Cariology 3 w/ Hodgson Flashcards
Dental caries
progressive loss by bacteria produced acid of apatite composed of dentin and enamel or of cementum and dentin-it is the disease
Acid from what causes caries
ONLY from bacteria
Dental cavity
break in enamel or dentin of tooth caused by caries
Caries reversible?
most not, will need operation
Caries infectious?
yeah
How many types of bacteria in biofilm in mouth
600-800
modifiers of caries
saliva and flouride
Why is diagnosis important
forms basis of treatment decisions, enables professional to inform patient, advises health service planners on population level
Diagnosis general definition
determination of the nature of a (one single) case of disease
clinical diagnosis defined
diagnosis based on signs, symptoms, and lab findings during life- cavities are a sign of the disease dental caries
who has caries
nearly everyone, cavities are less ubiquitous
Diagnostic Problems…
Chart
Disease + and Test + = true +
Disease + and Test - = false -
Disease - and test + = false +
Disease - Test - = true -
Continuum of caries
Mineral loss over time, some do not lose enough tooth structure to develop a cavity
Sensitivity vs specificity
Sensitivity is the True ++ and specificity is true negative –
Explain the trend of caries
Depends on when you have girlfriends and how much booze you consume
universal definition of when a tooth needs to be restored
there is not one
True + plus false - =
1
Sensitivity (and % of dental tests)
How often do we get a true positive=90%
Specificity (and % of dental tests)
How often do we get a True Negative= 85%
When disease prevalence drops, what happens to accuracy?
It drops significantly
How should we diagnose caries? (what to tell the patient/classification)
Do not tell patients they have no caries
number of surfaces/sites that can develop a cavity
4
pits/fissures, proximal, smooth/cervical, root
Caries extent types
4 Sound surface Initial Moderate Advanced
Caries that involves DEJ
Advanced
Caries Activity
Inactive
Active
Undetermined-cannot tell
Not recorded
of items recorded on a lesion
12
Dry tooth increases
sensativity
highest specificity test
visually
opaque white spots
carious lesion
good lighting increases
visual sensitivity
Tactile detection
resistance to catch of explorer, palpate for roughness
Disadvantages of tactile detection (3)
catch on healthy tooth
Too much force causing microfractures
May seed bacteria from one area to another
location of interproximal cavity
lesions develop under the interproximal contacts
Orthodontic separators allow for
better inter proximal vision
Radiographic sensitivity and specificity vs tactile and visual
lower, only shows deminerlization
Disadvantages of Radiographs (3)
radiation
does not show activity
extent of demineralization more extensive than shown on radiograph
How to determine activity of caries
serial radiographs needed
digital enhancement of radiographs (vs film)
not as good as film unless enhanced, does have lower levels of radiation
Subtraction radiography
two radiographs taken at two different times placed over one another, image is subtracted from the other, gives great contrast
Fiber Optic transillumination sensativity
very low
Digitally enhance fiber optic transillumination sensitivity and specificity
very high
DIAGNOdent (laser light flourescense) sens and spec
not better than visual
Qualitative light flourescence
very expensive, commercially available; mineral loss quantifiable
Electrical conductance
time consuming, fluids more conductive, enamel low in fluids and electrolytes, caries increases conductivity
Electrical impedance
opposite of conductance, resistance to flow of electrical current, carious tissue has lower impedance (conduct electricity better)
Ultrasound
works, not available, would eliminate radiaiton
evidence of caries arrestment is which level
Inactive
evidence of continued deminerlization is which level of caries
active
unable to provide evidence of arrestment or advancement is which level of caries
Undetermined
a full cavitation through enamel and the dentin is clinically exposed
Advanced caries lesion
deep deminerlization with possible surface microcavtations/shallow cavitation/dentin shadowing through enamel (50-88% of lesions likely to have histological dentin penetratioin)
moderate caries lesion
no clinically detectable lesion is which caries level
sound surface
earliest detectable lesion- usually remineralizable (0-50% may have histologic evidence of dentin penetration)
Initial caries lesion
initial caries lesion still considered cavitated?
No
