Caries Risk Assessment (also for operative) Flashcards
What is the definition of cariology?
The study of caries and cariogenesis
What is the definition of caries?
decay, in bone or teeth
- BACTERIAL disease
- Leads to demineralization of inorganic components
- Leads to destruction of organic components
What type of disease is dental caries?
- INFECTIOUS disease
- MANAGEABLE disease
- PREVENTABLE disease
What are the requirements for caries?
- Susceptible host
- Bacteria
- Food Source
- Time
What is the specific plaque hypothesis?
◦Biofilm is responsible for the disease
◦Plaque is pathogenic when disease is present
◦Specific Microbes are the cause
◦Strep Mutans
◦Lactobacillus and Actinomyces V. (acid producers, can live in acid)
Control the pathogens=
control the disease
What is the definition for biofilm?
Community of bacteria, bacterial by-products, extracellular matrix, and water
Accumulation of biofilm on teeth is ________ ORGANIZED
HIGHLY
Few microorganisms are able to adhere to oral surfaces, what is the prominent group?
Streptococci
Normal saliva biofilm made up mostly of…
Strep sanguis and Strep mitis (non-pathogenic)
What begins caries formation?
Strep Mutans
Lactobacillus follows
What lives in pits and fissures?
◦Simple streptococcal bacteria
What lives on the root surfaces?
◦Complex bacterial community
◦Mostly filamentous and spiral bacteria
What is an additional complication of root surfaces?
anatomy of root may render hygiene practices ineffective –> unable to reach concavities with floss
Can you have different bacterial communities on the SAME tooth?
Yes- bacterial communities may differ from one another in different areas on the same tooth
Caries does have a ___________ component
genetic
Dentist has a responsibility to help the patient overcome the _________ component of caries
genetic
Caries formation is a constant battle between…
DEMINERALIZATION and REMINERALIZATION
What causes demineralization?
-Bacteria living in plaque feed off “leftovers”
-Bacterial waste product is ACID
-Acid demineralizes enamel
-Phosphates and Calcium are lost
What causes remineralization?
-Saliva rinses away sugars
-Saliva buffers acids
-Minerals in saliva (calcium, phosphate) re-enter tooth
-Presence of fluoride facilitates process
A CARIOUS LESION occurs when:
Demineralization is greater than Remineralization over time
What does hydroxyapatite demineralizes at pH at?
below 5.5
What leaves the enamel when it gets demineralized?
calcium, phosphate ions
What does a carious lesion progression look like?
- =demineralization
- =white spot lesion
- ->cavitation
What does fluorapatite (enamel with fluoride) demineralize at?
Demineralizes at pH below ~4.5
What does dentin demineralize at?
Dentin demineralizes at ~6.2 pH
__________ activity removes the organic portions of dentin (remaining collagenous matrix)
Proteolytic
If the carious lesion progresses to dentin, what might not be possible?
remineralization
What are remineralization besties?
- Saliva
- Plaque removal
- Diet modification
- Fluoride
What are the functions of saliva?
- Buffers
- Cleanses
- Antibacterial
- Calcium and Phosphate Ions
What acts as a buffer in saliva?
Bicarbonate ion HCO3−
◦Raises pH to non-demineralizing levels
How many liters of saliva is produced to flush away organisms a day?
1-1.5L/day
What are the antibiotic salivary proteins?
lysozome, lactoperoxidase, lactoferrin, agglutinin
What aids in plaque removal?
- Removes bacteria’s habitat
- Plaque must ADHERE to cause damage
- Home care
- Professional dental visits
What does diet modification do for caries?
◦Preferred food source: fermentable carbohydrates
◦Strep Mutans loves sugar
___________ OF CONSUMPTION IS MOST IMPORTANT FACTOR
FREQUENCY
◦More important than amount of sugar consumed
What is the new cultural norm for diet?
increased consumption of sugary and acidic beverage –> no chewing = saliva doesnt know to come to the party
What does fluoride do?
- Replaces Hydroxyl groups in hydroxyapatite
- Increases rate of Remineralization
- Inhibits bacterial activity
- Fluoride should be on the surface of the tooth for these mechanisms to work
_______ surfaces respond best to remineralization
Smooth
◦Root surfaces are second, followed by proximal surfaces
What can we offer to improve the remineralization process?
- Fluoride (varnish, rinse, or toothpaste)
- Dietary changes: reduce sugar frequency (ESPECIALLY DRINKS)
- Oral hygiene instructions
What is the role of strep mutans in caries pathogenesis?
initiates lesion
◦Produces lactic acid
◦Survives in low pH
◦Able to store and use intracellular glycogen
◦Produces glucans or dextrans
What do glucans and dextrans do for carious lesions?
-allow S. mutans to stick to tooth
-forms barrier so remineralization can’t occur
What is the role of lactobacilli in caries pathogenesis?
follows and leads to progression of caries
◦High acid producer
◦Found in advanced dentinal caries
Dietary ________ is the most important factor in producing cariogenic plaque
sucrose
◦Strep mutans doubles in only _____ hours in sucrose
1.32 (compared to 20 hours in saliva)
______ frequency exposure is more damaging that lower frequency, high volume
High
What are the layers of bacterial invasion?
