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4th Yr - CCD2 > Management of early caries > Flashcards

Management of early caries Flashcards

1
Q

what is caries?

A

Biofilm-mediated, sugar-driven, multifactorial, dynamic disease resulting in the imbalance of the demineralisation and remineralisation processes of dental hard tissues

-This definition emphasizes the dynamic nature of the disease and its dependency on both biological and environmental factors

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2
Q

what do caries lead to ?

A

localised destruction of these tissues, primarily driven by acids produced from bacterial fermentation of dietary carbohydrates.

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3
Q

Impact of caries on a child?

A

Eating
Sleeping
Tooth brushing
School
Lower participation in activities
Work attendance for parents when attending appointments
Damage to underlying permanent teeth
Orthodontic considerations due to extracted teeth
Hospitalisation/General anaesthetic experience

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4
Q

The burden of restorative care?

A

Restorations – lifecycle
Average life expectancy 91yrs of child born in 2024
Burden for child
Requirement for LA
Reduce chance of crown or extraction in future?

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5
Q

List some of the environmental impacts

A

1) Greenhouse gas emissions -associated with inhaled anaesthetic agents:
- sevofluorane 100x more potent than CO2 in terms of global warming potential (GWP)
- Nitrous oxide: sedation 300x GWP compared with CO2

2) Environmental persistence -
Anaesthetic gases not easily broken down in the atmosphere further exacerbating impact (e.g. sevofluorane has lifetime of 14yrs)

3) Waste and by-products - single-use materials, impromper disposal of anaesthetic agents and materials can lead to environmental contamination

4) Energy consumption- theatres are energy-intensive environments

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6
Q

what is the most common reasons for hospital admissions in children?

A

tooth decay

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7
Q

Number of tooth extraction admissions from 2022 to 2023 in 0-19 yr olds ?

A

47,581

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8
Q

Number of tooth extractions with primary diagnosis of tooth decay

A

315,165
with 60% = 5-9 yr olds

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9
Q

Cost of decay related extractions per child?

A

£1,300

£40.7 mill in 2023

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10
Q

list ways in which the pandemic impacted paeds

A
  • Unable to provide AGPs eg. High speed handpiece with water, 3-in-1 together
  • Use of alternative restorative options e.g. Hall crowns
  • Focus on prevention- Strengthening community-based oral health programs and increasing public awareness of the importance of early dental visits could help mitigate the impact of similar disruptions in the future.
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11
Q

what were some modifications in tx approaches during pandemic?

A

To minimise aerosol production, there was a shift toward non-aerosol-generating procedures (NAGP) in paediatric dentistry.

Techniques such as silver diamine fluoride (SDF) application, atraumatic restorative treatment (ART), and the Hall Technique gained popularity as they offered effective caries management while reducing the risk of viral transmission.

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12
Q

how do clinically examine caries ?

A
  • OH assessment first: plaque and calculus, gingival health, decay, demin, oral mucosa
  • caries assessment next: dry, plaque free teeth
  • Good overhead light
  • Reflected light best from mirror
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13
Q

what are the advantages and disadvantages of visual inspection ?

A

Advantages:
Simple and non-invasive.
Provides immediate information.
Can be used to detect surface irregularities, discolorations, and cavitations.

Limitations:
Less effective in detecting early carious lesions, especially on occlusal surfaces and proximal areas.
Highly operator-dependent, requiring skill and experience to interpret findings accurately.

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14
Q

what is the IDAS system ?

A
  • provides a consistent method for scoring dental caries that can be applied globally, allowing for more reliable comparisons across studies and populations.
  • scoring focuses on the detection and classification of carious lesions. It categorizes lesions based on their severity, location, and activity status (active or inactive).
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15
Q

what is code 0?

A

Sound tooth surface: No evidence of caries after 5 sec air drying

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16
Q

what is code 1 ?

A

First visual change in enamel: Opacity or discoloration (white or brown) is visible at the entrance to the pit or fissure seen after prolonged air drying

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17
Q

what is code 2 ?

A

Distinct visual change in enamel visible when wet, lesion must be visible when dry

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18
Q

what is code 3?

A

Localized enamel breakdown (without clinical visual signs of dentinal involvement) seen when wet and after prolonged drying

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19
Q

what is code 4?

A

Underlying dark shadow from dentine

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20
Q

what is code 5?

A

Distinct cavity with visible dentine

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21
Q

what is code 6 ?

A

Extensive (more than half the surface) distinct cavity with visible dentine

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22
Q

what is ALARP?

