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Caries > Methods of caries management- the biological approach > Flashcards

Methods of caries management- the biological approach Flashcards

1
Q

What is detection?

A

determining the presence or absence of the disease

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2
Q

What is diagnosis?

A

– determining the presence or absence of the disease,
– knowing whether or not the disease is active or arrested such that appropriate treatment can be planned

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3
Q

What aids diagnosis of caries?

A
  • Plaque Chart
  • Full mouth prophylaxis
  • Good lighting
  • Inspect without drying for dentinal shadowing (best seen in wet conditions)
  • Dry tooth with three in one for 5-10 seconds
  • Use of 2.5 X magnification is recommended
  • Good quality bitewings
  • Temporary elective tooth seperation (TETS)
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4
Q

What can a cpitn probe be used for?

A

can be used gently remove debris from fissures, to conform visual impression of borderline cavitation and to determine the consistency of carious dentine

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5
Q

What are special tests that can be used?

A
  • Transillumination
  • FOTI
  • Diagnodent
  • Plaque PH
  • Salivary flow rate * Plaque pH
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6
Q

What is the depth of caries that present as enamel discoloration with/out surface destruction?

A

caries in outer quarter of dentine

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7
Q

What are levels?

0-4

A

0 = no / slight change after drying
1 = opacity visible after drying
2 = opacity visible without drying
3 = localised enamel breakdown in opaque / discoloured enamel +/- discolouration from underlying dentine
4 = cavity in enamel exposing underlying dentine

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8
Q

Which part of the fissue do occlusal caries usually start at?

A

sides rather than base

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9
Q

Why is transillumination useful?

A

carious lesions absorb light

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10
Q

What are bitewings good at detecting?

A

approximal lesions for intervention/prevention

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11
Q

Where can you use TETS and how is it used?

A
  • Interproximal caries only
  • Orthodontic separator between teeth
  • Review minimum 2 days later (can leave 1 week)
  • Inspect surface for cavitation
  • Take a silicone impression of
    approximal surface
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12
Q

How are root caries described?

A
  • Primary or secondary
  • Described according to surface of tooth affected
    – Eg Buccal, proximal etc.
  • Active, arrested or remineralised
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13
Q

How are root-surface caries diagnosed?

A
  • Clean teeth
    – can’t see caries under plaque
  • Tactile assessment – use a probe!
  • Visual assessment
    – position in relation to gingival margin
    – dimensions of lesion
    – colour of root caries (less reliable than tactile)
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14
Q

What does a soft lesion usually have?

A

have higher bacterial loads and are more likely to be active - probably the best indicator.

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15
Q

What does a lighter colored lesions usually have?

A

have higher bacterial loads - but colour alone is NOT a reliable indicator

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16
Q

What colour do larger lesions tend to be?

A

light brown yellow

smaller lesions tend to be darker brown

17
Q

What is the distance from the gingival margin for softer, lighter coloured lesions?

A

<1mm from gingival margin

18
Q

What is the distance from the gingival margin for harder, darker coloured lesions?

A

> 1mm from gingival margin

19
Q

What are indications for non-operative intervention?

A

– hard, dark-colored lesion, > 1mm from gingival margin
– does not trap plaque
– not rapidly progressing
– patient able to participate in non- operative management

20
Q

Where is the site of secondary caries for amalgam restorations usually?

A

cervical

21
Q

What does non-operative management include?

A

dietary analysis
oral hygiene instruction
fluoride exposure
professional prophylaxis

22
Q

How often should fluoride varnish be applied for at risk populations?

A
  • Full mouth
  • every 3-6 months
23
Q

What is more effective than fluroide but has a major disadvantage?

A

SDF - silver diamine fluoride

staining

24
Q

What is the adjunctive effect of CPP-APP (tooth mousse)?

A

lightens teeth

25
Q

How does CPP-ACP work?

A
  • CPP - Casein Phosphopeptide stabilises
  • ACP - Amorphous Calcium Phosphate
  • Remineralises subsurface enamel
  • Based on anticaries effect of cheese
  • Casein peptides dissolve into plaque and supersaturate Calcium and Phosphate ions from ACP
  • Thereby, promoting remineralisation!
26
Q

How is ICON used?

A
  • Etch the lesion
  • Dry the lesion (ethanol)
  • Infiltrate the lesion
27
Q

When are dental restorations indicated

A

Dental restorations are only indicated when lesions have advanced to obvious cavitation and where remineralisation techniques have reached their limits

28
Q

What are the objectives of care?

A

*Restore significant loss of dental tissue
*Eliminate plaque retention/stagnation
*Restore physiological masticatory function
*Minimise the risk of recurrent disease *Restore aesthetics where appropriate.

29
Q

What tactile indicator does secondary caries have?

A

ditches wide enough to admit a periodontal probe

30
Q

What probe can be used on root caries?

A

soft feel with sharp probe

31
Q

How can the bacteria be starved in occlusal caries?

A

fissure sealant

32
Q

What is the depth if the occlusal caries is visible radiographically?

A

lesion extends into middle third of dentine

33
Q

What are the options of management of deeper carious lesions?

A
  • non-selective removal of carious tissue to hard dentin
  • selective removal to firm dentin
  • stepwise excavation treatment
  • selective removal to soft dentine
34
Q

What is expected with selective removal to firm dentine?

A

pulp exposure (direct pulp capping)

35
Q

Why is stepwise excavation good?

A

avoid pulp exposure and consequently increase tooth vitality

36
Q

Why is stepwise bad?

A
  • Completed SW presented survival rates similar to those of SRSD
  • After incomplete removal of deep caries, pulpal failure was more common than non-pulpal failure.
37
Q

What are topical applications that could be used in non-operative management?

A
  • Topical fluoride application
  • Fluoride Toothpaste twice daily
  • 1450ppm
  • 2800ppm
  • 5000ppm
  • Fluoride Varnish
  • CPC-APC?
  • Chlorhexidine
  • Silver Diamine Fluoride
38
Q

What infiltrate can be used to reduce demineralisation?

A

ICON resin

Caries (8 decks)

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