- bacterial front: closest to oral environment
- discoloration front
- softening layer: closest to pulp
Infected dentin must be ________
removed
*bacteria present
Affected dentin may…
remain to prevent pulp exposure
*no bacteria present
What role does acid play in caries pathogenesis?
- acid destroys tissues
- acid output in caries active plaque is twice that of caries inactive plaque
REDUCE CARBOHYDRATE CONSUMPTION= REDUCE ______ PRODUCTION
ACID
Cavitation occurs when:
Tooth surface becomes anaerobic and acidic
Decay expands rapidly in more organic part of tooth:
DEJ and dentin
What happens when the tooth is cavitated?
Bacterial (lactobacilli) that adhere poorly are now able to more easily adhere to more retentive deep area of cavity
Where does caries pathogenesis begin?
white spots
What is the first clinically detectable stage of caries?
white spot lesions
T/F Surface level of enamel is still intact with white spot lesions
True
You must treat the ______, not only the symptoms
DISEASE
What do you need to caries diagnosis?
- Clinical visualization
- Tactile
- Radiographs
__________ radiographs for interproximal lesions
BITEWING
Avoid using explorer on __________ surfaces
smooth
- Could cavitate an area that could have remineralized
Poor oral hygiene and diet can produce white spot lesion in ____ weeks
3
Fluoride ____ rate of caries progression
SLOWS
On average it takes ____ months for caries to progress from outer surface of enamel to DEJ
43
Pit and Fissure Caries account for ___% of caries
85%
What do active caries look like?
◦White spots
◦Matte, frosted
◦Cavitated
◦Visible dentin
What do arrested caries look like?
◦ White or brown spot
◦ SHINY surface
What do you rely on primarily to diagnose caries?
radiographs
NO radiolucencies present means ____% chance of no caries
98
Radiolucency present means _____% chance of no caries
40-70%
*radiolucency does not always mean that cavitation is present
What are the non-surgical treatments for inital carious lesions?
◦Fluoride varnish
◦Oral hygiene instructions
◦Dietary counseling
◦Resin infiltration
What are the treatment options for moderate carious lesions?
◦Restore with amalgam or composite
◦Supplement with nonsurgical treatment (education, fluoride, etc.)
What are the treatment options for advanced carious lesions?
◦May be treated with restoration (surgical)
◦Increased patient education is necessary because:
—Will likely require additional treatment
—endo, fixed, OS
How do you treat recurrent caries?
◦Remove old restoration and restore with amalgam or composite
◦Supplement with non-surgical treatment
This is not caries! This is…
cervical burnout
What is the traditional surgical model of caries management?
◦A condition or a cavity
◦Detection of cavity
◦No susceptibility assessment and modification
◦Restoration of function and/or relief of pain
◦Does not stop disease progression
◦Results in repaired but unhealthy mouth
◦Frequent recurrence and often replacement, eventually lose teeth
outdated
What is the medical model for managing caries?
◦We’re treating an infectious disease
-Diagnosis of a disease
- Risk assessment and modification
- Disease control and prevention of the disease and absence of disease occurrence
- Stop disease progression
◦Results in a managed and healthy mouth
◦Prevention of recurrence and minimal replacement, save teeth for life
What is the single best risk predictor for dental caries?
current caries
What are other significant risk factors for caries besides current caries?
*Parent and siblings with caries
*Extensive restorative work
*Orthodontic appliances
*Multiple medications
*Recession
* Nutritional habits
*Poor OH
What is the CAMBRA?
Caries Management By Risk Assessment
What is the overview of CAMBRA?
- Any conditions in high risk= HIGH RISK
- A useful tool to help manage the disease of caries
- UMKC has its own system based on CAMBRA
What are additional risk factors not listed in the UMKC CAMBRA form?
- Are saliva-reducing factors present (medications/radiation/systemic)?
- Is Salivary Flow Adequate?
- History of Eating Disorder?
–Provide details - Special health care needs (developmental, physical, medical, or mental disabilities that prevent or limit performance of adequate oral health care by themselves or caregivers)
- MS and LB culture done?
–Provide results
What is the caries managment for 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
What is the caries managment for medium 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
AND
- Add interventions based on patient need. For example,
◦OTC Fluoride rinse (ACT or Fluorigard); must rinse for 1 minute!
◦F varnish @ 6 months
What is the caries managment for high 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 - Add interventions based on patient need. For example,
–OTC Fluoride rinse (ACT or Fluorigard); must rinse for 1 minute!
–F varnish @ 6 months - Surgical treatment of caries
- Professional Fluoride varnish at recall appointments/ 3 month intervals
- Prescribe Fluoride toothpaste
- Nutrition Counseling
- Xylitol chewing gum - 2 pieces for 30 minutes 3-5 times per day
What are the ways to manage caries non-surgically?
◦Education
◦Oral hygiene instructions
◦Nutrition counseling
◦Remineralization
◦Fluoride
Is patient education treatment?
YES
