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BDS3 Caries Symposium > Methods of caries management the biological approach > Flashcards

Methods of caries management the biological approach Flashcards

1
Q

What are the 4 factors that cause caries formation?

A
  • Tooth (susceptible surface)
  • Time
  • Diet (substrate)
  • Bacteria
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2
Q

What does ‘detection’ mean?

A
  • Determining the presence or absence of the disease (improtant to know what lesions are there)
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3
Q

What does ‘diagnosis’ mean?

A
  • 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
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4
Q

In order to diagnose caries what must we do/have? (9)

A
  • Plaque chart
  • Full mouth prophylaxis (full mouth clean)
  • Good lighting
  • Inspect without drying for d entinal shadowing (best seen in wet conditions)
  • Dry tooth with 3 in 1 for 5-10 seconds (looking for enamel demineralisation which often shows up white)
  • Use of 2.5x magnification is recommended
  • BPE probe can be used to gently remove debris from fissures, to conform visual impression of borderline cavitation and to determine the consistency of carious dentine
  • Good quality bitewings
  • Temporary elective tooth separation (TETS) (all lesions between the inner half of enamel and the outer half of dentine should have TETS performed to confirm cavitation)
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5
Q

What are possible special investigations we can use to detect caries? (5)

A
  • Transillumination
  • FOTI
  • Diagnodent
  • Plaque pH
  • Salivary flow rate
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6
Q

How could you do a direct visual assessment of caries? (4)

A
  • Naked eye (sharp eyes, clean, dry tooth)
  • Magnified vision
  • Transillumination
  • FOTI
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7
Q

If there is enamel discolouration +/- surface destruction what does this correlate with?

A
  • Correlates with caries in the outer quarter of dentine
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8
Q

What might you see if you visually detect coronal caries? (8)

A
  • Normal enamel translucency after 5sec drying
  • Enamel opacity after 5sec drying
  • Enamel opacity without drying
  • Enamel opacity with local surface destruction
  • Enamel discoloration +/- surface destruction
  • Surface breakdown opaque enamel
  • Surface breakdown discoloured/opaque enamel
  • Enamel cavity into dentine
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9
Q

When there is an opacity visible in enamel without drying what does this tend to suggest?

A
  • Tends to suggest that there is some spreading beyond the ADJ into the dentine
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10
Q

If a pit/fissure is translucent with dark staining in tissue then what is this more likely to be?

A
  • Exogenous staining
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11
Q

If there is a periphery of white demineralisation with dark staining what is this more likely to be?

A
  • Caries

- When we see an appearance like this the caries are likely to be in the outer quarter of dentine

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12
Q

Once we have an actual cavity with a periphery of demineralisation what does this mean?

A
  • There is significant histological dentinal involvement
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13
Q

Which part of the tooth is tactile assessment of dentinal caries used for?

A
  • NOT for enamel caries

- Excellent for dentine caries (residual caries in a cavity, root caries)

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14
Q

Why do we NOT probe enamel caries?

A
  • Breakdown of fragile surface zone preventing potential remineralisation
  • High indices of false positives (probe sticks in a sound fissure)
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15
Q

Where do occlusal caries often start in a fissure?

A
  • Usually at the sides of a fissure rather than at the base
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16
Q

What are 3 things you can sometimes see through direct visual assessment?

A
  • Demineralisation
  • Uptake of stain
  • Cavitation
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17
Q

Where do interproximal caries usually occur?

A
  • Below the contact point
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18
Q

Why can we use transillumination to detect caries?

A
  • As carious lesions absorb light
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19
Q

Where in the mouth is it easier to use transillumination?

A
  • Easier to do this anteriorly

- Can possibly detect proximal as well

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20
Q

What type of radiograph is it essential to take to identify interproximal lesions?

A
  • Bitewing radiographs
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21
Q

Can you detect occlusal lesions on bitewing radiographs ?

A
  • Occasionally will pick up occlusal lesions
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22
Q

For which type of caries wold you detect using temporary elective tooth separation?

