Chapter 25 Flashcards
What are dental caries?
Dental caries is a biofilm-mediated, diet- moduläted, multifactorial, noncommunicable, dynamic disease resulting in a net mineral loss of the hard tissues.
___bacteria produce acid as a result of metabolizing fermentable carbohydrates consumed by the individual.
Acidogenic and aciduric
When acidogenic and aciduric bacteria predominate the oral flora, the risk for dental caries increases or decreases?
increases
What are the of bacteria predominate in the caries process?
The mutans streptococci (Streptococcus mutans and Streptococcus sobrinus are two most prevalent bacteria in the group)
Lactobacillus
Actinomyces and non-Actinomyces species
Bifidobacteria (associated with early childhood caries)
Mutans streptococci are infectious organisms that colonize the teeth and help to form the dental biofilm because they___
create a sticky environment for survival and multiplication
Mutans streptococci and
Bifidobacteria are most active during the___ of demineralization and caries formation.
initial stages
lactobacilli are more active during the__ of the caries.
progression
_____of fermentable carbohydrates enhance the amount of biofilm and acid produced and results in increased demineralization.
Frequency and form
What effects does acid have on the teeth?
The acid formed passes freely into the tiny diffusion channels between the enamel rods or into the exposed root surfaces.
• Acids can dissolve the enamel crystals into calcium and phosphate ions.
• The subsurface initial carious lesion is formed and appears clinically as a white spot lesion.
_____is the process by which the minerals of the tooth structure are dissolved into solution by organic acids produced from acidogenic bacteria that metabolize fermentable carbohydrates.
Demineralization
With_____, the tooth demineralization can outpace the remineralization process. The end product of this activity is the cavitated carious lesion.
repeated bathing of the tooth surface with the acids
____is the natural repair process of moving minerals back into the subsurface of the intact enamel.
Remineralization
Function of saliva:
provides protective factors to promote remineralization like buffering of acids and clearance of bacteria and food debris and supplying minerals to replace calcium and phosphate ions dissolved from the tooth during demineralization.
____reduces buffering capacity and aids in the demineralization process.
Low saliva flow (hyposalivation or xerostomia)
Maintaining a neutral or basic saliva pH of____ is necessary to maximize remineralization.
7
After an exposure to fermentable carbohydrate, the pH drops to the critical pH of____, at which point demineralization occurs.
5.5
Exposure to topical fluoride can increase____
available salivary levels of fluoride.
Saliva is a reservoir for fluoride to aid in___.
remineralization
Fluoride accumulation in saliva comes from many sources, including____
water, dentifrice, mouthrinse, and professionally applied therapies.
What is the function of fluoride in saliva?
Inhibits demineralization
Enhances remineralization
Inhibits bacterial growth; In the biofilm, the HF diffuses through the cell membrane of acidogenic bacteria. Fluoride ions interfere with the essential enzyme activity within the bacterial cell wall.
The stages when caries development is still reversible is:
ICCMS Initial Stage Caries or CCS
Initial Caries Lesion when there is no cavitation of the lesion
The stages when caries development is irreversible is:
ICCMS Moderate Stage Caries or
CCS Moderate Caries Lesion where there is cavitation of the enamel.
ICCMS Extensive Stage Caries or
CCS Advanced Caries Lesion where the lesion extends into the dentin.
___is commonly used to assess the risk fäctors for disease so that individualized
prevention and management plans can be developed and implemented.
Risk assessment
___is an essential component in the decision-making process for patient-centered caries management.
Caries risk assessment (CRA)
___can be defined as the clinical process of establishing the probability of a patient to develop new caries lesions or the likelihood of a change to the size or activity of lesions already present over a certain period of time.
CRA
Risk factors fall into two categories:
• Modifiable risk factors.
• Nonmodifiable risk factors.
This CRA has assessment forms for age 0-6 years and those older than age 6 years.
Ada caries risk assessment
The ADA caries risk assessment includes the following factors:
Contributing conditions
General health conditions
Clinical conditions
Risk levels for the ADAs CRA include
low, moderate, and high risk.
The AAPD CAT is for
infants, children, and adolescents.
• 0-3-year-olds for nondental providers such as physicians.
• 0-5-year-olds for dental providers.
• Older than 6-year-olds for dental providers.
The AAPD CAT assessment includes the following factors:
• Biologic factors
• Protective factors
• Clinical findings
Risk levels of the AAPD CAT include:
• Low and high for the nondental providers.
• Low, moderate, and high for dental providers.
What is a cariogram?
