Prevention and management of caries Flashcards
How much toothpaste do you use for a child under 3 years old?
Smear
How much toothpaste do you use for a child 3 years old and over?
Pea size
What is caries driven by?
Biofilm on surface of teeth
What are the 4 zones of enamel caries?
Surface zone, body of lesion, dark zone and translucent zone
What sort of disease is caries?
Socioeconomic
What are the impacts of caries for children?
Pain, time off school, difficulty brushing teeth, difficulty eating, loss of sleep, interference with social activities
what percentage of UK children have dental sepsis?
5%
Why do we need to diagnose accurately?
To make correct restorative decisions and initiate prevention
How can you detect and diagnose caries?
Visual examination Radiographs FOTI TTS Laser fluorescence Magnification
Under what conditions would you look at enamel and dentine caries?
Enamel - dry
dentine - wet
Why do we no longer use probing as the main method of detection of caries?
Probing can break surface of tooth and lead to more bacteria entering - plaque trap
The probe transfers cariogenic bacteria between different teeth
probing does not mean a better or more accurate diagnosis
What does ICDAS code 0, code 1, code 2, code 3, code 4, code 5 and code 6 mean?
Code 0 - sound tooth, no evidence of caries after surface drying
Code 1 - first visual change in enamel, white/brown discoloration at entrance to pits/fissures, after drying
Code 2 - distinct enamel change when wet, must also be seen when dry
Code 3 - localised enamel breakdown without dentine involvement, seen when wet and after prolonged drying
Code 4 - underlying dark shadow from dentine
Code 5 - distinct cavity with visible dentine less than half the surface
Code 6 - more than half the surface showing cavity with visible dentine
What is included in the risk assessment of caries?
Previous disease Diet Social Use of fluoride / plaque control Medical history Saliva Bacteria Hunch
What 4 things do you need to think about when diagnosing caries?
Detection
Risk
Activity
Management
How would you brush an erupting tooth?
Sideways brush strokes
What is the hall technique?
A non-invasive treatment for decayed baby back teeth. Decay is sealed under preformed crowns, avoiding injections and drilling.
What is the critical pH?
5.5
What does active and arrested caries tend to look like on the teeth?
Active - white spot usually
Arrested - brown spot usually
What are the 4 factors of caries?
time, tooth surface, microflora, substrate
What type of lesion is not visible on a bitewing radiograph?
Enamel lesions
Which tooth surface is difficult to spot a white spot lesion on?
Approximal surface
What is best used to detect approximal caries?
bitewing radiograph
What are the advantages of using transmitted light to detect caries?
Better in patients with posterior crowding as BW will produce overlapping and for pregnant women to avoid unnecessary radiation
How does tooth separation help to detect caries?
Place separators/matrix bands between contact points - after 2 days feel gently with probe to detect cavity. Elastomer impression material can be used between teeth to record cavity if present
How may laser fluorescence methods be inaccurate to detect caries?
Readings can be confused by staining and calculus so should be used in conjuction with conventional methods
How does laser detect caries?
Emits light 655nm
laser light penetrates tooth
light is measured and intensity is an indication of size and depth of lesion
better for occlusal caries
What factors indicate high risk of caries?
Medical history - disability, sjorgrens
dental history - past caries/restorations
oral hygiene - low frequency of tooth cleaning etc
diet - high sugar
saliva - stimulated and un-stimulated saliva flow is low
social and demographic factors - poverty, education, religion, unemployed
How does a white spot lesion occur?
Enamel exposed to acids from microbial biofilm, mineral is removed from surface.
inter-crystalline spaces enlarge and become more porous
clinically has white spot appearance
What is the response to caries in dentine?
Odontoblasts form tertiary dentine at pulp/dentine border - tubular sclerosis
Which comes first infected or affected dentine?
Infected
What are dead tracts?
empty dentinal tubules filled with air due to degeneration of OB processes (caries etc)
What are transverse clefts?
Penetration of bacteria in the dentinal tubules which traverse at right angles to the tubules along the incremental lines of growth
What is the defense to dentine caries?
