Caries Symposium Flashcards
How can we classify caries?
- Extent
- Cavitation
- Activity
- Site
- Location
Extent
What is D₁ caries?
Caries on the outer half of enamel.
Extent
What is D₂ caries?
Caries that extend into the inner half of enamel.
Extent
What is D₃ caries?
Carious lesions extending into dentine.
Cavitation
What tool is best for testing cavitation?
A ball-ended probe (Perio Probe).
Cavitation
Why should a regular probe not be used for diagnosing cavitation?
It may break the surface of the enamel.
Cavitation
What does a ‘catch’ while running a probe indicate?
The presence of cavitation.
Activity
What are the two types of caries activity?
Active (demineralising) and Inactive (remineralising).
Activity
What does an active root surface lesion indicate?
Demineralisation.
Activity
What does an inactive root surface lesion indicate?
Remineralisation
Site
What are the four main sites where caries can develop?
Smooth surface, Occlusal, Root surface, Approximal/interproximal.
Location
What is primary caries?
Caries developing on a previously healthy surface.
Location
What is secondary caries?
Caries adjacent to an existing restoration.
What do sensitivity and specificity measure in caries diagnosis?
- Sensitivity: % of diseased correctly identified.
- Specificity: % of healthy correctly identified.
What are the prerequisites for a good clinical examination?
Good light, dry tooth, take your time, don’t use a sharp probe.
What are some diagnostic tools used to improve accuracy?
Magnification, Radiographs, ICCMS, FOTI (Fibre-Optic Transillumination).
What is the advantage of using radiographs for caries diagnosis?
Permanent record, ability to see between and under teeth.
What is the disadvantage of using radiographs?
Radiation exposure.
What is ICCMS and why is it recommended?
International Caries Classification and Management System, which greatly increases the detection rate of caries.
How does FOTI help in caries diagnosis?
Uses fibre-optic transillumination to detect lesions.
What is DIAGNOdent used for?
A laser fluorescence device to detect caries.
What are the four key factors necessary for caries development?
- Tooth surface
- Substrate
- Time
- Flora (Bacteria)
Which groups are at higher risk for caries?
- Children (with past caries, medically compromised)
- Adults (medically compromised, disabled).
What are the two broad categories of caries risk factors?
- General (Social, General Health)
- Local (Oral Hygiene, Diet, Fluoride exposure, Past Caries, Orthodontics).
What are the seven elements of caries risk assessment?
- Clinical evidence
- Dietary habits
- Fluoride use
- Plaque control
- Saliva
- Social history
- Medical history
What is the significance of a dmft ≥ 5 in primary dentition or DMFT ≥ 5 in permanent dentition?
It indicates a high caries risk.
Why are orthodontic appliances considered a high caries risk factor?
They are difficult to clean and can trap plaque.
How can prosthetics (fixed or removable) impact caries risk?
They make oral hygiene more difficult, increasing the risk.
How many sugar intakes per day significantly increase caries risk?
More than 3 sugar intakes per day.
Which is more cariogenic: frequency or volume of sugar intake?
Frequency is more important than volume.
Why are refined carbohydrates more cariogenic than natural sugars?
They break down quickly and feed bacteria more efficiently.
How can lactose contribute to early childhood caries?
It is a natural sugar that can still promote decay.
What should a diet diary include for an accurate assessment?
A weekend date to reflect realistic eating habits.
What are some social factors associated with caries risk?
SIMD category, Education, Employment, Work stress, Single parent families, Access to healthcare.
What happens if fluoride is not present in the water supply?
Higher risk of caries.
How does fluoride help prevent caries?
It forms fluorapatite, which is more resistant to demineralisation.
What effect does fluoride have on bacteria?
It reduces bacterial adhesion to tooth surfaces.
What is the most common form of clinically applied fluoride?
Fluoride varnish.
What oral hygiene factors contribute to increased caries risk?
