Caries Symposium Flashcards
what factors are necessary for caries
tooth surface
substrate - carbohydrate
flora - bacteria, strep mutans
time
what are the 7 factors for caries risk assessment
clinical evidence oral hygiene diet fluoride exposure saliva medication social status
what can be measured for someones clinical evidence
caries experience - dmft either primary or permanent
what causes white spot lesions
build up of plaque, acid produced, demineralisation of enamel but not cavitated
what is the consequence of white spot lesion on dentine
causes demineralisation of dentine, can get tertiary dentine formed
why are pits and fissures higher risk of caries
more likely to get food down here and stuck, but have reduced flow of saliva down for clearance, allows for demineralisation of enamel. also difficult for bristles of toothbrush to get down. the enamel at this region is also thinner, so gets into dentine quicker - fast spread
what are different strategies of intervention for prevention of caries
individual - specific education and prevention measures tailored to individual, caries risk assessment
targeted population level - target the population at higher risk, fluoride varnish on high risk children’s teeth
whole population - health education and promotion for everyone
what is the benefit of targeting the whole population
moves the distribution of whole population to a lower risk category - not just those high risk
what is proportionate universalism
targeting the whole population but increasing measures for those at high risk
what are the different levels of interventions
upstream - national, change in policies and programmes
midstream - community level, training other people
downstream - chairside dental education
what are risk indicators for children
bottle feeding, parental smoking and oral hygiene, diet, fluoride exposure, socioeconomic status
what are the 8 preventative measures
tooth brushing technique diet advice fluoride toothpaste fluoride varnish fluoride supplementation sugar free medication radiographs fissure sealants
what diet advice can be given to prevent caries
water and milk only - if need juice, only at meal times and as diluted as possible, and through a straw
sugary foods and snacks at mealtimes only
cheese can be given after meal - anticariogenic
snack ideas - cheese and crackers, bread sticks, crisps
what is nursing caries
caries in children who have been given a bottle to go to bed, suck on it all night. constantly low pH in mouth. caries on upper anteriors and molars
what bottle should children use
free flowing spout
what levels of fluoride should be in toothpaste for standard risk
under 4 - 1000ppm
4-16 - 1000-1500ppm
what levels of fluoride should be in toothpaste for high risk
under 10 - 1500ppm
10-16 - 2800ppm
16+ - 5000ppm
what are the classifications of caries
extent - enamel only or enamel and dentine
cavitation
activity - active or inactive, demineralising or re
location - primary or secondary
site - occlusal, approximal, smooth surface, root surface
what are the 2 components of accuracy
sensitivity - % of correctly identified disease
specificity - % of correctly identified health
what is required for clinical examination in detecting caries
dry tooth surface, light, probe but not sharp (ball ended) and time
what can be used in helping to diagnose caries
magnificiation, radiographs, ICCMS
what are advantages and disadvantages of using magnification to detect caries
improves sensitivity for D1, much greater detail seen, but smaller field of vision - D3 sensitivity not as good
what are advantages and disadvantages of using radiographs to detect caries
allows more surfaces to be seen - approximal, good for D3, but not as good for D1 - also exposes patient to ionising radiation
what is ICCMS
drying every surface of tooth for 30 seconds, and spending more time detecting caries
what are advantages and disadvantages of ICCMS
increase in sensitivity for both D1 and D3
but decrease in specificity - more false positives, looking for something that isnt there
what is infected dentine
top layer of dentine, infected by bacteria, structure has been compromised by MMP’s - needs to be removed. irreversible denaturation of matrix
what is affected dentine
the layer underneath infected, no bacteria present, still contains hydroxyapatite crystals. but some collagen has been compromised but is remineralisable
what makes bond strength to affected dentine poor
poor infiltration of resin and increase in dentinal fluid
what is the ethos for dealing with caries
remove as little tooth tissue as possible
achieve restorative seal
maintain pulpal health
successful restoration - right cavity size and shape
what must be done before restoring caries
find out the reason and cause - address these issues first. if not, caries will be recurring
what is the similarities with partial caries removal and stepwise technique
access caries, visualise extent at ADJ, remove as much caries as possible in dentine without damaging pulp, maximise cavity for restoration
what is different between stepwise technique and partial caries removal
partial caries removal - removes as much caries as possible, any caries over pulp is left. definitive restoration is placed
stepwise technique - temporary restoration is placed - RMGI, allows tertiary dentine to form from pulp, can then go back in, remove the rest of caries and place definitive restoration
what is a differential diagnosis for a patient with infalmmaed gingiva most of the time, all over with plaque present
chronic generalised plaque induced gingivitis