A

Low As Reasonably Practicable
in radiology

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23
Q

when do we use radiographs?

A

Radiographic caries detection is highly accurate for cavitated proximal lesions, and seems also suitable to detect dentine caries lesions. For detecting initial lesions, more sensitive methods could be considered in population with high caries risk and prevalence.

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24
Q

BW freq for high risk children?

A

Every 6 months until no new or active lesions are apparent

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25
Q

BW freq for mod risk children?

A

Every 12 months until no new or active lesions are apparent

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26
Q

BW freq for low risk children?

A

every 12-18 months

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27
Q

BW freq for low risk adults and children with permanent dentition ?

A

every 2 years
consider extending the interval if continuing evidence of low caries activity

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28
Q

age for BW ?

A

4yrs above deepening on their dental condition and coop

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29
Q

what are some radiological considerations ?

A
  • snapshot in time
  • series over time required
  • after progression in primary teeth
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30
Q

how do we use tooth separators ?

A

1- 7 days in situ
Check if cavitated or not
Use light-bodied silicone interproximal to check surface changes
- used to check inter proximal caries

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31
Q

lists some other diagnostic tools

A

Fibre optic transillumination: BWs detect dentinal and enamel lesions better diagnostic yield, therefore limited use

Electrical methods – focuses on electrical resistance, further research needed

Laser fluorescent diagnodent – fluorescence from bacterial by products
False positives and over treatment, limited use

Quantitive laser fluorescence – tooth tissue fluoresces under specific wavelength. - research stage
Caries activity tesets – check strep mutans levels

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32
Q

Dental caries risk factors:

A
  • Behavioural
  • biological
  • environmental
  • socio- economic
  • medical conditions
  • dietary
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33
Q

what are some behavioural risk factors?

A
  • Poor Oral Hygiene: Infrequent brushing, improper brushing techniques, or not using F- toothpaste increases risk of caries.
  • Frequent Consumption of Sugary and acidic Foods and Drinks: contributes to the development of caries.
  • Inadequate Use of Fluoride: Lack of fluoride, whether from toothpaste, water, or professional treatments, can lead to an increased risk of caries.
  • Bottle Feeding with Sugary Drinks: Prolonged bottle feeding, especially with sugary liquids, can lead to early childhood caries (baby bottle tooth decay).
  • Frequent Snacking: Constant snacking, especially on sugary or starchy foods, provides a continuous supply of sugars to oral bacteria, leading to acid production
34
Q

what are some biological risk factors?

A
  • Reduced Salivary Flow (Xerostomia): Conditions or medications that reduce saliva production increase the risk of caries, as saliva helps neutralize acids and remineralize enamel.
  • Presence of Cariogenic Bacteria: High levels of bacteria like Streptococcus mutans and Lactobacilli in the mouth are strongly associated with an increased risk of caries.
  • Existing Dental Restorations or Appliances: Teeth with previous restorations, crowns, or orthodontic appliances are at higher risk due to difficulties in cleaning and areas prone to plaque accumulation.
35
Q

what are some environmental risk factors?

A
  • Non-Fluoridated Water Supply: increase the risk of caries.
  • Family History of Caries: may indicate a shared environment or genetic predisposition to developing caries.
  • Poor Access to Dental Care: Limited access to preventive dental care and education can increase the risk of untreated caries.
36
Q

what are some socio- economic risk factors?

A
  • limited access to dental care, lack of education, and higher consumption of cariogenic foods.
  • The level of parental education and attitudes towards oral health can significantly impact a child’s caries risk.
37
Q

what are some medical risk factors ?

A
  • Chronic Diseases: Conditions like diabetes can increase the risk of caries due to factors like dry mouth and altered immune response.
  • Gastroesophageal Reflux Disease (GERD): Acid from the stomach can erode enamel and increase the risk of caries.
  • Developmental Defects of Enamel: Teeth with enamel hypoplasia or other developmental defects are more susceptible to caries.
38
Q

what are some dietary risk factors ?

