root caries Flashcards
What is caries?
Reversible but progressive disease on dental hard tissues
Instigated by action of bacteria upon fermentable carbohydrates in the plaque biofilm on tooth surfaces over time
Leading to bacterially generated acid demineralisation and ultimately proteolytic destruction of the organic component of tissues
What bacteria works mostly on root caries?
Actinomyces spp (gram positive anaerobes)- due to proteolytic affect
Also, mutans streptococci and lactinobacilli
What are pathological factors?
Acid-producing bacteria
Fermentable carbs frequency
Saliva flow/function abnormal
What are protective factors?
Saliva
Fluoride
Antibacterials (chlorhexidine, xylitol etc)
Why is saliva important?
Mechanical flushing (99% water)
Calcium and phosphate ions- lowers pH
Critical pH- 5.5
Antibacterial effects- fluoride, hydrogen peroxide, thiocyanate, IgA, lysozyme, PRP)
Buffering systems (bicarbonate, phosphate, protein)
What is the epidemiology of root caries?
7% of adults
20%- 75-84yrs
What are the risk factors for root caries?
Polypharmacy (dry mouth/contain sugar) Oral hygiene Institutionalisation Movement disorders Diminished cognitive skills More exposed root surfaces Drug addiction Hyposalivation Systemic diseases Decreased saliva quality Diet (soft and short meals high in carbs) Poor manual dexterity
Why might someone have hyposalivation?
Radiotherapy Medications Autoimmune disorders (sjögrens disease) Smoking Idiopathic
What is the histopathology?
Demineralisation- soft consistency, not always change in colour
Cementum/dentine
Darkening- extrinsic staining into softened more porous dentine
Intact collagen- reversible
Continuing demin- collagen broken down
Necrotic dentine- needs removal
How does the caries spread?
Along cementoenamel junction without being too deep
-encircles
Advanced lesions progress to pulp
Can spread coronally to enamel and cause delamination
How can you tell a lesions activity?
Active- lighter/matte, softer/rougher, gingival inflam, plaque build up, inaccessible
Inactive/arrested- dark and shiny, harder, clean
How can non operative caries control be undertaken?
OHI- modify handles? Carer education
Plaque control- remove plaque retentive factors
Diet advice
Fluoride
Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)
Antimicrobial agents
How can hyposalivation be managed?
Potentially manage cause OHI High fluoride toothbrush, mouthwash, varnish Diet sheet- limit sugar Sip water freq Chewing gum- xylitol Saliva substitute (Biotene) Extreme caries risk- 2-3 months recall Salivary stimulant med- pilocarpine
What are the aims of operative management of carious lesions?
- Aid plaque control and manage caries activity at location
- Protect pulp-dentine complex and arrest lesion by sealing
- Restore function, form and aesthetics
What do retraction cord?
Packed into gingival sulcus to retract gingivae to improve visibility, access and moisture control
-rubber dam not always achievable
