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Restoration and Maintenance of Oral Health > Caries > Flashcards

Caries Flashcards

1
Q

Why is caries management important in modern dentistry? (4 reasons)

A
  1. Second most prevalent non-communicable disease in adults worldwide and it affects quality of life
  2. Known links between caries and systemic health - caries is preventable
  3. Aesthetic restorations are part of the rehab of med/high caries-risk pts motivation, value, responsibility)
  4. Manufacturers producing high quality direct, adhesive aesthetic materials/cements
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2
Q

What is ‘MI’ dentistry?

A

Minimum Intervention Oral Care

Holistic and patient -focussed and involves all members of oral health care team. Aims to achieve long-term oral health.

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3
Q

Name the 4 domains of oral care plans

A
  1. Identify
  2. Prevent and control
  3. MI restore
  4. Recall - pt focused
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4
Q

What is involved in the ‘identify’ stage of the oral care plan?

A

Verbal history, oral exam, caries lesion detection, radiographs, aetiological factors for susceptibility

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5
Q

What is the (long) definition of dental caries?

A

Reversible disease process of hard tissues.

Instigated by action of bacteria on fermentable carbs in plaque biofilm at tooth surfaces.

This leads to formation of carious lesion: acid demineralization and ultimate proteolytic destruction of the organic component of dental tissues

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6
Q

Outline what dental caries is

A

Progressive, non communicable disease initiated at the surface in the biofilm that is reversible up to a point

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7
Q

What is a carious lesion?

A

It is where the tooth substance has softened and has been destroyed

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8
Q

What is the caries PROCESS?

A

The histopathological metabolic interactions occurring in the plaque biofilm causing disease

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9
Q

What is a carious LESION?

A

The signs of the disease on dental hard tissues i.e. early lesions/discolouration/opacities/cavities etc

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10
Q

Which bacteria is primarily associated with the caries process?

A

Strep Mutans

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11
Q

What 4 factors need to occur in order for caries to develop?

A

Bacteria (relevant bacteria)

Susceptible tooth surface

Carbohydrates

Time

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12
Q

At what pH is the enamel particularly susceptible to acid attack (critical pH)?

A

5.5

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13
Q

What’s the critical pH of dentine?

A

6.2

it’s more susceptible to acid attack

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14
Q

What 5 factors are required for good visual detection?

A

Sharp eyes + magnification

Good light

Clean, dry tooth surface

Dental explorer (blunt) - e.g. perio probe

Time

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15
Q

What steps are involved in diagnosing caries? (4)

A

Caries history/susceptibility assessment

Signs- detection

Symptoms i.e. pain history

Special investigations: sensibility tests (temp, electrical, percussion etc), radiographs

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16
Q

Name the factors that can increase susceptibility of caries

A

Medical (certain drugs, sucrose-based meds)

Social: stress, lifestyle change

Dietary: prolonged breast feeding, grazing

Host resistance: previous caries experience, lesions on certain tooth surface, soft,light coloured lesions

Salivary: Low secretion and buffering

Microbiology: high numbers S Mutans and Lactobacilli

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17
Q

What does it mean if a pt is low risk?

A

Inactive/controlled:

0-1 active lesion/no history of recent restorations

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18
Q

What does it mean if a pt is medium risk?

A

Active/modifiable:

> 1 active lesions
2 new, progressive or filled in last 2 years

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19
Q

What does it mean if a pt is high risk?

A

Active/unmodifiable or unidentifiable risk factors:

> 1 active lesions
2 new, progressive or filled lesions in last 2 years

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20
Q

How would you control caries risk for low risk patients?

A

OH, fluoride, standard home care

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21
Q

How would you control caries risk for medium risk patients?

A

OH, supplementary fluoride mouthwash or gels.

Dietary modifications

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22
Q

How would you control caries risk for high risk patients?

A

Control at individual pt level

Same as medium risk plus salivary flow stimulation

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23
Q

What causes the enamel to dimineralise and form a lesion?

A

The biofilm releases acids that lower the pH to 5.5 or below. This causes the dissociation of minerals/ions in the enamel (but the surface can still be intact and demineralised) = underlying enamel is porous

24
Q

How are the enamel crystals arranged?

A

Arranged into prisms

25
Q

Which particular part of the enamel suffers from acid attack?

A

The enamel prisms and boundaries

26
Q

How would you describe an early white spot lesion on enamel?

A

Frosty white appearance, chalky and softened, increased porosity

27
Q

How would you describe an early white spot lesion on enamel?

