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DMD2 > ICCMS: caries management and classification > Flashcards

ICCMS: caries management and classification Flashcards

1
Q

What are the 5 keystones of ICCMS staging?

A
  1. Staging of caries lesion
  2. Risk assessment and classification
  3. Decision matrices for diagnosis
  4. ICCMS comprehensive patient management plan
  5. Outcomes of caries management using ICCMS
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2
Q

What are the ICDAS categories of caries?

A

Sound surface: ICDAS 0

Initial stage caries: ICDAS 1 and 2

Moderate stage caries: ICDAS 3 and 4

Extensive stage caries: ICDAS 5 and 6

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3
Q

What is ICCMS keystone 1?

A

Staging of caries lesion; ICDAS stages.

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4
Q

What is ICCMS keystone 2?

A

Risk assessment and classification

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5
Q

How are risk factors assessed in caries?

A

Head and neck radiation

Active caries lesion

Dry mouth

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6
Q

What is ICCMS keystone 3?

A

Combination of ICCMS diagnosis (none, initial, moderate/extensive) + risk assessment (low, moderate, and high)

Uses the first two keystones to classify the patient into a low, moderate or high
likelihood of existing lesion progression and development of new carious lesions.

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7
Q

What is ICCMS keystone 4?

A

A comprehensive patient management plan:

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8
Q

What recommendations are given to patients based on their risk level?

A

Low risk: Home care (toothbrushing 2x a day with at least 1000ppm fluoride) and clinical care (Promote healthy dietary and oral hygiene behaviours.

Medium risk: Same recommendations as for low-risk patients + daily (226 ppm F) or weekly (900 ppm F) fluoride rinses. Clinical care: preventive procedures such as sealants, fluoride varnish applied at least twice a year, 2% fluoride gel applied twice a year. Consult with other health professionals about recreational drug use or medications that reduce salivary flow.

High risk: Same recommendations as medium risk + chlorhexidine mouthrinse or varnish and fluoride applications; fluoride varnish 4 x’s per year + high concentration preventive dentifrice (5,000 ppm F) for daily use on patients 16 years or older.

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9
Q

What guides decisions for all restorative care?

A

TPOP (Tooth Preserving Operating Principles) should guide decisions for all restorative care. TPOP is a set of guides that aim to preserve tooth structure, whenever tooth structure is removed surgically. Surgical restorative interventions are only used as a last resort.

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10
Q

What is ICCMS keystone 5?

A

Outcomes of caries management using ICCMS.

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11
Q

What outcomes should result from patient care plans?

A

Patient care plans should be value focused and designed to evaluate these potential outcomes:

Health promotion: Maintaining sound teeth/free of new disease.

Disease control: Initial caries lesions/radiographically detected lesions remain unchanged or do not progress.

Patient-Centered quality metrics: Satisfaction with their dental health, risk reduction, improving oral hygiene and diet, reduction of cost of care.

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12
Q

What are the positives of using ICDAS classification?

A

ICDAS employs an evidence-based and preventitively oriented approach.

ICDAS supports decision making at both individual and public health levels which has caused ICCMS to enable improved long-term caries outcome.

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13
Q

What are the radiographic scoring ratings?

A

No radiolucency = 0

Initial stages are RA1, RA2, RA3.

RA1 is a radiolucency in outer 1/2 of enamel

RA2 is a radiolucency in the 1/2 of the enamel +/- (Enamel-Dentine Junction)

RA3 is a radiolucency limited to the outer 1/3rd of dentin

RB are moderate stages and include RB4 with radiolucency reaching the middle 1/3 of dentin.

RC are extensive stages with radiolucency reaching the pulp and with clinical cavitation.

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14
Q

How are likelihood matrices formed for risk categories?

A

Uses the first 2 categories to classify patient as a low, moderate, or high likelihood of existing lesion progression and development of new carious lesions.

● 9 cells

● Combines moderate and extensive active caries lesions into one category

● Once there is any active lesion, risk status is at least ‘moderate’

● Visual, traffic light system

● Each risk category has distinct preventative and management strategies

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15
Q

How are low risk patients managed?

A

Home care: Tooth brushing 2x a day with >1000ppm fluoride dentrifice.

