Prevention of caries in adults and children Flashcards
What does development of caries depend on?
Host, micro-organisms, substrate and time
What is caries driven by?
Biofilm on surface. No plaque = no caries. Caries will become self-cleansing if no plaque
Which enamel caries zones remineralise and demineralise?
Surface zone and dark zone remineralise
Translucent zone and body of lesion demineralise
What are the zones of dentine caries?
Demineralisation, bacterial invasion, destruction, sclerosis.
Or infected and affected
What is affected dentine?
Nearer pulp. Still bacteria in but not as denatured.
What is the decline in caries since the 1970s down to?
Fluoride toothpaste
What is the current decay experience for 5-, 12- and 15-yos?
5yos: -31% affected -Mean DMFT 0.9 12yos: -34% affected -Mean DMFT 0.6 -43% filled that have caries 15yos: -46% affected -Mean DMFT 1.2 -61% filled that have caries
How many 5 yos and 12 yos in England experienced toothache within last 6 months? (2013)
14% of 5yos
20% of 12yos
What are the impacts on 5yos and 12yos with tootache
Difficulty eating Loss of sleep (tiredness at school) Time off school Problems with tooth-brushing Interference with school activities
How many children have dental sepsis?
5% of children aged 5
What are the impacts of severe early childhood caries on children?
-Failure to thrive
-Preschool: weigh less, smaller than peers
6x more likely to have iron-deficiency anaemia (caries affects diet)
How much are general anaesthetics used for caries?
50,000 children admitted with caries
31% of all GAs
£30 million in England
25% increase in 10 years (less caries being restored?)
Why is an accurate diagnosis important?
Correct restorative decisions
-don’t want to cut unnecessarily
initiate prevention
Name 3 methods of detection and diagnosis of caries?
Visual exam Radiographs FOTI TTS Laser fluorescence Magnification
What is the best method of caries diagnosis?
Good visual exam with support of radiographs
Define meticulous caries diagnosis
Evidence based structured and systematic approach to caries diagnosis, including disease staging (at enamel threshold)
What are the 2 caries assessment systems?
ICDAS (better)
Nyvad
Outline stages of IDCAS
Dry and wet
Probe transmits bacteria/ can’t remin (surface broken)/ don’t help
What should a caries risk assessment include?
Previous disease Diet Social Use of fluoride/ plaque control Medical history Saliva Bacteria Hunch
Factors that prevent caries
Sealants + diet + FLUORIDE (only advice proven to work)
Behaviour modification
What should your behavioural advice to patients be?
Personal
Practical
Positive
Name foods with hidden sugar
Beans
Ketchup
Cereal
Smoothies
Why is xylitol gum beneficial?
Affects glycolysis in S mutans
How effective is fluoride?
Toothpaste: 24% reduction in caries, permanent teeth
Mouthwash: 27% “”
Water: 26% “” and 35% in primary teeth
Straight graph: more F, more effect
What do children 6/7 and 10/11 associate tooth brushing with?
Appearance / freshness/ cleanliness
No link to caries (related diet to caries)
Teeth ‘going grotty’/ falling out
How should one brush erupting teeth?
From side
F varnish
Chewing gum
Diet
How effective are sealants? What is a recent progression
58% reduction in caries
GIC and resin equally good
Approximal sealants
How many lesions will progress under therapeutic sealants?
1 in 10
Progress and monitor
What is Hall technique?
Decay sealed under crowns
Non-invasive
Children
