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Questions and Answers
What percentage of 5-year-olds in the UK have experienced dental caries?
What percentage of 5-year-olds in the UK have experienced dental caries?
Which factor is NOT associated with arrested or inactive caries?
Which factor is NOT associated with arrested or inactive caries?
What characterizes arrested or inactive caries?
What characterizes arrested or inactive caries?
What characteristic defines active dental caries compared to inactive caries?
What characteristic defines active dental caries compared to inactive caries?
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Which of the following treatments is recommended for arrested or inactive caries?
Which of the following treatments is recommended for arrested or inactive caries?
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Which type of caries occurs due to poor oral hygiene leading to demineralization?
Which type of caries occurs due to poor oral hygiene leading to demineralization?
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Which of the following is a common cause of dental caries in children?
Which of the following is a common cause of dental caries in children?
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What does a shiny and hard appearance of dentin in a carious lesion imply?
What does a shiny and hard appearance of dentin in a carious lesion imply?
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Which description would NOT be used for a type of caries according to its location?
Which description would NOT be used for a type of caries according to its location?
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During probing, how does inactive caries typically feel?
During probing, how does inactive caries typically feel?
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What does the presence of arrested caries indicate about a patient's risk for future caries?
What does the presence of arrested caries indicate about a patient's risk for future caries?
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What is one possible outcome of a carious lesion that has undergone remineralization?
What is one possible outcome of a carious lesion that has undergone remineralization?
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What proportion of healthcare budgets do industrialized countries spend on treating dental caries?
What proportion of healthcare budgets do industrialized countries spend on treating dental caries?
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Which description correctly defines Class V caries?
Which description correctly defines Class V caries?
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What characterizes secondary caries?
What characterizes secondary caries?
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Which of the following statements about residual caries is accurate?
Which of the following statements about residual caries is accurate?
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What is the best definition of incipient caries?
What is the best definition of incipient caries?
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Which statement about Class VI caries is incorrect?
Which statement about Class VI caries is incorrect?
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What initiates the process of dental caries?
What initiates the process of dental caries?
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What is the primary reason for the importance of studying dental caries?
What is the primary reason for the importance of studying dental caries?
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What occurs after a certain point in the progression of dental caries?
What occurs after a certain point in the progression of dental caries?
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Which statement accurately describes the distinction between different types of dental caries?
Which statement accurately describes the distinction between different types of dental caries?
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Which factor contributes to the irreversibility of dental caries?
Which factor contributes to the irreversibility of dental caries?
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What is the estimated number of people with permanent dental decay worldwide?
What is the estimated number of people with permanent dental decay worldwide?
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Describing dental caries based on its causative factors focuses on which aspect?
Describing dental caries based on its causative factors focuses on which aspect?
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Which phase of dental caries is characterized by reversible damage?
Which phase of dental caries is characterized by reversible damage?
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Which primary tissue is most affected by root caries?
Which primary tissue is most affected by root caries?
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What secondary factor contributes to the development of root caries?
What secondary factor contributes to the development of root caries?
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What is the recommended restorative material for root caries when enamel is absent and isolation is challenging?
What is the recommended restorative material for root caries when enamel is absent and isolation is challenging?
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What condition associated with radiotherapy can exacerbate the risk of root caries?
What condition associated with radiotherapy can exacerbate the risk of root caries?
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Which population is particularly challenged with oral hygiene that may lead to root caries?
Which population is particularly challenged with oral hygiene that may lead to root caries?
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What is the ADA definition of early childhood caries related to?
What is the ADA definition of early childhood caries related to?
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What characterizes rampant caries?
What characterizes rampant caries?
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How does decreased salivary flow affect teeth health concerning root caries?
How does decreased salivary flow affect teeth health concerning root caries?
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What is one of the primary functions of saliva in relation to teeth?
What is one of the primary functions of saliva in relation to teeth?
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Which group of rampant caries is specifically induced by a lack of saliva?
Which group of rampant caries is specifically induced by a lack of saliva?
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How is treatment for rampant caries generally different from treatment for isolated lesions?
How is treatment for rampant caries generally different from treatment for isolated lesions?
