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112 Cards in this Set
- Front
- Back
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2 functioins of drying tooth with air/water syringe
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1. remove saliva that can obscure a lesion
2. dry a white spot lesion (demineralization) |
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What do bitewings detect?
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interproximal, occllusal, recurrent carious lesions
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How do lesions appear?
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structure-shiny, matte, smooth, cavitated
cosistency-hard,soft tooth color-white, yellow, brown |
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surfaces at risk for dental caries
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occlusion fissure
recession |
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initial evidence of cariess
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white spot/lesion
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surfaces affected by remineralization/demineralization
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enamel pits
fissures smooth surfaces |
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criteria for visual examination of caries
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1. no change in enamel transluceny after drying
2. on wet surface opacity is slightly visible and distinctly visible after drying 3. opacity or discolaration is visible wo air drying 4. localized enamel demineralization in opaque or discolored enamel 5. cavitaion in enamel exposing the dentin |
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criteria for histologic examination of pit and fissure caries
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1. no enamel demineralization
2. enamel demineralization limited to outer half of enamel 3. demineralization involving between half of enamel and outer third of dentin 4. demineralization involving middle third of dentin 5. demineralization involving pulpal thrid of dentin |
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most visible lesion
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smooth surface lesions
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what type of lesion is most likely to become arrested due to preventive treatment?
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smooth surface lesion
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what indicated smooth surface lesion activity?
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1. white spot lesion chlose to gingival margin that has a matte apperance and plaque covered.
2. cavitated plaque covered lesions with/without exposed dentin. soft dentin indicated infected dentin and active lesions |
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arrested lesions
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shiny white, brown
not plaque covered cavitated lesions that may be dark brown in color with hard dentin and not plaque covered maybe away from gingival margin |
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no lesion progression on radiograph.
lo caries risk following treatment |
arrested lesions
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where are interproximal lesion activities seen?
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pt with hi caries risk
persistent gingival inflam. |
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Dental caries risk at age 50
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by age 50, one half of population will have at least one surface of root caries
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Initial phase of root caries
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recession
abrasion aging periodontal conditions |
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Phase II of root caries
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Begins apical to cemento enamel junction
few clinical symptoms |
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Where are active root caries lesions
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close to gingival margin and covered in plaque
soft or leatherly lesion |
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arrested lesion of root caries
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distance from gingival margin and not covered in plaque
hard consistency as surrounding tooth color of lesion not reliable |
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Class VI caries
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carious lesions located on incisal edge of anterior teeth and cusp tips of posterior teeth
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DIAGNOdent
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ddevice for detecting caries using laser fluorescence
laser is fixed wavelength. penetrated 1-2mm teeth have flu. charactersistics that change w/caries. the laser measures the change in fluorescne qualitites of tooth |
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What is a necessary factor for a carious lesion?
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biofilm
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What does biolfilm on tooth structure for a period of time with metabolic activity cause?
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numerous minute flucturatins in pH at interface between tooth surface and biofilm
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other causes of dental caries
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ind. oral hygiene
diet attitude disability medical issues lack of knowledge |
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3 main causes of caries
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plaque
tooth diet |
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is there a single cause of dental caries
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no. different set of causes for diff people
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where does demineralization/remineralization occur on ttoth?
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at the interface between tooth surface and microbial biofilm deposits
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What does removal of biofilm result in?
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half of mineral loss of tooth and/or remineralizatin of tooth surface
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factors that determine loss of mineral and rate
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pH fluctuation
comp/thickness of biofilm salivary secretion rate fl ionc conc. in saliva |
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when is tooth fully mineralized?
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when tooth erupts in oral cavity it is fully mineralized.
95% mineral and 5% water and org matrix |
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what does normal enamel consist of ?
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hydroxyapatite crystals and is translucent
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how are enamel crystals arranged?
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in rods as a prism. each crystal is seperated by intercrystalline spaces filled with water and organic material. this forms a diffusiion of pathways called micropores
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what is dentin composed of?
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70% mineral and 20% organic
mineral portion is made of hydroxyapatite and small crystals org matrix is composed of collagen in triple helix of 3 intertwinted pp chains |
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structural backbone of dentin
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collagen, it hold together the apatite crystallites
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How to detect caries in clinical exam.
