caries risk assessment Flashcards
study of caries and cariogenesis
cariology
decay in bone or teeth
caries
steps that cause caries
- bacterial disease
- leads to demineralization of inorganic components
- leads to destruction of organic components
3 dental caries
infectious disease
manageable disease
preventable disease
4 caries requirements
susceptible host
bacteria
food source
time
etiology of caries.
specific plaque hypothesis
- ____= responsible for the disease
- ___= pathogenic when disease is present
- ___=are the cause
- Strep Mutans
- Lactobacillus and Actinomyces V. =_____ and can live in acid
- biofilm
- plaque
- specific microbes
- strep mutans
- acid producers
control the pathogens=
control the disease
Community of bacteria, bacterial by-products, extracellular matrix, and water
biofilm
accumulation of biofilm on teeth is
highly organized
what bacteria is prominent group for biofilm
streptococci
normal saliva biofilm made up of mostly
strep sanguis and strep mitis
(non-pathogenic)
primary bacteria in caries
strep mutans
strep mutans begin caries formation
followed by:
which are responsible for progression of caries
lactobacillus
different habitats= different
bacteria
pit and fissures bacteria
simple streptococcal bacteria
root surface has complex bacterial community
mostly filamentous and spiral bacteria
bacterial communities may different from one another in different areas on
on the tooth
Bretz WA 2005 Twins Study
Found genetics play a significant role in caries
Up to
40%
Genes involved is ______
unknown
do Caries have a genetic component?
yes
-doesnt mean patient is off hook if they have caries. means they must be more diligent to prevent future caries
Caries formation is:
constant battle between
dynamic
demineralization and remineralization
what happens in demineralization
-Bacteria living in plaque feed off “leftovers” (sugars,
fermentable carbohydrates)
-Bacterial waste product is ACID (lactic)!!!!!!
-Acid demineralizes enamel
-Phosphates and Calcium are lost
what happens during remineralization
-Saliva rinses away sugars
-Saliva buffers acids
-Minerals in saliva (calcium, phosphate) re-enter
tooth
-Presence of fluoride facilitates process
Demineralization is greater than Remineralization over
time
carious lesion occurs
in enamel, hydroxyapatite demineralizes at pH below:
5.5
calcium, phosphate ions leave enamel
=demineralization
what about fluorapatite?
demineralizes at pH below 4.5
enamel carious lesion progression:
- hydroxyapatite demineralizes at pH below ~5.5
- calcium, phosphate ions leave enamel
- =demineralization
- =white spot lesion
- ->cavitation
- What about Fluorapatite?
- Demineralizes at pH below ~4.5
Dentin demineralizes at ~
6.2 pH
Remineralization may not be possible in
dentin
Remineralization besties:
saliva
plaque removal
diet modification
fluoride
buffers
cleanses
antibacterial
calcium and phosphate ions
saliva
saliva buffers by
◦Raises pH to non-demineralizing levels
◦Bicarbonate ion HCO3
−
saliva cleanses by
◦Flushes away free-floating organisms
◦1-1.5L/day
saliva is an antibacterial by
Salivary proteins: lysozome, lactoperoxidase, lactoferrin, agglutinin
◦Shown NOT to have huge impact on caries
plaque must ____to cause damage
adhere
plaque removal:
- Removes bacteria’s habitat
- Plaque must ADHERE to cause damage
- Destroy its home, it can’t hurt you
- Home care
- Professional dental visits
diet modification
- starve bacteria
◦Preferred food source: fermentable carbohydrates
◦Strep Mutans loves sugar - FREQUENCY OF CONSUMPTION IS MOST IMPORTANT FACTOR
-more important that amount of sugar consumed!
-aim to REDUCE frequency
Reduce sugary or acidic beverages
* Sugary beverages= food for bacteria
* Acidic beverages= lower pH of oral environment
lower pH of oral environment
fluoride replaces ______ in hydropxyapatite.
this:
1. strengthens ________
2. forms ______
3. renders____
hydroxyl groups
- strengths crystalline structure
- forms fluorapatite
- renders enamel more resistant to demineralization
___increases the rate of remineralization by:
fluoride
1. attracts Ca ions
2. Ca ions attract phosphate ions
these surfaces respond best to remineralization:
____
these are second, followed by
smooth surfaces
root surfaces second
proximal surface third
in remineralization these lesions have best results
early lesions
_____fluoride being used more for remineralization
silver diamine fluoride
the body is ideally remineralizing naturally, so we can offer suggestions to improve:
1
2
3
- fluoride- varnish, rinse, toothpaste
- dietary changes: reduce sugar frequency (ESPECIALLY DRINKS)
- oral hygiene instructions
this bacteria initiates the lesion:
produces:
survives in:
able to store and use:
produces_____which allows it to stick to tooth and form barrier so remineralization cant occur
strep mutans
produces latic acid
survives in low pH
able to store and use intracellular glycogen
produces glucans or dextrans
this bacteria follows strep mutan and leads to progression of caries
lactobacilli
this bacteria is a high acid producer and found in advanced dentinal caries
lactobacilli
dietary ___is the most important factor in producing cariogenic plaque, and leads to growth of highly acidogenic bacteria
dietary sucrose
strep mutans doubles in only ___hours in sucrose
and ___ in saliva
1.32 hours
20 hours in saliva
this is more damaging than lower frequency, high volume
high frequency
layers of bacterial invasions:
- bacterial front- closest to oral environment
- discoloration front
- softening layer- closest to pulp
infected vs. affected dentin
infected must be removed since bacteria present
affected may remain to PREVENT PULP EXPOSURE and no bacteria present
this production plays an important part in caries and destroys tissues.
