NOT INCLUDED - Week 9 - Cariology: Aetiology, clinical characteristics, detection and identification: risk assessment and management Flashcards
(23 cards)
What is the philosophy of prevention of disease
An appreciation of the ecology of the oral cavity enables a more holistic approach, considering nutrition, physiology, host defences and general wellbeing of the patient as they affect the balance and activity of the resident oral microflora
Future episodes of disease will occur unless the cause of any breakdown in homeostasis is recognized and remedied.
Identification of critical control points means that selection of appropriate caries preventive strategies are tailored to the needs of individual patients
The clinician does not just treat the end result of the caries process, but also attempts to identify and interfere with the factors that if left unaltered will inevitably lead to more disease.
A customized patient centred oral health care plan matches patient need with best evidence based care.
how does caries occur
more demineralisation than remineralization
what are strategies to prevent caries
- Inhibition of plaque acid production e.g. by fluoride containing products or other metabolic inhibitors
- Avoidance between main meals of foods and drinking containing fermentable sugars and substitute
- The stimulation of saliva flow after main meals e.g. by sugar free gum
caries is prone to develop where there is
- Physical retention of biofilm
- Limited salivary access due to tooth shape (pit and fissures)
- Limited local salivary access due to presence of adjacent tooth
- Limited local salivary access due to adjacent soft tissue contour
- Pathological limitation of salivary flow
what are the sites where caries develop frequently
- Fissures, pits, other surface defects
- Approximating tooth surfaces below the contact area
- Cervical regions
Why does pit and fissures have increased risk
- Double biofilm thickness
- Limited access to salivary movement
- Calcification commences at the cusp tips and progresses until cusps fuse
- Modern low abrasive diet causes only limited occlusal wear and therefore lasting maintenance of the fissure pattern anatomy
What is the management of pit and fissure caries
- Sealing pits and fissures (fissure sealant)
- Fissure sealing halts the progression of a lesion at the site by changing the local biochemistry and physically preventing access of simple sugar substrate to any remaining bacteria
what are the different types of fissure sealant
- Resin composite in various flowable forms
- Glass ionomer cements are also of value
what is the technique for sealant placement
- Clean surface
- Etch enamel to decrease the surface energy of enamel and to dissolve the outer layer of enamel rods – induction of porosity allows penetration of unfilled resin and a micromechanical attachment
What are the limitations of fissure sealant
- Amorphous (outer) enamel may not accept the etch pattern
- Presence of biofilm interferes with process
- The occlusal surface should be well clearned prior to placement, but care should be taken not to more debris during cleaning
- If the fissure is <200um wide resin cannot physically flow to full depth
how does GIC sealant bond to tooth
- Can develop adhesion to the enamel through ion exchange – continuing the ion exchange with the environment and the subjacent tooth structure occurs
What is the technique fore GIC sealant
- Condition the clean surface with polyacrylic acid (10%) for 10 sec to remove most of the biofilm and reduce the enamel surface energy
- Wash with water and dry lightly
- Flow into fissure system placing under some pressure (digital)
What are advantages of GIC sealant
releases fluoride into enamel
What are disadvantages for GIC sealant
- Same as composite sealant
- Physically a fissure cannot be completely cleaned without the use of cutting instruments
- Compressive strength of GIC is less than composite
describe smooth surfaces, below contact area as a site of caries formation
- Plaque is thickest here since its difficult to remove biofilm with a toothbrush
- Requires daily flossing or use of interdental brushes to remove biofilm
- In young patients a lesion usually forms around 1mm below the contact area
- In older patients the risk often increases if salivary flow is compromised by drugs or pathology
what are methods to reverse surface defects
- Change diet by decreasing the amount and frequency of sucrose in the diet
- Increase salivary flow via vigorous chewing several times a day
- Decrease plaque thickness by effective interdental oral hygiene
- Increase local concentration of fluoride
- Eliminate recreational drug use
describe cervical region are an area where caries develop
Smooth surfaces of enamel near the gingiva or root surfaces
- Least common sight as biofilm can be removed by toothbrushing and there’s adequate salivary access
What are the steps in plaque formation
- Acquired pellicle formation
- Reversible adhesion – involving weak long range physico-chemical interactions between the cell surface and the pellicle, which can lead to stronger adhesin-receptors mediate attachment
- Co-adhesion resulting in attachment of secondary colonizers to already attached cells
- Multiplication and biofilm formation and on occasion detachment
What are the 5 R’s in managing the failing tooth restoration
- review
- refurbishment
- resealing
- repair
- replacement
- All tooth restoration complexes have a finite lifespan
- Modern restorations can be refurbished, required, and or replaced
- Repairing failing portions of an existing restorations is the more conservative and minimally invasive options
What is review
- Only minor defects are evident, such as surface roughness/irregularities without concomitant plaque biofilm stagnation
what is refurbishment
- Small defects in the restoration which require intervention (reshaping and or polishing)
what is resealing
- Application of sealant into a non carious, defective margin gap and or surface
what is replacement
- Complete removal of the existing restoration
