Diagnosis and Tx Planning Flashcards
methods of clinical examination of caries
Visual examination for changes in tooth surface texture and/or color. This must be conducted in a dry, well-illuminated field, as moisture and poor lighting can make it difficult to detect irregularities.
Tactile examination requires field isolation, by placing cotton rolls along the oral vestibules and removing excess saliva. It is conducted in conjunction with the visual exam, by careful use of an explorer.
Radiographs are valuable, as they help with diagnosis of lesions which may not be accessible for visual-tactile examination.
Transillumination is when a bright light is shined through anterior tooth junctions. The detection of shadows can indicate interproximal decay.
How is an explorer used during the clinical examination of caries detection?
Previously, the explorer was utilized to detect any stickiness or softness of the enamel.
However, recent findings support careful examination, as the sharp end can:
- Introduce a cavitation by accident
- Transfer cariogenic bacteria from infected to non-infected areas
- Provide false positives when the explorer catches on pits and fissures
The tooth must undergo ______% mineral loss for radiographic detection.
30-40%
radiographs often utilized for anterior and posterior caries detection respectively
periapical and bitewing radiographs
Transillumination can also be used to differentiate between __________ and __________.
craze lines and fracture
*Fractures will block the light, while craze lines will allow light to pass through the tooth.
Visual examinations for amalgam restorations include the following:
- detection of blueish hues (corrosion products may leach into dentinal tubules, or underlying enamel may be seen through translucent enamel)
- marginal gaps and/or ditching (>0.5mm)
- gaps or ditching under 0.5mm are not considered defective due to the self-sealing properties of amalgam, major gaps or ditching are considered carious or carious-prone and must be repaired
- proximal and/or marginal overhangs
- voids and/or fracture lines must be monitored
chemical loss of tooth structure caused by acidic foods/beverages or gastric acid, WITHOUT bacterial involvement
erosion
often presents as bowl shaped ditching of cusp tips on posterior teeth, known as cupping –> this can result in restorations appearing higher than the tooth structure
erosion
pathological loss of tooth structure by mechanical wear, induced by opposing natural tooth structure
attrition
may be induced by a combination of tooth flexure, toothpaste abrasion, and chemical erosion
attrition
pathological loss of tooth structure by mechanical wear, induced by external materials
abrasion
most common cause of abrasion
porcelain or ceramic crowns of the opposing teeth
loss of tooth structure in cervical regions
abfraction
can happen when the dentinal tubules on the root surfaces become exposed
hypersensitivity
hypothesizes that dentinal fluid movement activates mechanoreceptors located in pre-dentin to cause pain
The Hydrodynamic Theory
explanation of root surface hypersensitivity (The Hydrodynamic Theory)
Dentinal tubules are filled with fluid and odontoblastic processes containing mechanoreceptors. Exposure of these tubules, temperature change, and osmotic pressure changes may result in fluid shifts, which can activate the nerve endings and result in sensitivity.
an effective product used in occluding dentinal tubules, preventing manipulation of dentinal fluid, and consequently reducing sensitivity
GLUMA
_______ surfaces are especially susceptible to sensitivity, due to the fast wearing of the thin cementum layer.
Root
treatment plan concept that states the patient need dictates the order of phases of operative treatment planning
greatest need treatment planning
Which sequence in the greatest need treatment planning is this? addresses the patient’s acute oral health needs such as from emergencies like infections, swelling, and high pain
urgent phase
Treatment in the urgent phase may include:
placing a temporary restoration, endodontics, and extractions
Which sequence in the greatest need treatment planning is this? includes controlling oral diseases, by eradicating active signs of the disease and managing the risk factors contributing to the disease
control phase
Which sequence in the greatest need treatment planning is this? monitoring patient improvement and ensuring there is no active disease
re-evaluation phase
Which sequence in the greatest need treatment planning is this? includes reforming the patient’s oral condition by establishing ideal function and esthetics
definitive phase (treatment may include orthodntics, prosthodontics)
