Describing Dental Caries hard

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?

• Dental caries (decay, rotten teeth, cavities) is a dynamic process of demineralization and remineralization.

• Initiated by acids produced by bacteria in the mouth digesting carbohydrates on tooth surfaces.

• These acids demineralize tooth surfaces, leading to the destruction of dental tissues.

• This is a dynamic process.

• Initially, damage is reversible, but it transitions to an irreversible state over time.

• 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)

• When to restore root caries

  • Cavitated lesions that may endanger the pulp.
  • Uncontrollable sensitivity.
  • When plaque control is inhibited.
  • If active and not arrested.

• 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