A
  • Interproximal caries only
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23
Q

How would you carry out temporary elective tooth separation?

A
  • Orthodontic separator between teeth
  • Review minimum 2 days later (can leave 1 week but advised to leave 5 days)
  • inspect surface for cavitation
  • Take a silicone impression of approximal surface
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24
Q

When there is a radiolucency on the outer half of enamel, what % of teeth are cavitated?

A
  • 0%
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25
Q

When there is a radiolucency on the inner half of enamel, what % of teeth are cavitated?

A
  • 10.5%
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26
Q

When there is a radiolucency on the outer half of dentine, what % of teeth are cavitated?

A
  • 40.9%
27
Q

When there is a radiolucency on the inner half of dentine, what % of teeth are cavitated?

A
  • 100%
28
Q

What are the most common causes of smooth surface/root caries? (3)

A
  • Elderly
  • Gum resorption due to age or periodontal disease
  • Reduced salivary flow rate
29
Q

How would you categorise root caries? (3)

A
  • Primary or secondary
  • Described according to surface of tooth affected e.g. buccal, proximal
  • Active, arrested or re-mineralised (most important)
30
Q

What would you do so that you could diagnose root-surface caries? (3)

A
  • Clean teeth (can’t see caries under plaque)
  • Tactile assessment (use a probe to check if it is hard and leathery or soft and progressive)
  • Visual assessment (position in relation to gingival margin, dimensions of lesion, colour of root caries)
31
Q

What is the texture of root surface caries if they are active?

A
  • Soft lesions have higher bacterial loads and are more likely to be active - probably the best indicator
32
Q

What is the colour of root surface caries if they are active?

A
  • Light coloured lesions have higher bacterial loads - but colour alone is NOT a reliable indicator
33
Q

Where is the site of root surface caries if they are active?

A
  • Softer, lighter-coloured lesions tend to be <1mm from the gingival margin whereas harder, darker-coloured lesions tend to be >1mm from gingival margin
34
Q

What is the size of root surface caries if they are active?

A
  • Larger lesions tend to be light brown or yellow (active)

- Smaller lesions tend to be darker brown (inactive)

35
Q

What are the indications for non-operative intervention for root-surface caries? (4)

A
  • Hard, dark coloured lesion, >1mm from gingival margin
  • Does not trap plaque
  • Not rapidly progressing
  • Patient able to participate in non-operative management
36
Q

What are secondary caries?

A
  • Caries that have occurred around existing restoration margins
37
Q

Where does secondary caries come from/go to?

A
  • Starts from the outside and works way in
38
Q

What part of secondary caries should prompt restoration replacement?

A
  • Wide ditches or frankly carious outer lesions should prompt restoration replacement
39
Q

Is the use of colour alone a good way of deciding if secondary caries need to be removed and the restoration replaced?

A
  • No, use of colour change along will result in unnecessary replacement of restorations
  • Residual staining within a cavity may be exogenous in nature
40
Q

If we decide to do non-operative management of caries what are we trying to modify? (3)

A
  • Either the shape of the tooth
  • The bacteria present
  • Or the substrate
41
Q

What are possible forms of non-operative management of caries? (3)

A
  • Dietary analysis (to reduce the amount of simple carbs)
  • OHI (to remove plaque regularly)
  • Increase fluoride exposure (to tip balance towards remineralisation)
42
Q

How often should high risk groups get fluoride varnish applied and to which teeth?

A
  • Full mouth

- Every 3-6 months

43
Q

What is the biggest problem with silver diamine fluoride?

A
  • It turns teeth black
44
Q

What does CPP and ACP do?

A
  • Remineralises subsurface enamel
45
Q

What is ICON and how is it used?

A
  • ICON = resin infiltration of the carious lesion
  • Like a fissure sealant but not for a fissure - for approximal and smooth surface lesions
  • When tooth is carious it becomes demineralised and so is softer
  • What we do is we acid etch and then dry off the lesion with ethanol which dries all the pores then put resin onto that and it sooks into the pores and basically replaces the porous enamel with resin
  • Some evidence that this can be successful in the reversal of white spot lesions
46
Q

When are dental restorations indicated?

