Caries Flashcards
Why is caries management important in modern dentistry? (4 reasons)
- Second most prevalent non-communicable disease in adults worldwide and it affects quality of life
- Known links between caries and systemic health - caries is preventable
- Aesthetic restorations are part of the rehab of med/high caries-risk pts motivation, value, responsibility)
- Manufacturers producing high quality direct, adhesive aesthetic materials/cements
What is ‘MI’ dentistry?
Minimum Intervention Oral Care
Holistic and patient -focussed and involves all members of oral health care team. Aims to achieve long-term oral health.
Name the 4 domains of oral care plans
- Identify
- Prevent and control
- MI restore
- Recall - pt focused
What is involved in the ‘identify’ stage of the oral care plan?
Verbal history, oral exam, caries lesion detection, radiographs, aetiological factors for susceptibility
What is the (long) definition of dental caries?
Reversible disease process of hard tissues.
Instigated by action of bacteria on fermentable carbs in plaque biofilm at tooth surfaces.
This leads to formation of carious lesion: acid demineralization and ultimate proteolytic destruction of the organic component of dental tissues
Outline what dental caries is
Progressive, non communicable disease initiated at the surface in the biofilm that is reversible up to a point
What is a carious lesion?
It is where the tooth substance has softened and has been destroyed
What is the caries PROCESS?
The histopathological metabolic interactions occurring in the plaque biofilm causing disease
What is a carious LESION?
The signs of the disease on dental hard tissues i.e. early lesions/discolouration/opacities/cavities etc
Which bacteria is primarily associated with the caries process?
Strep Mutans
What 4 factors need to occur in order for caries to develop?
Bacteria (relevant bacteria)
Susceptible tooth surface
Carbohydrates
Time
At what pH is the enamel particularly susceptible to acid attack (critical pH)?
5.5
What’s the critical pH of dentine?
6.2
it’s more susceptible to acid attack
What 5 factors are required for good visual detection?
Sharp eyes + magnification
Good light
Clean, dry tooth surface
Dental explorer (blunt) - e.g. perio probe
Time
What steps are involved in diagnosing caries? (4)
Caries history/susceptibility assessment
Signs- detection
Symptoms i.e. pain history
Special investigations: sensibility tests (temp, electrical, percussion etc), radiographs
Name the factors that can increase susceptibility of caries
Medical (certain drugs, sucrose-based meds)
Social: stress, lifestyle change
Dietary: prolonged breast feeding, grazing
Host resistance: previous caries experience, lesions on certain tooth surface, soft,light coloured lesions
Salivary: Low secretion and buffering
Microbiology: high numbers S Mutans and Lactobacilli
What does it mean if a pt is low risk?
Inactive/controlled:
0-1 active lesion/no history of recent restorations
What does it mean if a pt is medium risk?
Active/modifiable:
> 1 active lesions
2 new, progressive or filled in last 2 years
What does it mean if a pt is high risk?
Active/unmodifiable or unidentifiable risk factors:
> 1 active lesions
2 new, progressive or filled lesions in last 2 years
How would you control caries risk for low risk patients?
OH, fluoride, standard home care
How would you control caries risk for medium risk patients?
OH, supplementary fluoride mouthwash or gels.
Dietary modifications
How would you control caries risk for high risk patients?
Control at individual pt level
Same as medium risk plus salivary flow stimulation
What causes the enamel to dimineralise and form a lesion?
The biofilm releases acids that lower the pH to 5.5 or below. This causes the dissociation of minerals/ions in the enamel (but the surface can still be intact and demineralised) = underlying enamel is porous
How are the enamel crystals arranged?
Arranged into prisms
Which particular part of the enamel suffers from acid attack?
The enamel prisms and boundaries
How would you describe an early white spot lesion on enamel?
Frosty white appearance, chalky and softened, increased porosity
How would you describe an early white spot lesion on enamel?
