Methods of caries management - the biological approach Flashcards
what is detection of caries
determining the presence or absence of the disease
what is diagnosis of caries
- determining the presence or absence of the disease
- knowing whether or not the disease is active or arrested such that, appropriate treatment can be planned
things handy for diagnosing caries?
- plaque chart
- full mouth prophylaxis
- good lighting
- inspect without drying for dentinal shadowing (best seen in wet conditions)
- dry tooth with 3 in 1
- use 2.5 x magnification
- CPITN probe for gently removing debris from fissures/ determine consistency of carious dentine
- good quality bitewings
- temporary elective tooth separation (TETS)
when should temporary elective tooth separation be performed
ALL lesions on the inner half of enamel and in the outer half of dentine
why should temporary elective tooth separation be performed
to confirm cavitation
what special tests can you use
- transillumination
- FOTI
- diagnodent
- plaque PH
- salivary flow rate
how can we visually detect coronal caries
enamel discoloration +/- surface destruction
what does a caries score of 0,1,2,3 and 4 indicate?
0 = no/slight change after drying 1 = opacity visible after drying (a little demineralisation in fissure but entirely limited to enamel) 2 = opacity visible without drying (minimal dentine involvement) 3 = localised enamel breakdown in opaque/ discoloured enamel +/- discolouration from underlying dentine (periphery of white around discolouration is indicitive of dentine caries) 4 = cavity in enamel exposing underlying dentine (significant dentinal caries)
when do we use tactile assessment of dental caries
dentine caries
NOT for enamel caries
why do we not probe enamel caries?
- breakdown of fragile surface zone preventing potential remineralisation
- high incidence of false positives i.e. probe sticks in a sound fissure
- occlusal caries often starts at the sides of a fissure rather than at the base
what 3 things to look for when doing a direct visual assessment for caries
- demineralisation
- uptake of stain
- cavitation
how do we carry out temporary elective tooth separation
- interproximal caries only
- orthodontic separator between teeth
- review min 2 days later (can leave 1 week)
- inspect surface for cavitation
- put probe in and drag it back through
- take a silicone impression of approximal surface
when the radiograph shows a radiolucent V which doesn’t make it to the adj, what does this mean
that the caries is only on the outer half of enamel and these are never cavitated so never need to operatively intervene
when the radiograph shows a radiolucent V which is on the inner half of dentine, what does this mean
these are always cavitated and you always need to operatively intervene
if the radioluecency is on the inner half of enamel, what does this mean
most of the time it isn’t cavitated but 10.5% of the time there is a cavity. Do TETS
if the radioluecency is on the outer half of dentine, what does this mean
41% of the time there is a cavity. Do TETS
most common causes of smooth surface/ root caries?
- elderly
- perio
- reduced saliva flow
how do you describe root caries
- primary or secondary
- surface of tooth affected e.g. buccal, proximal etc
- active, arrested or remineralised
how do you diagnose root caries
- clean teeth (can’t see caries under plaque)
- tactile assessment (use a probe)
- visual assessment (position in relation to gingival margin, dimensions of lesion, colour of root caries)
if root caries is close to the gingival margin what does this indicate
it’s more likely to be active
what indicators tell us about the activity of root caries
- texture
soft lesions = more likely to be active - colour
lighter coloured = more likely to be active - site
<1mm from gingival margin = more likely to be active - size
larger lesions = more likely to be active
what are indications for non-operative intervention of root surface caries
- hard, dark-coloured lesion, >1mm from gingival margin
- doesn’t trap plaque
- not rapidly progressing
- patient able to participate in non-operative management
how does secondary caries tend to progress
tends to begin from the outside in so if margins of restoration are good and intact it should be find internally
where is the most likely site for secondary caries
cervical margin
