Etiology and prevention dental caries in children

Question 1

Caries

Answer 1

Chronic disease or Pathological
condition involving demineralization of tooth
tissue.
Dental caries is caused by dietary
carbohydrates being fermented by plaque
bacteria to acid

Question 2

Classification

Answer 2

Enamel caries – limited to just enamel
* Root caries – on the exposed cementum and dentin
* Primary caries – unrestored surfaces
* Secondary caries – secondary caries, on restored surfaces
* Residual caries – demineralised
* Active caries – involves progressing demineralization
* Arrested caries – lesion in which demineralization ceased (no
treatment needed)
* Initial/incipient caries or White spot lesion – lesion visible upon
inspection (white)
* Rampant caries – multiple active lesions
Can also classify according to anatomical location, ie:
– Free surface, pit and fissure, cervical, root, enamel, dentinal, etc

Question 3

Acidogenic theory of caries aetiology

Chemoparasitic theory as proposed by W.D. Miller in 1890

Answer 3

Organic acid formed due to fermentation of dietary carbohydrates by oral bacteria leads to progressive decalcification of the tooth structure which lowers the pH below 5.5 at which the enamel will dissolve

Question 4

Stephen curve

Answer 4

1. Under normal conditions pH of plaque is constant (6.9-7.2)
2. Following exposures to sugars (glucose rinse) pH drops very rapidly in few minutes to its lowest level (5.2-5.5) critical level at which the tooth is at risk of acid attack
3. After 30-60 minutes pH returns to its original value

Early or “pre-cavitation” carious lesions are able to remineralise

Question 5

Role of saliva

Answer 5

1. ion reservoir – supersaturated with calcium and phosphate ions
which promotes remineralisation;
2. buffer – neutralises plaque pH after eating to minimise time for
demineralisation;
3. fluid/lubricant – protects mucosa against mechanical, chemical
and thermal irritation;
4. cleansing – clears food;
5. excretion – secretion of substances;
6. antimicrobial – IgA, lysozyme, lactoferrin and sialoperoxidase;
7. agglutination – aggregation of bacterial cells;
8. pellicle formation – a protective diffusion barrier of salivary
proteins formed on enamel;
9. taste – acts as a solvent with foodstuff to interact with taste buds;
10. digestion – breakdown of starch by salivary amylase

Question 6

Caries detection

Answer 6

1.** Visual and tactile inspection** (ball-ended or blunt probe only)
2. ICDAS-II(The International Caries Detection and Assessment
System)- shown to be more accurate than other traditional methods)
3. Radiography.
– Bitewings
– orthopantomograms (OPTs)
– bimolars
– periapicals.
4. Transillumination.
**5. **Tooth separation
6. Fluorescence.
– Laser light fluorescence
7. Electronic caries monitor (ECM)

Question 7

Caries‐Risk Assessment

Answer 7

1. Socio-demographic: Socio-economic status, Educational level, Ethnicity
2. Behavioural: Diet, habits, fluoride exposure, tooth brushing
3. Clinical
4. Radiographic
5. Supplemental tests

Question 8

4 Pillars of prevention

Answer 8

• plaque control (toothbrushing)
• diet;
• fluoride;
• fissure sealants

Question 9

Two main types of pits and fissures

Answer 9

1. V shaped: tends to be self cleansing and caries
   resistant
2. I shaped: caries susceptible as they provide a niche
   for plaque accumulation

Question 10

Priority groups of children

Answer 10

– caries in the primary dentition
– siblings with past history of caries
– caries in first permanent molars
– continued poor oral hygiene
– medically compromised
– special needs and/or learning disability
– teeth with deep pits and fissures

Assessing the need for fissure sealants
* Susceptibility of the individual occlusal
surfaces
* The general caries activity in the mouth
* The length of time the tooth has remained
caries free
* The patients tooth preventative regimen

Question 11

Fluoride toothpastes:

Answer 11

– Sodium fluoride
– Stannous fluoride
– Monofluorophosphate

Question 12

Antimicrobials

Answer 12

1. Chlorhexidine
2. Iodine
3. Xylitol