Dentistry -- Dental Caries Flashcards
Correlation of poor oral health to 3 diseases
Higher incidence of:
- Diabetes
- CVD
- Pneumonia
What kind of disease do oral diseases share risk factors with?
Chronic diseases and conditions such as:
- Heart disease
- Cancer
- Stroke
- Diabetes
- Obesity
Prevalence of caries disease in Canada
- Canadian children and adolescents = ~60%
- Adults = 96%
The most common chronic disease of childhood
Dental caries (five times more prevalent than asthma)
Which groups of people have the highest rate of dental caries?
Children from disadvantaged communities and ethnic minorities
The single greatest risk factor of caries
Poverty
Define dental caries
A multifactorial, ubiquitous, life-long disease process, which is initiated into the tooth biofilm and leads to the formation of localized chemical dissolution of the tooth surface – caries lesion
Consequence of not producing enough saliva (xerostomia)
Increased risk for dental caries
What kinds of people most commonly experience xerostomia (dry mouth)
People who take mulitple medications (i.e. elderly, radiotherapy patients for oral cancer)
Effect of topical fluoride
Like a topical medication on the skin, applied to the teeth, it will slow down and stop the caries process
What part of one’s diet puts them at risk for dental caries
Refined carbohydrates
3 characteristics of dental plaque (tooth biofilm)
- A community of microorganisms with a collective physiology that is organized as a structure
- Forms by the growth of resident oral micro-flora
- Always metabolically active
How do bacteria form dental caries?
Bacteria metabolise fermentable sugars and produce acid into the dental plaque and the bacteria bury themselves a “hole” in your tooth for protection
Bacteria type mostly responsible for dental caries
Streptococcus mutans
pH that leads to tooth decay
pH ~5 and lower
Explain the state of acidity in the mouth
There are pH flutuations in dental plaque over time with a mineral loss and gain in enamel over time as well, so the formation of a caries lesion depends on if there is a net loss and net over-acidity in the mouth
3 Pathological factors in the caries disease process
- Acid producing bacteria
- Fermentable carbohydrates
- Insufficient saliva flow
2 protective factors in the caries disease process
- Fluoride
- Saliva flow and buffering capacity
Describe the general caries disease process
NOTE: Dental caries ARE NOT the “cavity” in the tooth
2 components of diagnosing caries disease and their sub-components
3 components of planning the treatment for dental caries
- Caries risk reduction
- Active lesions treatment
- Review (recall) and monitoring
What is the problem with the caries lesion cavitating through the enamel to the dentin?
Direct connection with blood and nerve in the pulp and faster progression of decay
4 stages of caries lesions
4 clinical indicators of carious lesions
- Lesion colour
- Lesion location/presence of dental plaque
- Lesion shape
- Tooth surface integrity
3 different colors of caries lesions
- White opaque
- Yellow/brownish
- Dark brown/black
Define a white spot lesion
The initial caries lesion characterized by mineral loss at the tooth surface and modification of enamel translucency
Describe the appearance of white spot lesions
- Loss of luster
- Matte
- Porous
- Often seen on anterior teeth of kids and adolescents, covered in plaque
What does it mean when a white spot lesion is farther from the gingival line?
- Arrested lesion = no longer active
- Occurred during tooth emergence
Why are some caries lesions yellow or brownish?
- Color due to dietary pigments (enamel lesion)
- Dentin lesion is naturally darker since dentin is darker than enamel (bottom pic)
Why are some caries lesions dark brown/black
Lesions that are likely arrested (less worrisome, no need for treatment; like a scar)
Define extrinsic staining
Stains throughout the mouth, but not necessarily on plaque stagnation surfaces (not caries)
7 plaque stagnation areas
- Along gingiva
- Under contact point
- Occlusal/buccal/lingual pits or fissures
- Roots (mostly in elderly people)
- Associated with partial dentures
- Along restorations (if not flush to tooth)
- Cavitated carious lesions
4 characteristics of active caries lesions
- On plaque stagnation areas
- Rough/soft (i.e.dentin) on gentle probing
- Loss of lustre
- Color = whitish/yellowish
5 characteristics of arrested caries lesions
- No dental plaque
- Located on some distance from gingiva
- Tecture = smooth/hard
- Lucter = shiny
- Color = brown/dark brown/ whitish
Define early childhood caries
The presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a child under the age of six
How common are early childhood caries?
- Most prevalent pediatric infectious disease
- The most common chronic disease of children
Prevalence of ECC in aboriginal children in Canada
66% to 98% have severe forms of ECC
3 biological risk factors for ECC
- Transmission of infectious bacteria from moth/caregiver to child
- Diet (exposure to fermentable carbohydrates)
- Susceptible tooth (newly erupted teeth, low level of fluoride, hypoplasia)
6 influences for the development of ECC
- Poverty (single greatest risk factor)
- Household crowding
- Family size
- Health behaviors
- Health parenting practices
- Parent’s oral health status
2 risky health parenting practices for the development of ECC
- Proonged use of the bottle or taining cups with sugar-containing drinks
- High frequency of sugary snacks per day
5 policies on the prevention of ECC
- Improving the oral health of parents in order to decrease the transmission of cariogenic bacteria to the child
- Minimizing saliva-sharing activites (i.e. sharing utensils) to decrease transmission
- Implementing oral hygiene measures no later then the time of eruption of the first primary tooth
- Tooth brushing should be performed for children by a parent twice daily, using a soft toothbrush of age-appropriate size
- Visiting a dentist no later than 12 months of age
How to apply toothpaste for a cihld under 2 years
Smear
How to apply toothpaste for a child over 2 years old
Pea-sized
4 diet-specific policies on the prevention of ECC
- Avoid high freq. consumption of liquids and/or solid food containing sugar. In particular, sugar-containing beverages in a baby bottle or no-spill training cup should be avoided (i.e. juices, soft drinks, milk)
- Infants should not be put to sleep with a bottle filled with milk or liquids containing sugar
- On demand breast-feeding should be avoided after the first primary tooth begins to erupt and other dietary carbohydrates are introduced
- Parents should be encourages to have infants drink from a cup as they approach their first birthday and cut the use of a bottle
6 risky states of your patients that you should be aware of
- Detection of caries lesions
- Readily visible plaque
- Patient is eating between-meal snacks (including juices and soft drinks)
- Patient is not using fluoride toothpaste twice a day
- Patient is not likely to visit the dentist
- Patient is pregnant (more for parenting advice)
