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Caries diagnosis and treatment planning Flashcards

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1
Q

What is dental caries

A
  • Disease of mineralized dental tissues caused by action of
    microorganisms on fermentable carbohydrates
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2
Q

In its early stages…
remineralisation is possible above a critical pH of

A

The disease can be arrested
5.5

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3
Q

Clinical caries diagnosis involves the process of what 3 things

A

1) Caries detection (non cavitation or cavitated)
2) Diagnosing if the lesion is arrested/active/ progressing rapidly
3) Recording findings

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4
Q

Early caries diagnosis allows

A

Successful caries prevention and management

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5
Q

Professor Nigel Pits created what to demonstrate caries diagnosis?

A

The iceberg of dental caries

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6
Q

The iceberg of dental caries is what

A

Demonstrative of the diagnostician thresholds used in epidemiology and practice

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7
Q

Describe the ‘Iceberg of dental caries’

A

In epidemiological surveys the iceberg floats at D3 threshold ie. cavity in dentine

Most lesions are stable by preventative care are hidden below the water

Patients who only present with D1 and D2 lesions are described as ‘caries free’ by epidemiologists.

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8
Q

No active care needed

(Under water)

A

Sub clinical initial lesions in a dynamic state of progression/regression

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9
Q

Preventative care advised

(Under water)

A

Lesions detectable only with traditional diagnostic aids

D1 Clinically detectable enamel lesions with ‘ion tact surfaces’

D2 Clinically detectable ‘cavities’ limited to enamel

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10
Q

Preventative and operative care advised

A

D3 Clinically detectable lesions in dentine

D4 Lesions into pulp

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11
Q

Caries classification
Anatomical site?
Activity?

A

Occlusal/ smooth surface (proximal/buccal)/root

Activity Active/arrested

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12
Q

Caries classification
Virginity?
Extent?

A

primary/ recurrent
incipient/occult/cavitation

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13
Q

Tissue?
No. Surfaces?

A

initial/superficial/moderate/deep/deep complicated OR
enamel/dentine/pulp

simple/compound/complex

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14
Q

Chronology?
Tooth surface affected?

A

early childhood/adolescent/adult

mesial/distal/occlusal/
buccal

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15
Q

Blacks Classification

A

class I,II,III, IV, V, VI

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16
Q

Methods of caries diagnosis in the paediatric patient-

Conventional techniques of caries diagnosis?

A

Simple visual
Tactile
Radiographs

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17
Q

Simple visual?

A

Dry the tooth
Separator

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18
Q

Tactile?

A

Probe

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19
Q

Radiographs?

A

Digital image enhancement
Digital subtraction radiography

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20
Q

Caries diagnosis-
Novel techniques?

A

Electrical current
Fluorescence
Enhanced visual techniques

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21
Q

Electrical current?

A

Electrical conduction measurement

Electrical impedance

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22
Q

Fluorescence?

A

Visual: QLF
Laser diagnodent

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23
Q

Enhanced visual techniques?

A

FOTI
DiFOTI

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24
Q

What should remain the standard practice in the clinical diagnosis of primary caries in paeds patients?