A
  • Diets rich in carbohydrates, especially refined sugars, provide fuel for acid
  • Regular consumption of acidic foods and drinks can erode enamel and create a more favorable environment for caries development.
    These factors contribute to the overall risk of developing dental caries, and effective prevention typically involves addressing multiple risk factors through good oral hygiene, diet management, fluoride use, and regular dental care.
39
Q

list some tooth risk factors

A
  1. presence of active carious lesions is a strong indicator of ongoing caries activity and a significant risk factor for the development of new lesions.
  2. history of dental caries, especially in the past 2-3 years, is a strong predictor of future caries risk. Individuals with multiple restorations or extractions due to caries are at higher risk.
  3. Early signs of demineralization, often seen as white spot lesions, indicate the beginning stages of caries.
  4. Poor OH- Visible plaque on the teeth, especially near the gum line and between teeth, is a sign of poor OH, which is a direct risk factor for caries development.
  5. Recession of the gums can expose the roots of teeth, which are more susceptible to caries because the root surface (cementum) is softer and less resistant to acid than enamel.
  6. Xerostomia): increases the risk of caries. Saliva crucial for neutralizing acids, providing minerals for enamel remineralization, and washing away food particles.
  7. Teeth with deep pits and fissures, especially on the occlusal surfaces of molars, are more prone to caries as these areas are difficult to clean and can trap food and bacteria.
  8. Poorly Fitting Dental Restorations:
    Margins of existing restorations (fillings, crowns, etc.) that are not well adapted to the tooth can create areas where plaque accumulates, leading to secondary caries.
  9. Braces and other orthodontic appliances can make OH more challenging, leading to increased plaque accumulation and higher caries risk.
  10. A clinical examination revealing frequent consumption of sugary or acidic foods and drinks, as well as signs of erosion, is a risk factor for caries.
  11. Teeth with developmental defects like enamel hypoplasia, which presents as pitted or grooved enamel, are more susceptible to caries.
  12. Use of Caries-Promoting Medications: Some especially those that reduce salivary flow (antihistamines, antidepressants), can increase caries risk.
  13. a clinical inquiry into the caries history of siblings or close family members can indicate a shared risk, often due to similar dietary habits or bacterial transmission.
  14. use of braces or other orthodontic appliances increases the risk of caries due to the difficulty in maintaining proper oral hygiene.
  15. Certain tooth shapes, such as teeth with deep grooves or pits, are more likely to trap food and bacteria, making them more susceptible to caries.
40
Q

what comes under preventive care management ?

A
  • clinical lesions
  • initial lesions progressing and regressing
  • no detectable caries
41
Q

what comes under preventative care with some operative care?

A
  • dentine lesions - seen on X-rays
  • caries into dentine
42
Q

what comes under preventative care and operative care ?

A
  • pulpal lesions
  • clinical dentine lesions
43
Q

how do we give diet advice ?

A
  • Diet diary - at least 24h recall of no. of eating and drinking occasions
  • Educate on high risk food and hidden sugars
  • Frequency of eating
  • Protective factors – dairy, drink water after meals/snacks
  • Acid drinks and food management - timing
  • Promote healthy snacking
  • Promote healthy eating - Eatwell plate/guide
44
Q

maximum amount if sugar for 4-11+ yr olds ?

A
45
Q

what is Stephan curve ?

A

illustrates relationship between sugar intake and pH level of plaque over time.
It demonstrates how pH in oral cavity, particularly in plaque, drops after the consumption of sugar and how it subsequently recovers.

46
Q

what is neutral ph in terms of the Stephan curve?

A

Before sugar intake, the pH level of dental plaque typically ranges between 6.2 and 7.0, which is considered neutral or slightly acidic. At this level, the environment is generally safe for teeth, and no demineralization occurs.

47
Q

why does PH drop?

A

When sugar is consumed, oral bacteria metabolize it, producing acids as a byproduct. This process, known as fermentation, rapidly lowers the pH of the plaque.
The pH can drop to below 5.5, known as the critical pH level. At this critical pH, the enamel begins to demineralize, making the teeth vulnerable to decay.

48
Q

when does the lowest point on the curve occur?

A

shortly after sugar intake= 5-10 mins . At this point, the plaque pH may drop to as low as 4.0 to 4.5, depending on the type and amount of sugar consumed and the bacterial activity in the plaque.

49
Q

what happens at PH recovery?

A
  • pH gradually begins to rise as saliva neutralizes the acids produced by the bacteria.
  • Saliva plays a crucial role in buffering the acids and bringing the pH back to a safer level.
  • time it takes for pH to return to its baseline level varies but typically from 20 to 60 minutes.
  • During this recovery period, the teeth remain at risk for demineralization if the pH is still below the critical level.
50
Q

what happens when there is an increase in freq of sugar intake

A

the pH may not have sufficient time to recover to a neutral level before the next sugar exposure. This leads to prolonged periods where the pH remains below the critical level, increasing the risk of enamel demineralization and, consequently, dental caries.

51
Q

tips for giving DA?

