9. Clinical Caries Flashcards
Dental Caries Process
The demineralization process that causes a defect in ____, ____, and ____
surfaces of a tooth
• Pit and fissure caries ○ \_\_\_\_ caries ○ Occurs in pits and fissures ○ Fissure § Defect in \_\_\_\_ ○ Pit § \_\_\_\_ • Smooth surface cavity ○ \_\_\_\_ or \_\_\_\_ surface of tooth ○ \_\_\_\_ and \_\_\_\_ as well • Root cavity ○ Below the \_\_\_\_, on cementum ○ Implicated in gum \_\_\_\_
enamel
dentin
cementum
class I groove fossa mesial distal buccal lingula CEJ recession
DENTAL CARIES
Initiated by:
• Bacteria in plaque metabolize refined ____ (processed sugars) for energy
• ____ is the by-product
• Acidic environment ____ the tooth structure over time - causing carious activity
carbohydrates
acid
demineralizes
DENTAL CARIES
- enamel development defects, lack of topical fluoride > ____
- poor oral hygiene > ____
- harmful food behaviors > ____
All 3 together come together and implicate ____
teeth
bacteria
diet
caries
DENTAL CARIES
n Acid from the breakdown of the fermentable sugars demineralize the tooth structure when:
n pH below ____
n Non acidic environment helps remineralize
the enamel and arrest the carious when:
n pH above ____
n Saliva acts as a ____
• Demineralization increases on medication that reduces \_\_\_\_ function, or during \_\_\_\_ that destroys salivary gland function
5.5
5.5
salivary gland
radiation
DENTAL CARIES PREVENTION n \_\_\_\_ removal – good oral hygiene n Fluoride toothpaste, rinses, gels, supplements n \_\_\_\_ n Regular dental care
• \_\_\_\_ replaces Ca++ in the enamel ○ \_\_\_\_ ○ Growing child, it can be a supplement so the secondary teeth will be strong and carry resistance • Sealants ○ \_\_\_\_ surface of molars ○ Only used on \_\_\_\_ and \_\_\_\_ ○ Doesn't stick to \_\_\_\_ surface
plaque
sealants
fluoride external occlusal pits (fossa) fissure (grooves) smooth
LOOK AT THE DENTAL CARIES RISK FACTORS
YAY
ADDITIONAL CARIES RISK ASSESSMENT FACTORS
n Clinical findings that indicate high caries risk:
n ____ or more active carious lesions
n ____ number of restorations
two
large
CARIES TREATMENT CONSIDERATIONS n Is \_\_\_\_ present? n How far does the caries \_\_\_\_? n Can the process be arrested by \_\_\_\_ treatment? n What is the \_\_\_\_? n Is a \_\_\_\_ required?
• Average life expectancy of composite is \_\_\_\_ years
caries extend preventive caries-risk restoration seven
Caries Treatment Considerations
____, detection/severity, assessment > ____ assessment > ____ control > ____ and treatment
lesion
risk
disease
monitoring
CARIES DETECTION AND DIAGNOSIS
A ____ test for caries diagnosis cannot be used…
Multiple ____ must be used
single
criteria
CARIES DETECTION AND DIAGNOSIS n Visual evidence of caries n Surface \_\_\_\_ n \_\_\_\_ appearance n \_\_\_\_ : Be careful! n \_\_\_\_
• Presence of pitted fissures upon removal of plaque • Unhealthy enamel and demineralized ○ Opaque and rough • Cavitation ○ An actual hole in the tooth
roughness
opaque
discoloration
cavitation
Detection and diagnosis • Caries development: ○ Stages of development: ○ \_\_\_\_ lesions (E1 lesion) ○ \_\_\_\_ (E1 or E2 lesion) ○ \_\_\_\_ carious lesion (E1, E2, or D1) § Try to catch a \_\_\_\_ at this point ○ \_\_\_\_ carious lesion (greater than D1) § An actual hole
white spot
deminerliazation
non-cavitated
cavitated
CARIES DETECTION AND DIAGNOSIS
n Tactile evidence of caries