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In GV Black's classification, what category does caries affecting the proximal surfaces of premolars and molars fall into?
In GV Black's classification, what category does caries affecting the proximal surfaces of premolars and molars fall into?
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Which type of caries often occurs just below the contact point between teeth?
Which type of caries often occurs just below the contact point between teeth?
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Which type of caries includes the incisal edge and is classified as Class IV?
Which type of caries includes the incisal edge and is classified as Class IV?
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What is a common approach to stabilize patients with rampant caries during treatment?
What is a common approach to stabilize patients with rampant caries during treatment?
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What is a key characteristic of Class I caries according to GV Black's classification?
What is a key characteristic of Class I caries according to GV Black's classification?
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Study Notes
Describing Dental Caries
- Dental caries is a dynamic process of demineralization and remineralization.
- Bacteria in the mouth digest carbohydrates, producing acids that demineralize tooth surfaces.
- Demineralization leads to the destruction of dental tissues.
- Initially, the damage is reversible, but it becomes irreversible over time.
- The aetiology of dental caries involves time, susceptible tooth surface, fermentable carbohydrates, and plaque bacteria.
GDC Learning Outcomes
- Describe oral diseases and their relevance to prevention, diagnosis, and treatment.
- Explain the aetiology and pathogenesis of oral diseases.
- Assess and manage caries, occlusions, and tooth wear, restoring the dentition minimally while maintaining function and aesthetics.
Intended Learning Outcomes
- Explain worldwide healthcare issues associated with dental caries.
- Describe dental caries based on causative factors.
- Describe dental caries based on anatomical location.
- Describe dental caries based on its progression stages.
- Explain how basic management principles vary for different clinical presentations of dental caries.
Pre-reading
- Aetiology of Dental Caries lecture
- Histopathology of enamel and dentine caries lectures
What is Dental Caries?
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Dental caries (decay, rotten teeth, cavities) is a dynamic process of demineralization and remineralization.
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Initiated by acids produced by bacteria in the mouth digesting carbohydrates on tooth surfaces.
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These acids demineralize tooth surfaces, leading to the destruction of dental tissues.
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This is a dynamic process.
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Initially, damage is reversible, but it transitions to an irreversible state over time.
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This was covered in further detail during the Aetiology of dental caries lecture.
Why Do We Care About Dental Caries?
- The World Health Organization (WHO) classifies it as the world's most widespread non-communicable (non-infectious) disease.
- Permanent tooth decay is the most prevalent oral disease globally.
- Deciduous tooth decay is the 12th most prevalent oral disease globally.
- Worldwide, 2.3 billion people have permanent tooth decay.
- 560 million children have deciduous tooth decay.
- 5-10% of healthcare budgets in developed nations are spent on treating dental caries.
- It is a major reason for children's hospitalizations in developed countries.
- Severe caries frequently causes absence from work or school.
- There is an association between dental caries and malnutrition.
- In the UK, 23% of 5-year-olds have had dental caries.
Descriptions of Dental Caries
- Types: Arrested/Inactive, Root, Early Childhood, Rampant, Pit/Fissures, Secondary, Primary, Smooth Surface, Residual, White Spot Lesions
- Descriptions are based on location or the underlying cause. Multiple descriptions may be used to describe the same lesion.
1) Arrested/Inactive Caries
- Balance between demineralization and remineralization favors remineralization.
- Lesions may heal, leaving a scar, if demineralization was prior.
- Causes for this change to favor remineralization can include:
- Improved oral hygiene.
- Removal of plaque retention causes.
1) Arrested/Inactive Caries- Treatment
- If caries is inactive, it doesn't always need active treatment.
- Can include:
- Fluoride application.
- Restoration with composite or glass ionomer cement (if discolouration is a concern).
- Continued prevention is needed due to the risk of reoccurrence.
2) Root Caries
- Primary tissue affected is cementum, followed rapidly by dentine.
- Resulting from root surface exposure due to recession.
- Followed by bacterial colonization.
- Cementum is softer than enamel, leading to faster progression.
2) Root Caries - Aetiology
- Decreased salivary flow (xerostomia) reduces sugar clearance.