A

Analyse diet diary
Explain how decay occurs – role of sugar
Educate on hidden sugars
Encourage reducing sugar intake
Frequency of carbohydrate consumption
Avoid eating within 1h of sleeping: golden hour
3 meals and 2 snacks; 2h gap between eating
Foods with protective factors
Xylitol chewing gum
Tailor advice to individual needs
Set realistic goals
Reinforce
Consider social aspect

52
Q

list some social considerations

A
  • The rapid increase in the cost of essential goods and services, outpacing wage growth, and leading to significant financial strain on households.
  • Impact on diet of children
  • Reduced food quality -cheaper processed foods
  • Food insecurity - reliance on food banks, malnutrition
  • Mental health impact – financial strain/food insecurity
  • Reliance on school meals
  • Long-term health consequences
53
Q

list the 4 mechanisms of actions of fluoride

A

Inhibition of demineralisation

Remineralisation of enamel

Inhibition of bacterial metabolism

Incorporates into developing enamel - fluorapatite

54
Q

How does fluoride help in the remineralisation of enamel ?

A

Strengthens Enamel: Fluoride promotes the remineralization process, where minerals like calcium and phosphate are redeposited into the enamel (the outer layer of the tooth) that has been demineralized by acids produced by bacteria in the mouth. When fluoride is present, the enamel formed is harder and more resistant to acid attack than the original enamel, making teeth more resilient to decay.

55
Q

how does fluoride help in the inhibition of demineralisation?

A

Acid Resistance: Fluoride reduces the rate at which enamel demineralizes in the presence of acids. This is because fluoride can help maintain a more stable and resistant enamel structure, slowing down the loss of minerals when the enamel is exposed to acidic conditions, such as after consuming sugary or acidic foods and drinks.

56
Q

how does fluoride help in inhibiting bacterial activity ?

A

Reduction of Acid Production: Fluoride can disrupt the metabolism of bacteria, particularly Streptococcus mutans, which is one of the primary bacteria responsible for tooth decay. Fluoride inhibits the enzymes that bacteria need to metabolize sugars, thereby reducing the amount of acid they produce. Less acid means less demineralization of the enamel.

57
Q

how does fluoride help in the formation of fluorapatite?

A

Stronger Tooth Structure: When fluoride is incorporated into the enamel during remineralization, it forms a compound known as fluorapatite, which is more resistant to acids than hydroxyapatite, the natural mineral form of enamel. This makes teeth less susceptible to decay over time.

58
Q

when should brushing start?

A

as soon as first primary tooth erupts using at least 1000ppmf toothpaste

for children at higher risk = 1350-1500 ppmf

59
Q

how much fluoride for children aged 3+?

A

1350-1500ppmf

60
Q

how much fluoride in 10+?

A

2800ppmf

61
Q

how much fluoride in 16+?

A

5000ppmf

62
Q

who can have f- mouthwash 0.05%NaF daily?

A

8+

63
Q

how do we give brushing advice ?

A
64
Q

what advice do we give to infants?

A

Establishing biofilm
Influencing biofilm
Habits establishing
Frequency sugar
Dummy – sugar, honey
Toothbrushing as soon as possible
Soft toothbrush
Dental Check by 1

65
Q

how do probiotics work in the prevention of caries?

A

influencing the oral microbiome in ways that could reduce caries risk

66
Q

what are the different ways in which probiotics work in balancing oral microbiome?

A
  1. Probiotics, which are beneficial bacteria, can compete with harmful bacteria such as Streptococcus mutans, one of the primary bacteria involved in the development of dental caries. By colonizing the oral cavity, probiotics can outcompete cariogenic bacteria for adhesion sites on the teeth and oral tissues, thereby reducing their numbers and activity.
  2. Modulation of pH: Probiotics can help maintain a healthier oral pH by producing less acid than cariogenic bacteria, or by neutralizing acids in the mouth.
  3. Inhibition of Pathogenic Bacteria:
    Production of Antimicrobial Substances: Some probiotic strains can produce substances like bacteriocins, hydrogen peroxide, and organic acids that inhibit the growth of cariogenic bacteria. This can directly reduce the population of harmful bacteria in the mouth.
  4. Probiotics may also affect the formation and composition of dental biofilms, making them less pathogenic. For example, they might promote the development of biofilms that are less acidic and more resistant to the cariogenic effects of other bacteria.
  5. Probiotics can modulate the host immune response, reducing inflammation in the oral cavity. Inflammation can contribute to the breakdown of oral tissues and create an environment more conducive to caries development.
67
Q

what are some considerations for use of probiotics?

A

Strain Specificity: The effectiveness of probiotics in reducing caries risk is strain-specific, meaning that not all probiotics will have the same effects. It’s important to use strains that have been shown in research to be effective against cariogenic bacteria.