A

Visual inspection combined with bitewing radiographs for proximal surfaces

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25
What is required for the visual diagnosis of caries?
* Dry tooth – compressed air * Clean teeth – brush, prophy * Good light * Dental mirror * Sharp eyes . Blunt or ball ended probe (NOT a sharp probe)
26
What is the purpose of drying the tooth
To identify white spot lesion and brown spot lesion.
27
White spot lesion on a dry tooth?
Penetrated 1/2 way through enamel
28
White spot lesion and brown spot lesion on wet tooth?
Through enamel and may be into dentine
29
How to carry out temporary tooth separation and what is it for?
* Elastomeric separator inserted for 30 mins-1 week * Direct exam or indirectly via impression * Diagnosis of interproximal lesions
30
What is the importance of temporary tooth separation?
May avoid need for radiograph/ supplement radiograph
31
What must temporary tooth separation be carried out over?
Multiple visits
32
Tactile diagnosis of caries- how do you do it and what do you use?
* Visual is aided by ball ended explorer NOT sharp probe * Remove any remaining plaque and debris and to check for surface contour, minor cavitation or sealants. * Sharp probe – not increased accuracy and may damage intact enamel over a carious lesion (Lussi 93)
33
How may a probe reflect morphology of fissure ?
Stickiness with the probe
34
Tactile diagnosis of caries in extracted teeth? Methods and percentage caries detected?
* Visual inspection of cavitated occlusal lesion – 62% caries detection * Bitewings only – 79% caries detected * Visual inspection + BW’s – 90% caries detection
35
Clinical caries diagnosis can be .. for example..
Difficult With dentine caries there may be no break in the surface
36
What is required because of the difficult caries diagnosis?
Adjunctive diagnostic aids ie radiographs are the most common used
37
What radiographs could we use in caries diagnosis?
Bitewings Lateral oblique jaw views OPT
38
What radiographs are the first choice for caries diagnosis in the primary and mixed dentition in kids?
Bitewings ie intra-oral radiography
39
What ages should radiographs be used in children as an adjunct to visual diagnosis?
4 and above
40
When should radiographs be taken
After clinical examination
41
What could be an example of when you don’t need radiographs?
Well spaced dentition with open contacts Record why you haven’t taken bitewings
42
What stuff with radiographs should you record?
Why you haven’t taken them If child is pre cooperative or lacking cooperative ability
43
What are the advantages of BWs?
* Surfaces inaccessible to clinical exam can be studied * Depth of lesion can be assessed * Non-invasive * Radiographs can be re-examined and comparisons can be made . Increased diagnostic yield when compared to clinical examination alone:...
44
Increased diagnostic yield compared with examinations alone?... how
The number of approximal lesions detected increases by a factor of between 2 and 8 when bitewings taken when compared to clinical examination alone. * Detection of inadequate restorations (86%) which otherwise appeared clinically sound or adequate on examination alone
45
Limitations of Radiographs in the diagnosis of Caries
* Age/ cooperation limitations * Occlusal caries may not be visible (enamel) * May get triangular radiolucencies on mesial surface upper E’s and 6’s due to Cusp of Carabelli * Usually underestimate the extent of a lesion * Use of ionising radiation -DNA damage . May have overlapping
46
Radio graphic investigations frequency- High caries risk status?
6 monthly
47
Moderate caries risk status?
12 monthly
48
Low caries risk status?
12-18 monthly for primary and mixed dentition 2 yearly for permanent dentition
49
Radiography should only be performed when
the patient history/ or objective findings and symptoms lead to the conclusion that further useful information might be obtained.
50
When should a radiograph not be taken?
When it is not expected to change diagnosis or treatment or add other useful information
51
Radiographs are
Adjuncts, not replacement to a good history and clinical examination
52
Ensuring successful radiography in children?
Use smaller film sizes (size 0) Use smaller holders or adhesive tabs Use child friendly terminology Demonstrate the equipment first Distraction techniques (counting, nose breathing)
53
What is the benefit of a lateral oblique jaw view?
Avoids an intra oral film Less cooperative ability required Provides additional information on the developing dentition
54
Lateral oblique jaw view and bitewings?
Fair to good agreement with each other
55
Benefit of OPT
Can detect occlusal dentine lesions eg large lesions
56
Disadvantages of OPTs
Increased radiation dose Lower sensitivity for caries diagnosis, especially approximally
57
Digital subtraction radiography- what does it do? (DSR)
* Determines qualitative changes that occur between 2 digital radiographic images taken at different time * Shows progression or regression
58
How does digital subtraction radiography work?
* Subtract pixel values for each coordinate of the 1st radiograph from equivalent coordinate in a 2nd radiograph= subtraction image * If 0- no change
59
Methods of caries diagnosis in the paeds patient- novel techniques?
1) Enhanced visualisation – FOTI 2) Fluorescence - Laser Fluorescence (Diagnodent) and QLF (Qualitative light fluorescence) 3) Electric – Electronic caries meter (Cariescan pro) 1)Chemicals- caries detector dyes
60
Principles of treatment planning- each treatment plan should comprise...
- Relief of pain – Prevention – Behaviour Management / Acclimatisation – Operative procedures * Logical treatment progression building on each previous visit - Recall interval and radiograph frequency
61
Preclinical phase?
Exposure Primary prevention Maintaining physiological equilibrium
62
Clinical phase- non cavitated?
Early diagnosis Primary prevention Maintaining physiological equilibrium OR Secondary prevention Non operative treatment
63
Cavitated?
Late diagnosis Secondary prevention Non operative treatment OR Tertiary prevention Operative treatment
64
Prevention treatment plan- Diet drinks advisce, brushing, dentist
Limit sugar to 4/5 times/day Water or milk as main drinks x2 day, appropriate F toothpaste for age and caries risk, consider F mouthwash * Dentist – Fissure sealants- resin or GIC – Fluoride varnish Prevention treatment plan...
65
Dentist- prevention treatment plan?
Primary prevention if no disease * Secondary prevention if early disease
66
Treatment plan for non cavitated lesions in primary teeth? Occlusal?
Complete caries removal Incomplete caries removal Fissure seal with resin or GIC
67
Treatment plan for non cavitated lesions in primary teeth? Proximal?
Complete caries removal Incomplete caries removal Seal with a Hall Crown
68
Treatment plan for cavitated lesions in primary teeth (no pulp involvement)? Occlusal?
Complete caries removal Incomplete caries removal Seal with a Hall Crown
69
Treatment plan for cavitated lesions in primary teeth (no pulp involvement)? Proximal?
Complete caries removal Incomplete caries removal Seal with a Hall Crown
70
What are the coexisting considerations for caries removal in children?
* Presence of absence of symptoms/ infection * Number of visits required * Number and extent of carious lesions, Oral Hygiene * Distance travelled, attendance history * Patient compliance * Parental motivation * Previous medical history * Caries rate/risk * Anaesthesia to be used
71
Planning- using quadrant dentistry- what’s the benefits?
Reduces number of visits Reduces number of episodes of LA
72
Planning- using quadrant dentistry- what are the things to note?
Take care with LA dose Requires good compliance often beyond younger children/ those with special needs
73
What are the possible alternatives to treatment?
* Preventive approach E.g. – To obtain stabilisation until compliance established – If carious lesions are arrested – If close to exfoliation and there is a permanent successor developing
74
There are some example cases with questions at the end to look at

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