The Cariogram is a visual representation of the interaction of caries with various etiologic factors to predict future risk.
The cariogram assessment includes
Bacteria
Diet
Susceptibility
Circumstances
Risk is displayed as a pie chart and the percentage of chance to avoid new caries is displayed, as well as the contribution of each of the factors on the risk of new caries.
Cariogram
what does CAMBRA stand for?
Caries management by risk assessment
CAMBRA has assessment forms for ages
0-5 years and those age 6 years through adult.
The CAMBRA includes the following categories of factors for ages 6 years through adult:
• Disease indicators (clinical examination)
• Biologic risk factors
• Biologic or environmental risk factors
• Protective factors
The risk levels for CAMBRA are
Low, moderate and high or extreme
The ICCMS assessment includes the following factors:
Medical history
Head and neck radiation.
Sugary foods and beverages.
Low fluoride exposure.
Primary caregiver caries experience.
Oral hygiene behaviors and heavy plaque biofilm.
Socioeconomic status.
Caries experience and presence of active carious lesions.
Exposed root surfaces.
Oral appliances such as orthodontic retainers and partial dentures.
The risk levels of the ICCMS are
Low-, medium-, high-risk
During review of the medical, dental, and psychosocial history, identify risk factors for caries such as
medical conditions or medications that cause xerostomia
After reviewing medical, dental and psychosocial history for risk factors for caries, complete the portion of the risk assessment related to
the medical, dental , and psychosocial history
For some assessment, bacteria, possible present caries and saliva need to be assessed. To do this the ____examinations are used
radiographic and clinical
Once the risk assessment is complete, using clinical judgment and the results of the risk assessment, the clinician needs to___
identify risk level and which risk factors are modifiable.
The____ risk factors are the ones to target for management when developing the care
(treatment) plan to reduce the risk of caries progression or development.
modifiable
The protocol is based on evidence-based literature and judgment of an expert panel.
The protocol is based on risk and takes into account the level of patient/parent cooperation.
AAPD Caries Risk Management
The management protocol is based on risk level and clinical judgment of the clinician.
CAMBRA
The CAMBRA recommendations are based on available evidence and were developed by
consensus of the Western
CAMBRA Coalition.
based on extensive critical analyses of the literature and consensus from a global group of experts. It is a systematic guide for the critical decisions clinicians need to make to develop a management plan based on caries risk.
The International Caries Detection and Assessment System (ICDAS) and
ICCMS systems
The ICCMS, CAMBRA and APD protocols vary by risk level and may include the following in the prevention and arrestment of caries:
• Diagnostics recommendations
• Interventions recommendations
• Restorative recommendations
When planning care for the patients caries risk level, the dental hygienist is challenged to select ____to meet the needs of each individual patient.
a caries management strategy
The care plan will not only need to provide for treatment of existing nonreversible carious lesions, but also provide a____
framework for changes in personal care previously unrecognized by the patient to prevent development of new lesions.
A plan for care in caries management is individualized depending on the
disease risk level, physical and cognitive abilities, and patient or parent desire to change.
What is the planning of care for a low caries risk patient?
• Primary prevention
• Provide the patient with positive feedback and education
• Review with the patient the existing habits that categorize them at low caries risk
• Recommend routine continuing care appointments.
What is the planning of care for a moderate caries risk patient?
• Provide the patient with positive feedback and support for the protective factors they currently exhibit.
• Motivational interviewing
• Work with the patient to plan strategies to reduce risk factors
• Increase protective factors
• Discuss addition of caries-preventive foods to diet
• Recommend appropriate continuing care schedule.
What is the planning of care for a high caries risk patient?
• Improved biofilm removal.
• Dietary counseling to reduce intake of fermentable carbohydrates.
• Initial one to three fluoride varnish application followed by application once every 3 months.
• Diamine fluoride application may also be indicated for early lesions to prevent progression.
The patient at high risk for caries displays
active carious lesions, has a recent history of restoration to repair carious lesions, or may have medications or systemic factors that cause severe dry mouth (patients who are at high risk and also suffer from dry mouth are categorized as extreme risk).
Continuing care appointments after caries risk assessment should include the following:
• Biofilm control assessment: Use disclosing agent and record the biofilm score. Address oral self-care issues.
• Reassess caries risk.
• Clinical detection for demineralization areas, need for sealants, and poor margins on restorations.
• Radiographs prescribed as indicated by level of risk and clinical findings.
• Assess patient compliance with caries management recommendations.
• Determine changes needed in caries management protocol.