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need good visibiligy
bright op. light mirror explorer dry off teeth to remove debris and saliva fro better visual exam |
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transillumination
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passage of light through the tooth.
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How is transillumination used for careis detection?
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when tooth illuminated w/bright light, healthy area of enamel lets light come through, light does not pass throug carious lesoin. this is used mainly for anterior teeth
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ways to detect caries
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clincal exam
transillumination stain demineralizatino radiograph |
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where does stain often occur with dental caries?
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occlusal surfaces
pits and fissure buccal and lingual grooves |
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when does demineralization occur?
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when acids produced by cariogenic bacterial plaque diffuse into the microchannels in enamel surface and dissolve minerals in the tooth structrue
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is early loss of mineral during demineralizaion visbile?
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no not early stages
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microchannels
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between enamel crystals
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what happens to enamel as more mineral is lost?
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it becomes porous. enamel looks white, chalky.
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Marginal ridge overlying carious lesoin
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discolored
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initial appearance of demineralization
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white spot appears with no breakthrough of enamel surface BUT over time the area turns darker due to food, bverages, tobacco
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what does demineralizzation and destruction of hard tooth structure result in?
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loss of tooth density in area of lesion. the decreased density allows for greater penetration of xray in carious lesion so lesion applears radiolucent on radiograph
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what determine caries radioluceny on Xray?
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extent and severity of destraction of tooth by carious process
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IS caries always furthered advanced in clinic or on xray?
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CARIES IS ALWAYS FARTHER ADVANCED CLINCALLY THAn RADIOGRAPHICALLY
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can a small, new carry be visualized on xray?
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early demineralization does not affect tooth density so a radiolucency may not be seen until furter desturction
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problem with pits in enamel
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makes plaque removal difficult or impossible so prone to decay
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places pit and fissure caries occurs
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occlusal pit in premolars/molars
buccal and lingual grooves lingual surfaces of maxillary incisors |
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What pathway do occlusal caries follow?
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pathway of enamel rods and dentinal tubules. carious lesion starts small and enlarges as it progresses through the tooth
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when do occlusal caries appear radiographically?
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occlusal caries appar once the lesion has brached the dentin enamel junction. caries spreads out laterally under the DEJ and moves toward the pulp
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what surface do caries begin in?
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smooth surfaces where there is no pit, fissrue, or groove. where bacterial plaque collects like proximal surfaces and cervial areas of buccal and lingual surfaces of teeth
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only way to see early interproximal caries
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on xray
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interproximal caries
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carious lesions develop apically to contact point between ajacent teeth
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How are advanced interproximal lesions identified clinically?
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by discoloration of enamel in marginal ridge and by checking buccal and lingual surfaces with an explorer
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incipient caries
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caries less that half way through enamel
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can incipient caries be stopped?
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yes. remineralizaion of tooth can stop it. Use Fluoride, decrease sugar, improve oral hygeine
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caries shapes
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half moon
triange (chevron) |
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when does pt have caries symptoms?
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when caries penetrate more than halfway towards the pulp tooth can be symptamatic to temp
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Root surface caries
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also called cervical, cemental or radicular caries.
root surface caries ae soft, progressive lesions of cementum and dentin |
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What are root surfaces subjected to?
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chemical erosioin
abrasive action of brushing |
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when does incidence of rooth caries increase?
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with age but not bc of age. usually due to gingival recession
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What is necessary for root caries?
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gingival recession
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What is root caries related to?
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periodonatal conditions that lead to gingival recession and associated w, xerostomia
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recurrent caries
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caries that develops at existing margins of restorations
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best way to detect recurrent caries
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explorer clinically
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radiograph of recurrent caries
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may be obscured or restorations may be superimposed over carious lesion
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appearance of recurrent caries
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check for discoloration of the enamel around the margins of the restoration.
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prevention of recurrent caries
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check for any space between enamel and restoration
check for any defects such as fracture in restoration |
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rampant caries
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widespread rapid progressive destructtion type of caries
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clinical feature of rampant caries
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decay affecting most teeth
numerous smooth surface lesions poor oral hygiene high sugar intake |
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example of rampant caries
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1.early childhood caries (BBTD)
caused by sleeping w/bottle with sugary liquid 2.Radiation caries following head/ neck radiation |
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prevention of early childhood caries
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demand breast feeding at night
oralhygiene begins when teeth erupt by wiping teeth |
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treatment of early childhood caries
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extraction
pulpectory stainless steel crowns if teeth restorable |
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radiation caries
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rampant caries followin head/neck radiation bc salivary gld atrophy and get xerostomia.