Clinical care: Promote healthy dietary and oral hygiene behaviours

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16
Q

How are medium risk patients managed?

A

Home care: Same recommendations as for low risk patients + daily or weekly fluoride rinses.

Clinical care: Preventative procedures such as sealants, fluoride varnish applied at least twice a year, consult with other health professionals about recreational drug use or medications.

17
Q

How are high risk patients managed?

A

Same recommendations as medium risk + chlorhexidine mouthrinses or varnish and fluoride applications.

18
Q

How are caries managed?

A

Customized to the type of lesion and activity status.

19
Q

What principles are followed in restorative care?

A

The ICCMS TPOP (Tooth Preserving Operating Principles)

20
Q

What should guide patient outcomes using ICCMS?

A

Patient care should be value-focused and designed to evaluate these potential ourcomes:

Health promotion: Maintaining sound teeth/free of new disease

Disease control:
Initial caries lesions/radiographically detected lesions remain unchanged or do not progress

Patient centered quality metrics:
Satisfaction with their dental health, risk reduction, improving oral hygiene and diet, and reduction of cost of care

21
Q

How is ICCMS keystone 2 caried out?

A

Risk assessment and classification:

Completed prior to oral examination

Caries risk factors are checked at the patient and intraoral level

22
Q

What are the limitations of current methods for risk assessment and classification of caries?

A

Evidence of predictive validity of current assessment tools is weak.

23
Q

What does ICCMS stand for?

A

The International Caries Classification and Management System

24
Q

How are caries lesions classified?

A

Staging of caries lesion severity (initial/moderate/extensive)

Caries activity assessment (Active or inactive)

These 2 are used to form the likelihood table.

25
Q

What are the aims of preventative management of caries?

A

Protect sound tooth structure

Stop progression of active caries

Control the disease process

Avoid initiating cycle of restoration

Preserve the tooth for as long as possible

26
Q

What is low risk defined as?

A

No exposure to high risk factors

Low level of other risk factors (sugary snacks, oral hygiene practice, fluoride exposure)

27
Q

What is moderate risk defined as?

A

Stage between low and high caries risk

Dentist cannot rule out that the individual is at low risk of developing caries

28
Q

What is high risk defined as?

A

Presence of any high risk factors AND

Previous restorations, appliances

Accumulation of biofilm

Low fluoride exposure

Low socioeconomic status

Mothers/caregivers with high caries experience

29
Q

What are the aims of managing carious lesions?

A

Manage dental caries and control activity of existing
cavitated lesions

Preserve hard tissue and retain teeth long-term

Methods for biofilm removal and control are first priority
for controlling disease in cavitated carious lesions

Cavitated lesions that are no longer able to be sealed or
cleansed are indicated for restorations

30
Q

What is dental caries?

A

Disease resulting from ecological shift within dental biofilm,

From a balanced population of microorganisms to an
acidogenic/acidoduric and cariogenic microbiological
population

Maintained by consumption of fermentable carbohydrates

Imbalance between demineralization and remineralization

Leads to net mineral loss of dental hard tissues

31
Q

How are non-cavitated lesions treated?

A

Biofilm removal and/or remineralization by sealing.

Smooth surface or proximal lesions are sealed with resin

32
Q

What are the types of cavitated lesions?

A

Cleansable and non-cleansable lesions

Cleansable = managed non-restoratively via biofilm removal or remineralization

Non-cleansable = Cannot be inactivated likely to still be active and will progress.

33
Q

What are the criteria for assessing the removal of carious tissue?

A

Primary criterion = Hardness

Secondary criterion = Moisture, colour and fluorescence, Dye stainability

These are weak recommendations, however.

34
Q

What is the difference between active and arrested lesions?

A

Active lesions are soft and moist whereas arrested lesions are harder, dry, and darker.

35
Q

How is carious tissue removed?

A

Several methods:

Hand excavators

Tungsten carbide burs

Ceramic burs

Air abrasion

Sonoabrasion

Chemomechanical caries tissue removal

Polymer burs

Laser removal

36
Q

Which methods of caries removal are most effective?

A

Insufficient evidence to place any method as superior

Chemomechanical or hand excavation might reduce pain

DMD2 (89 decks)

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