Caries in the Permanent Dentition Flashcards
What has been the trend in dental caries in Australia since 1990?
Decline until 1996-1997 due to water fluoridation After increase (theories include decreased use of fissure sealants, increased bottle water usage
What percentage of teenagers between 12-15 have decay in the permanent teeth?
40-57%
In the top 10% in regards to most extensive history, 5-8 permanent teeth affected (ignore this line if too confusing)
What are some risk factors for permanent tooth caries?
- If from Indigenous population
- Household income < $40 000
- Parents not attended Uni
- <50% lifetime exposure to fluoride
- Brushing < 1/2 x day
- Living in regional or remote location
- Drinking 3 or more sugar sweetened beverages per day
What is the order of susceptibility of the permanent dention to caries (which teeth are most likely to get caries)
- First permanent molars
- Second molars
- Premolars
- Upper lateral incisors
*Most at risk sites are occlusal surface of the upper 6’s and occlusal/buccal surfaces of lower 6’s (think buccal developmental groove)
- Second most at risk sites:
- Occlusal of upper 7’s
- Occlusal/buccal of lower 7’s
- Occlusal of 5’s
- Palatal of upper 6’s
What should you do straight away as part of management if detect interproximal caries?
-Fissure seal rest of occlusal system
(Occlusal is usually at greater risk of decay than proximal; most of the time will develop first, thus if detect proximal then take a good look at occlusal and if no caries prevent)
What are some patterns of caries development?
- Often occur symmetrically
- Similar pattern in maxilla and mandible
- Occlusal more often than interproximal
- Distal caries on E’s signficant risk indicator for caries on mesial of 6’s–>NEVER leave distal caries on E’s even if they are about to fall out, be more aggressive on treatment of E e.g. consider restoration even if only into enamel on the E.
*If find caries on 16, F/S 26, 36, 46 as well
If children have caries in their primary teeth, how does this affect their chance of getting caries in permanent teeth?
-3x more likely to get permanent tooth caries
What is occult caries and how do they develop?
-Caries that have no signs clinically (i.e. clinical examination shows sound crown but subsurface caries visible radiographically)
- Develop due to the presence of resorptive cells getting inside the tooth due to developmental defect and start resorptive process (more common)–>treat as normal caries
- Usually progresses much quicker once tooth erupted into mouth
- If actual caries reaches this area it will progress very very quickly
-Fluoride keeps crown sound while bacteria cause caries to progress subcoronally (rarer)
What information would you collect on a patient’s history if they were previously low risk and you detect some plaque build up?
- Change in lifestyle
- Oral hygiene
- Diet
- Saliva
- MHx
What prevention options have you got available?
- Fluoride varnish, fluoride toothpaste
- Tooth mousse
- Mouth wash
What additional risk factors do adolescents have to oral hygiene?
- Less parental influence
- Increased independance (choice of food and drink), parents less reliable as source of info
- May participate in smoking, alcohol consumption, recreational drugs
- Parents wanting orthodontic therapy
- Change in lifestyle and attitudes (not prioritising oral health, busier)
- MHx and SHx in constant change
What are some tricks to get teenagers to disclose more information?
- Ask parents to wait out in waitng room with an excuse (e.g. needing to take more x-rays)
- Build rapport
- Avoid lecturing/going through parents–>teenager will jsut shut down
How should you manage caries in children?
- Gatehr info
- Behaviour modification
- Home/clinic preventative care
- Clinical management
- MOre frequent review
Summary: determine the cause, treat the cause, treat the caries, review