n ____ of tooth
n ____ of surface
n Explorer ____ to removal
• If you see someone poking so hard that their muscles are straining, they're doing it wrong ○ Not supposed to actually make a cavity themselves ○ Tip of explorer may just be getting stuck in between lobes • Explorer should be at an \_\_\_\_ - simply feeling the grooves • If it sticks to the caries: ○ Resisting \_\_\_\_
softness roughness resistance angle withdrawal
CARIES DETECTION AND DIAGNOSIS n Radiographic Evaluation n \_\_\_\_ areas in the proximal and the occlusal surfaces n Radiolucencency does \_\_\_\_ indicate if the surface has been cavitated
* Bottom-left: pit and fissure lesion * Bottom-right: interproximally located
radiolucent
not
Detection and Diagnosis
E0 - no ____
E1 and E2 are termed: ____ caries
• E1: outer half of \_\_\_\_ • E2: inner (and outer) half of \_\_\_\_ ○ E1 and E2 § Incipient lesions • Interproximal caries a result of ingesting sugary drinks • D1 lesions can be remineralized \_\_\_\_ of the time • And so on for D (thirds)… • D2/D3 will definitely be \_\_\_\_
caries incipient enamel enamel 80% intervened
CARIES DETECTION/ DIAGNOSIS
• Pit and fissure lesions ○ "Surprises" ○ Much \_\_\_\_ than initially expected • Gross lesions ○ Cavitation with a large hole ○ Systematic approach to repairing § Remove caries without hitting nerve and reassess ○ A large \_\_\_\_
larger
D3
CARIES DETECTION/ DIAGNOSIS
Incipient (in enamel only)
n Non \_\_\_\_ (E1 or E2) n \_\_\_\_ intact n \_\_\_\_ or \_\_\_\_ of surface may be present n \_\_\_\_ radiolucency may be present on the radiograph ***REMINERALIZE VS PREPARATION
* Can make a cavitated lesion from an E1 and E2 with use of an explorer * Do not use an \_\_\_\_ for pit and fissure caries
cavitated surface opacity discoloration superficial
explorer
CARIES DETECTION/ DIAGNOSIS
Cavitated:
n Surface ____, detected ____ or tactilely
n Surrounding tooth structure may be ____
n Radiolucency is present
through the ____ (____ and greater)
• Not all radiographic radiolucencies are associated with \_\_\_\_ ○ Studies show \_\_\_\_ of D1 lesions are not cavitated
broken visually discolored DEJ D1 cavitation 40.9%
TYPES OF CARIES:
PIT AND FISSURE LESIONS
n Most frequent location:
n ____ surfaces of posterior teeth
n Followed by:
n ____ pits of mandibular molars
n ____ pits of maxillary incisors
• Lingual pit most likely located on the \_\_\_\_ above the \_\_\_\_ ○ Posterior, anterior (maxillary lateral incisor), occlusal surfaces, smooth surfaces
occlusal buccal lingual maxillary lateral right cingulum
PIT AND FISSURE LESIONS:
Diagnosed by:
n Tactile: ____ enamel – ____ removal of the explorer
n Visual: ____ appearance surrounding the pit or fissure
softened
resists
opaque
PIT AND FISSURE LESIONS:
Diagnosed by: ____ Radiograph
n Radiolucent area spreading laterally under the occlusal enamel from a pit or fissure
bitewing
PIT AND FISSURE LESIONS
Prevented by: ____ placement
* Specific only to fossa and grooves * Drilling does not make the teeth any more \_\_\_\_ to the sealant
sealant
retentive
TYPES OF CARIES: SMOOTH SURFACE LESIONS
Most frequent locations
n Proximal surfaces just ____ to the contact
—• Most common within the embrasure (cervical ____ of M/D)
nCervical 1/3 ____ and ____
cervical
1/3
facial
lingual
PROXIMAL SMOOTH SURFACE LESIONS:
Diagnosed by:
