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BDS3 - caries symposium > methods of caries management the biological approach > Flashcards

methods of caries management the biological approach Flashcards

1
Q

what are the main 4 factors needed for caries to develop

A
  • tooth
  • time
  • bacteria in biofilm
  • diet
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2
Q

what is the demineralisation and remineralisation process

A
  • 2-way street
  • there is the potential to provide an environment that is concussive to remineralisation with buffering of saliva, eliminate bacteria and reduction in sugar can create environment that’s not acidic
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3
Q

how is caries detected and diagnosed

A
  • need to determine presence or absence of disease
  • if can’t see it then can’t restore it
  • need to know whether it is arrested or active
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4
Q

what are some diagnostic tools

A
  • plaque chart
  • full mouth prophylaxis
  • good lighting
  • dry tooth
  • CPITN probe
  • bitewings
  • TETS
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5
Q

in what environment can you best see caries

A
  • when tooth is wet can see dentinal caries better

- when teeth dry can see enamel caries much better

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6
Q

what is TETS

A
  • temporary elective tooth separation
  • used to confirm cavitation
  • good to use when notice lesions on bitewings but want to confirm before cutting into tooth
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7
Q

what special equipment is used

A
  • transillumination
  • FOTI
  • dignodent
  • plaque pH
  • salivary flow rate
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8
Q

what do we use for direct visual assessment

A
  • naked eyes = need sharp eyes, clean and dry tooth
  • magnified visions helps
  • transillumination
  • FOTI
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9
Q

how do you know if tooth has coronal caries or not

A
  • normal enamel translucency after 5 seconds drying
  • enamel opacity after 5 second drying
  • enamel opacity without drying
  • enamel opacity with local surface destruction
  • enamel discolouration +/- surface destruction
  • surface breakdown opaque enamel
  • surface breakdown discoloured/opaque enamel
  • enamel cavity into dentine
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10
Q

what dos it mean if no change after drying

A
  • entirely normal tooth
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11
Q

what does it mean fi there is opacity after drying

A
  • little bit of demineralisation in fissure pattern and histologically it is entirely limited to the enamel
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12
Q

what does it mean if there is opacity visible without drying

A
  • minimal dentinal involvement
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13
Q

what does it mean when there is localised enamel breakdown in opaque/discoloured enamel +/- discoloured from underlying dentine

A
  • peripheral white and stain in centre then likely caries

- probably in outer 1/4 of dentine

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14
Q

what does it mean when there is cavity in enamel

A
  • once have an actual cavity then can be sure that there is significant dentine involvement
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15
Q

what is a tactile assessment used for

A
  • for dentinal caries
  • NOT enamel caries
  • can tell if there is residual caries in a cavity
  • excellent for dentine caries
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16
Q

why don’t we probe enamel caries

A
  • can cause breakdown of fragile surface preventing potential remineralisation
  • high incidence of false positives
  • can form a cavity by probing soft enamel
  • point of no return is cavitation
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17
Q

what can be seen with direct visual assessment

A
  • can’t really see demineralisation with just vision
  • can see cavitation well with just vision
  • can use a probe under contact points to feel if there is any catching or cavitation if see staining
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18
Q

how does transillumination work

A
  • carious lesions absorb light
  • easier to do anteriorly
  • surgery light only really works for anterior
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19
Q

what are bitewing radiographs used for

A
  • approximal lesions
  • safety net for occlusal lesions
  • essential we take these for interproximal lesions
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20
Q

what is TETS used for

A
  • interproximal caries

- radiographs doesn’t tell if cavity or not

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21
Q

how is TETS done

A
  • place and orthodontic band in between teeth using 2 forceps
  • as band contracts it pushes teeth slight apart
  • leave it for 5 days
  • will create space to see surface
  • can take a silicone impression or use a probe to feel for cavity
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22
Q

what does the extent of radiographic caries mean for cavitation

A
  • radiolucency in outer half enamel = 0% cavitation
  • radiolucency in inner half enamel = 10.5%
  • radiolucency in outer half dentine = 40.9%
  • radiolucency in inner half of dentine = 100%
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23
Q

who is most common to have root caries

A
  • older people

- recession from age, or poor periodontal health or due to low salivary flow rate

24
Q

how to diagnose root caries

A
  • clean teeth = can’t see caries under plaque
  • tactile assessment = use a probe
  • visual assessment = position in relation to gingival margin (if at GM then active, if far away then likely arrested)
  • colour of root caries = less reliable than tactile
25
Q

how does texture help diagnose root caries

A
  • soft lesions have higher bacteria loads and are more likely to be active
  • most important assessment
26
Q

how does colour help diagnose root caries

A
  • light coloured lesions have higher bacterial loads

- but this alone is NOT a reliable indicator

27
Q

what are the indicators for non-operative intervention for root caries

A
  • hard, dark coloured lesion, >1mm from GM
  • does not trap plaque
  • not rapidly progressing
  • patient able to participate in non-operative management = willing to improve OH
28
Q

what is secondary caries

A
  • caries that has occurred around about an existing restoration margin
  • most common reason for restoration failure
    BPE probe would easily drop into it
29
Q

how can you prevent secondary caries

A
  • if tooth is sound around the margins of the restoration, then not likely to have anything going on
  • caries doesn’t seep from inside out, goes outside in
30
Q

why is colour change alone not a good indicator of secondary caries

A
  • amalgam can cause staining as can foods
31
Q

where is secondary caries most common

A
  • for 94% amalgam and 24% composite site is cervical
32
Q

what are some non-operative treatments

A
  • dietary analysis
  • oral hygiene instructions
  • increased fluoride exposure
  • fluoride varnish
  • CPP-APP
  • ICON
33
Q

how does dietary analysis help

A
  • reduce amount of simple carbohydrates = reduce substrate

- give patient targeted advice based on frequency and amount they are having of sugar

