Caries I

Question 1

what is M.I dentistry?

Answer 1

The concept of “Minimum Intervention Dentistry” involves the holistic approach to individualised patient care.

Question 2

What are the steps involved in Minimum intervention oral care plan?

Answer 2

1. Identify – diagnosis/ prognosis
2. Prevent and control

Question 3

how can you diagnose a patient?

Answer 3

established patients caries susceptibility through
* verbal history
* oral examination
* visual carriers lesion detection
* radiographs
* aetiological factors for susceptibility

Question 4

how can you develop a care plan?

Answer 4

develop a care plan by looking at:
* Lesions presence or absence
* Cavitied or not
* Susceptibility

Question 5

what are dental caries?

Answer 5

“A reversible disease process of dental hard tissues, instigated by the action of bacteria upon fermentable carbohydrates in the plaque biofilm at tooth surfaces.

This leads to the carious lesion formation: acid demineralisation and ultimately proteolytic destruction of the organic component of dental tissues.”

Progressive disease initiated at the tooth surface, that is reversible up to a point. If the lesions progress, it results in softening and ultimate destruction of tooth substance.

Question 6

what does caries mean in latin?

Answer 6

decay

Question 7

what does carious process mean?

Answer 7

The histopathological metabolic interactions occurring in the plaque biofilm cause disease.

So that drives the disease

Question 8

what does carious lesion mean?

Answer 8

The signs of the disease on dental hard tissues, i.e. early lesions / discolouration / opacities, cavities etc.

The lesion is the consequence of the disease.

Question 9

What are the causative factors of caries?

Answer 9

• Bacteria – Strep mutans primarily
• Tooth surface that is exposed to the biofilm
• Carbohydrates – the biofilm needs to be fed by the carbohydrates
• Time

Question 10

How does the enamel become demineralised?

Answer 10

The plaque biofilm changes become cariogenic and have a dysbiotic change with the fermentable carbohydrates with time causing lactic acid production.

This reduces the pH which causes acid demineralisation of the enamel.

Question 11

What can be done to remineralise the enamel?

Answer 11

In the oral environment the saliva with buffering capacity and diet can be modified, including other ions like fluoride and oral hygiene practises and all of this shifts the environment to a more neutral pH and therefore remineralisation can occur.

Question 12

Explain stephan curve.

Answer 12

When a patient takes a bolus of food we see a drop from normal pH (7.0) to the critical pH (5.5) until the factors involved in remineralisation results in an increase in pH.

The period of time where the tooth is susceptible to demineralisation is when the pH is lower the critical pH.

Dentine has a critical pH of 6.2 therefore when exposed can be more susceptible to acid attack for a long period.

The longer the time frame the tooth is susceptible to demineralization the more chance there is tipping the caries process into activity.

Question 13

How is caries diagnosed?

Answer 13

• Caries history / susceptibility assessment
• Signs - detection
• Symptoms, i.e. pain history
• Special investigations:
  – Sensibility tests (temperature, electrical, percussion )
  – Radiographs

Question 14

What Factors contribute to increased risk of caries?

Answer 14

• Medical: drug therapy, sucrose-based medication
• Social: stress, lifestyle change
• Dietary: prolonged breast feeding, “grazing”
• Host resistance: previous caries experience, lesions on certain tooth surfaces, soft, light coloured lesions
• Salivary: low secretion and buffering
• Microbiology: high numbers S. mutans and lactobacilli