Tubular sclerosis
tertiary dentine formation
reduction in permeability of the dentine
removal of bacterial mass and sealing it - allow patient to clean/OH/fluoride can arrest lesions and encourage reparative dentine
What are the 3 types of caries management?
Non invasive/preventive, minimally invasive, restorative
Describe preventive caries management
3 diet diary - assess extrinsic and intrinsic acids effective tooth brushing salivary flow assessment fluoride exposures - optimal levels fluorides in gels, varnish, mouthwash, toothpaste etc DBOH
Why should we restore teeth?
Aids plaque control prevent sensitive teeth pulp is endangered failed alternative preventative measures function has been impaired loss of contact point and subsequent tooth movement aesthetic reasons
When should surgical intervention for caries only be carried out?
Once cavitation has occurred
What are the factors associated with compliance?
Disease Patient Operator Treatment support system facilities
What are the 3 operator variables that exist for compliance factors?
- Explanations
- Attitude towards the treatment
- Quality of the therapeutic relationship
Why is communication important? (6 points)
- Patient trust
- Patient involvement in decision making
- Patient motivation/co-operation
- Management of patient expectations
- Patient satisfaction
- Prevents medico-legal issues/complaint
What are the general barriers to communication?
- Social status: class, age, gender, socio-economic group
- Cultural/ethnic
- Environment
What are the patient barriers to communication?
- Pain
- Anxiety
- Embarrassment
- Cognitive level
- Jargon
What are the dentist barriers to communication?
- Lack of interpersonal skills/training
- Lack of sensitivity/empathy
- Lack of active listening
- Time pressures
What are the three models of health care relationship?
- Active/passive
- Guidance/co-operation
- Consensus/Action
What are the 3 types of motivated patient groups?
- Already motivated; guidance and reinforcement
- Latent motivation; only need a “trigger”
- Lacking motivation; difficult
What are the 4 pre-requisites for change?
- A problem exists which affects the patient personally
- There will be an unwanted outcome – loss of teeth
- There is a practical solution – adequate plaque control
- The problem is serious enough to justify inconvenience/time/effort
What are the strategies for changing motivation? (5 points)
- Education and communication
- Participation
- Facilitation and support
- Negotiation
- Coercion/Threat
How would you approach OHI? (3 points)
- Explain problem, using appropriate resources. (radiographs, mirror, models, charting/indices)
- Disclose
- Plaque score
What does effective communication improve? (7 points)
The quality and amount of information obtained from the patient
increased accuracy and efficiency of diagnosis
The likelihood of patient adherence to recommendations and treatment
Health outcomes for patients
Patient’s anxiety levels
Satisfaction for both patient and dentist
Levels of patient complaints and litigation
Patient referrals
What are the goals of communication in dentistry? (4 points)
To increase; Accuracy Efficiency Supportiveness To enhance patient and dentist’s satisfaction To improve health outcomes To promote collaboration and partnership
What type of approach is the Calgary-Cambridge framework? - Silverman J, Kurtz S & Draper J. (2005). Skills for communicating with patients (2nd Ed.).
Patient-centred
What is a patient centred approach?
Dentist tries to enter the patient’s world to see the [illness/symptoms/condition] through the patient’s eyes
What are the 5 stages of a consultation?
Initiating the session Gathering information Physical examination Explanation and planning Closing the session
What are the 7 steps in initiating the session?
Establishing initial rapport
- Greet patient and obtain name
- Introduce yourself and clarify role
- Demonstrates respect and interest
Identifying reasons for appointment
- Identifies the patient’s problem/issue with appropriate opening question e.g. why are you here today?
- Listens attentively to opening statement without interrupting or directing conversation
- Confirms list and screens for further problems
- Negotiates agenda taking patient’s needs into account
What is attentive listening?
the process by which an individual listens to and,
at the same time, attempts to interpret and summarise
what the speaker is saying
Wait time
Facilitative response
‘Occasional smile, nod, praise, eye-contact
‘uh-huh’, ‘go on’, ‘I see’
Non-verbal skills
Picking up patient’s verbal and non-verbal cues
