Cariology Flashcards
Cariology
The study of dental caries and cariogenesis
Dental Caries
An infectious microbiologic disease of the teeth resulting in
localized dissolution and destruction of calcified tissues
Without teeth,
bacteria have no habitat
Bacteria
◦ Streptococcus mutans
Substrate
◦Any type of carbohydrate will support some strain of bacteria
Tldr; Recipe for Caries (3)
Tooth
Biofilm (plaque)
Food source
Caries is —
MULTIFACTORIAL
Types (4)
◦ Steptococcus mutans
◦ Streptococcus sanguis
◦ Streptococcus mitis
◦ Bacteroides melaninogenicus
Streptococcus mitis (1)
◦ Considered normal oral flora- presence can actually slow the growth of Strep mutans
colonies
Bacteroides melaninogenicus (2)
◦ Obligate anaerobe
◦ Associated with periodontal disease
Dental Plaque (2)
◦Gelatinous mass of bacteria adhering to tooth surface
◦BIOFILM
Cariogenic Bacteria Metabolism
◦ Simplified: bacteria consume sugars, the waste product is acid
Acids lower pH in mouth to below –
5.5
pH at – is when demineralization of enamel begins to take place
5.5
Enamel is STRONGER= requires higher acidity than —
dentin
Dentin demineralizes at pH of —
6.2
pH remains below 5.5 for — minutes after each sugar exposure
20-60
Bacteria eats what we eat:
Fermentable Carbohydrates
Past 30 years: (4)
- Younger children (2-8yrs) have had minor decrease in caries prevalence
- Caries prevalence has remained constant for older children
- Minority youth still most at risk for caries
- Lower income youth still most at risk for caries
Sites for Caries Initiation (3)
Pits and Fissures
Smooth Surfaces
Root Surfaces
Smooth Surfaces (2)
◦Interproximal Contacts (Cl II and III)
◦Near Gingiva (Cl V)
CLINICAL FEATURES (5)
White spot lesion Smooth surface caries Occlusal caries Interproximal caries Root surface caries
White spot lesion
-NONcavitated
Smooth surface caries
-Cavitated
Interproximal caries
-can occasionally see clinically,
more often use radiographs
Pit and Fissure Caries (4)
Class I caries Occlusal surfaces of posterior teeth Buccal surface of posterior molars ◦Buccal pit Lingual surface of lateral incisors
Most prevalent location for caries
pits anf fissures
Can be prevented by —
sealants
Detection (3)
◦ NOT A STICK- use explorer to drag along surface to check for softness. Use gentle pressure. ◦ Clinical visualization- shadowing ◦ Radiographs ◦ Only when large enough
Presence of high concentrations of mutans streptococci in pits
or fissures is typically followed by a carious lesion in
6-24 months
Important to place sealants shortly after — of teeth
eruption
Buccal and Lingual Caries (2)
◦ Class V
◦ Diagnose visually
Interproximal (3)
◦ Class II
◦ Difficult to diagnose visually
◦ Diagnose with radiographs
◦ Diagnose with radiographs (2)
◦ BITEWINGS
◦ PA angulation= INACCURATE
Smooth Surface Caries (2)
Associated with high sugar intake
Prevalent in “Soda Sippers”
Easily restored
◦Is still a serious lesion
Root Surface Caries (4)
Comparatively rapid succession
Often asymptomatic
Closer to the pulp
More difficult to restore
Recurrent/Secondary Caries
Caries developed at margin of a restoration
Visual (2)
◦ Color
◦ Matte vs shiny
Tactile (2)
◦ Firm
◦ Soft (leathery)
DIAGNOSIS (3)
visual
tactile
radiographs
Caries MANAGEMENT (3)
◦ Moving away from “Caries Prevention” and “Caries Treatment”
Surgical
◦ What we do in lab!
Non-surgical options
Factors to consider: (3)
General health
Xerostomia
Fluoride Exposure
Xerostomia (3)
◦ Radiation and chemotherapy
◦ Medical conditions
◦ Medications
Fluoride Exposure (3)
◦ Water, toothpaste, fluoride rinse
Prevent (3)
Oral Hygiene Instructions ◦ Plaque-free surfaces do not decay! Dietary Counseling ◦ Identify sources ◦ Reduce frequency and ingestion Sealants
Sealants (2)
◦ Thin resin coating placed on chewing surfaces of teeth
◦ With or without enameloplasty
Arrest (5)
◦ Fluoride (Enamel resists acids more effectively)
◦ Oral hygiene improvement (Reduces biofilms)
◦ Dietary changes (Reduces bacteria’s food source)
◦ Professional cleanings (May change recall intervals, more frequent assessment)
◦ Address xerostomia
Intermediate option:
Resin infiltration
Resin infiltration
Icon is used in our clinic (4)
◦ Clean tooth well (pumice)
◦ Dry working field (rubber dam)
◦ Etch for at least 30 seconds 1-3 times; rinse and DRY well
◦ Infiltrate using Icon resin
◦ Etch for at least 30 seconds 1-3 times; rinse and DRY well (2)
◦ Icon Etch is 15% hydrochloric acid gel
◦ Acts as a “chemical” drill
Surgical Management (2)
◦ STILL A GREAT OPTION
◦ Cavitated carious lesions
skipped
◦ Cavitated carious lesions (4)
◦ Remove carious lesion
◦ Establish resistance form in preparation
◦ Avoid fracture of tooth or restoration in the future
◦ Establish retention form in preparation
◦ Avoid restoration being dislocated or lost
◦ Restore
UMKC School of Dentistry uses — Caries Classification System
ADA
UMKC School of Dentistry uses ADA Caries Classification System Method of (2) management of caries
classifying and determining