A

Frosty white appearance, chalky and softened, increased porosity. The surface becomes roughened and cavitated

28
Q

What is a brown spot lesion

A

It’s where a white spot lesion has arrested. It has been stained from the diet

29
Q

Which part of dentine plays a critical part in matrix and mineralisation production?

A

Non-collagenous proteins

10% of dentine

30
Q

What 3 components make up dentine?

A

Mineral, collagenous matrix, tubules

31
Q

What are the biochemical affects of caries attack on dentine?

A

Demineralisation due to acid attack

Bacterial penetration via tubules and branches

Proteolysis- collagen breakdown via host and bacterial enzymes (primarily host enzymes)

32
Q

Why does dentine become various shades of brown when attacked?

A

Maillard reaction: between proteins and carbs in acidic environment

33
Q

What signs would suggest that the dentine-pulp complex has triggered a defence reaction?

A

Translucent dentine

Reparative (tertiary) dentine

34
Q

Why does dentine become soft when attacked by acid or caries?

A

Due to demineralisation

35
Q

What is translucent dentine made up of?

A

Plate-like crystals of whitlockite

36
Q

What structural factor plays a part in the hardness of the tissue?

A

The way the crystals are arranged in each layer - i.e the crystalline structure

37
Q

Name 3 ways in which dentine-pulp complex defends itself to attack?

A

Translucent dentine, reparative dentine, inflammatory/serum proteins in pulpal fluid (these are then pushed up into tubules)

38
Q

Outline stage 0 of the modified ICDAS scale

A

0 - no or slight change in enamel translucency after prolonged drying >5secs.No enamel demineralisation or narrow surface zone of pacity

39
Q

Outline stage 1 of the modified ICDAS scale

A

Opacity or discolouration hardly visible on a wet surface, but distinctly visible after air drying.

Enamel demineraliseation limited to outer 50% of the enamel layer

40
Q

Outline stage 2 of the modified ICDAS scale

A

Opacity or discolouration distinctly visible without air drying. No clinical cavitation detectable.

Demineralisation involving between 50% of the enamel and the outer third of dentine

41
Q

Outline stage 3 of the modified ICDAS scale

A

Localised enamel breakdown in opaque or discoloured enamel +/- greyish discolouration from underlying dentine.

Demineralisation involving the middle third of dentine.

42
Q

Outline stage 4 of the modified ICDAS scale

A

Cavitation in opaque or discoloured enamel exposing the underlying dentine.

Demineralisation involving the inner third of dentine

43
Q

Why can caries affected dentine be remineralized?

A

Because the collagen in the affected dentine has been damaged NOT denatured

44
Q

What is the difference between a D1 and D2 carious lesion?

A

D2 is closer to the dentine layer

45
Q

What is the histology of D1 & D2 carious lesions?

A

Early subsurface demineralisation

Early porosity

? Bacterial penetration

? tertiary dentine

46
Q

What are the clinical signs of D1 & D2 carious lesions?

A

White spot lesion, frosty

Chalky, roughened surface

Arrested brown spot lesion

47
Q

What are the symptoms of D1 & D2 carious lesions?

A

Minimal symptoms

Slight sensitivity to H/C/S if at EDJ

48
Q

What would the treatment of D1 & D2 carious lesions be?

A

Monitor

OHI, fluoride, diet

? Fissure seal/PRR

49
Q

What is the histology of D3 carious lesions?

A

Enamel demineralisation

Increased porosity

Bacterial penetration

organic/inorganic dentine/tubular destruction

Translucent dentine

Tertiary/reparative dentine

50
Q

What are the signs of D3 carious lesions?

A

Cavitated (open)/non-cavitated (closed)

Discolouration/opacities

51
Q

What are the symptoms of D3 carious lesions?

A

? acute, reversible pulpitis

52
Q

What is the treatment for D3 carious lesions?

A

Monitor/OHI/Fluoride/diet

Minimal cavity prep

Sealed restoration

53
Q

What is the histology of D4 carious lesions?

A

Gross demineralisation

Gross bacterial penetration

Tubular destruction with pulp exposure

54
Q

What are the signs of D4 carious lesions?

A

Cavitation

Gross discolouration

Visible necrotic pulp ?

55
Q

What are the symptoms of D4 carious lesions?

A

Chronic, irreversible pulpitis

Loss of function

56
Q

What is the treatment for D4 carious lesions?

A

Pulp capping

Sealed, layered, complex restoration

Pulp extirpation and/or RCT

Restoration and Maintenance of Oral Health (29 decks)

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