n ____ radiographs are the most effective method of detection for ____ surface lesions
bitewing
proximal smooth
PROXIMAL SMOOTH SURFACE LESIONS:
n Radiographic caries detection needs to be followed by caries ____
n Not all proximal radiolucencies are associated with ____
n Early lesions provide evidence of caries activity which CAN be ____ and the tooth surfaces remineralized through appropriate
treatment
diagnosis
cavitation
arrested
CERVICAL SMOOTH SURFACE LESIONS:
n Almost always seen in individuals with ____ activity
n Incipient caries appears ____, chalky white which appear when surface is ____
n Restoration needed when cavitation occurs
• No \_\_\_\_ on decalcification (dull, opaque) ○ Cervical third of maxillary lateral incisor in image
high caries
opaque
reflection
CERVICAL SMOOTH SURFACE LESIONS:
Diagnosed by:
n ____
n ____
• Diagnose visually, do not need \_\_\_\_
visual
tactile
bitewings
CERVICAL SMOOTH SURFACE LESIONS:
Cavitated, active cervical lesions
Non Cavitated, active cervical lesion – (E1 or E2) MOST likely to be arrested with ____ treatment only
preventative
SMOOTH SURFACE ROOT SURFACE LESIONS:
n Originates on ____ of teeth
n Root may be exposed in presence of periodontal disease
n Most often found in ____ patients
n “____ caries”
root
older
senile
SMOOTH SURFACE CARIES
Prevented by: ____ applications
- Sealants are not retained on ____ surfaces, therefore, not a treatment option
fluoride
smooth
CARIES:
ARRESTED LESIONS
n Remineralized lesions
n Clinically observed as intact, but discolored ____ or ____ spots
n ____ resistant to subsequent caries attack than the unaffected enamel
n SHOULD NOT BE RESTORED UNLESS ____ OBJECTIONABLE
brown
black
more
esthetically
Exam: normal (no lesions)
Restorative Tx: ____
Follow-up ____
Exam: Demineralized enamel (E1 or E2 white, opaque spot on visible smooth surfaces)
Restorative Tx: ____
Follow-up: ____
none
6mo-1 year clinical exam
for esthetics ONLY - try to remineralize
6mo- 1 year clinical exam
Exam: Incipient pit and fissure enamel lesion (E1, E2)
Restorative Tx: ____
Follow-up: ____
Exam: Incipient proximal lesion (shown on BW) (E1, E2)
Restorative Tx: ____
Follow-up: ____
seal defective pits and fissures if high risk, fluoride also
3-6 mos. evaluation
fluoride
3-6 mos. evaluation
Exam: Cavitated lesions (active caries); shown on BW’s (through DEJ)
Restorative Tx: ____
Follow-up: ____
Exam: Arrested caries
Restorative Tx: ____
Follow-up: ____
restorations, sealants on other high risk pit/fissure areas, Fluoride
3-6 mos evalution
elective for esthetic reasons only
6 mos-1 year examination
HIGH RISK PATIENT TREATMENT SUGGESTIONS
One or more high risk factors
Treatment of the ____ (Restorations/Pit and Fissure
sealants
____
____ treatments: Xylitol gum or OTC Fluoride rinses
____ Month recall
infection
fluoridated varnish
supplemental
3
SUMMARY: CARIES DETECTION AND
TREATMENT
n Caries is a ____ process
n Caries diagnosis requires caries ____ and ____.
n Before invasive treatment, noninvasive options need to be explored - remineralization (____, ____)
n ____ measures need to be taken
dynamic activity risk assessment sealants fluoride preventative
SUMMARY CARIES DETECTION AND
TREATMENT
n Clinical Goal:
n ____ the process,
when indicated
n Surgically remove the infected area from the tooth once ____ and deeper and
n Restore the tooth to optimal form, function and esthetics
arrest/remineralize
D1
