Methods of caries management- the biological approach Flashcards
What is detection?
determining the presence or absence of the disease
What is diagnosis?
– 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
What aids diagnosis of caries?
- 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)
What can a cpitn/BPE probe be used for?
can be used gently remove debris from fissures, to conform visual impression of borderline cavitation and to determine the consistency of carious dentine
What are special tests that can be used?
- Transillumination
- FOTI
- Diagnodent
- Plaque PH
- Salivary flow rate
What is the depth of caries that present as enamel discoloration with/out surface destruction?
caries in outer quarter of dentine
What are levels?
0-4
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
Which part of the fissue do occlusal caries usually start at?
sides rather than base
Why is transillumination useful?
carious lesions absorb light
What are bitewings good at detecting?
approximal lesions for intervention/prevention
Where can you use TETS and how is it used?
- 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
How are root caries described?
- Primary or secondary
- Described according to surface of tooth affected
– Eg Buccal, proximal etc. - Active, arrested or remineralised
How are root-surface caries diagnosed?
- 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)
What does a soft lesion usually have?
have higher bacterial loads and are more likely to be active - probably the best indicator.
What colour do larger lesions tend to be?
light brown yellow
smaller lesions tend to be darker brown
What is the distance from the gingival margin for softer, lighter coloured lesions?
<1mm from gingival margin
What is the distance from the gingival margin for harder, darker coloured lesions?
> 1mm from gingival margin
What are indications for non-operative intervention?
– hard, dark-colored lesion, > 1mm from gingival margin
– does not trap plaque
– not rapidly progressing
– patient able to participate in non- operative management
Where is the site of secondary caries for amalgam restorations usually?
cervical
What does non-operative management include?
dietary analysis
oral hygiene instruction
fluoride exposure
professional prophylaxis
How often should fluoride varnish be applied for at risk populations?
- Full mouth
- every 3-6 months
What is more effective than fluroide but has a major disadvantage?
SDF - silver diamine fluoride
staining
What is the adjunctive effect of CPP-AcP (tooth mousse)?
lightens teeth
How does CPP-ACP work?
- 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!