Frosty white appearance, chalky and softened, increased porosity. The surface becomes roughened and cavitated
What is a brown spot lesion
It’s where a white spot lesion has arrested. It has been stained from the diet
Which part of dentine plays a critical part in matrix and mineralisation production?
Non-collagenous proteins
10% of dentine
What 3 components make up dentine?
Mineral, collagenous matrix, tubules
What are the biochemical affects of caries attack on dentine?
Demineralisation due to acid attack
Bacterial penetration via tubules and branches
Proteolysis- collagen breakdown via host and bacterial enzymes (primarily host enzymes)
Why does dentine become various shades of brown when attacked?
Maillard reaction: between proteins and carbs in acidic environment
What signs would suggest that the dentine-pulp complex has triggered a defence reaction?
Translucent dentine
Reparative (tertiary) dentine
Why does dentine become soft when attacked by acid or caries?
Due to demineralisation
What is translucent dentine made up of?
Plate-like crystals of whitlockite
What structural factor plays a part in the hardness of the tissue?
The way the crystals are arranged in each layer - i.e the crystalline structure
Name 3 ways in which dentine-pulp complex defends itself to attack?
Translucent dentine, reparative dentine, inflammatory/serum proteins in pulpal fluid (these are then pushed up into tubules)
Outline stage 0 of the modified ICDAS scale
0 - no or slight change in enamel translucency after prolonged drying >5secs.No enamel demineralisation or narrow surface zone of pacity
Outline stage 1 of the modified ICDAS scale
Opacity or discolouration hardly visible on a wet surface, but distinctly visible after air drying.
Enamel demineraliseation limited to outer 50% of the enamel layer
Outline stage 2 of the modified ICDAS scale
Opacity or discolouration distinctly visible without air drying. No clinical cavitation detectable.
Demineralisation involving between 50% of the enamel and the outer third of dentine
Outline stage 3 of the modified ICDAS scale
Localised enamel breakdown in opaque or discoloured enamel +/- greyish discolouration from underlying dentine.
Demineralisation involving the middle third of dentine.
Outline stage 4 of the modified ICDAS scale
Cavitation in opaque or discoloured enamel exposing the underlying dentine.
Demineralisation involving the inner third of dentine
Why can caries affected dentine be remineralized?
Because the collagen in the affected dentine has been damaged NOT denatured
What is the difference between a D1 and D2 carious lesion?
D2 is closer to the dentine layer
What is the histology of D1 & D2 carious lesions?
Early subsurface demineralisation
Early porosity
? Bacterial penetration
? tertiary dentine
What are the clinical signs of D1 & D2 carious lesions?
White spot lesion, frosty
Chalky, roughened surface
Arrested brown spot lesion
What are the symptoms of D1 & D2 carious lesions?
Minimal symptoms
Slight sensitivity to H/C/S if at EDJ
What would the treatment of D1 & D2 carious lesions be?
Monitor
OHI, fluoride, diet
? Fissure seal/PRR
What is the histology of D3 carious lesions?
Enamel demineralisation
Increased porosity
Bacterial penetration
organic/inorganic dentine/tubular destruction
Translucent dentine
Tertiary/reparative dentine
What are the signs of D3 carious lesions?
Cavitated (open)/non-cavitated (closed)
Discolouration/opacities
What are the symptoms of D3 carious lesions?
? acute, reversible pulpitis
What is the treatment for D3 carious lesions?
Monitor/OHI/Fluoride/diet
Minimal cavity prep
Sealed restoration
What is the histology of D4 carious lesions?
Gross demineralisation
Gross bacterial penetration
Tubular destruction with pulp exposure
What are the signs of D4 carious lesions?
Cavitation
Gross discolouration
Visible necrotic pulp ?
What are the symptoms of D4 carious lesions?
Chronic, irreversible pulpitis
Loss of function
What is the treatment for D4 carious lesions?
Pulp capping
Sealed, layered, complex restoration
Pulp extirpation and/or RCT
