W2: Cario: FS for Caries Prevention Flashcards
Discuss the distribution of caries within communities and describe the
characteristics of susceptible populations
- caries more due to sugar, esp low SEB (socioeconomic backgroud) as less FS placed
Explain the concept of ‘polarization of caries experience’ within the population
and provide evidence to support this
Discuss the site-specific distribution of caries
- green = caries free
- btw 74’ and 1990 we are getting better with prevention
grey= occlusal
orange= IP
red= incisive anteriors
in 74’ more caries in incisor and IP, shrinks in 1990
occlusal band has kinda stayed the same.
OCCLUSAL= fissures, so anatomy pays role in caries (apart of multifactorial risk),
Understand the ‘risk-based’ approach to considering the placement of the
sealants for patients
- are they high or low SEB? look of them as a whole
- look at tooth risk status: diet, OH good (kids under 8 not good at brushing teeth)
- F exposure?
- fissure anatomy, is it deep/ stained?
- sealants retentive? can you make it more?
- what material might you use?
Describe the evidence on the effectiveness of sealants in caries prevention
- study with bunch of kids, one side sealed, no seal contralat tooth
- post 5 yrs
- did not repeat 10 yrs bc not ethical
- after 5 years 352 kids (1 sealed 1 not)
- 1 decay
in control= 18% decay
Describe the relationship between sealant retention and sealant efficacy
Describe the clinical considerations before choosing materials that are to be
used for the placement of fissure sealants and fissure protections.
DMFT and dmft
permanent vs primary
decay decrease with FS
comment
F help caries.
gingival= 86 reduction in caries
IP= 75% reduction
BUT pits and fissures = 36% reduction (significantly lower.
which is lower?
b. lower bc of distal cusp.
upper or lower?
oblique ridge prominent
extra cusp of carabelli (always look out for it bc sometimes fissure is there and you may need to seal it)
classify occlusal fissures
4 types
describe occlusal fissure types
- U: the bottom is wide
- V looks like V
- I long skinny
- IK: long skinny, lil opening
can’t really tell clinically, you just have to use clinical judgement
what types are easiest occlusal type to seal
V and U
Whats the problem of Pit/ fissures on teeth?
Not all pits/fissures can be reached by toothbrush bristles
– Dietary carbohydrates can become lodged in the fissures and
provide a source of nutrients
– Note that the anatomy of some pits/fissures is very complex and
impossible to clean
fissure Cross section reveals…?
tooth brush not going to go pass black part
less cariogenic= need to cover it
What’s a good fissure system?
nice, smooth, F system covered, buccal and palatal considered. easy to clean
type of fissure
more of I type, demineralisation on base of fissure due to acid from biofilm.
- hard to see early demin on occlusals, more easier on IP surface
I vs U
material cannot get into I style fissure, what you can do is technique.
If you place it well, you can arrest demin, bc if no food access to bacteria= no demin
The role of fissure sealants
A) benifits of fissure seal?
B) why is baby teeth more decay prone?
A) clean(easier), caries resistant (no carbs = no bacteria food), can remin if use GIC
B) has more HA than Fha (no strong enamel)
Fissure sealants are placed in the caries susceptible pits and fissures of primary and
permanent in order to form a physical barrier.
- use GIC= can add fluoride even years after placing it
- occlusals of permanent molars= most sus sites for dentition (occlusals >IP> B> L)
Why is lingual< buccal less susceptible to caries
tongue mechanical movement
Does the placement of fissure sealants prevent caries ??
dependent on how well it is sealed, need monitor
- better than no sealant/no varnish F
nosealant= more decay
study showing all sealant missing and decay
sf no sealant= as if no seal, decay
Sealant + rate
3 recc
A) sealants are used to prevent?
B) up to what ICDAS code can be fs?
C) what material should we use?
What is mechanical adhesion? What is essential for Resin material?
Why is resin material more adhesive than GIC?
etch tooth 10 sec, wash away to make it porous mechanically
- you see frosty appearance bc demin area, crystals displaced so you see like hedgehog hairs
- when you run bond it will run it will run on all those lil hairs and set
NEED
- moisture control, don’t want sealants to fall off and risk decay
- better retention than GIC
filled vs unfilled vs Fluoride resin
filled resin= flowable, thicker, high viscocisty, don’t penetrate as deep into fissures (deep V or I= wont get far), lower wear
unfilled= no filler particles, like bond with pigments, clinpro, better bc runnier and can get deeper
fluoride resins= doesn’t go to tooth as much. non f resin better.
GIC vs resin
Which GIC is more runny and has more F?
GIC= chemically adhered
- greater F
- GIC you can use for F release
- FUJI VII= runnier than other FUJI, not light cured, can get it in pink as well
all FUJI has F, but FUJI 7 has more (if its a boy kid, say FUJI orange- tell em to look for orange to help them clean)
- when you top up F on FUJI 7= can make fluoride reservoir to strengthen enamel and fissure seal.
- still need moisture control but not as much for resins/composites
- good for newly erupted teeth (half in half out)
- flap of gum= eperculum
notes:
- equia forte= more thick so more for fillings
flap of gum on erupting tooth risk
- flap of gum= operculum
- risk factor
- flap of gum can trap food, can cause pericoronitis,
- can’t get tb in and around it
GIC or resin more retentive?
Resin.
but study shows GIC even if lost, still a bit remains creating ‘barrier’
Which GIC resin modified has fluoride?
FUJI II
Photacfill
not much study.
fissure seal is better than no sealant good study
considerations for fissure seals
A) why kids need help brushing?
B) what to do if decide to not tx with fs?
C) is fluoride water and tp enough to stop decay in fissure?
A) molar pops has operculum hard to clean on top of dodgy kid cleaning
B) varnish
C) no bc can’t brush in fissures. Need fs.
- water F good BUT still need FS to prevent fissure lesion
- encourage parents to wash plaque of kids, they are not good
- parents unaware permanent molars erupted
- operculum= gum flaps, present on distal 6, 7, 8 when they erupt
- FS might not be tolerated, so varnish can be applied every 6 months until sealants
When should you Fissure seal to protect Non-cavitated Caries? Consider ICDAS codes
ICDAS 0,1,2
1=if primary had lesions, then seal permanent 6s as soon as you can
2= changes in enamel then fissure seal
3= use x-ray to see if needs filling instead, if there is break down then restore then seal rest of pit and fissure
do you FS all pt?
Not for good OH, shallow fissures.
Even though it doesn’t cost parent, it may cost GOVT
Recommendations for sealant application
- poor recall attendance= dont FS (can still put even though they don’t come back, partial retain is better than nothing
- ICDAS 1-3= FS
- clean with prophy cup, pumice
- clean= retention
Should you open a fissure system? (Drill it)
NO, bc if fs falls off, could risk decay + loss of enamel
What advice can you give patients who are not going to get fissure seals?
- reccomend diet
- antibacterial agent or varnish until FS available
Options for the prevention of caries in pits and fissures
- Brushing technique,
- Parent involvement,
- Diet modifications,
- antibacterial agents,
- fluoride varnish
until susceptible occlusal surfaces can be fully protected by a fissure
sealant.
(Bekes, 2018)
wet, dry
yes seal
I type
yes
x-ray
filling
1
Can you do a Filling then seal on top?
No bc won’t adhere
IK gets sealed and there is lil biofilm. Will decay stop?
Yes. if you block and starve that is good.
wont eat into dentin bc no food.
