Diagnosis and Tx Planning

Question 1

methods of clinical examination of caries

Answer 1

Visual examination for changes in tooth surface texture and/or color. This must be conducted in a dry, well-illuminated field, as moisture and poor lighting can make it difficult to detect irregularities.

Tactile examination requires field isolation, by placing cotton rolls along the oral vestibules and removing excess saliva. It is conducted in conjunction with the visual exam, by careful use of an explorer.

Radiographs are valuable, as they help with diagnosis of lesions which may not be accessible for visual-tactile examination.

Transillumination is when a bright light is shined through anterior tooth junctions. The detection of shadows can indicate interproximal decay.

Question 2

How is an explorer used during the clinical examination of caries detection?

Answer 2

Previously, the explorer was utilized to detect any stickiness or softness of the enamel.

However, recent findings support careful examination, as the sharp end can:
- Introduce a cavitation by accident
- Transfer cariogenic bacteria from infected to non-infected areas
- Provide false positives when the explorer catches on pits and fissures

Question 3

The tooth must undergo ______% mineral loss for radiographic detection.

Answer 3

30-40%

Question 4

radiographs often utilized for anterior and posterior caries detection respectively

Answer 4

periapical and bitewing radiographs

Question 5

Transillumination can also be used to differentiate between __________ and __________.

Answer 5

craze lines and fracture

*Fractures will block the light, while craze lines will allow light to pass through the tooth.

Question 6

Visual examinations for amalgam restorations include the following:

Answer 6

• detection of blueish hues (corrosion products may leach into dentinal tubules, or underlying enamel may be seen through translucent enamel)
• marginal gaps and/or ditching (>0.5mm)
• gaps or ditching under 0.5mm are not considered defective due to the self-sealing properties of amalgam, major gaps or ditching are considered carious or carious-prone and must be repaired
• proximal and/or marginal overhangs
• voids and/or fracture lines must be monitored

Question 7

chemical loss of tooth structure caused by acidic foods/beverages or gastric acid, WITHOUT bacterial involvement

Answer 7

erosion

Question 8

often presents as bowl shaped ditching of cusp tips on posterior teeth, known as cupping –> this can result in restorations appearing higher than the tooth structure

Answer 8

erosion

Question 9

pathological loss of tooth structure by mechanical wear, induced by opposing natural tooth structure

Answer 9

attrition

Question 10

may be induced by a combination of tooth flexure, toothpaste abrasion, and chemical erosion

Answer 10

attrition

Question 11

pathological loss of tooth structure by mechanical wear, induced by external materials

Answer 11

abrasion

Question 12

most common cause of abrasion

Answer 12

porcelain or ceramic crowns of the opposing teeth

Question 13

loss of tooth structure in cervical regions

Answer 13

abfraction

Question 14

can happen when the dentinal tubules on the root surfaces become exposed

Answer 14

hypersensitivity

Question 15

hypothesizes that dentinal fluid movement activates mechanoreceptors located in pre-dentin to cause pain

Answer 15

The Hydrodynamic Theory

Question 16

explanation of root surface hypersensitivity (The Hydrodynamic Theory)

Answer 16

Dentinal tubules are filled with fluid and odontoblastic processes containing mechanoreceptors. Exposure of these tubules, temperature change, and osmotic pressure changes may result in fluid shifts, which can activate the nerve endings and result in sensitivity.

Question 17

an effective product used in occluding dentinal tubules, preventing manipulation of dentinal fluid, and consequently reducing sensitivity

Answer 17

GLUMA

Question 18

_______ surfaces are especially susceptible to sensitivity, due to the fast wearing of the thin cementum layer.

Answer 18

Root

Question 19

treatment plan concept that states the patient need dictates the order of phases of operative treatment planning

Answer 19

greatest need treatment planning

Question 20

Which sequence in the greatest need treatment planning is this? addresses the patient’s acute oral health needs such as from emergencies like infections, swelling, and high pain

Answer 20

urgent phase

Question 21

Treatment in the urgent phase may include:

Answer 21

placing a temporary restoration, endodontics, and extractions

Question 22

Which sequence in the greatest need treatment planning is this? includes controlling oral diseases, by eradicating active signs of the disease and managing the risk factors contributing to the disease

Answer 22

control phase

Question 23

Which sequence in the greatest need treatment planning is this? monitoring patient improvement and ensuring there is no active disease

Answer 23

re-evaluation phase

Question 24

Which sequence in the greatest need treatment planning is this? includes reforming the patient’s oral condition by establishing ideal function and esthetics

Answer 24

definitive phase (treatment may include orthodntics, prosthodontics)

Question 25

Which sequence in the greatest need treatment planning is this? establishing excellent at home self-care of the patient, routine cleanings, and/or examinations

Answer 25

maintenance phase

Question 26

2 criteria for restoring teeth

Answer 26

• a carious lesion extending into the DEJ radiographically and/or clinically
• a cavitated carious lesion

*Any carious lesion that is NOT cavitated is considered reversible.

Question 27

T or F: Any carious lesion that is not cavitated is considered reversible.

Answer 27

T

Question 28

treatment of non-cavitated lesions

Answer 28

fluoride or arrested with silver diamine fluoride

Question 29

Patients with a high caries risk must be monitored. High risk patients may demonstrate several of the following:

Answer 29

• 2 or more active caries
• multiple number of restorations
• poor oral hygiene and dietary habits
• low fluoride exposure and salivary flow
• uncommon tooth morphology (ex: deep pits/fissures)

Question 30

2 examples of preventive dentistry

Answer 30

1) Remineralization of incipient smooth surface lesions. This process can be promoted with fluoride treatment or reversal of high caries risk behaviors.
2) Include treating caries-prone pits and fissures with sealants in pediatric patients.