Cariology Sem 2

Question 1

Detail the non-specific microbiological approaches to preventing caries:
Small molecules

Answer 1

• The oral microbiota manufactures a massive array of small molecules
• Some of which are correlated with health and are likely to antagonise pathogens
• 3F1 selectively dispersedS. mutansbiofilms and served to modestly reduce caries in rodent model

Question 2

Understand the biological effect of plaque control

Understand the clinical effect of plaque control

Understand the effect of professional on plaque control

Answer 2

Biological effect: you cannot make a tooth surface 100% free of bacteria

Clinical effect: toothbrushing with fluoride is effective

Professional effect: is only effective when patient looks after their responsibilities

Question 3

What are challenges involved in the remineralisation of caries?

Answer 3

1. Presence of high density surface layer: the surface layer of enamel carries acts like a dense barrier
2. Surface precipitation: Putting in more minerals on top reduces permeability of the surface layer and causes rapid reduction in mineral ion gradient
3. Lack of concentration gradient: the concentration gradient of the remineralising minerals between inside and outside of the lesion is usually not enough to transport the necessary minerals deep into the lesion
4. Remineralising within the hierarchy of enamel: Remineralisation can only happen if the framework of the rod and interrod units/ crystals are preserved

Question 4

Explain fluoride gels and varnish

Answer 4

Gels:
• NEUTRAL NaF gel: 9000 ppm F, used for enamel erosion, exposed dentine, carious dentine, hypomineralization, preferred where restorations of GI cement, composite resin or porcelain
• Stannous fluoride gel (0.4%): used for remineralization of white spot and hypomineralized enamel, root caries. Stannous ion may cause discoloration of teeth stain margins of fillings

Varnish:
• Duraphat: 22,600ppm FL (22.6%)
• Only used for high risk caries, including children under age 10 years

Question 5

Describe the clinical considerations before choosing materials that are to be used for the placement of fissure protections.

Answer 5

GIC:
• Chemical adhesion : via an ion exchange layer
• Moisture control is necessary but “desiccation” is not essential
• Less technique sensitive
• Fluoride release ( depending on the type of GIC ) and re-uptake to adjacent surfaces

Resin-based materials
• Can be filled or unfilled, thus it affects retention considerations
• Micro-mechanical adhesion
• Moisture control is absolutely necessary (i.e Rubber dam)
• Technique sensitive
• Possible Fluoride release (depending on the type of resin material) or no Fluoride re-uptake
• Longevity

Question 6

Define:
Caries risk marker

Caries risk factor

Answer 6

Caries risk marker:
Sign that disease is there

Caries risk factor:
Factors that contribute to the level of risk

Question 7

What are four things involved in assessing the patient and the lesion?

Answer 7

Plaque:

• assess their toothbrushing style
• API scores

Lesion

• Bitewings
• Separators
• Cavitations
• Caries markers and risk factors

Saliva:

• LS and MS counts
• Reasons for hyposalivation
• Monitors saliva flow and PH

Diet:
* Frequency and timing

Question 8

What is involved in managing and monitoring the patient?

Answer 8

We must empower the patient to take control by providing them education and training in self care.
With patient visits, we must routinely check things like current diet, toothbrushing and plaque index. In addition, we should take radiographs and check for lesions/ progressions.

Question 9

What are involved in

• 6 monthly visit
• 12 monthly visit

Answer 9

6 monthly:

• Check toothbrushing
• API/SBI
• Radiographs
• Separators for lesion changes

12 monthly:

• Persuading patient to establish a life- long collaboration with dental team
• Check up on home care