Questions and Answers
What are Class V caries lesions?
Lesions or defects involving gingival 1/3 of facial or lingual surfaces of anterior or posterior teeth.
What are the types of Class V caries?
Why do caries lesions occur?
Inadequate oral hygiene, reduced salivary flow, frequent sugar intake, lack of regular dental care, existing dental work leading to plaque accumulation, xerostomia.
Why do Class V caries affect the gingival 1/3rd surface?
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Why do non-carious cervical lesions occur?
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Enamel and dentin have different tensile strengths.
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What leads to stress concentration in the cervical area?
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What is the abfraction theory?
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What is erosion?
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What are some factors of erosion?
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Which causes more dissolution?
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What is abrasion?
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What should be assessed in deciding a treatment plan?
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What is the appearance of an early lesion?
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What is the appearance of an active lesion?
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What is the consistency of an active lesion?
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What is the appearance of slowly progressing lesions?
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What is the consistency of slowly progressing lesions?
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What is the appearance of an inactive lesion?
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What does the treatment of NCCLs include?
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The majority of NCCLs do not require restoration.
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When should NCCLs be restored?
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When is no treatment necessary?
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How action should be taken by the dentist for shallow, non-sensitive, non-carious lesions?
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What does the treatment protocol for carious lesions depend on?
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What should be considered when treating carious lesions?
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When should the medical model treatment be used?
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For non-cavitated lesions, when in doubt, _______ is preferred.
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In non-cavitated lesions, the spread of lesion in dentin is limited to the area of demineralized enamel rods.
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What are some treatment options for the medical model?
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What is the main challenge of restorations?
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How can isolation be achieved?
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When should coverage be used in periodontal therapy?
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What are the soft tissue grafting procedures?
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What are the restorative material options?
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When should amalgam be used?
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What are some contraindications for amalgam?
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What are the basic steps of the amalgam procedure?
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What are the main features to keep in mind during amalgam preparations?
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What are the features to optimize the strength of the restoration?
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What are features to protect the remaining tooth tissue?
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What are the features to help retain the restorative material in the cavity?
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What is needed for amalgam restorations?
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What is the 330 bur used for?
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What are the steps of amalgam preparation?
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What should be avoided when performing amalgam restorations?
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How deep should the retentive groove be?
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How deep should the preparation be?
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What are the steps of the amalgam restoration?
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Which instruments are used for amalgam restorations?
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What are the basic steps of composite preparation?
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If it is an NCCL, no prep is required.
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What are some rules for placing an enamel bevel?
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What are some rules for packing the cord?
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What are RMGI restorations indicated for?
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What are RMGI restorations non-indicated for?
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RMGI's have good wear resistance.
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What is a sandwich restoration?
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What is an open sandwich restoration?
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What is a closed sandwich restoration?
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When should a sandwich restoration be used?
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Study Notes
Class V Caries Overview
- Class V caries lesions occur in the gingival third of the facial or lingual surfaces of both anterior and posterior teeth.
Types of Class V Caries
- Two main types: Carious (root caries) and Non-carious cervical lesions (NCCLs).
Causes of Caries Lesions
- Inadequate oral hygiene and reduced salivary flow contribute to caries development.
- Frequent sugar intake and lack of dental care increase risk.
- Existing dental work can trap plaque, exacerbating the issue.
- Xerostomia (dry mouth) also plays a significant role.
Specifics of Class V Caries
- The gingival one-third surfaces are more affected due to increased surface roughness and organic content.
- Lower pH levels required for demineralization of cementum compared to enamel make these areas more susceptible to decay.
Non-Carious Cervical Lesions
- Causes include abrasion, erosion from acidic foods, and abfraction due to uneven occlusal forces.
- Non-carious lesions can be multifactorial in origin.
Assessment and Treatment Considerations
- Comprehensive examination is crucial; do not rely on singular findings.
- Treatment plans should consider caries risk, progression stage, sensitivity, and aesthetics.
- Early lesions may appear as well-defined, discolored areas at the cementoenamel junction (CEJ).
Lesion Appearances
- Active lesions are soft, yellowish to brown, often covered with microbial deposits.
- Slowly progressing lesions exhibit a brown to black color and have a leathery consistency.
- Inactive lesions are shiny, smooth, and predominantly dark brown or black.
Treatment Protocol for Various Lesions
- Reduction of factors causing NCCLs includes changing brushing habits and reducing oral acid exposure.
- NCCLs do not typically require restoration unless sensitized, aesthetically undesirable, or structurally compromised.
- Restoration decisions for carious lesions depend on the stage of progression and the treatment model (surgical vs. medical).
Remineralization Preference
- For non-cavitated lesions, remineralization is preferred when in doubt.
Medical Model Treatment Options
- Potential options include fluoride varnish, RX fluoride toothpaste, Theragum, Mi paste, and the Icon treatment.
Restoration Challenges
- Isolation during the restoration process is critical.
- Techniques for achieving isolation include using cotton rolls, retraction cords, or rubber dams.
Amalgam and Composite Restorations
- Amalgam is suitable for lesions with significant gingival cementum exposure and when moisture control is challenging.
- Contraindications for amalgam include aesthetic concerns and safety issues.
- Amalgam procedures involve specific steps to ensure proper cavity preparation and retention.
Restoration Techniques
- Crowning features of amalgam preparation focus on optimizing restoration strength, protecting remaining tooth tissue, and retaining the restorative material.
- For composites, thorough plaque removal and shade selection precede isolation and cavity preparation.
RMGI Restorations
- Glass ionomer restorations are preferred for moderate to high caries risk but are not effective for NCCLs.
- Sandwich restorations combine RMGI with composite materials for enhanced aesthetic appeal and caries prevention.
Sandwich Restoration Types
- Closed sandwiches have all RMGI covered, while open sandwiches expose some RMGI at the restoration surface.
General Principles
- Avoid excessive tooth removal during restoration procedures to minimize trauma and preserve remaining structure.
- Retentive grooves in preparations should have a depth of approximately 0.25 mm.
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Test your knowledge on Class V caries with these flashcards. Learn about the lesions, their types, and the reasons behind their occurrence. Perfect for dental students or anyone interested in oral health!