Week 4 - Wrap up operative procedures in hypersensitivity and root caries Flashcards
(26 cards)
What is dentine sensitivity
a sharp sudden pain of short duration in response to thermal stimuli such as intake of cold or hot foods, but may also arise from tactile stimuli e.g. using a toothbrush
15% of population suffer
What are mechanisms used to explain dentine sensitivity
- the dentine contains nerve endings that respond when stimulated
- the odontoblasts serve as receptors and are coupled to nerves in the pulp
- The tubular nature of dentine permits fluid movement to occur within the tubule when a stimulus is applied, a movement registered by free nerve endings in close to the odontoblasts
What is the hydrodynamic theory for dentine sensitivity
that fluid movement through the tubule distorts the local pulpal environment and is sensed by the free nerve endings in the plexus of Raschkow
- when dentine is first exposed small blebs of fluid can be seen on the cavity floor
- increased sensitivity at the dentin enamel junction is explained by the profuse branching of the tubules in this area
- this explains why local anesthetics applied to exposed dentine fail to black sensitivity and why pain is produced by thermal change, mechanical probing, hypertonic solutions, and dehydration
- Stimuli act on exposed dentine
- These stimuli cause movement of fluid within the dentinal tubules
- The movement disturbs the nerve endings present in the pulp dentine complex
- Disturbance transmit pain signals to the brain
How is dentine sensitivity diagnosed
- based on detailed history and clinical examination with radiographic examination
- blasting air or water using an air water syringe
What are different dentine sensitivity diagnoses
- cracked tooth syndrome
- fractured restorations
- chipped teeth
- marginal leakage
- post restorative sensitivity
- dental caries
- gingival inflammation
- palatogingival grooves
- pulpitis
- vital bleaching
What are non invasive management strategies for dentine sensitivity
- desensitizing agents for home use + removing modifying predisposing factors
- OH - regular brushing twice daily with desensitizing toothpaste
What are invasive strategies for dentine sensitivity
- periodontal surgery and endodontic treatment
What is the desensitizing agents mechanism of action
- act by blocking open dentine tubules
- potassium nitrate had a depolarising effect causing disruption of pain transmission
- toothpastes containing arginine and calcium carbonate occlude dentine tubules offering relatively fast and effective treatment
What are causes for decreased salivary flow
- dehydration
- salivary gland pathology
- medical conditions
- side effect of recreational drugs
- medications
- head and neck or total body irradiation
- primary and secondary sjogren’s syndrome
What is root caries
tooth decay on the root of the tooth
what is a prerequisite for the development of root surface caries
gingival recession
What is the main cause of root caries
presence of a cariogenic biofilm (plaque) and fermentable carbohydrates (sugar)
- unlike coronal enamel caries - caries in coronal dentine and root caries not only demineralisation but also collagen degradation hence more rapid in root surfaces
other factors
- salivary hypofunction due to xerostomia inducing medication
- lifestyle
salivary gland injury
- past experience of coronal caries
What are risk factors for root caries
- poor biofilm control
- xerostomia
- coronal decay
- gingival recession
- frequent carbohydrate intake
- low fluoride
- advanced age
- low socioeconomic status
- cognitive decline
- reduced manual dexterity
- number of exposed root surfaces
- lifestyle factors such as tobacco use and alcohol consumption mainly in people over 45
What are the most common type of teeth to have root caries
- most frequently involves mandibular molar teeth )buccal and proximal sides)
- followed by the buccal surfaces of mandibular premolars
is approximal or labial surface more likely to get root caries on incisor teeth
approximal
-> lesion starts interdentally eventually wrapping around the tooth in a circumferential pattern
What is the pronged approach to management of root caries
- methods to protect roots from exposure
- protection of roots once they become exposed to the oral environment by using various coating materials
- the application of fluorides, CPP-ACP and other materials to roots to make them more resistant to dental caries
What are techniques and materials for the pronged approach to management
- control of dietary carb intake
- improvement of oral hygiene (active biofilm control)
- antimicrobial agents
- chewing gums
- fluoride containing toothpastes
- fluoridated water, salt or milk
- professionally applied topical fluoride (gels, varnish)
- argine based toothpastes, ACP CPP
How do you arrest root caries
- use of GIC (pain on)
- Stimulate salivary flow (gum)
- Arrest of lesions using ozone, silver fluoride or CPP ACP
What is RA - Initial Stage
RA 1 - RA3
- Radiolucency is seen in the outer half of the enamel
- Early signs of demineraization
- Typically non cavitated and reversible with preventive car
- Corresponds roughly to ICDAS code 1-2
What is RA 1
Radiolucency in the outer 1/2 of the enamel
What is RA 2
Radiolucency in the inner 1/2 of the enamel +- EDJ
What is RA 3
Radiolucency limited to the outer 1/3 of dentine
What is RB - Moderate Stages
RB4
- Radiolucency reaching the middle 1/3 of dentine
- Indicates a progressing lesion but may still be non cavitated clinically
- Preventive and possibly minimally invasive treatment
- Roughly aligns with ICDAS code 2-3
What is RC - extensive stages
RC5-RC6
- Lesion extends into the middle or inner third of the dentine
- Indicates a more advanced lesion like cavitated
- Requires restorative treatment
- Corresponds to ICDAS code 4-6
