Revision and CMF Flashcards
Assessing the patient
Persons characteristics and behaviours
Assessing the lesion
The extent and severity of the lesion and surfaces at risk
Treating the patient
Modifying key risk factors using motivational behaviour change and skill development
Treating the lesion
Lesions non-invasively and operatively in the home and clinics
Monitoring the patient
Lifestyle changes
Monitoring the lesion
Lesion changes
Define primary prevention
- Primary prevention aims to avoid the development of a disease
- E.g encouraging less consumption of sugars to reduce caries risk, fluoridated toothpaste
Define secondary prevention
- The focus of secondary prevention is early disease detection, making it possible to prevent the worsening of the disease
- Detection of disease in asymptomatic patients with screening or diagnostic testing and preventing the spread of communicable diseases
- Treating a white spot lesion
Define tertiary prevention
- Reduce the negative impact of an already-established disease by restoring function
- Drilling and filling
The patient
- Empowering the person exposed to the risk factors of this preventable, chronic disease in their cultural, socioeconomic, & physical environments
The lesion
- Managing the lesion
in the dental tissues as a result of the pathophysiology in the mouth and the dental biofilm
List the types of gels used
- APF gel: 12300 ppm NaF with acid
- NEUTRAL NaF gel: 9000 ppm F, used for enamel erosion, exposed dentine, carious dentine, hypomineralization, and restorations of GIC, composite resin or porcelain
- Stannous fluoride gel: used for remineralization of white spot and hypomineralized enamel, root caries. Warning: discolouration
Why would you use a sodium fluoride rinse?
- Ortho patients
- Post radiation hyposalivation
- Inadequate toothbrushing
- High caries risk
How long does it take for a lesion to progress into dentine in a:
- Fluoridated community
- Non- fluoridated community
Fluoridated community
8. 7 years
Non- fluoridated community
1. 5 years
What non- operative treatment occurs in:
- Primary prevention
- Secondary prevention
Primary prevention:
- Professional cleaning
- Polishing
- Application of topical fluoride
- Application of sealants and protective coatings
Secondary prevention: * AIM: arrest WSLs to avoid cavitation * Application of topical fluoride * Sealing pits and fissures
How would you treat an ICDAS: Code 1 Code 2 Code 3 Code 4 Code 5 Code 6
Code 1
* Twice daily tooth brushing with fluoridated toothpaste
Code 2
* F varnish or GIC
Code 3
* Sealant
Code 4
- If lesion is not radiographically in dentine, SEAL
- If lesion is radiographically in dentine, ultra-conservative restoration
- Remove infected dentine, keep affected dentine
Code 5
- Ultra-conservative restoration
- Remove infected dentine, keep affected dentine
Code 6
* Restore
Assessing the person’s characteristics and behaviours
- Diet assessment
- Plaque assessment
- Toothbrushing assessment
- Saliva flow
Assessing the lesion and surfaces at risk
- Separators
- Radiographs
- Pre and post- op progression
- Caries risk factors
- Caris risk markers
Modifying key risk factors through motivational behaviour change and skill development
- 4 caries risk factors
- Effective oral care modifies fluoride, saliva and plaque risk factors
Motivational behaviour change
- Educate on toothbrushing
- Educate on benefits of Fluoride
- Educate about disease prognosis
- Educate about treatment options, treatment iatrogenesis, treatment shelf- life
Treating the lesion at:
- Home
- Operatively in clinics
Home
- Tooth Brushing
- Fluoride
- Diet
- Gum
- High risk = chlorhexidine
Operatively in clinics
- Sealants
- Topical fluorides
- Dental cleans/ polishing
- TREATING SOUND HOMOLOGOUS SURFACES AS A PREVENTION
Monitoring life style changes
Depends on which risk a person had:
- Fluoride risk:
Assess fluoride intake - Plaque risk:
Assess plaque index scores
Assess toothbrushing which should be effective and least damaging - Saliva risk:
Saliva testing
LS and MB counts
Buffer, saliva flow rate - Diet risk:
Assess frequency and composition of diet
Define dental caries
• Dental caries is a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues
• Caries can occur throughout life, both in primary and permanent dentitions, and can damage the tooth crown and, in later life, exposed root surfaces
* The balance between pathological and protective factors influences the initiation and progression of caries
Describe the development of the carious lesion.
The caries lesion begins when bacteria becomes tolerant to, and begins producing high levels of acid on a tooth surface.
While normally in the tooth there is a healthy, dynamic balance where remineralisation overpowers demineralisation, the presence of acid tolerant and acid producing bacteria causes demineralisation to outweigh remineralisation.
As a result, huge amounts of demineralisation causes cavitation within the enamel. With enamel being cavitated, bacteria can reside within the cavity and the continuing process of demineralisation can eventually work its way into dentine. This creates a huge zone of demineralisation.
Affected dentine occurs; the dentine has succumbed to the acid attack but is free from bacteria.
Beneath the affected dentine, more calcified dentine known as “sclerotic dentine” is formed. This attempts to acts as a fortified, calcified wall meant to ward off the acid attack away from the pulp.
In addition, reactionary dentine forms as projectory into the pulp chambers, further reinforcing the blockade against the acid attack.
