caries diagnosis and treatment planning Flashcards

1
Q

what is dental caries?

A

> Disease of mineralized dental tissues caused by action of microorganisms on fermentable carbohydrates

> In its early stages the disease can be arrested -remineralization is possible above critical pH of 5.5

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2
Q

what does the clinical caries diagnosis process involve?

A
  1. Caries detection (non-cavitated or cavitated)
  2. Diagnosing if lesion: arrested/ active/ progressing rapidly
  3. Recording findings
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3
Q

what does early caries diagnosis allow us to do?

A

> successful prevent caries and manage the patient

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4
Q

what is the WHO classification of caries? (iceberg dental caries)

A

> sub-clinical initial lesions in a dynamic state of progression regression = no active care advised

> lesions detectable with only traditional diagnostic aids = preventative care advised

> D1 - clinically detectable enamel lesions with intact surfaces = preventative care advised

> D2 - clinically detectable cavities limited to the enamel = preventative care advised

> D3 - clinically detectable lesions in dentine = preventative and operative care advised

> D4 - lesions in pulp = preventative and operative care advised

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5
Q

what are all classifications of caries?

A

CLASSIFICATION BASIS

> Anatomical site = Occlusal/ smooth surface (proximal/buccal)/root

> Activity = active/ arrested

> Virginity = primary/ resurrent

> Extent = incipient/ compound/ cavitation

> Tissue = initial/superficial/moderate/deep/deep complicated OR enamel/dentine/pulp

> No. of surfaces = simple/ compound/ complex

> Chronology = early child hood/ adolescent/ adult

> Tooth surface affected = mesial/ distal/ occlusal/ buccal

> Blacks Classification = class 1,11,111, IV, V, VI

> WHO classification = D1 D2 D3 D4

> ICDAS = code 1-6

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6
Q

what are the conventional technique in diagnosing caries?

A

> simple visual = dry tooth, separator

> tactile = probe

> radiographs = digital image enhancement, digital subtraction radiography

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7
Q

what are novel techniques used to diagnose caries?

A

> electrical correct = electrical conduction measurement, electrical impedance

> fluorescence = visual (QLF), laser (diagnodent)

> enhanced visual techniques = FOTI, DiFOTI

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8
Q

what is required for visual diagnosis of caries?

A

> Dry tooth – compressed air

> Clean teeth – brush, prophy

> Good light

> Dental mirror

> Sharp eyes

> Blunt or ball ended probe (NOT sharp probe)

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9
Q

what does a white spot lesion indicate on a dry tooth?

A

> the caries penetrated 1/2 through the enamel

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10
Q

what does a WSL and BSL indicate on a wet tooth?

A

> the caries is through enamel and may be into the dentine

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11
Q

how do you carry out a temporary tooth separation and what is it used for?

A

> Elastomeric separator inserted for 30 mins-1 week

> Direct exam or indirectly via impression

> Diagnosis of interproximal lesions

> May avoid need for radiograph/ supplement radiograph

> Multiple visits

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12
Q

how do you carry out a tactile diagnosis of caries?

A

> Visual is aided by ball ended explorer NOT sharp probe

> Remove any remaining plaque and debris and to check for surface contour, minor cavitation or sealants.

> Sharp probe – not increased accuracy and may damage intact enamel over a carious lesion (Lussi 93)

> Stickness with probe may reflect morphology of fissure (Kidd et al 1993)

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13
Q

what are the % caries detection rates per examination? (lussi 1993)

A

> Visual inspection of cavitated occlusal lesion
= 62% caries detection

> Bitewings only
= 79% caries detected

> Visual inspection + BW’s
= 90% caries detection

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14
Q

why can clinical diagnosis of caries be difficult?

A

> Can be difficult e.g. with dentine caries there may be no break in the surface

> Adjunctive diagnostic aids are therefore often required

> Radiographs are the most commonly used.

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15
Q

what are the radiograph options for diagnosing caries in paediatric patients?

A

> bitewings

> lateral oblique jaw views (extra oral view for uncooperative children)

> OPT

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16
Q

what is first choice for caries diagnosis in children in the deciduous or mixed dentition?

A

> intra oral radiography (bitewings)

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17
Q

why would you take dental radiographs in children?

A

> important adjusts to visual diagnosis of caries for children and 4 and above

18
Q

when should you take dental radiographs in children?

A

> should be taken after every clinical examination if indicated

19
Q

what circumstance would indicate you NOT to take a radiograph in a child?