Poor technique, irregular brushing, lack of assistance, difficult-to-clean dentition.
Which groups may struggle with oral hygiene maintenance?
Young children, elderly, and people with manual dexterity issues.
What are the key saliva factors affecting caries risk?
Amount, Flow rate, Buffering capacity, pH, Viscosity.
How does xerostomia contribute to caries risk?
It reduces saliva, which helps neutralise acids.
How can medication directly contribute to caries?
Some medicines contain free sugars for taste.
Why are cancer patients at higher risk for oral health issues?
Cancer drugs can cause mucositis and dry mouth.
How does a mother’s oral health impact her child’s caries risk?
Higher maternal caries rates increase risk for the child.
What feeding habits contribute to early childhood caries?
Prolonged nursing, bottle at bedtime.
What are some common mistakes in infant/toddler oral health care?
Frequent cariogenic snacking, lack of tooth cleaning, low fluoride exposure.
What is epidemiology?
The study of the distribution and determinants of diseases in populations.
What is the difference between prevalence and incidence?
Prevalence is the proportion of a population with a disease at a given time, while incidence is the number of new cases in a defined population over a defined period.
What does standardized data take into account?
Population age-structure.
How many people worldwide suffer from caries in permanent teeth?
Around 2.4 billion people.
How many children suffer from caries in primary teeth globally?
Around 500 million children.
What is the DMF index?
A measure of decayed, missing, and filled teeth (DMFT) or surfaces (DMFS).
What does ICDAS stand for?
International Caries Detection and Assessment System.
What is the Significant Caries Index?
A measure that accounts for the skewed distribution of caries in a population.
What are the main risk factors for caries?
Diet (sugar intake), fluoride availability, and socioeconomic factors.
What is the dominant dietary factor contributing to caries?
High sugar consumption.
What are the three main approaches to caries prevention?
- High-risk individual approach
- Targeted population approach
- Whole-population approach.
Give an example of a targeted population approach.
Focusing on deprived communities with high caries rates.
What are three common fluoride delivery strategies?
Fluoride toothpaste, water fluoridation, and community fluoride schemes.
What is the “Common Risk Factor Approach” in health improvement?
Addressing shared risk factors (e.g., sugar intake, socioeconomic status) to improve overall health.
What is Childsmile?
A multi-level oral health program in Scotland that includes nursery toothbrushing, fluoride varnish, and community outreach.
What were the key outcomes of Childsmile?
Increased percentage of children with no obvious decay and cost savings from reduced dental treatments.
What policy measures help reduce sugar intake?
Sugar tax, reformulation of products, and clearer labeling.
Is there any benefit to the child if a pregnant mother takes fluoride supplements?
No, pregnant women should be advised that fluoride supplements do not benefit the child.
At what age should a child transition from a bottle to a feeder cup?
From 6 months, a feeder cup (free-flow spout) should be used instead of a bottle.
Why should children not be put to bed with a feeder bottle or cup?
It increases the risk of early childhood caries (nursing caries).
What is the main concern with soya milk formula?
It is potentially cariogenic and should only be used when medically indicated.
What type of drinks should never be put in a feeder bottle/cup?
Drinks containing free sugars.
What advice should be given when sweetened drinks are used by children?
They should be restricted to mealtimes, diluted as much as possible, and consumed through a straw held at the back of the mouth.
What are the only safe drinks to consume between meals?
Plain water or milk.
Give three examples of safe snacks for children.
Milk/water, fruit, crackers and cheese.
What should be assessed in a diet diary?
Identify where sugar is consumed, when it is consumed, and whether it can be restricted to mealtimes.
Why should you not tell a patient to change their diet when first giving them a diet diary?
To get an accurate record of their normal diet before providing advice.
What are the sources of fluoride?
Water, droplets, tablets, toothpaste, mouth rinse, and varnish.
What is the optimum level of fluoride in drinking water?
1.0 ppm.
When should tooth brushing begin for children?