- Lowers mineral reservoir on tooth surfaces.
- People with reduced salivary flow (especially those who suck on sweets) are at higher risk.
- Radiotherapy can damage salivary glands and cause xerostomia.
2) Root Caries - Treatment
- Preventative measures:*
- Oral hygiene instruction, diet advice (sugar-free sweets), fluoride use (varnish/toothpaste/mouthwash).
- Oral hygiene can be challenging in elderly or physically impaired individuals.
- Treatment:*
- Restoration with fluoride-releasing glass ionomer cement or composite resin.
- Saliva substitutes and medication (pilocarpine).
- Tooth mousse (can be found within prevention lectures).
2) Root Caries - Treatment (When to restore)
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When to restore root caries
- Cavitated lesions that may endanger the pulp.
- Uncontrollable sensitivity.
- When plaque control is inhibited.
- If active and not arrested.
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Treatment technique
- Isolation (ideally rubber dam).
- If adequate enamel and able to isolate, use composite.
- If unable to isolate or no enamel, use GIC.
3) Early Childhood Caries
- Defined by the presence of more than one decayed (non-cavitated or cavitated), missing, or filled tooth surface in a preschool-age child (birth to 71 months/age 5-6).
- Previously termed 'bottle caries' or nursing caries.
- Refers to any child under 6 with decay.
4) Rampant Caries
- Extensive form of caries affecting multiple teeth.
- Usually, more resistant to decay, especially mandibular incisors.
- Three main subgroups:
- Early childhood rampant caries.
- Xerostomia-induced rampant caries.
- Radiation-induced rampant caries
4) Rampant Caries - Treatment
- Treatment varies for patients with rampant caries compared to isolated lesions.
- Prevention: All patients require extensive preventive measures.
- Stabilization: To prevent worsening, temporary restorations are often used to assess the response to the preventive plan before definitive restorations are completed.
5) Caries Based on Anatomical Position
- Caries is described by the anatomical position on the tooth surface.
- Types: Smooth surface, pit and fissure, interproximal.
GV Blacks Classification:
- This system is used to classify the cavity preparation design used after decay removal.
- Used for describing caries location in tooth preparation.
- Classes from I to VI based on location.
5) Caries based on anatomical position - Class I
- Pit and fissure caries (premolars and molars on occlusal surfaces with 2/3 of the buccal and lingual + palatal surfaces of anterior teeth) .
5) Caries based on anatomical position - Class II
- Caries presence on the proximal surfaces of both premolars and molars.
5) Caries based on anatomical position - Class III
- Caries on the proximal surfaces of anterior teeth (incisor and canine), not involving the incisal edge.
5) Caries based on anatomical position - Class IV
- Interproximal caries on anterior teeth surface at the proximal surfaces- proximal areas, involving incisal edge of the same tooth
5) Caries based on anatomical position - Class V
- Caries on the gingival 1/3 of facial, lingual, or palatal surfaces of all teeth.
- Caries within the coronal 2/3 (would fit into one of the other classes).
5) Caries based on anatomical position - Class VI
- Caries on incisal edges of anterior teeth and cusp tips of posterior teeth without involving other surfaces.
6) Primary/Secondary Caries
- Primary caries: Caries affecting a tooth surface that hasn't been previously treated.
- Secondary caries: Caries affecting a tooth surface that has previously been treated (with a restoration, onlay, filling, or fissure sealant).
7) Residual Caries
- Caries remaining after a restoration is completed.
- This might be intentional (e.g., stepwise excavation close to the pulp, sealing with fissure sealant), or unintentional (e.g., missing caries removal before restoring).
8) White Spot Lesions and Incipient Caries
- Incipient caries is the first sign of carious activity, not yet reaching the amelodentinal junction.
- These lesions can be remineralized with preventative measures.
- Also known as reversible caries or white spot lesions.
Follow up reading
- 'Detection of dental caries'
- 'Caries prevention'
- 'Caries management' lectures
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Description
Test your knowledge on dental caries, particularly in children. This quiz covers various aspects including prevalence, characteristics of different caries types, and treatment recommendations. Explore the factors influencing caries and their relation to oral hygiene.