A

> well spaced dentition with open contacts

> If a radiograph is not expected to change diagnosis or treatment or add other useful information

20
Q

what else should you record after taking a dental radiograph apart from the report in children?

A

> record if pre cooperative/ lacking cooperative ability for radiographs

21
Q

why are lateral obliques not good for caries diagnosis?

A

> there is superimposition of the opposite side

> only large caries will be detected

22
Q

what are the advantages of bitewings?

A

> Surfaces inaccessible to clinical exam can be studied

> Depth of lesion can be assessed

> Non-invasive (relatively)

> Radiographs can be re-examined and comparisons can be made

23
Q

what is the factor increase on the detection of caries using bitewings compared to a clinical examination alone?

A

> between 2 and 8

24
Q

what are the limits of radiographs in the diagnosis of caries?

A

> Age/ cooperation limitations

> Occlusal caries may not be visible (enamel)

> May get triangular radiolucencies on mesial surface upper E’s and 6’s due to Cusp of Carabelli

> Usually underestimate the extent of a lesion

> Use of ionising radiation -DNA damage

> May have overlapping

25
what is the radiographic investigation frequency based off the FGDPuk 2013 selection criteria guidelines?
> high caries risk = 6 monthly > moderate caries risk = 12 monthly > low caries risk = 12-18 monthly primary and mixed dentition/ 2 years permanent dentition
26
what are some practical tips for a successful radiograph in a child?
> Use smaller films (size 0) > Use smaller holders or adhesive tabs > Use Child Friendly Terminology (camera, photograph) > Demonstrate equipment first (TSD) > Distraction Techniques (counting, nose breathing)
27
why would you used a lateral oblique jaw view?
> Avoids intra oral film > Less cooperative ability required > Additional information on developing dentition > Fair to good agreement with bitewings but not as clear
28
what are they key points of taking an OPT?
> Increased radiation dose > Can detect occlusal dentine lesions ie. large lesions > Lower sensitivity for caries diagnosis, especially in detection of approximal lesions. > cervical spine superimposition
29
what is digital subtraction radiography (DSR)?
> Determines qualitative changes that occur between 2 digital radiographic images taken at different time > Subtract pixel values for each coordinate of the 1st radiograph from equivalent coordinate in a 2nd radiograph= subtraction image > If 0- no change > Shows progression or regression.
30
what are then adjective methods of detection in caries diagnosis?
> Enhanced visualisation – FOTI > Fluorescence - Laser Fluorescence (Diagnodent) and QLF (Qualitative light fluorescence) > Electric – Electronic caries meter (Cariescan pro) > Chemicals - Caries detector dyes
31
what should each treatment plan comprise of?
> Relief of pain > Prevention > Behaviour Management / Acclimatisation > Operative procedures - Logical treatment progression building on each previous visit > Recall interval and radiograph frequency
32
what is part of a prevention tx plan?
> Diet advice- limit sugar to 4/5 times/day > Drinks advice- water or milk as main drinks > Brushing – x2 day, appropriate F toothpaste for age and caries risk, consider F mouthwash > Dentist - Fissure sealants- resin or GIC - Fluoride varnish
33
what is the difference between primary prevention and secondary prevention?
> Primary prevention if no disease > Secondary prevention if early disease
34
what are the treatment options for occlusal non cavitated caries in primary teeth?
> complete caries removal > incomplete caries removal > tissue seal with resin/ GIC
35
what are the treatment option for a proximal non cavitated caries in primary teeth?
> complete caries removal > incomplete caries removal > seal with hall crown
36
what are the tx options for occlusal cavitated caries in primary teeth?
> complete caries removal > incomplete caries removal > seal with hall crown
37
what are the tx options for proximal cavitated caries in primary teeth?
> complete caries removal > incomplete caries removal > seal with hall crown
38
what are some coexisting considerations before carrying out a treatment plan?
> Presence of absence of symptoms/ infection > Number of visits required > Number and extent of carious lesions, Oral Hygiene > Distance travelled, attendance history > Patient compliance > Parental motivation > Previous medical history > Caries rate/risk > Anaesthesia to be used.
39
wha is a common treatment planning method used ?
> Quadrant dentistry: - Reduces number of visits - Reduces number of episodes of LA But: - Care with LA dose - Requires good compliance often beyond younger children/ those with special needs
40
what a possible alternative approach for a child lacking in cooperative ability but has asymptomatic decay?
> Preventive approach E.g. - To obtain stabilisation until compliance established - If carious lesions are arrested - If close to exfoliation and there is a permanent successor developing.