DPH Handout - MI Dentistry Flashcards
(FDI) 5 underlying factors for minimal intervention in dental caries management
- modifying oral flora
- educating patients
- remineralizing non-cavitated lesions of enamel and dentin
- undertaking minimal operative intervention of cavitated lesions
- repairing defective restorations
MI dentistry definition
minimal intervention dentistry
2 sides of MI dentistry
- maximal interception of disease
- minimal invasion
earlier concepts of MI
“microdentistry”, “smaller cavity preparations”
(November 2009) definition of MI
- philosophy for whole of life management of oral environment
- comprehensive, personalized approach to diagnosis and management of oral disease and the factors which influence those diseases
- means for empowering patient with knowledge and skills to reduce their ongoing burden of disease
ICDAS
International Caries Detection and Assessment System
the ‘D’ in ICDAS stands for
detection of dental caries according to:
1. stage of carious process
2. topography of lesion
3. anatomy
4. restoration or sealant status
ICDAS: topography of lesion
pit-and-fissure vs smooth surfaces
ICDAS: anatomy
crown vs roots
the ‘A’ in ICDAS stands for
assessment of caries process by:
1. stage
2. activity
ICDAS: stage
non-cavitated vs cavitated
ICDAS: activity
active vs arrested
ICDAS: 6 stages in the carious process
Code 0 = sound
Code 1 = first visual change in enamel
Code 2 = distinct visual change in enamel
Code 3 = localized enamel breakdown
Code 4 = underlying dark shadow from dentin
Code 5 = distinct cavity with visible dentin
Code 6 = extensive distinct cavity with visible dentin
ICDAS: Code 0
sound tooth
ICDAS: Code 1
first visual change in enamel (seen after prolonged air drying)
ICDAS: Code 2
distinct visual change in enamel
ICDAS: Code 3
localized enamel breakdown
ICDAS: Code 4
underlying dark shadow from dentin
ICDAS: Code 5
distinct cavity with visible dentin
ICDAS: Code 6
extensive distinct cavity with visible dentin
ICDAS: targets for modern remineralizing therapies
Code 1-3
focus of minimal intervention dentistry philosophy
- disease prevention
- diagnosis at earliest timepoint
levels of prevention: primary
prevent initiation of disease by addressing causal factors
levels of prevention: secondary
find disease early and arrest its progression
levels of prevention: tertiary
limit disability; repair diseased tissue and replace lost, missing or diseased tissue
primary prevention: dental caries
- mechanical plaque control
- diet modification
- lifestyle changes
- systemic and topical fluorides
- chlorhexidine
- xylitol and sugar substitutes
- sealants
- pH elevation using bicarbonate
- culture-based tests for cariogenic bacteria
secondary prevention: dental caries
- clinical examination for dental caries (blunt probes, magnification)
- intra-oral cameras
- bitewing radiographs
- drying teeth to identify early carious lesions (ICDAS)
tertiary prevention: dental caries
- tooth restoration
- atraumatic restorative technique, air abrasion, chemomechanical caries removal, lasers, ultrasonics, and micro-preparation burs
- ozone
- photo-activated disinfection
primary prevention: dental erosion
- dentally safe drinks
- diet modification
- lifestyle changes
- fluoride
- recaldent
secondary prevention: dental erosion
- clinical assessment of erosive tooth wear and sensitivity related to dental erosion
- in-office and at-home application of remineralizing and desensitizing agents
tertiary prevention: dental erosion
- tooth restoration with conservative adhesive
- intracoronal or extracoronal restorations
sample methods for modifying dental plaque biofilm
- Recaldent
- xylitol
- chlorhexidine
- pH elevation using urea or bicarbonate
enhancements to conventional radiography
- automated image analysis
- subtraction radiography
- use of contrast media to enhance detection of proximal cavitations
current & emerging technologies - primary prevention: dental caries
- tooth surface protection
- plaque fermentation tests
- salivary tests for physico-chemical properties
- salivary tests for cariogenic bacteria
- Recaldent
- light-activated fluoride
- biofilm modification using ecological therapies
current & emerging technologies - secondary prevention: dental caries
- subtraction radiography
- digital image analysis
- contrast-enhanced radiography for proximal cavitations
- light-induced fluorescence (QLF) assessment of surface mineral changes
- laser fluorescence detection of incipient and occult occlusal and proximal lesions
- fiber optical transillumination
- optical coherence tomography
- impedance detection of mineral loss
- biologically active tooth coatings
- internal remineraliation
- lesion reversal using Recaldent
current & emerging technologies - primary prevention: dental erosion
- saliva testing
- modification of erosive foods and drinks
- therapeutic sugar-free chewing gums
- light-activated fluoride treatments
- surface-coatings of teeth to increase acid resistance using adhesive resin or laser deposited or laser-sintered technologies
current & emerging technologies - secondary prevention: dental erosion
- physical methods for assessing tooth wear and mineral loss at chairside (i.e. smart sensor coatings indicating mineral loss or gain)
- light-induced fluorescence (QLF) assessment of surface mineral changes
- rapidly acting desensitizing and remineralizing agents
- sacrificial surface coatings for at risk tooth surfaces
natural progression of proximal caries
- molar and premolar regions
- maxillary anterior teeth
- mandibular anterior teeth
can be used to track mineral loss and mineral gain
light-induced fluorescence
methods of digitally enhanced optical imaging
- digitally enhanced fiber optical transillumination (DiFOTI)
- optical coherence tomography (OCT)
chemical conversion of apatities to fluoroapatites if fluoride is present at the same time as laser or other intense light is applied
photonic conversion
combined with Recaldent in more recent developments for rapid reversal of white spot of lesions
fluoride
