Dental Caries Flashcards
Painful teeth and early tooth loss due to caries have severe adverse consequences on a child’s…
nutrition, growth, body weight, systemic health, psychosocial development, quality of life.
Name 3 oral manifestations of (untreated) HIV
- Oropharyngeal candidiasis
- Necrotizing ulcerative periodontisis (gum disease)
- Hairy leukoplakia (if it comes back, may indicate inadequate medical control of HIV or inadequate adherence to therapy)
Define xerostomia
Dry mouth - not enough saliva to keep mouth wet
We are seeing more xerostomia than ever. Why?
Because life expectancy is increasing - people are living longer and xerostomia is very frequent in elderly populations.
How does xerostomia increase the risk of developing caries?
The absence of salivary calcium and phosphate doesn’t allow the process of natural re-mineralization to occur[iii] and your teeth aren’t protected anymore. This increases the risk of caries.
What are some common causes for xerostomia?
Diseases, medical treatments
Radiotherapy: Causes fibrosis of salivary glands, so less saliva will be produced
Medications: Very common cause of xerostomia
Drug addictions: Drug addicts will often crave sugar, have a poor diet, poor oral hygiene
Sjogren’s syndrome?
Autoimmune disease causing dry eyes and dry mouth (xerostomia)
Xerostomia is a risk factor for..
developing caries lesions
The burden of untreated caries is shifting from children to adults. What are the 3 peaks of prevalence (age)?
6 years
25 years
70 years
Name 2 reasons explaining the increasing global burden of untreated caries
a) population growth and increasing longevity
b) decrease in prevalence of total tooth loss
Collectively, Canadians have experienced a significant …. in levels of dental decay over the past 40 years.
a) increase
b) decrease
a) decrease
Definition: What is the dental caries process (tooth decay process)?
A dynamic, ubiquitous, life-long process which is initiated into the tooth biofilm and which can be controlled in a state of dynamic stability.
It is NOT a disease process so long as stability (homeostasis) is maintained.
Dental caries lesions result from… (name the process)
the dental caries DISEASE process
Definition: What is the dental caries disease process?
A shift or imbalance in the ecology and metabolic activity of the plaque biofilm which leads to chemical dissolution of the tooth surface.
The threshold to determine the presence of disease is important. Explain this statement using dental caries lesions as an example.
If you take the threshold as the cavitated disease stage, many caries lesions will not get diagnosed and you will underestimate the prevalence of the disease. This is important to keep in mind when reading papers.
Bacteria produce acid when metabolizing sugar. This leads to fluctuation of…
pH fluctuations in the dental plaque (this is constantly happening over time).
Summarize the ongoing natural dynamic caries process.
Sugar metabolism by bacteria produce acid into the dental plaque, causing pH fluctuations.
However, in normal circumstances, mineral loss is balanced with mineral gain over time.
Caries lesions develop when…
imbalance in the natural caries process, leading to caries disease process.
Pathological factors (3) vs protective factors (2) contributing to the caries process.
Pathological factors:
* Acid-producing bacteria
* Fermentable carbohydrates in diet
* Sub-normal saliva production (xerostomia)
Protective factors:
* Fluoride
* Normal saliva production
Describe the progression of caries lesions (if untreated)
Non-cavitated lesions will eventually become cavitated lesions if untreated.
Name the 3 main layers of a tooth
Outer: Enamel
Middle: Dentin
Core: Pulp
Clinical indicators of caries lesions (4)
- Lesion colour
- Lesion location/presence of dental plaque
- Lesion shape
- Tooth surface integrity
Caries lesions appear on tooth surfaces in places where…
dental plaque biofilm can stagnate for long periods of time
First change in colour indicating caries lesions
White spot lesion (sticky, white, chalky, matte plaque along the gum line): enamel is losing translucency due to demineralization process.
It usually forms a banana shape along the gum line.
Why do caries lesions turn yellow/brown?
The destruction of the tooth biofilm makes it porous, so food items (coffee, tea, other food pigments) get trapped in these pores, causing darker discoloration.
Are dark brown/black caries lesions worrisome?
No. If the lesions have turned dark brown/black, have a shiny luster, the lesions are arrested (will not progress or cause further damage).
What are extrinsic stains?
Extrinsic stains most commonly develop as a result of exposure to dark-coloured foods (coffee, tea, tobacco). They are superficial in nature (do not go any deeper than enamel) and are NOT localized to areas where dental plaque can stagnate (i.e. not just alongside the gums).
Most common caries lesion location and shape
Location: along the gumline
Shape: banana-shaped (arch-shaped)
If you want your patient to decrease or control their sugar intake in order to control their dental caries, what should you tell them?
Avoid having sugar in between meals and try replacing sugary snacks with nuts, fresh fruits, cheese.
Describe the diagnostic severity stages of caries lesions (D0-D4)
D0: subclinical initial lesions
D1: Enamel non-cavitated lesions
D2: Enamel cavitated lesions
D3: Dentinal lesions
D4: Pulp lesions
Describe the features of active dental caries lesions (4)
- Located in areas of plaque stagnation
- Rough/soft on gentle probing
- Loss of lustre
- Whitish/yellowish enamel
Describe the features of arrested dental caries lesions
- No dental plaque
- Located on some distance from gingiva
- Smooth/hard texture
- Shiny lustre
- Brown/dark brown/black or whitish
Define early childhood caries
Presence of one or more decayed teeth (noncavitated or cavitated lesions), loss of teeth due to caries, or filled tooth surfaces in affected teeth of a child under 6.
NEVER let young parents leave a baby sleeping with a milk bottle in the mouth.
Just know this info
When should oral hygiene measures be implemented for a child?
No later than the time of eruption of the first primary tooth.
How often should a child (or their parent) brush their teeth?
2 times per day, using a soft toothbrush of age-appropriate size.
When should a child visit the dentist for the first time?
No later than at 12 months of age.
How much toothpaste should a child use?
Under 2 years: rice-sized
Over 2 years: pea-sized
Diet recommendations to prevent caries lesions (for kids). (4)
- Minimize snacking on sugary foods in between meals.
- Avoid sugar-containing beverages (milk, juice) in baby bottles. Do not put a baby to sleep with sugary liquids in a bottle.
- On-demand breast-feeding should be avoided after the first primary tooth erupts.
- After first birthday, avoid bottles and encourage kids to drink from a cup.
Improper Invisalign hygiene is a risk factor for…
caries lesions and cavities
Name an alternative approach to treatment of cavities in children (faster and cheaper than tooth restoration).
Silver diamine fluoride
What is an effective treatment of tooth caries in the elderly and/or individuals unable to tolerate more extensive dental treatment?
Silver diamine fluoride
Caries have stages - they do not cause cavities at first (cavities = last stage of the disease)
BEFORE cavities develop: the disease is reversible!
After cavities develop: treatment requires surgery, drilling, tooth restoration
We want to avoid placing restorations on teeth, because they will eventually weaken the tooth; also, they do not last forever and will need to be replaced
Silver diamine fluoride treatment downsides
- Unpleasant metallic taste
- May irritate gingiva and mucosa
- Tooth surfaces to which it is applied may be stained black