Adjunct to Traditional Care: Probiotics should be considered as a complementary strategy to traditional caries prevention methods, not a replacement. Good oral hygiene practices, fluoride use, and dietary control remain essential for caries prevention.

Safety and Side Effects: Probiotics are generally considered safe for most people, but their use should be discussed with a healthcare provider, especially for individuals with compromised immune systems or other underlying health conditions.

68
Q

where can we find probiotics ?

A

Milk
Cheese
Yoghurts
Tablets
Lozenges
Drops
Powder

69
Q

mechanisms of action of xylitol

A
  • reduces the levels of Streptococcus mutans and decrease caries incidence
  • Stimulates saliva production, which helps neutralise acids in the mouth and promotes remineralisation of enamel
  • Xylitol is not fermented by oral bacteria, which means it does not contribute to acid production
70
Q

what is Casein Phosphopeptide –Amorphous Calcium Phospate (CPP-ACP)?

A

Tooth Mousse / MI paste
Lab studies show remineralisation; not so good in clinical trials
Contains a milk-derived protein
Supersaturation of calcium and phosphate ions at tooth surface in slow-release form
Neutralise acids, reduce enamel demineralisation, enhances remineralisation
Synergistic with fluoride

71
Q

when do we use tooth moose and how do we use it?

A

Management of white spot lesions
Alleviation of sensitibity

Apply pea-sized mount onto teeth using a clean finger, ideally after brushing. Leave for 3 mins, avoid eating or drinking for 30mins

Consider milk protein (casein) allergy

72
Q

how do we use fluoride varnish ?

A

duraphat= caries prevention and high risk caries
At least twice per year
5% sodium fluoride, 22,600ppm
allergy - Colophony
43% reduction D(M)FS and 37% in d(m)fs

73
Q

what is SDF?

A

Colourless liquid
Silver- antibacterial
Fluoride – anti-caries 44800ppm
Product licence for desensitisation
Arrests caries: overall 89% higher caries arrest compared with topical fluoride and atraumatic restorative technique
use in covid 19

74
Q

SDF uses and application

A

Non-invasive treatment option for arresting caries
To be used where patient too young for conventional treatment
Causes black staining of teeth and can cause painful gums
Do not use if allergy to silver or another heavy metal
Healthy parts of the teeth do not discolour

75
Q

fissure sealants uses

A
  • high risk caries
  • used on Deep fissures, pits and enamel defects
  • Fully erupted
  • need X-rays to check caries first
    -Materials: resin or GIC
  • Toolkit recommendations - Children from 7 years and young people up to 18 years giving concern because of dental caries risk
  • No clear evidence for bonding- may be beneficial where high saliva contamination
  • Need for maintenance, monitoring – clinically and radiographically
76
Q

what are the 2 types of sealants ?

A

Resin -75-80% retention at 2 years
Good caries reduction when maintained
Risk is with leak, wear, fracture
Need cooperation and fully erupted tooth

Glass ionomer - 40-60% retention at 2 years
Fluoride is released
Caries reduction even when partially lost
Appropriate for partially erupted tooth
Can use with minimal cooperation or with sensitive teeth

77
Q

what is smooth sealing ?

A
  • Application on top of a lesion or susceptible surface to prevent further decay.
  • Demonstrates potential to reduce enamel lesions by 50%.
  • Offers a non-invasive alternative to cutting the tooth.
  • Ideally placed after separators are utilized.
78
Q

who can use smooth sealing?

A

High caries-risk adolescents with enamel lesions or erosion, particularly on palatal surfaces (as per Bartlett et al, 2011).
- High-risk children, especially if they demonstrate good cooperation, with proximal lesions (as per Martignon et al, 2010).

79
Q

What are some key points about resin infiltrations?

A
  • Utilize low molecular weight resin to infiltrate early lesions.
  • Example product includes ICON.
  • Aim to halt lesion progression.
  • Once applied, remineralization is no longer possible.
  • Require rubber dam isolation and good patient cooperation.
  • Suitable for treating enamel and early dentine lesions.
  • Consideration for use in high-risk adolescents.
80
Q

what to do with early inter proximal and early smooth surface lesions?

A

Separate teeth with orthodontic separators (interproximal only)
Isolate teeth
Protect adjacent tooth with matrix strip
Etch and rinse tooth
New matrix strip and apply resin sealant
Check no excess pooling around gingivae
Light cure
Floss (interproximal only)

4th Yr - CCD2 (6 decks)

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