Caries risk assessment Flashcards
clinical clues about caries risk?
- heavily restored
- active white spot lesions
- arrested lesions
- sound, entact dentition
- cavities
- ortho appliances
- partial denture
- several previously extracted teeth
what are NME sugars?
non-milk extrinsic sugars
the 3 NME sugars are?
- sucrose
- glucose
- fructose
what is the milk sugar?
lactose
what type of sugar is found in fruit and veg?
- intrinstic sugars
the 2 main sources of NME sugars are?
- confectionary
- soft drinks (esp if given frequently)
name the two subgroups of sweeteners?
- intense sweeteners
- bulk sweeteners
what are examples of intense sweeteners?
- aspartame
- acesulfame
- saccharin
what are examples of bulk sweeteners?
- sorbitol
- xylitol
- mannitol
which type of sweeteners are non-cariogenic and which type are metabolised so slowly by plaque bacteria that they pose no threat to the teeth?
intense sweeteners are non cariogenic and bulk sweeteners are slowly metabolised by plaque bacteria
what group of sweeteners are in chewing gum?
non cariogenic - intense sweeteners
relationship between low socio-economic background and caries?
in children - higher caries rate - fewer caries free teeth - fewer sealants - more untreated caries different beliefs - place less importance on dental health - except that edentulousness is inevitable(dont see as preventable) - attend when in pain and thats it
what is the DEPCAT score?
a score that helps understand the level of deprivation based on postcode
(deprivation category)
do plaque levels have a direct impact upon caries?
no but an indirect one
how does having heavy plaque deposits influence caries?
it reduces the exposure of fluoride
the effect of the saliva on caries?
huge impact
low saliva flow = reduced buffering capacity and reduced antimicrobials = increased caries risk
what are the 2 main functions of saliva?
- protection and digestion
- antimicrobials
- buffers (increases with flow rate)
- bolus formation - enamel stabilisation
- balances remineralisation and demineralisation
how many L of saliva is produced throughout the day at a constant low level?
0.5 - 0.6L
what is the main composition of saliva?
- 5 % water
0. 5% electrolytes and proteins
what are the 3 main salivary glands?
- parotid (mainly when stimulated)
- submandibular (mainly at rest)
- sublingual
3 main groups of medications causing xerostomia?
1 - diuretics (given to pts who retain fluid so makes sense)
2 - antihistamines
3 - tricyclic antidepressants
2 other causes for xerostomia other than medications?
- radio/chemo therapy
2. sjogrens syndrome
what is the treatment for xerostomia?
- changes in medication
- salivary substitute
- salivary stimulant
- fluoride supplement or CHx gels
- excellent OH
how can xerostomia present clinically?
- dry, glossy, atrophic look about oral mucosa
- frequent fungal/bacteria mucosal infections common
- angular chelitis
- difficulty with speech/mastication/swallowing
- increased caries
- possible dry eyes if sjogrens syndrome
learning diffuculties and caries?
not directly linked
association with
- poorer OH
- increased sugar snack consumption
high untreated caries and extraction rate
carers are often relied upon to provide oral care and it is often not a priority
learning difficulties and tx planning
- take into account the ability of the patient or carer to maintain treatment provided
- be realistic
- best intrest of patient
- consider their ability to give consent (adults with incapacity to consent certificate)
- consider using sponges soaked in CHx
- consider modifiying toothbrush
- consider a super brush (3 bristles = only round each Q 1x)
- GA is often the only option for patients with disabilities
factors indicating low caries risk?
- regular attender
- good OH
- DMFT = 0
- few active WSL
- fit and healthy
- fluoridated area
- low sugar diet
- socially advantaged background
factors indicating a moderate caries risk?
- non-fluoridated area
- OH fair
- diet contains NMEs
- small and few restorations
- active WSLs
factors for a high caries risk patient?
- poor attender
- poor OH
- DMFT high
- high sugar diet
- socially disadvantaged background
- non-fluoridated area
- cavitated lesion
- medically compromised (eg special needs)
