Caries Flashcards
How do we see periodontal pockets on a radiograph?
We place a GP point in the pocket
Therefore, the GP will show the depth of the pocket on the radiograph.
Classify this caries
Decalcification.
It presents as white or brown spot lesions.
Classify this caries
Pit or fissure caries.
Classify this caries
Smooth surface caries.
This presents as caries on the buccal, lingual or cervical areas
Classify this caries
Interproximal caries.
Caries that develops where the teeth touch.
Classify this caries
Early childhood caries
It typically affects
- maxillary incisors
- Maxillary and mandibular 1st molars
- Mandibular canines.
Classify this caries
Secondary caries
Classify this caries
Arrested caries.
The caries is still present but it will not get worse.
It is black and hard rather than brown and sticky.
What is rampant caries?
When the patient has more than 10 new lesions a year.
Caries in lower anteriors is a warning sign (Normally well protected)
Discuss the caries pattern in primary teeth
- Caries is found in lower molars, upper molars and upper anteriors.
- If caries found in the lower anterior buccal or lingual surfaces = rampant caries.
- Occlusal caries is more common on the 2nd primary molar than the 1st primary molar. (as 1st primary molar is easily cleansible)
- MIH
Discuss the caries pattern in mixed dentition.
- Caries is more commonly found in lower 6s than upper 6s.
Found in:
-Upper 6 palatal groove
- upper 2 palatal groove
- upper 2 cingulum pits
- lower 6 buccal
What should you do in high risk patients with early permanent dentition.
Seal the second molars with fissure sealant when they erupt.
Why do we stabilise the teeth?
- If the patient needs lots of restorative work and you can’t get it all done in one go.
- To prevent pain
- Arrest restorable lesion s
- decrease bacterial load in the mouth.
Why is the developmental stage of the teeth relevant to restoring?
There is no point restoring a primary tooth if it is close to exfoliation
Discuss the importance of space maintainers?
The earlier primary teeth are removed, the greater degree of space loss.
- The loss of primary teeth will cause crowding.
- The loss of 1st permanent molars allows mesial drift of the second molars.
Discuss the balance and compensation of teeth after extraction.
We may need to extract the other tooth to prevent a central line shift or overuption
Canines- BALANCE (extract from same arch)
First primary molars- BALANCE if arch is crowded.
Lower first permanent molars- Compensate (Extract from same side)
What is the optimum age of extraction of maxillary First permanent molars?
Complete erruption of the 7s
What is the optimum age of extraction for the mandibular 1st permanent molars
Calcification of the bifurcation region of the lower 7s.
What happens when the maxillary first permanent molars are lost before optimum age
Rotation and mesial movement of the 7
Distal drift of the 5.
What happens when the mandibular first permanent molars are lost before optimum age
The 7s tilt
What happens when the mandibular first permanent molars are lost after optimum age
The 5 drifts distally and rotates.
Name and Describe this space maintainer
This is the band and loop space maintainer.
It is an orthodontic band for the 1st permanent molar with a wire that touches the distal surface of the 1st primary molar.
Name and describe this space maintainer.
This is a distal shoe.
It has a metal spike that slides down into bone.
This means that the unerrupted permanent molar will errupt into the right space.
List some dental symptoms of sepsis
- Abscess
- Sinus
- INter-radicular radiolucency
- Non-physiological mobility.
How do we make a lesion self cleansing & why do we want this?
You remove the obstacles to good cleaning
To allow saliva in to make the caries inactive
What is partial caries removal?
When superficial caries is removed, up to the line of the ADJ but there is still caries left in the cavity.
Why would we chose to complete partial caries removal?
To reduce the risk of pulp exposure.
Compare hall technique crowns to performed metal crowns?
Performed metal crowns- The tooth is prepared to remove the caries
Hall crowns- The crown is applied without preparation (It seals the caries in)
Describe interproximal discing of the primary anteriors?
If there is caries on the primary anteriors:
You take away a slither of carious material (look at dotted lines) to allow saliva access to clean the gaps.
What are strip crowns?
The type of crowns we apply to incisors.
A labial grove is used to attach the crown as well as an incisal reduction and a taper to the gingival margin
How do you treat early enamel caries in permanent teeth?
- Apply a fluoride varnish.
- OHI and monitor.
What is a sealant restoration and when do we use these for treatment?
A sealant restoration is when we remove the caries, restore the tooth and seal the remaining fissures.
We do this if we see microcavitation, shadowing under enamel or dentinal caries.
How do we protect a FPM if it is developing beside a carious E?
We can place a performed crown on the E or make it self cleansing.
What is silver Diamine Fluoride?
A liquid containing silver fluoride stabilised in ammonia.
How does Silver diamine fluoride work?
SDF occludes the dentinal tubules to relieve sensitivity.
Silver is antibacterial.
Fluoride promotes remineralisation.
When can you not use SDF?
If there:
- are signs of infection.
- Is Caries to the pulp
- are inflamed or ulceated gingiva.
Discuss the disadvantages of SDF?
It causes discoloration of carious tissue (very dark staining) and it can also stain tissue (so you put vaseline on the tissue to protect it)
Compare the conditions for inspecting teeth for caries?
