Caries Lab Flashcards by Deleted Deleted

Caries process vs Caries disease

Caries PROCESS: is a natural phenomenon
there is always deminieralization and remineralization happening in our teeth

Caries DISEASE: is when the demineralization is greater than the remineralization/ the balance is disturbed.

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Is caries an infectious disease?

It is caused by bacteria, the OPPORTUNISTIC bacteria that take advantage of the imbalance in the microflora/ biofilm demineralization/ increased porosity

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Caries lesion vs cavitation

Caries lesion; is a consequence of caries disease process. Can be in a state of regression or progression/ arrested vs active

Cavitation: severe form of caries lesion where there is loss of surface tooth integrity AND exposed dentin

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Ecological Plaque Hypothesis

Net mineral gain: 
- Lesion regression/arrest
Surface feature: 
- shiny/smooth: enamel 
- Shiny/hard: dentin

( even if it is BLACK if it is shiny and hard = net mineral GAIN)

Net mineral loss
Lesion initiation/progression 
 Surface features: 
- dull/rough: enamel 
- dull/soft: dentin

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Dynamic Stability stage

Low-pH non MS and Actinomyces

Dominance of non MS and actinomyces

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What are the three tooth biofilm stages

Dynamic Stability stage
Acidogenic Stage
Aciduric Stage

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Acidogenic Stage

Low- pH, non MS and Actinomyces

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Aciduric Stage

Increase in MS and non-mutans aciduric bacteria

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Define Caries Diagnosis

It is the human professional summation of all the signs and symptoms of disease in order to chose the best possible way of managing the caries process.
(Schulte et al., 2011)

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why must we use a ball ended probe

Demineralized surface can be damaged by sharp explorer !!

Use your vision
o Use a ball-ended probe if needed o Do not put much pressure when
probing the surface!

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What are the four clinical indicators for caries lesion?

change in colour (sharp/dark colour changes)
- white, yellow, black
shape (banana, kidney, other)
Location (plaque stagnation areas)
Change in tooth surface integrity (cavitation)

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Define Normal and Sound Enamel

Micro-porous solid
Considits of tightly packed crystals
A glass like appearance: SMOOTH and SHIINY
TRANSLUCENT

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White Spot lesion in Caries Lesion

due to increased enamel porosity

there is DECREASED translucency, INCREASED opacity/matte appearance

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Yellow/Brownish Caries Lesions

What makes them change colour? when there is an active caries lesion (more deminieralization) diet will stain the more porous area.

when there is cavitation, it will be yellowy because of the EXPOSED dentin

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Colour of caries lesion: dark brown/ black

how do you know it’s not a stain?

caries lesions are DARK colours, very sharp colour change vs stains are more faint, lights colours like reddish brown or grey!!

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What are the 6 plaque stagnation areas?

Along gingiva (smooth and proximal surfaces*)
• Occlusal/Buccal/Lingual pits or fissures
• Cavitated carious lesions
• Roots
• Along restorations
• Associated with partial dentures

Flurosis

DDX for white lesion

strait parallel lines + snow capped edges

Hypoplasia

white patch of discolouration, found on the middle surface of teeth: NOT on plaque stagnation areas

in severe cases: it can be a little yellow but the LOCATION is the giveaway for this one

Cavitation

there MUST be change in surface integrity

Definition of “sound tooth”

there is no sign of CARIES LESION

so if the tooth is just stained = sound

What are the differential diagnoses that explain change in colour of a tooth NOT RELATED TO CARIES LESIONS

hypoplasia
flurosis
extrinsic/intrinsic staining
erosion, attrition, abrasion

Dental Erosion:

This is a PROCESS.

Dental erosion is the chemical loss of mineralized tooth substance caused by the exposure to acids not derived from oral bacteria.

people who vomit/eating disorders

Tooth Wear

is a CONDITION
The cumulative surface loss of mineralized tooth substance due to physical or chemophysical processes (dental erosion, attrition, abrasion).

Dental Attrition

A Process

Dental attrition is the physical loss of mineralized tooth substance caused by tooth to tooth contact.

Dental Abrasion

A process Dental abrasion is the physical loss of mineralized tooth substance caused by objects other than teeth. i.e. tooth brush

Lesion Severity Assessment (D1-D4)

D1: Enamel non- cavitated lesions D2: Enamel Cavitated Lesions D3: Dentinal Lesions ( include SHADOWS) D4: Pulp Lesions For severity, if not sure, the less severe stage should be chosen

Define Sound tooth

There should be no evidence of caries (either no or questionable change in enamel translucency after air drying (suggested drying time 5 seconds). > Surfaces with developmental defects such as enamel hypoplasia, fluorosis; tooth wear (attrition, abrasion and erosion), and extrinsic or intrinsic stains will be recorded as sound. > The examiner should also score as sound, a surface with multiple stained fissures if such a condition is seen in other pits and fissures, a condition which is consistent with non-carious habits (e.g. frequent tea drinking).

Define NON-cavitated Caries Lesion

After air drying there is a change in color (white/yellowish/brown lesion) that is not consistent with the clinical appearance of developmental defects or extrinsic/intrinsic staining. >There is no change in surface integrity.

Micro-Cavitated Caries Lesion

This would be D2 severity grade, still enamel base >Once the surface is dried, in addition to the signs of non- cavitated lesion (white/yellowish/brownish change in color), there is a distinct visual loss of surface integrity (loss of tooth structure, no visible dentin). >If in doubt, or to confirm the visual assessment, the ball ended probe can be used gently across the surface to confirm the loss of surface integrity. >The pits or fissures may appear substantially and unnaturally wider than normal or there is a well defined small micro-cavitation (no visible dentin).

Shadow

this is D3, DENTIN is involved** The underlying shadows usually originate from occlusal or proximal surfaces and they usually confined to dentine. The shadows present as grey, blue or brown discolored dentine visible beneath the enamel surface or an opaque ring around the pit or fissure from undermined enamel. ***The shadows may be associated with non-cavitated/micro- cavitated or cavitated carious lesions.

Cavitated Lesion

Cavitation is in opaque or discolored enamel exposing the dentin beneath. Cavitation is easily visible with the naked eye. The ball ended probe can be gently used to confirm the presence of a cavity in the dentin.

What are the Lesion Severity Stages IN CLINIC

1. Non-Cavitated (NC) - change in colour, shape (D1) 2. Non-Cavitated, micro (NCmicro) - colour change, AND loss in surface integrity within enamel (D2) 3. Cavitated: cavitation is easily visible with naked eye, dentin exposed (D3) SHADOW can be assosciated with any of these.. shadow means dentin is involved so it is more severe