Cariology (Exam I) Flashcards
What are the 5 guiding principles of caries management?
1) Assess caries risk status
2) Diagnose disease early
3) Treat disease by remineralizing tooth surface & controlling infection
4) Avoid or delay operative intervention
5) Restore “active” disease ONLY
(Note: ADT-AR)
1908- GV Black ?
- 1908 developed caries pathology prevention and appropriate restorative dentistry protocols
- Still used in many dental schools today
What events occurs in the 1940s-1950s?
- Rampant and recurrent carries lead to development of operative dentistry
- Role of diet and bacteria lead to development of the study of cardiology
- Effects of fluoride lead to development of public health dentistry
What occurred in 2007 pertaining to Dental Caries?
Dental caries philosophy changes
The disease and its clinical management
CAMBRA: Caries Management By Risk Assessment
What is the Dental Caries 1970’s view?
- Bacterial disease
- Dependent on presence of sugars and carbohydrates
What is the Dental Caries 1990’s view?
- Involves these 4 factors: Microbe, Host& Teeth, Substrate & Time.
- Bacterial disease
- Dependent on presence of sugars and carbohydrates
- Modified by salivary flow & composition
- Modified by fluoride
- Dental caries is a complex multi-factorial disease process
What are other factors that can affect Today’s complete view?
- Education
- Social Class
- Income
- Knowledge
- Attitude
- Behavior
Describe Dental Enamel
1) Highly mineralized acellular tissue
- Consists of calcium phosphate crystals
- 99% dry weight
- Crystals resemble the mineral hydroxyapatite
2) Solubility of hydroxyapatite affected by pH
What 2 types of lesions can exposure of Enamel to Acids lead to?
1) Carious lesions
2) Erosion
What are Caries?
- Can remineralize
- Chemical dissolution of the dental hard tissues by acidic bacterial products from degradation of low molecular wt sugars
What is Erosion?
- CANNOT remineralize
- Dissolution of the dental hard tissues caused by acids of any other origin or mechanical wear
What is Remineralization?
1) Partially demineralized apatite crystals can grow to their original size (especially in the presence of fluoride)
2) Formation of entirely new crystals is rare
3) If goal is to remineralize removal of intact surface layer is NOT advisable
Note: Can’t develop new crystals from scratch
Dental caries is a disease that….?
-In absence of treatment what occurs?
- Chronic disease that progresses very slowly in most individuals
- In the absence of “treatment” will progress until the tooth is destroyed
What are the Enamel Reactions During Eruption?
1) Erupting tooth
-Enamel is FULLY mineralized
-Outermost surface layer is porous and low in fluoride
Note: Immature enamel is more prone to decay, overtime it becomes resistant to decay.
2) If fluoride is present in the oral fluids
-Gradual increase in fluoride in surface enamel
-“Secondary maturation”
Note: Adding fluoride to water systems, that adds an additional benefit.
For an Experimental caries model in completely UNDISTURBED plaque, what happens visually & histologically from week 1, 2 & 4?
After 1 week-
Visual: none
Histological: slight increase in enamel porosity
After 2 weeks
Visual: Whitish changes with air-drying
Histological: Subsurface lesion starts to form
After 4 weeks
Visual: White spot lesion with chalky surface
Histological: Enlarged inter-crystalline spaces
Note: Caries lesion starts below surface–>we can still remineralize
What happens when plaque is REMOVED after 1 and 2 weeks?
After 1 week:
Visual: Chalky appearance diminishes
After 2 weeks:
Visual: Surface has a shiny appearance of normal enamel
Note: This occurs because it becomes remineralized from saliva which contains the proteins. There is a balance of remineralization and mineralization going on.
Lesions can be classified as ?
1) Non-cavitated; demineralization with surface enamel STILL INTACT
2) Cavitated; demineralization with a BREAK in the surface enamel ( need to use a tool to restore)
Which Caries Classification D1-D4 is Cavitated vs Non-cavitated?
D1-D3 Non-cavitated
D3-D4 cavitated
What is D0 Caries?
- Lesion detectable only w/ additional diagnostic aids & Sub-clinical lesions in a dynamic state of progression/regression
- Sub-clinical lesions in a dynamic state of progression/regression (white spot lesions after 2 wks)
What are D1 Caries?
Clinically detectable enamel lesion w/ INTACT surface
caries reaches outer-half of enamel
What are D2 Caries?
Clinically detectable cavitation LIMITED to ENAMEL
What are D3 Caries?
Clinically detectable lesion in dentin (Caries on outer half of the dentin)
What are D4 Caries?
Lesion into pulp
Caries on inner half of dentin
What is the relationship between the Host and Teeth?
It has been estimated that the human body is composed of approximately 1014 cells, of which only 10% are mammalian. The remainder are the organisms that comprise resident microflora of the host.