A
  • Only indicated when lesions have advanced to obvious cavitation and where remineralisation techniques have reached their limits
47
Q

What is the purpose of restorations? (5)

A
  • Restore significant loss of dental tissue
  • Eliminate plaque retention/stagnation
  • Restore physiological masticatory function
  • Minimise the risk of recurrent disease
  • Restore aesthetics where appropriate
48
Q

What might you identify in a visual assessment of primary corona caries? (3)

A
  • Cavitated lesions
  • Enamel discoloration +/- localised surface destruction
  • Plaque trap area
49
Q

What might you identify in a tactile assessment of primary corona caries?

A
  • Cavitated lesions
50
Q

What might you identify in a visual assessment of secondary caries? (2)

A
  • Frankly carious lesions
  • Plaque trap area
  • We would intervene here
51
Q

What might you identify in a tactile assessment of secondary caries?

A
  • Ditched wide enough to admit a periodontal probe

- We would intervene here

52
Q

What might you identify in a visual assessment of root surface caries? (3)

A
  • Pale-coloured or black lesion, <1mm from gingival margin
  • Plaque trap
  • Patient unable to participate in non-operative management
53
Q

What might you identify in a tactile assessment of root surface caries?

A
  • Soft feel with sharp probe
54
Q

Sometimes we want to starve the caries to stop them getting food. What is one way we could do this?

A
  • By usinf a resin fissure sealant
55
Q

When are you likely to place a restoration in a tooth? (3)

A
  • When there is dull grey staining, brown staining and cavitation in the fissures
56
Q

What are the treatment options when we have deeper carious lesions? (4)

A
  • Non-selective removal of carious tissue to hard dentine
  • Selective removal to firm dentine
  • Stepwise excavation treatment (leave soft wet dentine at the bottom but we go back in a number of months later and remove the rest of the caries)
  • Selective removal of soft dentine (most conservative - puncture through into the lesion, create a peripheral seal and leave the soft dentine behind)
57
Q

What is expected to occur when selective removal to firm dentine is performed in deep carious lesions?

A
  • Pulp exposure is expected to occur
58
Q

When doing stepwise excavation we tend to avoid pulp exposure. What does this consequently increase?

A
  • Tooth vitality
59
Q

What are examples of non-operative management of caries (non-clinical)? (4)

A
  • Patient education
  • Dietary modification
  • OHI
  • Professional prophylaxis
60
Q

What are examples of materials that can be used for topical application to prevent/arrest caries? (4)

A
  • Topical fluoride application
  • CPC-APC? - think about cost effectiveness
  • Chlorhexidine (seems to be effective for root caries)
  • Silver diamine fluoride (effective but bad staining)
61
Q

What are examples of non-operative management of caries (clinical)? (6)

A
  • Active monitoring
  • Non-operative treatment of root caries
  • Non-operative management of smooth surface caries
  • Sealing in occlusal caries
  • Ensuring areas are self-cleansing
62
Q

What are examples of minimally invasive techniques of management of caries? (6)

A
  • Repair and refurbishment of restorations
  • Preventative resin restoration
  • Ultrasonic minimal preparation
  • Bioactive linings
  • Partial caries removal
  • Stepwise caries excavation
63
Q

What are the principles of placing a restoration? (6)

A
  • As little tooth structure as possible should be removed to preserve the strength of the remaining tooth
  • Take care to protect the adjacent tooth when preparing an approximal restoration
  • Establish a contact point
  • The margins should fit, which is a challenge cervically
  • When deciding to replace a restoration, be very clear as to why this option has been chosen (there are 2 reasons - new caries or technical failure of the previous restoration)
  • Always consider whether the tooth could be repaired, rather than replacing the restoration

BDS3 Caries Symposium (7 decks)

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