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how is radiation caries characterized?
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progression of cervial and smooth suface caries of most teeth
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arrested caries
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incipint or more advanced caries may be arrested if change in oral environ. that slows down carious process. Incipint caries can remain dormant for a long time or even be reversed with remineralization
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how do arrested caries appear?
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shiny white lesion
same hardness as surrounding tooth no plaque covering it |
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describe arrested caries of occlusal lesions that become static
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look like white/ brown spot with shiny surface
not plaque covered |
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demineralization is stopped or reversed and dull apperance now looks shiny
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sign of inactive caries of arrested caries
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how does remineralizatin occur?
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same microchannels that allow acid to diffuse into the enamel and dssolve tooth minerals can also allow Calcium, phosphate, and fluoride to diffuse back into the tooth.
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what neutralizes acid by raising pH?
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SALIVA
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neutral pH befor eating
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6.2-7.0
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at what pH does root surface demineralization occur
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6.0-6.7
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what does amount of demineralization depend on?
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frequency and length of time the aid is in contact with the tooth
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Function of saliva
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neutralize acid
provides the calcium and phosphate molecules to diffuse back into the tooth |
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common agent used to prevent and reverse dental caries
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fluoride
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what is largely responsible for decrease of caries in past two decades?
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fluoride
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amound of fluoride needed to get benefical effect
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v. little
.04-.08 ppm |
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3 ways fluoride inhibits cariuous process
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1. inhibit plaque bacteria
2. inhibit demineralization 3. enhance remineralization by creating a caries reistant surface called a fluroapatite |
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chlorhexidine gluconate mouthrinses
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peridex, periogard. they are chemotherapeutic agents
absorbed on tooth suface, dental plaque, and oral mucosa. reduces plaque use 2x a day for 14 days |
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xylitol
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nonacidogenic, noncariogenic sugar substitute with caries inhibitor effects. sweetener used in food products such as gum. it is noncaloric and has sweetness like sugar
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how does xylitol work?
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it has unfavorable environ. by causing streptococcus mutans to become less adherent to plaque
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Class I caries
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cavities in pits/fissure
-occlusal of premolars/molars -facial/lingual side of molar -lingula side of max. incisor examine by direct or indirect viion, exporer, radiographs NOT used |
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Class II
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cavities in proximal surfaces of premolars and molars.
detect by: early caries-xray only moderate caries not broken through from proximal to occlusal look at color change and translucency, exploration. extensive caries involving occlusal use direct vision |
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Class III
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cavities in proximal surfaces of incisiors and canines that do no involve the incisal angele
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detection of Class III caries
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early caries by xray or transillumination
moderater caries not broken through lingual or facial look at colr change, exporation, xray extensive caries use direct vision |
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Class IV
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caviteis in proximal surfaces of incisors or canine the involve incisal angel
use visual or transilluminatin to detect |
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Class V
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cavities in cervial 1/3 of factial or linual surface
to detcet use: direct vision with dry surface, exploration for demineralization, sensitivity |
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Class VI
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cavities on incisal edges of anterior teeth and cusp tips of posterior teeth
to detect us direct visual bc areas maybe discolored |
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when was dentistry established as a scientific discipline?
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100 yrs ago
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Miller and Black
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wrote texts about path and caries. accurately describes process and cause of dental caries.
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term Black used to describe dental plaque
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geainoid plaques
now referred to as Biofilm |
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streptococcus mutans
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gram + aerobic non motile bateria made in acids.
streptococcus sobrins streptococcus sanguis |
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Lactobacilli
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gram + non motil rods gros under anaerobic conditions and acid
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% of tooth enamel that is mineralized
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95-98%
composed of ydroxyapatite crystals containing calcium and phosphate |
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% of tooth dentin that is mineralized
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60-65%
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what does saliva contain to minimize drops in pH
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electrolytes and organic molecules
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what does saliva contain?
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electrolytes/org mol.
Na HCO3 and P to buffer sialin |
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sialin
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salivary protein helps raise pH to neutral levels
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