Preventive Management of Root Caries Flashcards

1
Q

Where are root caries found?

A
  • Root caries is located on the root surface
  • Due to the root having less mineralised materials, root caries spread very easily
  • Gingival recession is frequently associated with root caries, though some lesions are found subgingivally
  • Usually found more commonly where salivary glands are absent: maxillary anterior, mandibular molars
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2
Q

Discuss aetiological factors surrounding root caries, mentioning the critical pH of dentine

A

Cariogenic biofilm that is regularly supplied with fermentable carbohydrates
• Root caries is faster progressing than enamel caries due to the less mineral content
• Critical pH for enamel demineralisation is 5.5 but for dentine it is 6.2
• The collagen in dentine is readily broken by the enzymes produced by bacteria

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3
Q

List some risk factors associated with root caries

A

Age: people are living longer with more tooth retention. Nursing home residents
• Periodontal disease because this results in gingival recession
• Decreased saliva function, mainly due to medications
• Wearing partial dentures
• Huge alcoholic intake or smoking tobacco (through modifying oral bacteria)
• Unemployed/ retired people
• Patients with cognitive issues
• Altered diets with high carbohydrates
• Low functional ability like arthritis = low ability to partake in OH
• Irregular dental attendance due to either mobility or decreased income

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4
Q

Differentiate the microbes found in culturing methods vs the microbes found through molecular technology.

A
Cultures
• Staphylococcus
• Streptococcus
• Pepto streptococcus
• Candida ssp
Molecular techniques
• Actinomyces
• Lactobacillus
• Pseudoramibacter
• S mutans
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5
Q

State how root caries are diagnosed

A
  • Colour, texture, surface smoothness, depth, distinctive border
  • Bitewings
  • Use the side of the probe/ explorer to feel defects
  • Inactive lesions: smooth, shiny, hard and dark
  • Active lesions: Plaque covered, soft, pale colour
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6
Q

List the four steps involved in preventive management

A

Identify and control risk factors

Remineralise

Restore if required

Prevention and recall

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7
Q

Explain the step of “identifying and controlling risk factors”

A

Risk factor: biofilm
• OH: electric toothbrush, ID cleaning, air floss or waterpik
• Leave dentures out at night

Risk factor: Sugar substrates
• Improve diet and eating patterns

Risk factor: saliva
• Check if meds can be changed with GP to improve saliva
• Limit intake of diuretics
• Drink water
• Encourage them to eat chewy foods
• Eat xylitol containing sweets
• Use a bicarbonate with water as a mouth rinse to increase pH

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8
Q

Explain the step of remineralisation

A

Once roots are exposed, plaque control is essential to enable remineralisation. Applying 5000PPM Fl- has reversed root caries

Remineralising agents:
• Silver Diamine Fluoride
• Arginine containing toothpastes
• Duraphat
• Chlorhexidine
• Fuji VII
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9
Q

Describe the mechanism of silver diamine fluoride

A
  • Alkaline solution with contain silver nitrate and sodium fluoride
  • Silver is antimicrobial. It reduces growth of cariogenic bacteria
  • Remineralise dentine
  • Prevents collagen degradation by inhibiting the action of collagenases and cathepsins
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10
Q

Describe the mechanism of arginine containing toothpastes

A

Contains arginine an amino acid
• This is metabolised by plaque bacteria and ammonia is released
• Ammonia helps neutralises plaque acids and pH
• Not as great as SDF, CH or Fl

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11
Q

List considerations associated with the remineralisation step

A

Considerations
• Sodium laurel sulphate inactivates chlorhexidine
• Chlorhexidine works better on a plaque free surface
• Chlorhexidine works great with Fluoride
• Stannous Fluoride stains demineralised lesions
• Acidulated phosphate fluoride (APF) can dissolve CR, CIG and porcelain restorations

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12
Q

Explain the step of restoring and its challenges

A
  • Shallow: Smoothen out lesion, polishing and slight recontouring with home care can arrest lesions
  • Lesions progress rapidly because of low mineral content. The margins of the lesion finish in areas that are difficult to access
  • It is impossible to adequately isolate and it is difficult to determine whether adequate caries removal is achieved
  • Restoration placement and retention is challenging
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13
Q

Explain the step of prevention and recall

A
  • Reinforce OHI/ denture hygiene
  • Reinforce diet
  • Check saliva flow
  • Regular recalls with professional cleaning and fluoride/ CHx varnish
  • Check integrity of restorations
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