management of caries Flashcards
caries assessment workflow
assessment diagnosis and risk assessment care planning preventative care operative care
what happens in the caries assessment
history taking
examination
special investigatons
dental caries
instigated by bacteria on fermentable carbohydrates in the plaque biofilm on tooth surfaces
leads to acid demineralisation and proteolytic destruction ( in dentine of organic component of dental tissues
Keyes triad
tooth
bacteria
diet
time
restoration of pits and fissures of posterior teeth
class I
proximal caries restoration type
posterior class II anterior class III prep
non carious lesiosn
balance of protective and pathologic factors remain stable overtime
what bacteria is found in higher quantities with caries
streptococcus mutans
how do coronal caries ddevelop
starts in enamel, bacteria retained in plaque
breakdown sugars in diet and release acid
demineralisation
loss of calcium and phosphate from the surface
demineralsiaoton leads to carious lesion
- white spot lesiojs
which ph leads to demineralsiaon
below 5.5
common areas for white spot lesions
around dental brackets
plaque retention around the brakets
white spot lesion progression
if OH does not improbe demineralsiaon of enamel progresses weakens enamel and will reach ADJ caries reaches the dentine and spreads along ADJ laterallu enamel breaks under occlslusal force
dental caries layers
carious enamle
infected dentine
affected dentiene
sound dentine
infected dentien
dentine that we want to remove clinically(outermost layer) cannot be repaired - necrotic zone of destruction -dark coloir - soft mushy wet - denatured collagen matrix - extensive mineral loss - tubular structure destroyed
affected dentine
inner layer of carious dentine
- paler brown, harder
- demineralised
- collagen still damaged but lesser exent
- tubular structure foundations remain
non operative caries control
- OH instructiosn Plaque control diet advice fluoride casein phospopeptide antimicrobial agents
Plaque control
removal of plaque retentive factors
calculus
restorations with poor borders
denture
when should you use operative caries manaagment
only when lesion is cavitated
lesion that renders plaque removal difficult or impossible
aims of operative manamgent
aid plaque control and thereby manage caries activity at location
protect pulp dentine complex and arrest lesion by sealing it
restore functional and aesthetic form
caries removal technique
complete caries removal
partial
stepwise
complete caires removal
removal of all caries material including enamel infected and affected dentine
- results in sound enamel and sound dentine (i.e. no darkened dentine
completely clean cavity
stepwise caries removal
1st appointment
- open cavity
remove infected dentine, place temporary dentine 2-6months
2nd
- removal of temporary restoration
removal of remaining caries at base and place restoration
how does stepwise caries removal work
after removing bacteria layer of affected dentine would Harden and calcify
increased distance between base of caries and pulp
allows tertiary dentine to be laid down
partial caries removal
selective removal of carious dentine
removing all carious enamel and infected dentine
leaves affected dentine
preserves pulp vitality
final cavity must have
sound enamel around cavity
no staining at ADJ to form seal
caries removal steps
enamel access clearing the ADJ management of unsupported enamel management of unsupported enamel management of body of the carious lesion working from out to in
enamel access
gain access to the carious dentine via high speef
not always needed if we have large carious lesio
clearing the ADJ
work around the periperhu of the lesion
informs the extent of the lesion and once cleared to sound enamel and dentine ensures a seal
managment of unsupported enamle
work around the periphery of lesion
removal of enamel not supported by dentine
why remove enamel not suppoted by dentine
will fracture under occlusal load
management of body of carious lesion
removing all infected dentine
retain caires affected dentine
working out to in
allows sound marins
allows removal of bacterial and prevents reaching the pulp
hand instruments
chisels
excavators
chiseals
gingival margin trimmers
hatchets
straight chiseal
manage caries and remove unsupported enamel
excavator
remove carious dentine to clear the ADJ
advantages of hand instruments
controlled removal of tooth structure
tactile feedback during instrumentation
cheap
no noise or vibration
disadvantages of hand instruments
time consuming
exclusivese of hand instruments limited to open cavities
operator fatigue
rotary instruments
high speed
low speed
high speed instruments
air powered 450000 rpm water cooling system used to remove enamel can modify cavity preparations to aid retention and support of restorative material
low speed instruments
motor powered
4000 rpm
use latch grip burs
advantages of rotary instruments
more efficient
can be used for anytime of carious lesion
tactile feedback during instrumentation
versatile different speeds burs and anguluations
disadvantages of rotary insttuments
noise vibrations can be uncomfortable for patient and operator
produce sig heat that requires cooling
less conrol
produce an aerosol
chemo mechanical caries removal
proteolytic chemical that breaks down the organic tissue in the caries
facilitates removal of it with an excavator type instruments
advantages of chemo mechanical removal
controlled removal of tooth structure
tactile feedback during instrumentation
may reduce need for local anaethetic
no noise or vibration
disadvantages of chemo mechanical caries removal
time consuming
limited use to open cavities
selective caries removal(claims not proven)
more fatiguing than other techniwues
air abrasion, lasers and ultrasonics
mainly to prepare cavities
reduce need for anethetic
slower
require purchese
advantages of air abrasion, lasers and ultrasonics
reduce need for local anaetheic
no noise or vibration
no drilling
air abrasion likely to improve bonding for composite
disadvantages of air abrasion, lasers and ultrasonics
most cannot remove soft caires
lack tackle feedback
more time consuming
expensive