34
Q

what is OHI

A
  • to remove plaque regularly = reduce bacteria on teeth
  • tooth brushing and interdental cleaning
  • instruct patent on removing plaque regularly
35
Q

why do we increase fluoride exposure

A
  • to tip balance towards remineralisation
  • higher fluoride concentration means more effective
  • those with higher caries risk can get higher ppm
36
Q

what does fluoride varnish fo

A
  • reduced the caries increment in target population
37
Q

how often do at risk patients get fluoride varnish

A
  • full mouth

- every 3-6 months

38
Q

what is SDF

A
  • silver diamine fluoride
  • potential to make huge difference
  • produces arrest in 96.1%
  • don’t need a drill with this = good for COVID
  • however it turns teeth black
39
Q

what is CPP-APP

A
  • tooth mousse
  • sugar free dental topical cream
  • contains fluoride and also seems to lighten teeth
  • CPP = casein phosphopeptide
  • APP = amorphous calcium phosphate
  • remineralises subsurface enamel
  • casein peptides dissolve into plaque and supersaturate calcium and phosphate ions from APP promoting remineralisation
  • not actually that beneficial
40
Q

what is ICON

A
  • resin infiltration of caries lesion
  • like a fissure sealant for approximate and smooth surface lesions
  • can get for interproximal areas too
41
Q

how does ICON work

A
  • etch lesion, dry lesions, infiltrate lesion
  • tooth is softer so acid etch this then dry lesion with ethanol which dries liquid that filled pores then put resin on that and ti sucks into the pores and basically replaces porous enamel with resin
  • resin has similar optical properties to enamel
  • can be successful in reversal of white spot lesions
42
Q

what is the purpose of operative treatment

A
  • restore significant loss of dental tissue
  • eliminate plaque retention/stagnation
  • restore physiological masticator function
  • minimise risk of recurrent disease
  • restore aesthetics where possible
43
Q

when do we intervene with secondary caries

A
  • when there is an obvious cavity
  • when here is a gap that a perio probe could get into
  • when it is a plaque trap
44
Q

when do we intervene with root surface caries

A
  • when pale coloured or black lesion, >1mm from gm
  • plaque trap
  • patient unable to do non-operative management
  • feels soft with a probe
45
Q

what are the operative treatment options

A
  • do nothing = if lesion self-cleansing just leave it
  • starve them = fissure sealants
  • fissure seal occlusal caries
  • restoration
46
Q

how does fissure sealant help treat caries

A
  • acid etch kills viable bacteria by 75%
  • when lesions are sealed and maintained bacteria die
  • need to monitor that it doesn’t disappear and things don’t progress
47
Q

how do we do restoration

A
  • first remove all overlying enamel
  • carry out hadn’t excavation or slow speed
  • as long as we have a wall of sound dentine and enamel then we can leave the rest as they will be starved
48
Q

what are the restorative options for deep carious lesions

A
  • non-selective removal of carious tissue to hard dentine
  • selective removal to firm dentine
  • stepwise excavation treatment
  • selective removal to soft dentine
49
Q

what is non-selective removal or carious tissue to hard dentine

A
  • get slow speed and keep going till all caries is gone

- take a sharp probe over it and if it is scratchy and hard

50
Q

what is selective removal to firm dentine

A
  • go down to leathery feeling dentine, not super hard
  • when pulpal exposure is likely
  • could do direct pulp-capping
  • very poor prognosis of tooth survival
51
Q

what is stepwise excavation treatment

A
  • 2 stages
  • remove majority of caries to provide peripheral seal and leave soft dentine then go back a few months later and remove rest of caries once tertiary dentine has formed
  • avoid pulpal exposure
  • survival rate 74%
  • need to create a periphery
52
Q

what is selective removal to soft dentine

A
  • puncture into lesions and create peripheral seal and leave all soft dentine behind
  • survive rate 90% after 3 years
  • easier to do and procedure is simpler
  • don’t go back and remove carious dentine
  • better success than stepwise
  • reduces risk fo pulpal failure
53
Q

why do we do minimal invasive techniques

A
  • if lesions not in place where you expect then use technique to remove least amount of tooth tissue to remove caries and create a cleansing environment
  • if can access caries without going through marginal ridge then do
54
Q

how can we cause remineralisation

A
  • even in some cavitated lesions we can achieve remineralisation
  • with toothbrushing and cleaning, caries can be minimised
  • once arrested the caries can improve the aesthetics
55
Q

what are some non-operative managements

A
  • patient education
  • dietary modification = 3-day diet diary, reduce amount and frequency of sugar
  • OHI
  • professional prophylaxis = see a hygienist but is expensive
  • topical fluoride application
  • active monitoring
  • non-operative treatment of root/smooth surface caries
  • sealing in occlusal caries
  • resin infiltration
  • ensuing areas are self-cleansing
56
Q

what are some minimally invasive techniques

A
  • repair and refurbishment of restorations
  • preventative resin restoration
  • ultrasonic minima preparation
  • bioactive linings = biodentine
  • partial caries removal
  • stepwise caries excavation
57
Q

what are the 2 reasons to replace a restoration

A
  • new caries

- technical failure of previous restorations

BDS3 - caries symposium (6 decks)

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