As soon as the first primary teeth erupt.
Why should children under 8 be supervised while brushing?
They lack manual dexterity.
How often should young children have their teeth brushed by an adult?
Before bed and at one other time during the day.
What is the standard fluoride concentration in toothpaste?
1500 ppm
What fluoride concentrations are available in enhanced toothpaste for high-risk patients?
2800 ppm and 5000 ppm.
What is the recommended fluoride toothpaste concentration for children at different ages?
- First tooth eruption: 1000 ppm
- Standard risk (ages 4-16): 1000-1500 ppm
- High risk under 2: 1000 ppm
- High risk under 10: 1500 ppm
- High risk 10 and over: 2800 ppm (pres only)
- High risk 16 and over : 5000ppm (pres only)
How much toothpaste should be used for children under 3?
A smear.
How much toothpaste should be used for children over 3?
A pea-sized amount.
Why should fluoride toothpaste recommendations be followed carefully?
To decrease the risk of mild fluorosis.
Why is a combination of brushing and flossing more efficient?
It removes more plaque and food debris than brushing alone.
At what age is mouthwash recommended, and what concentration should be used?
Not recommended under 6 years old.
225 ppm fluoride mouthwash can be used from age 6-7 if the child can spit it out.
How often should professionally applied fluoride varnish be used for children?
At least twice yearly, and more frequently for high-risk patients.
What is the fluoride concentration in professional fluoride varnish?
22,600 ppm.
How frequently should fluoride varnish be applied to high-risk adults?
More than two times in a year
What are the fluoride supplement dosages by age?
- 6 months - 3 years: 0.25 mg/kg
- 3 years - 6 years: 0.5 mg/kg
- 6 years+: 1 mg/kg
What are the key impacts of caries on preschool children?
Aesthetic problems, loss of function, pain, and infection.
Name three key risk indicators for caries in children.
Oral hygiene
Diet
Fluoride exposure
What are early childhood caries also known as?
Nursing caries.
Which teeth are typically affected by early childhood caries?
Upper anterior and molar teeth.
What is a major cause of early childhood caries?
Inappropriate use of feeding cups and bottles.
What are the three key prevention methods for caries?
Diet, fluoride, and oral hygiene.
What is the NHS recommendation for keeping a diet diary?
4 days total—3 weekdays and 1 weekend day.
Name three hidden sources of sugar in food.
Ketchup, granola, and sports drinks.
Why is it important to give realistic goals to patients regarding their diet?
To encourage achievable and sustainable improvements.
Name two supplementary self-delivered fluoride sources that are NOT recommended for children under 6.
Fluoride drops and fluoride tablets.
What four factors are required for carious lesions to form?
Dental Plaque, Diet, Tooth, and Time.
What acts as a primer for bacterial attachment to enamel?
Saliva
When does bacterial colonization of enamel occur?
Immediately after tooth brushing.
Why does enamel need time before it can produce acid?
The plaque must mature before becoming cariogenic.
What is a white spot lesion?
A lighter, chalky area on enamel indicating subsurface demineralization.
Why does enamel appear intact despite demineralization?
Saliva provides a superficial remineralization effect.
Where does demineralization occur in an enamel lesion?
In the inter-rod regions, causing gaps between enamel rods.
How does caries progress through enamel and dentine?
In a triangular shape, with the apex toward the pulp and base toward the exterior.
What happens when enamel collapses?
The lesion progresses toward the dentine.
What change in oral hygiene can promote remineralization?
Improved brushing and fluoride exposure.
Why is saliva less effective at neutralizing acids in pits and fissures?
It only buffers the superficial plaque, leaving deeper plaque unneutralized.
How does caries progress in pits and fissures compared to smooth surfaces?
The triangular lesion has its apex toward the surface and base toward the pulp (opposite of smooth surface caries).
How does fluoride help remineralization?
It replaces the hydroxyl group in hydroxyapatite, forming fluorapatite.
