4 biological caries management

Question 1

what is detection?

Answer 1

determining the presence/absence of disease

Question 2

what is diagnosis?

Answer 2

detection + knowing whether or not the disease is active or arrested such that appropriate tx can be planned

Question 3

requirements for diagnosis

Answer 3

plaque chart
full mouth prophylaxis
good lighting
inspect without drying for dentinal shadowing
dry tooth for 5-10 seconds
2.5 magnification recommended
probe can be used to gently remove debris from fissures
bitewings
temporary elective tooth separation

Question 4

what are the special tests?

Answer 4

transillumination
FOTI
diagnodent
plaque pH
salivary flow rate

Question 5

what are the options from visual detection?

Answer 5

0= no change after drying
1=opacity visible after drying
2=opacity visible without drying
3=localised enamel breakdown in opaque/discoloured enamel +/- discolouration from underlying dentine
4=cavity in enamel exposing underlying dentine

Question 6

when is tactile assessment of caries used?

Answer 6

not for enamel caries
for dental caries
-residual caries in a cavity
-root caries

Question 7

what is transillumination?

Answer 7

carious lesions absorb light

Question 8

what are bitewings used for?

Answer 8

approximal lesions for intervention/prevention

safety net for occlusal lesions

Question 9

what is temporary elective tooth separation used for?

Answer 9

interproximal caries only
orthodontic separator between teeth
review 2 days 
inspect surface for cavitation
take silicone impression of approximal surface

Question 10

root surface caries diagnosis requirements

Answer 10

clean teeth
tactile assessment
visual assessment
-position in relation to gingival margin
-dimensions of lesion
-colour

Question 11

how do you know if root surface caries are active?

Answer 11

texture- soft more bacterial loads so probable active
colour- lighter coloured lesion more bacterial load
site- closer to gingival margin
size- larger

Question 12

what are the indications for non-operative management of root-surface caries

Answer 12

hard, dark, >1mm from gingival margin
not plaque trap
not rapidly progressing
px able to participate

Question 13

describe secondary caries

Answer 13

demineralization, staining, soft around large ditched area, probe would drop in
lesion goes from out to in so if sound on outside no lesion

Question 14

what is non-operative management of caries?

Answer 14

dietary analysis
-reduce simple carbs
OHI
-remove plaque regularly
-brushing and interdental
increase fluoride exposue
-tip balance towards remineralization

Question 15

how is fluoride varnished used?

Answer 15

for at risk px

every 3-6 months

Question 16

describe silver diamine fluoride

Answer 16

very effective caries arrest
no need for drill
no biological consequence
good for px with limited cooperation
bad aesthetics

Question 17

what is ICON?

Answer 17

resin infiltration
good for approximal/smooth surface
etch, dry, infiltrate

Question 18

when is a restoration indicated?

Answer 18

when lesions have advanced to obvious cavitation and where remineralisation techniques have reached their limits

Question 19

when is a rest indicated in primary coronal lesions?

Answer 19

cavitated
enamel discolouration and surface destruction
plaque trap

Question 20

when is a rest indicated in secondary caries?

Answer 20

frankly carious lesions
plaque trap
ditches wide enough for perio probe

Question 21

when is a rest indicated in root surface caries?

Answer 21

pale/black lesion
<1mm from gingival margin
plaque trap
px uncooperative
soft feel with sharp probe

Question 22

what type of lesions are fissure sealants used for?

Answer 22

radiographically visible occlusal caries, lesion extending into middle third of dentine heavily infected
vital pulp

Question 23

what are the operative lesions for deeper carious lesions?

Answer 23

non-selective removal of carious tissue to hard dentine
selective removal to firm dentine
stepwise excavation tx
selective removal to soft dentine

Question 24

what is the disadvantage of selective removal to firm dentine?

Answer 24

pulp exposure expected very poor prognosis for tooth vitality

Question 25

what are the minimally invasive techniques?

Answer 25

repair and refurbishment of restorations
preventative resin restoration
ultrasonic minimal prep
bioactive linings
partial caries removal
stepwise caries excavation