CON-B Tutorial 2 - how caries detection/risk assessment leads to our diagnosis Flashcards
What can we see in the image?
On the lower right second molar, there is a white fissure sealant and tooth around it seems healthy.
On lower left second molar there is greyness in the fissure, suggesting caries or staining. Black suggests arrest of caries.
Calculus on lower central incisors
What is a fissure sealent is?
Fissure sealants are plastic coatings that are painted on to the grooves of the back teeth. The sealant forms a protective layer that keeps food and bacteria from getting stuck in the tiny grooves in the teeth and causing decay.
What can we see in this image?
-Chipped teeth
-Lateral incisor is chipped exposing dentine.
-Arrest of caries as she may be trying to reverse the demineralisation with fluoride toothpaste.
What are the 2 types of radiographs?
Bitewing and periapical (to see pulp)
What is demineralisation, how does it happen?
Low pH drives calcium and phosphate from tooth to biofilm resulting in demineralisation.
Occurs when:
-Eating frequency is high
-Local fluoride concentration is low
-Saliva buffering is poor
what does it mean by critical pH?
The critical pH level in your mouth is 5.5, as it is when the pH drops below this point, that your teeth start to demineralize or dissolve.
This is something you need to get to grips with, because it holds the keys to oral hygiene and not getting cavities.
What is the critical pH for enamel and dentine?
Enamel : 5.5
Dentine : 6.2
How are caries detected in the mouth?
By looking
By radiographs
How can remineralization occur?
When concentration of calcium and phosphate is supersaturated.
If there is sufficient
Saliva (buffering) + Fluoride + Low eating frequency + hygiene + natural protective factors = remineralisation
What are some questions to help us determine the caries risk status of a patient?
What colour is the lesion you can see?
Is the patient’s oral hygiene good or is there lots of plaque present?
What’s the patient doing if anything to keep their teeth clean?
Do they use a fluoride toothpaste?
Do they use a fluoride mouthwash?
Do they use floss or interdental brushes?
Do you think the patient has a normal amount of saliva or do they have a dry mouth?
Are there any medical relevant factors?
What is the patients view of their teeth?
How is their lifestyle and commitments?
How is the patient’s diet?
What is a diagnosis?
Diagnosis is the act of identifying a disease from its signs or symptoms.Without a diagnosis you cannot come up with a relevant care plan.
Why is caries diagnosis important?
To provide more preventive and non-invasive dental care, it is essential to detect carious lesions as early as possible, preferably when still within the enamel to increase the success chance of non-invasive and micro-invasive management.
What causes demineralisation?
Diet + Plaque = Plaque acids
Plaque may have a varying bacterial flora.
Carigenic bacteria include: Strep.Mutans, Strep.Sobrinus, Lactobacillius.
Plaque content varies with thickness.
Bacterial plaque + refined carbohydrate = demineralisation
Plaque can be retained in the tooth contact areas, restoration overhangs, over contured pits fissures and sticky foods.
Saliva + hygiene + fluoride + natural protective factors = remineralisation
salivia buffering , saliva flow, presence of fluoride and carbohydrate intake frequency will all influence plaque.
What does phosphoric acid do to enamel, where is it commonly found?
It etches enamel (37%), commonly found in soft drinks.
What is the mechanism for caries development? *
Hydroxyapatite = Ca10(PO4)6(OH)2
Hydroxyapatite is reactive is H+ ions at to below the critical pH for HA.
H+ ions react preferentially with the phosphate groups in an aqueous environment.
H+ + PO4 3- = HPO4 2- THIS ALSO RESULTS IN BUFFERING OF H+ IONS.
This results in demineralisation.
