Preventive Management of Root Caries Flashcards
Where are root caries found?
- 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
Discuss aetiological factors surrounding root caries, mentioning the critical pH of dentine
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
List some risk factors associated with root caries
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
Differentiate the microbes found in culturing methods vs the microbes found through molecular technology.
Cultures • Staphylococcus • Streptococcus • Pepto streptococcus • Candida ssp
Molecular techniques • Actinomyces • Lactobacillus • Pseudoramibacter • S mutans
State how root caries are diagnosed
- 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
List the four steps involved in preventive management
Identify and control risk factors
Remineralise
Restore if required
Prevention and recall
Explain the step of “identifying and controlling risk factors”
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
Explain the step of remineralisation
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
Describe the mechanism of silver diamine fluoride
- 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
Describe the mechanism of arginine containing toothpastes
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
List considerations associated with the remineralisation step
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
Explain the step of restoring and its challenges
- 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
Explain the step of prevention and recall
- Reinforce OHI/ denture hygiene
- Reinforce diet
- Check saliva flow
- Regular recalls with professional cleaning and fluoride/ CHx varnish
- Check integrity of restorations