Diagnosis and management of early caries Flashcards
Describe dental caries
It is a preventable disease that can be stopped and reversed in early stages
How can dental caries affect someone qualify of life
Can affect: Eating Sleeping School attendance Loss of work
How many extractions did the NHS carry out in 2016
42,911
List some caries risk factors
- Diet
- Fluoride exposure
- Oral hygiene
- Saliva
- Habits
- Family caries
- Health
- dental attendance
How do we assess caries risk clinically
LOOK AT:
- Tooth surface
- Enamel quality
- Morphology
- Caries in adjacent teeth
- Presence of dental plaque
How do we clinically assess a tooth for caries
- Dry the tooth and look using reflected light
- Careful probing to feel surface texture with a blunt probe
- Transillumination
- Separation of teeth
State the different stages of a carious lesion
- Sound
- Dry Opacity- white, brown
- Wet opacity- white, brown
- Surface integrity loss
- Underlying grey shadows
- Distinct cavity
- Extensive cavity
Describe how an active lesion would present clinically
- White/yellow surface
- Enamel is opaque
- Rough to periodontal probe
- Covered in plaque
Describe how an inactive lesion would present clinically
- White brown black surface
- Enamel is shiny
- Smooth to periodontal probe
- No plaque
After assessing clinically what is the nest step to forming a diagnosis
Radiographs
Which score do we use to assess caries on teeth
ICDAS scores
How is the ICDAS score used
Scale of 0-6
Talk through what each score of the ICDAS scale relates to
0- sound
- first visual change in enamel
- Distinct visual change in enamel
- Localised enamel breakdown
- Underlying dentine shadow
- Distinct cavity with visible dentine
- Extensive cavity with visible dentine
How else can we diagnose caries other than clinically and radiographically
- Laser fluorescence
- Electrical impedance
- Caries activity tests
- Caries detection dyes
Name the difference categories we place management of caries in
- Preventative care
2. Operative care
What is the management technique dependent on
How far the caries has progressed
In terms of diet what things are we looking at
- Number of eating/ drinking occasions in 24 hours
- Frequency and amount of Risk foods
- Bedtime eating
- Dairy exposures each day
- Acid drinks
- Water
- If they snack and what on
- Fruit and veg intake
When talking to patients about diet advice what can we talk about?
- Explain how decay occurs
- Explain risks with sugary drinks
- Explain frequency of eating carbohydrates
- Advise use of diary foods for protection
- Avoid eating at bedtime especially after brushing teeth
What specific diet advice can we give all patients
- Avoid sipping drinks other than water
- Give your teeth a rest between meals (2 hours)
- Eat foods with protective factors
- Sugar free gum after meals
Why is fluoride good at preventing dental caries spread
- Slows down demineralisation
- Enhances remineralisation
- Interferes with bacterial metabolism
- Is incorporated in developing enamel
What advise do we give parents of children up to 3 years regarding fluoride tooth paste
Toothpaste with 1000ppm F-
Smear of toothpaste
Avoid swallowing toothpaste
Parents brush
What advise do we give parents of children 3-6 years regarding fluoride tooth paste
Toothpaste with 1350-1500ppm F-
Pea size toothpaste
Avoid swallowing toothpaste
Parents help with brushing
Other than fluoride toothpaste how else can we give fluoride to children
- Fluoride prophylaxis paste
- Fluoride varnish
- Fluoride mouthwash
- Silver diamine fluoride
- Fluoride containing sealants
How can we show parents and patients where the plaque is in the mouth
By using disclosing solution or tablets
What oral hygiene advice can we give patients and guardians
- Brush as soon as first teeth erupt
- Identify plaque with disclosing tablets
- Brush twice daily with fluoride toothpaste
- Advise appropriate brush
- Flossing
- Parents brush until child is around 7
Give examples of new research that may be used to treat and manage caries
- Probiotics
- Xylitol
- Casein Phosphate amorphous calcium phosphate tooth mousse
How can probiotics be delivered
- Milk
- Cheese
- ice cream
- Yogurt
- Tablets
How can we protect the fissures in permanent teeth
Fissure sealing
What can we use to fissure seal teeth
- Resin
2. Glass ionomer
Other than fissure sealants how else can we prevent caries
- Smooth surface sealing
2. Resin infiltration
What key things do we consider in early caries
- Accurate diagnosis
- Oral hygiene with florid
- Professional fluorides
- Diet advice
- Sealing and other new materials
- Patient motivation
- Regular monitoring
