Class V Caries Flashcards

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?

Only non-carious lesions

Only carious lesions

Caries (correct)

Non carious cervical lesions (NCCLs) (correct)

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?

Greater surface roughness, greater organic content, and less pH drop needed for demineralization of cementum compared to enamel. Signup and view all the answers

Why do non-carious cervical lesions occur?

Abrasion, erosion, abfraction, multifactorial causes. Signup and view all the answers

Enamel and dentin have different tensile strengths.

True Signup and view all the answers

What leads to stress concentration in the cervical area?

Occlusal loading. Signup and view all the answers

What is the abfraction theory?

Micro fractures occur in the enamel and dentin of the cervical area due to tooth flexure. Signup and view all the answers

What is erosion?

The loss of dental hard tissue that is chemically etched away from the tooth surface by acid and/or chelation without bacterial involvement. Signup and view all the answers

What are some factors of erosion?

Dietary, environmental, gastric. Signup and view all the answers

Which causes more dissolution?

Citric acid Signup and view all the answers

What is abrasion?

Mechanical rubbing of teeth by some object or objects. Signup and view all the answers

What should be assessed in deciding a treatment plan?

Caries risk, stage of progression of lesion, sensitivity or pain, aesthetics. Signup and view all the answers

What is the appearance of an early lesion?

Small, well-defined, discolored area located at the CEJ. Signup and view all the answers

What is the appearance of an active lesion?

Yellowish or light brown in color and frequently covered by microbial deposits. Signup and view all the answers

What is the consistency of an active lesion?

Upon probing, the tooth structure is soft in nature. Signup and view all the answers

What is the appearance of slowly progressing lesions?

Brownish to black in color. Signup and view all the answers

What is the consistency of slowly progressing lesions?

Leathery. Signup and view all the answers

What is the appearance of an inactive lesion?

Typically dark brown, almost black; surface is shiny, smooth, and hard on probing; root surface may appear glossy. Signup and view all the answers

What does the treatment of NCCLs include?

Reduction of suspected etiological factors, reduction of toothpaste use, change in brushing habits, reduction in oral acid challenges, avoidance of brushing after an acid challenge. Signup and view all the answers

The majority of NCCLs do not require restoration.

True Signup and view all the answers

When should NCCLs be restored?

When there is sensitivity, esthetic desires of the patient, or structural integrity of the tooth is threatened. Signup and view all the answers

When is no treatment necessary?

Shallow, non-sensitive, non-carious lesions. Signup and view all the answers

How action should be taken by the dentist for shallow, non-sensitive, non-carious lesions?

Discuss probable etiology with the patient, document the size of the NCCL, see if they will change their habits, follow up to monitor changes. Signup and view all the answers

What does the treatment protocol for carious lesions depend on?

Stage of progression. Signup and view all the answers

What should be considered when treating carious lesions?

Material and restorative options, surgical model vs. medical model. Signup and view all the answers

When should the medical model treatment be used?

For early lesions that are slowly progressing with little to no cavitation present. Signup and view all the answers

For non-cavitated lesions, when in doubt, _______ is preferred.

remineralization Signup and view all the answers

In non-cavitated lesions, the spread of lesion in dentin is limited to the area of demineralized enamel rods.

True Signup and view all the answers

What are some treatment options for the medical model?

Fluoride varnish, Theragum, Rx fluoride toothpaste, Mi paste, Icon. Signup and view all the answers

What is the main challenge of restorations?

Isolation. Signup and view all the answers

How can isolation be achieved?

Cotton rolls, retraction cord, rubber dam and cervical retainer. Signup and view all the answers

When should coverage be used in periodontal therapy?

For gingival coverage of large, shallow lesions and soft tissue grafting procedures. Signup and view all the answers

What are the soft tissue grafting procedures?

Pedicle graft, connective tissue graft, double-papilla procedure, visor procedure. Signup and view all the answers

What are the restorative material options?

All of the above Signup and view all the answers

When should amalgam be used?

When the gingival margin is mostly cementum or where moisture control and access difficulties exist. Signup and view all the answers

What are some contraindications for amalgam?

Both A and B Signup and view all the answers

What are the basic steps of the amalgam procedure?

Achieve isolation, access and remove carious dentin, add undercut retention, cavosurface margin approximately 90 degrees, tooth preparation based on lesion size. Signup and view all the answers

What are the main features to keep in mind during amalgam preparations?

Optimize strength of the restoration, protect remaining tooth tissue, help retain restorative material in the cavity. Signup and view all the answers

What are the features to optimize the strength of the restoration?

Enough bulk of material as defined by lesion depth, cavosurface margins of 70-90 degrees. Signup and view all the answers

What are features to protect the remaining tooth tissue?

Finishing of fragile enamel margins. Signup and view all the answers

What are the features to help retain the restorative material in the cavity?

Retentive grooves. Signup and view all the answers

What is needed for amalgam restorations?

Burs (330 tapered fissure and 1/4 round burs). Signup and view all the answers

What is the 330 bur used for?

Cutting that parallels enamel rods. Signup and view all the answers

What are the steps of amalgam preparation?

Isolate area, locate initial penetration, prepare facial at a depth of 1-1.5 mm, enlarge preparation to line angles, create rounded gingival outline, keep bur perpendicular to create rounded axial wall, finish axial wall and cavosurface margins, place incisal and gingival retention grooves. Signup and view all the answers

What should be avoided when performing amalgam restorations?

Latrogenic trauma, excessive tooth removal. Signup and view all the answers

How deep should the retentive groove be?

0.25 mm. Signup and view all the answers

How deep should the preparation be?

0.5 mm inside DEJ, 0.8 mm inside root surface; ideal axial depth is dentin depth, not overall depth. Signup and view all the answers

What are the steps of the amalgam restoration?

Condense into internal angles, overfill using large condensers, prevent land sliding, pre-carve burnish with controlled pressure. Signup and view all the answers

Which instruments are used for amalgam restorations?

Small condenser, large condenser, foot ball burnisher, explorer, Hollenback. Signup and view all the answers

What are the basic steps of composite preparation?

Ensure area is plaque-free, shade selection, achieve isolation, caries removal, bevel of incisal cavosurface. Signup and view all the answers

If it is an NCCL, no prep is required.

True Signup and view all the answers

What are some rules for placing an enamel bevel?

Use flame shaped or round diamond; no bevel on gingival margin. Signup and view all the answers

What are some rules for packing the cord?

Use mini 3 or explorer to pack the cord; cord should be visible but not interfere with margins. Signup and view all the answers

What are RMGI restorations indicated for?

Moderate to high caries risk. Signup and view all the answers

What are RMGI restorations non-indicated for?

NCCL situations. Signup and view all the answers

RMGI's have good wear resistance.

False Signup and view all the answers

What is a sandwich restoration?

RMGI first, veneered with resin composite. Signup and view all the answers

What is an open sandwich restoration?

Some RMGI open to the surface of restoration. Signup and view all the answers

What is a closed sandwich restoration?

All RMGI covered with resin composite. Signup and view all the answers

When should a sandwich restoration be used?

When there is an elevated risk of caries but RMGI alone will not provide the desired esthetic result. Signup and view all the answers

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!