider regarding caries?
General health
Xerostomia
Fluoride exposure
What are causes of xerostomia?
- radiation and chemotherapy
- medical conditions
- medications
What are ways to prevent caries?
Oral Hygiene Instructions
◦ Plaque-free surfaces do not decay!
Dietary Counseling
◦ Identify sources
◦ Reduce frequency and ingestion
Sealants
What are sealants?
◦ Thin resin coating placed on chewing surfaces of teeth
◦ With or without enameloplasty
What are things that “arrest” (stop) caries?
Fluoride
◦ Enamel resists acids more effectively
Oral hygiene improvement
◦ Reduces biofilms
Dietary changes
◦ Reduces bacteria’s food source
Professional cleanings
◦ May change recall intervals, more frequent assessment
Address xerostomia
What is an intermediate option to managing caries?
Resin infiltration
What do we use in our clinic to infiltrate resin to manage caries?
Icon is used in our clinic
◦ Clean tooth well (pumice)
◦ Dry working field (rubber dam)
◦ Etch for at least 30 seconds 1-3 times; rinse and DRY well
◦ Icon Etch is 15% hydrochloric acid gel
◦ Acts as a “chemical” drill
◦ Infiltrate using Icon resin
What are some ways to manage caries?
- silver diamine fluoride
- surgical management
Describe using surgical management for caries
◦ STILL A GREAT OPTION
◦ Cavitated carious lesions
◦ Remove carious lesion
◦ Establish resistance form in preparation
◦ Avoid fracture of tooth or restoration in the future
◦ Establish retention form in preparation
◦ Avoid restoration being dislocated or lost
◦ Restore
What classification system does UMKC SOD use?
ADA caries classification system
What is terminology of classifying caries?
◦ Sound Tooth Structure
◦ Initial Caries
◦ Moderate Caries
◦ Advanced Caries
