Early Carious Lesions Flashcards
What are the aims for early carious lesions? (5)
- Prevent new lesions
- Prevent lesion progression (+ encourage lesion regression)
- Seal lesions
- Infiltrate lesions
- Fill lesions
What are risk factors for caries? (7)
- Diet (frequency and especially fermentable carbs)
- F- exposure
- OHI
- Saliva (flow rate/medications reducing salivary flow)
- Habits (bedtime eating/drinking/sipper bottles)
- Family caries
- Health (sugary medications)
- dental attendance (access to dentist)
What are the clinical risk factors for caries?
- tooth surface (smooth/fissures/interproximal) - each surface has a diff risk level
- enamel quality (normal/hypomineralised) - hypomineralised not risk in itself for caries BUT if carious it will progress > as enamel not as mineralised
- morphology (fissures)
- presence of dental plaque
How do you clinically examine for caries?
- teeth need to be dry
- ideally examined after plaque removal
- run blunt probe to feel texture of surface (feel for roughness)
- use light (transillumination) to detect shadowing
- separation of teeth (to look interproximally)
what determines the clinical management?
the stage of the lesion
how does an active lesion appear?
- surface (white/yellow)
- enamel opaque
- rough to perio probe
- covered in plaqye
how does an inactive lesion appear?
- surface (white, brown, black) BUT brown/black lesions may still be active
- enamel shiny
- smooth to perio probe
- no plaque
what does ICDAS stand for?
International Caries Detection and Assessment System
What are the ICDAS scores 0-6?
0 = sound
1 = first visual change in enamel
2 = distinct visual change in enamel
3 = localised enamel breakdown
4 = underlying dentine shadow
5 = distinct cavity with visible dentine
6 = extensive cavity with visible dentine
What is the management for initial lesions / clinical lesions in intact enamel?
Preventative care
what is the management for caries just into dentine (radiographs - but no surface breakdown) and lesions in dentine
Preventative care and some operative care
what is the management for clinical dentine lesions and pulpal lesions?
Preventative care and operative care
What has an indirect influence on caries?
- environment (unhealthy foods)
- socioeconomic status (if low they’re at > risk)
- health
- water fluoridation (some areas)
- access to care
How do you assess diet? what should be included on the diet sheet?
- write foods AND drinking occasions (over 24hrs) to assess frequency
- identify risk foods for people (fermentable carbs)
- bedtime eating (less saliva to neutralise acids)
- dairy exposures each day (for protection)
- acid drinks – includes cordial (erosion)
- water
- snacks (eg: dried fruits but still > sugar)
- fruit and vegetables
what diet advice can you provide?
- explain how decay occurs
- explain risks with sugary drinks
- explain frequency of eating carbohydrates
- advise use of dairy foods
- avoid eating at bedtime after brushing teeth
- 3 meals and 2 snacks
- avoid sipping drinks other than water
GIVE TEETH A REST - at least 2 hours for remineralisation to occur - foods with protective factors
- sugar free gum – especially with xylitol
- apply to the patient’s diet
what effect does fluoride have?
- slows down demineralisation
- enhances remineralisation
- interferes with bacterial metabolism
- incorporated in developing enamel
what fluoride toothpaste advice should be given for children up to 3 years?
toothpaste with 1000ppm F-
smear of toothpaste
avoid swallowing toothpaste
parents brush
what fluoride toothpaste advice should be given for children 3-6 years?
toothpaste with 1350-1500 ppm F-
pea size toothpaste
avoid swallowing toothpaste
parents help with brushing
what other fluorides can be used apart from toothpaste?
- prophylaxis pastes
- varnish
- prescribe mouthwash
- silver diamine fluoride (silver helps arrest caries but it turns lesion black so limitation for where we can use it)
- fluoride containing sealants
