Caries Clinical Presentation And Diagnosis (1)

Question 1

What is the first way to diagnose caries?

Answer 1

Anatomical position

Question 2

What are ways to describe anatomical position of caries?

Answer 2

Smooth surface - proximal or services

Occlusal - pit and fissure

Linear enamel caries

Root

Question 3

What location of caries is shown?

Answer 3

Smooth surface

Question 4

What surface are these caries found?

Answer 4

Inter-proximal

Question 5

What location of caries is shown here?

Answer 5

Pits and fissures

Question 6

What groove is C and D referring to and where does it start and end?

Answer 6

Central groove

Medial to distal surface

-grooves can extend over marginal ridges

Question 7

What fissures are shown here and where do they terminate?

Answer 7

Fissure Developmental groove on lower first molar

Terminates at a pit

Question 8

What are the types of terminations of fissure?

Answer 8

Shallow and self cleanable or deep, narrow and retentive

Question 9

What types of fissure termination sites are cleanable?

Answer 9

V and U =cleanable
I and K = uncleanable

Question 10

Name the 4 fissures?

Answer 10

Question 11

What fissures completely penetrate the enamel?

Answer 11

Question 12

Describe root caries

Answer 12

Root caries is a disease that is expressed as a soft, progressive lesion found on a tooth root surface that has lost its connective tissue attachment and thereby has become exposed to the environment of the oral cavity.

Question 13

What pH does demineralisation occur in coronal caries?

Answer 13

5.5

Question 14

What pH can the demineralisation occur in root caries?

Answer 14

6.7 , can cause caries

Question 15

What bacteria are involved in root caries? (Specific)

Answer 15

Gram-positive anaerobes

Streptococcus sobrinus (in combination with S. mutans it is a determinant of having a caries lesion).

Actinomyces

Question 16

What in the diet can promote caries?

Answer 16

Carbohydrates … sucrose

Question 17

What demographic is more likely to get root caries?

Answer 17

Older people, sweeter diet

Question 18

How do inactive (arrested) caries present?

Answer 18

Well-defined.
Dark brownish or black in colour. Smooth, shiny surface.
Hard on probing with moderate pressure. Usually not covered with plaque. Cavitation may be/is present.

Question 19

How do active caries present clinically?

Answer 19

Yellowish, light brown.
Soft or leathery on probing with light pressure. Covered by visible plaque.
Cavitation may or may not be present.

Question 20

How would you classify a carie by length?

Answer 20

GRADE 1-4

Question 21

What are 3 ways to derive the texture of a root carie?

Answer 21

Hard
Leathery
Soft

Question 22

Is an active carie, hard, leathery or soft?

Answer 22

Leathery or soft

Question 23

Describe lesions 1-4?

Answer 23

Question 24

What is acute caries?

Answer 24

Usually in children

Effect large number of teeth

Question 25

What has caused this type of acute caries?

Answer 25

Radiation caries

Question 26

Why does radiation cause caries?

Answer 26

• reduces the saliva, parotid glands get affected there will be no saliva in mouth.
• brushing is painful
• mucositis can be seen (red and inflamed gums)

Question 27

What are 3 ways to rate caries based on their progression?

Answer 27

1. Acute
2. Chronic
3. Arrested

Question 28

Where are chronic caries usually located?

Answer 28

Occlusion anterior surfaces

Question 29

What are arrested caries?

Answer 29

Static

Show sclerosis of dentinal tubules and secondary dentin formation (brown)

Question 30

What type of caries is shown here, based on progression?

Answer 30

Arrested

Brown marks

Question 31

What are the 3 layers of arrested caries?

Answer 31

1. Surface layer
2. Pigmented zone
3. Sclerotic zone

Question 32

What zone of arrested dental caries is leathery and brown?

Answer 32

Zone 1 - surface zone

Question 33

What zone of arrested dental caries is hard and dark brown?

Answer 33

Zone 2: pigmented zone

Question 34

What zone of arrested dental caries is hard and white?

Answer 34

Zone 3 : sclerotic zone

Question 35

Is there bacteria in the sclerotic zone?

Answer 35

No

Question 36

What is caries-infected vs caries-affected dentin?

Answer 36

Caries infected dentin -> outermost, irreplaceable, necrotic zone of destruction

It is dark brown, soft, wet, mushy

Caries-affected dentin -> inner layer of various dentin which can be repaired by the dentin-pulp complex

Paler brown, harder, “ sticky and scratchy‘’dentin

Question 37

What is the mineral content of the infection dentin?

Answer 37

– Mineral component has dissolved away due to acid attack.
– Collagen matrix has been denatured.
– Bacterial load very high.
– Dentine tubular structure destroyed.

Question 38

What is the mineral content of affected dentin?

Answer 38

– Mineral dissolution still occurs but lesser extend.
– Collagen is still damaged by proteolysis but to a lesser extend so permitting dentine repair.
– Bacterial load lessens but there are still bacteria present.
– Dentine tubular structure returns gradually within the depths of this zone.

Question 39

What layer needs to be clinically removed, infected or affected dentin?

Answer 39

Infected

Question 40

Why do we need to remove the infected dentin?

Answer 40

– Cannot be repaired.
– Poor quality bonding substrate fir adhesive materials to achieve adequate seal.

Question 41

Why can the affected layer not be removed?

Answer 41

– Deepest layer (4):
– Hypermineralized translucent dentine.
– Reparative reactions of the dentine-pulp complex.