Caries symposium Flashcards
7 elements of caries risk
social
oh/plaque
diet
medical history
fluoride exposure
clinical evidence
saliva
whats the worst type of sugar
sucrose
highly processed carbs
milk left in mouth overnight
soya is bad too
whats good about fluoride
- stronger, more resistant to demineralisation
- antimicrobial, interferes with bacterial glycolysis and adhesion to tooth surface
what are we looking for in patient’s mouth? clinical evidence
dmft >5
3 year caries increment >3
ortho
prosthetics
caries in 6s at 6yo
whats dmft
decayed
missing
filled teeth
index
what are we looking for in saliva consistency
pH
viscosity
buffering
flow
amount
what is an example of a medication that affects salivary flow?
asthma inhaler
prilocarpine is a drug that TREATS xerostomia
how do meds affect oral health
xerostomia
some meds contain sugar
some people take sugary drinks to make meds more palatable
what are early childhood caries?
drinking milk when sleeping
decreased salivary flow when sleeping, no cleansing of the milk sugars
lactulose
a medication for constipation but may cause caries
know diet diary
time
4 days
1 weekend
details of food
tooth brushing and bed times
before bed, what time to stop eating
20 min beforehand
xylitol gum adv
Xylitol gum is good
- Sugar free chewing gum
- Increase salivary flow rate
- Neutralize acid in the mouth
5 ways of classifying caries
- extent
- location
- site
- cavitation
- activity
using ICDAS classification system, what is 0-6
0 No evidence of caries
1 Initial caries
2 Distinct visual change in enamel
3 Localised enamel breakdown due to caries with no visible dentine
4 Underlying dark shadow from dentine
5 Distinct cavity with visible dentine
6 Extensive distinct cavity with visible dentine
sensitivity vs specificity
sensitivity =% of disease found correctly
specificity = % of health found
Clinical examination basics
- Good light
- Dry
- Time
- Do not use sharp prob, may accidentally cavitate a non carious lesion
Improving accuracy
ICCMS - dry and good light
magnification - loupes
x rays - BW for approximal caries
whats Fibre optic transillumination diagnodent?
FOTI works quite simply. By placing an intense, narrow beam of light on the tooth’s surface, your visual inspections can quickly provide you with a wealth of information. When a healthy tooth is illuminated, the light will transmit uninterrupted across the tooth (1).
how to know if a cavity is a cavity?
blunt probe or perio probe, run gently to see if it catches onto anything
D1, D2 vs D3
D1 stop before adj, outer half od enamel
D2 before adj, inner half of enamel
D3 caries are at or beyond adj, detectable lesions in dentine
epidemiology
study of the distribution and determinants of diseases in populations
prevalence
proportion of population with a disease at any given point or period
ICDAS
intl caries detection and assessment system
SIC
significant caries index
takes into account skewed distribution of caries in population
The Significant Caries Index is a variation of the DMFT Index that focuses on identifying the most severe cases of dental caries within a population.
determinants
cause or risk factor
when accessing dmft, what do you consider caries?
caries into dentine (OBVIOUS decay, stage 5 or 6)
epidemiology is all about data, how do u get data?
WHO, CDC, Adult/child dental health surveys, NDIP (national dental inspection program scotland)
what has been the main driver of improvement in dental caries since 1970s?
fluoride toothpaste
burden
distribution
SIMD
scottish index of multiple deprivation
turku sugar studies
The results showed a massive reduction of the caries increment in relation to xylitol consumption. Fructose was found to be less cariogenic than sucrose. It was suggested that the non- and anticariogenic properties of xylitol principally depend on its lack of suitability for microbial metabolism and physico-chemical effects in plaque and saliva.
vipenholm caries study
It concluded that the risk of sugar increasing caries activity is greatest if the sugar is consumed between meals and is in the form in which the tendency to be retained on the surfaces of the teeth is pronounced with a transiently high concentration of sugar on those surfaces. This study would now be considered to be unethical.
bell curve shift in populations
a whole population approach may be more ideal than a specific targeted approach. shifting the whole population into a lower risk category benefits more individuals than just shifting high risk individuals into a lower risk category
proportionate universalism
entire population gets positive outcome but the most deprived get an even bigger push to close the gap
strategies for delivery of fluroide
toothpaste
water fluor
community fluoride schemes
strategies for better population diet
sugar tax
industry
sugar subs
reformultion
labelling
links with obesity
sugar tax
(18p per litre) applies to drinks with sugar content between 5 grams and up to (but not including) 8 grams per 100ml
(24p per litre) applies to drinks with sugar content equal to or greater than 8 grams per 100ml
what is upstream, midstream and downstream actions?
upstream = macroeconomic policies
midstream = community like schools or community assets
downstream = individual behaviour, psychosocial, health services
is there benefit of taking fluoride supplements during pregnancy
no
what is a better alt to sugar?
sweeteners like xylitol
what are some safe snack recs
- milk
- water
- fruit
- savoury sandwiches
- crackers
- cheese
- bread sticks
- occasionally a pack of crisps
Cheese has casein
1. Prevents bacteria sticking
2. Neutralise acids
what is the fluoride toothpaste rec for a high risk child age 7
1500ppmF
what is the fluoride toothpaste rec for a high risk child age 12
2800pppmF
what is the fluoride toothpaste rec for a high risk child age 17
5000ppmF (prescription)
what is the fluoride toothpaste rec for a standard risk child age 5
1000-1500ppmF
fluorosis
enamel defects due to high levels of fluoride
increase in mineral resistance
whats the toxic dose of fluoride?
5mg/kg of body weight
what info do you need to determine fluoride toxcitiy ?
body weight and amount of fluroide consumed
what happens if you over consume toxic levels fluroide?
below5mg/kg-give calcium orally
5-15mg/kg - calcium orally or calicum gluconate
Above 15mg/kg – admit to hospital cardiac monitoring and IV calcium gluconate
duraphat fluoride content
22600ppmF
how to determine high risk or low risk usually?
look at timescale of development of caries
- fast, ie many caries in a year indicates worry
- not acute, caries have been around for long time may mean that the caries are arrested
Caries appear white because?
Demineralization causes the enamel prisms to not transmit light through, cannot see yellowish dentine under
stippled appearance of gum indicates?
- Gingivae very healthy, stippled appearance indicates collagen is bound tightly to the periosteum
- How to tell if caries arrested?
colour smoothness hardness
active usually white chalky soft
STRCTURE of enamel rods and ir region in enamel lesions
- In enamel lesion, the rods are still present but the gaps between the rods are larger
- When caries arrest, the IR region become chalky -> smooth
purpose of FS
- In kids, the enamel is weaker/ immature, more carbonate-apatite which is more acid soluble
- Fissure sealants allow time for young enamel to mature
why is comp weak on root caries?
- Composite binds to enamel and dentine, root caries doesn’t have enamel only dentine
- Bonding is weaker
- Why surface of the tooth has higher fluoride content in enamel than subsurface enamel?
Higher potential of fluoride being incorporated into hydroxyapatite when demineralised enamel is being remineralised