Wet teeth- Dental shadowing can be best seen
Dry teeth-Enamel demineralisation shows up white.
Both conditions are beneficial.
When do we use temporary tooth seperation
To check if lesions on the inner half of enamel or outer half of dentine are cavitated.
You have dried the tooth and an opacity is visible, what does this tell us about the location of the demineralisation?
Demineralisation is only within enamel.
An opacity is visible without drying the tooth.
What does this tell us about the location of the demineralisation?
There is minimal dentinal involvement.
On visual examination,
There is a cavity in the middle of an area of white demineralisation?
There is significant soft caries.
How can you distinguish between staining and discoloration from underlying dentinal involvement.
Look around the stain.
If there is translucent enamel around the ‘stain’ it is a dark stain in the fissure.
If there is a periphery of white stain around the dark stain, caries is more likely.
compare detection techniques for enamel caries?
Transilumination- Because carious lesions absorb light
Temporary elective tooth separation so that you can inspect the surface for cavities.
What do we check before diagnosing root surface caries?
Texture- active lesions are soft and progressing.
Location- active lesions are within 1mm of the gingival margin.
Colour- lighter lesions have more bacteria.
How does occlusal caries develop?
From the sides of the fissure instead of the base.
How does secondary caries develop?
It starts from the outside and works its way in.
What is non-operative caries treatment?
Trying to modify the host, bacteria, time or substrate through:
- Dietary analysis.
- Increased fluoride exposure
- OHI
- Ensuring areas are self cleansing.
What is ICON?
A treatment to reverse white spot lesions through resin infiltration.
(You remove the liquid in the enamel pores replace the porous enamel with resin. )
When do we intervene for coronal caries?
WHen we see-
- cavitated lesions (Or feel them with our probe)
- enamel discoloration
- Localised surface destruction
- Plaque trap area
*
When do we intervene for secondary caries?
when we see:
- carious lesions
- plaque traps.
Tactile-When there are ditches wide enough to admit a periodontal probe.
When do we intervene for root surface caries?
WHen we see:
A pale coloured or black lesion <1mm from the gingival margin.
Tactile- when you use a sharp probe and the lesion feels soft.
Describe non selective removal of carious tissue to hard dentine?
You keep cutting until all of the carious tissue is removed.
But this comes with a risk of pulp exposure.
Compare stepwise excavation to Selective removal to soft dentine?
Stepwise excavation- majority of the caries is removed, but we leave some soft caries and come back in to remove it at a later date.
Selective removal to soft dentine- soft dentine is left behind and a peripheral seal created. This AVOIDS pulp exposure.
What is the most important question to ask parents during dietary analysis?
What do you do in the last hour before bedtime.
What are the two types of Fluoride in the mouth?
Mineral deposists (CaF2 in saliva and the fluid phase of plaque)
Biologically/ bacterially bound. (Bugs in the mout have fluoride attached aswell)
Compare upstream and downstream prevention.
Upstream prevention is the population based approach.
Downstream prevention refers to what we would do on an individual basis.
How is water fluoridation beneficial?
When water is ingested, fluoride becomes encorporated into saliva.
This means your saliva contains low but constant amounts of fluoride, so you are constantly absorbing fluoride.
How does fluoride work?
At lower pH’s Fluoride products have a greater bioavailability.
The presence of fluoride ions drives remineralisation.
How much toothpaste a day would a child aged 1 have to swallow to cause fluorosis?
1mg/day.
How much toothpaste a day would a child aged 5-6 have to swallow to cause fluorosis?
2mg/day.
Name some key caries pathogens:
- Streptococcus mutans
- Lactobacillus acidophilus
- Candia Albicans.
Discuss the virulence factors of strep mutans
- Adhesions- to help bacteria bind to enamel
- Binding proteins- Take your sugars and turn them into glucans
- Sugar modifying enzymes- turn sugars into sticky things
- Polysaccharides- act as a matrix to provide protection and store glycogen.
- Acid tolerance and adaption- If the pH reduces, the pump returns the pH to a more neutral one to ensure that the bacteria will survive.
Compare the two types of Glucans produced by Strep mutans
Water Soluble Glucans- They can be readily degraded for an energy source and form lactic acid.
Water insoluble glucans- These stick to tooth surface, are hard and promote plaque accumulation
How do glucans cause demineralization?
Glucans take aprt in glycolysis which produces CO2 and drives acid production (latic acid/ acetic acid)
A drop below 5.5 (acidic pH) drives demineralization.
What is the ecological plaque hypothesis?
If you give bacteria the oportunity (e.g. modifying environment) it will grow and take over.
How does a high protien diet affect dental disease?
The organisms present in a high protein diet are associated with periodontal disease.
P for protein.
P for Periodontal disease.
How does a high carbohydrate diet affect dental disease?
In high carb diets the aciduric ogranisms thrive.
This drives cariogenic processes.
C for carbs C for caries.
When would you treat a lesion with a fissure sealant and why?
We would treat teeth without cavitation with a fissure sealant.
This is to seal in the caries.
