Caries Flashcards
Why is caries management important in modern dentistry? (4 reasons)
- Second most prevalent non-communicable disease in adults worldwide and it affects quality of life
- Known links between caries and systemic health - caries is preventable
- Aesthetic restorations are part of the rehab of med/high caries-risk pts motivation, value, responsibility)
- Manufacturers producing high quality direct, adhesive aesthetic materials/cements
What is ‘MI’ dentistry?
Minimum Intervention Oral Care
Holistic and patient -focussed and involves all members of oral health care team. Aims to achieve long-term oral health.
Name the 4 domains of oral care plans
- Identify
- Prevent and control
- MI restore
- Recall - pt focused
What is involved in the ‘identify’ stage of the oral care plan?
Verbal history, oral exam, caries lesion detection, radiographs, aetiological factors for susceptibility
What is the (long) definition of dental caries?
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
Outline what dental caries is
Progressive, non communicable disease initiated at the surface in the biofilm that is reversible up to a point
What is a carious lesion?
It is where the tooth substance has softened and has been destroyed
What is the caries PROCESS?
The histopathological metabolic interactions occurring in the plaque biofilm causing disease
What is a carious LESION?
The signs of the disease on dental hard tissues i.e. early lesions/discolouration/opacities/cavities etc
Which bacteria is primarily associated with the caries process?
Strep Mutans
What 4 factors need to occur in order for caries to develop?
Bacteria (relevant bacteria)
Susceptible tooth surface
Carbohydrates
Time
At what pH is the enamel particularly susceptible to acid attack (critical pH)?
5.5
What’s the critical pH of dentine?
6.2
it’s more susceptible to acid attack
What 5 factors are required for good visual detection?
Sharp eyes + magnification
Good light
Clean, dry tooth surface
Dental explorer (blunt) - e.g. perio probe
Time
What steps are involved in diagnosing caries? (4)
Caries history/susceptibility assessment
Signs- detection
Symptoms i.e. pain history
Special investigations: sensibility tests (temp, electrical, percussion etc), radiographs
Name the factors that can increase susceptibility of caries
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
What does it mean if a pt is low risk?
Inactive/controlled:
0-1 active lesion/no history of recent restorations
What does it mean if a pt is medium risk?
Active/modifiable:
> 1 active lesions
2 new, progressive or filled in last 2 years
What does it mean if a pt is high risk?
Active/unmodifiable or unidentifiable risk factors:
> 1 active lesions
2 new, progressive or filled lesions in last 2 years
How would you control caries risk for low risk patients?
OH, fluoride, standard home care
How would you control caries risk for medium risk patients?
OH, supplementary fluoride mouthwash or gels.
Dietary modifications
How would you control caries risk for high risk patients?
Control at individual pt level
Same as medium risk plus salivary flow stimulation
What causes the enamel to dimineralise and form a lesion?
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
How are the enamel crystals arranged?
Arranged into prisms