acid
acid output in caries active plaque is ____that of caries inactive plaque
twice
diets high in sucrose= ____caries rate
high
reducing carbohydrate consumption= reduced
acid production
cavitation occurs when
tooth surface becomes anaerobic and acidic
Once tooth is cavitated
Bacterial (lactobacilli) that adhere poorly are now able to more easily adhere to more
retentive deep area of cavity
Decay expands rapidly in more _____ part of tooth
organic
DEJ and Dentin
where does caries all begins
this is first clinically detectable stage of caries where surface level of enamel is still intact
white spots
initial lesion depth at ____week=20-100um
visible energy change at ___weeks=400-500um
1 week
2 weeks
radiographs clinical visualization
BITEWING radiographs for interproximal lesions
not Pas- angulation misleading
restoring teeth with active caries is like putting a new roof on a burning house. you MUST ______, not only the symptoms
treat the disease
clinical visualization:
good light
air dry
tactile
radiographs
tactile clinical visualization
- Gently feeling occlusal surface for soft areas may be appropriate
- Avoid using explorer on smooth surfaces
-Could cavitate an area that could have remineralized
Poor oral hygiene and diet can produce white spot lesion in how many weeks
3 weeks
Fluoride slows rate of progression in
pit and fissure
fluoride slows rate of progression on what surfaces
smooth
smooth is already slower than fissure
on average, how many months for caries does it take to progress from outer surface of enamel to DEJ
43 months
what percent of caries are pit and fissure
85%
active pit and fissures
◦White spots
◦Matte, frosted
◦Cavitated
◦Visible dentin
arrested pit and fissures
- white or brown spots
- shiny surface (do NOT need to treat surgically)
interproximal caries
- rely primarily on radiographs to diagnose
if there is NO radiolucencies present= ___% chance of no caries
98%
does radiolucency mean that cavitation is present?
radiolucency present = __% chance of no caries
no
40-70%
radiographs by level of cavitation
outside to inside
E1, E2
D1, D2, D3
what carious lesions are non-surgical treatment, fluoride varnish, oral hygiene instructions, dietary counseling, resin infiltration
initial carious lesions
what carious lesion can you
-restore with amalgam or composite= surgical treatment
or
-supplement with nonsurgical treatment
moderate carious lesions
what carious lesion
-may be treated with restoration= surgical
-increased patient education is necessary because: will likely require additional treatment like endo, fixed, OS
advanced carious lesions
what carious lesion
-remove old restoration and restore with amalgam or composite
-supplement with non-surgical
recurrent caries
not caries???
cervical burnout??
how we are currently managing caries:
MEDICAL MODEL
1. treating infectious disease
-dx of disease
2. risk assessment and modification
3. disease control and prevention of disease and absence occurrence
4. stop disease progression
results in:
managed and healthy mouth
prevention of recurrence and minimal replacement, save teeth for life
What is the single best risk predictor for dental caries?
Other significant factors:
current caries
other:
*Parent and siblings with caries
*Extensive restorative work
*Orthodontic appliances
*Multiple medications
*Recession
* Nutritional habits
*Poor OH
caries risk assessment
CAMBRA
caries
management
by
risk
assessment
cambra
1. any conditions in high risk=
2. moderate and low conditions only=
3. low risk conditions only=
- high risk
- moderate risk
- low risk
CARIES MANAGEMENT-Low Risk Patients
- Toothpaste 2x day (F 1000ppm)
- Sealants for all Molars
- Age-related Oral Hygiene Education
◦Between meal snacks
◦Acidic or sugary drinks, like sports drinks
CARIES MANAGEMENT-Medium Risk Patients
all low risk managements and
* Add interventions based on patient need. For example,
◦OTC Fluoride rinse (ACT or Fluorigard); must rinse for 1 minute!
◦F varnish @ 6 months
CARIES MANAGEMENT-High Risk Patient
all low and moderate risk AND
1. Surgical treatment of caries
2. Professional Fluoride varnish at recall appointments/ 3 month intervals
3. Prescribe Fluoride toothpaste
-Dispense: Prevident5000 (1.1% NaF) Sig: Brush with small amount for 2 minutes before bedtime, expectorate excess
DO NOT RINSE
4. Nutrition Counseling
5. Xylitol chewing gum
-2 pieces for 30 minutes 3-5 times per day
