Dental caries & PRR

Question 1

Caries lesions

Answer 1

An infectious microbiological disease that results in localized dissolution / destruction of calcified tissues of the teeth.

Question 2

E0-2, D1-3 labeled

Answer 2

E0: no lesion
E1: outer 1/2 of enamel
E2: inner 1/2 of enamel
D1: outer 1/3 of dentin
D2: middle 1/3 of dentin
D3: inner 1/3 of dentin

Question 3

Root surface lesions facts

Answer 3

Begins directly on cementum/dentin
Typically with recessed gingiva
Pot-hole (saucer-shaped)

Question 4

Recurrent lesions definition and causes

Answer 4

Type of caries that is observed around the edges / under restoration

Causes: Poor oral health care, restoration with poor margins

Question 5

Invasive bacteria into dentin

Answer 5

Mutans S. facilitates (enamel)

Lactobacillus propagates (dentin)

Question 6

Primary / Secondary Dentin

Answer 6

Primary: Forms primary shape of tooth. Initial formation occurs

Secondary: Next to pulp. Lifelong.

Question 7

Types of altered Dentin:

Sclerotic Dentin

Tertiary Dentin

Answer 7

Sclerotic Dentin: occurs as a result of caries / normal aging process. Dark / harder than normal dentin.

Tertiary Dentin: Laid down in response to attrition, caries, or restorative dental procedure. Not as hard as primary dentin. protects pulp (reactionary dentin, reparative dentin)

Question 8

Control of non-cavitated lesions

Answer 8

E1, E2
Remineralization
- fluoride application
- MI paste (recaldent)
- calcium + phosphate
CHX
Xylitol gum
Diet modification
Routine check-ups

Question 9

Control of cavitated lesions

Answer 9

Surgical removal of decay / weak structures.

Restored with material of choice: amalgam, composite, glass ionomer

Quality of restorations = factor for long term health / prevention of recurrent decay.

Question 10

Caries management in fissured surfaces

Answer 10

no caries / arrested caries : no treatment if caries risk low.
sealent if moderate/high caries risk

suspected but no evidence of caries: high caries risk = sealant

Obvious cavitation or radiographic evidence : restoration

Question 11

Indications for caries

Answer 11

Tooth can be isolated
Minimal catch in grooves / area of distinct incipient enamel caries
surrounding grooves unaffected
occlusal contacts on sound tooth structures

Question 12

Type A

Answer 12

Caries = incipient / limited to enamel.

No radiographic findings, not possible to remineralize.

Cur # 201.3 / 330, also #1/4 round burs

Question 13

Type B

Answer 13

Caries extend minimally into dentin & is small / confined

Bur #330 / 201.3

Question 14

Procedure:

Answer 14

Remove lesion using small diamond burs (201.3 D / 330 D)
Remove unsupported enamel
Clean surrounding grooves
Ultra Etch 20 sec
Rinse
2 layers scotchbond universal 20 sec
air thin 5 sec
light cure 10 sec
Permaflo in shallow areas 0.5mm / Filtek Supreme and Sealants in deep areas 1 mm.
20 sec light cure
polish
check occlusion (too high too low)

Question 15

Infected Dentin facts

Answer 15

Superficial Layer
Soft consistency
Highly infected by Bacteria
Irreversible degradation of Collagen fiber
No remineralization
Stained by caries detector
Must be removed
Light yellow to orange in color

Question 16

Affected Dentin facts

Answer 16

Below the superficial infected layer
Hard and leathery consistency
No bacteria. Only Toxin penetration
Collagen still intact, partial demineralization
Can be remineralized
Cannot be stained by caries detector dye
Can be preserved
Yellow brown in color

Question 17

Pulpal necrosis

Answer 17

Result of severe irritation

Infection, death of pulp, abscess

Question 18

Detection of caries:

Answer 18

Pit and fissure: visual, tactile

Proximal surfaces: radiographs, visual

Facial and lingual surfaces: Visual, tactile with explorer

Recurrent lesions: Visual, tactile, and radiographs

Question 19

Paradigm

Answer 19

Surgical model

Medical model
- prevention / remineralizatior