Sequelae of Dental Caries GN PDF

Sequelae of Dental Caries Oral and Dental Science Josh Hudson GDC Learning Outcomes: 1.1.4 Explain ae-ology and pathogenesis of oral disease 1.1.11 Recognise psychological and sociological factors that contribute to poor oral health, the course of diseases and success of treatment 1.2.7 Discuss t...

Sequelae of Dental Caries Oral and Dental Science Josh Hudson GDC Learning Outcomes: 1.1.4 Explain ae-ology and pathogenesis of oral disease 1.1.11 Recognise psychological and sociological factors that contribute to poor oral health, the course of diseases and success of treatment 1.2.7 Discuss the importance of each component of the pa-ent assessment process 1.14.5 Explain the role of a dental therapist in restora-on of teeth Intended Learning Outcomes: By the end of the session you will be able to; DeDne what sequelae means List the sequelae of dental caries Describe the process of the ‘restora-ve spiral’ Recognise what happens should caries be allowed to progress Describe the varying stages of pulp health as caries progresses What does sequelae mean? Sequelae de?ni@on: “A condi)on which is the consequence of a previous disease or injury”  Looking at consequences of dental caries Caries will progress over @me if not treated 1 2 3 4 5 Intact healthy White spot Early loss of Cavita@on and Gross carious staining of enamel lesion enamel tooth surface lesion surface surface Ul@mately leading to total crown destruc@on Therefore, what are the sequelae of dental caries? What are the consequences of allowing dental caries to progress Sequelae of dental caries: Treatment options: consequences Aesthe-c concerns Sensi-vity  Direct restora-on Worsening Reversible pulpi-s  Cusp fracture Irreversible pulpi-s  Indirect restora-on Apical periodon--s  Extrac-on Acute dental abscess  Impaired func-on Celluli-s (Inflammation of surrounding skin) Root canal treatment/extrac-on 8  Important for patients 1) Aesthe@c Concerns As the disease progresses, aesthe-cs will worsen. This may;  Reduce self-esteem  Become a barrier to employment Embarrassed to speak to others  Have a nega-ve eRect on the pa-ents quality of life 2) Sensi@vity Due to the loss of surface enamel and exposure of den-nal tubules, some sensi-vity may be observed. Caries As you will see in the histology lectures, if a slow process, these tubules may occlude and hence this may not be an issue. Sensi-vity when caries is present is likely related to reversible pulpi-s.. Sensitivity when caries is present is likely related to reversible pulpitis 3) Reversible pulpi@s These pa-ents have pulpal symptoms from the tooth that resolve in a few seconds of the s@mulus being removed. Short sharp pain Does not keep pa-ent awake Is not constant Due to inTamma-on of superDcial pulp Comes and goes oUen in rela-on to; 1. Cold 2. Hot 3. Sweet 3) Reversible pulpi@s These pulpal symptoms are reversible following restora-on of the tooth (hence the name) but need to be weary of pulp exposure. Can always progress further to irreversible pulpitis Healthy Inflamed 4) Irreversible pulpi@s These pa-ents have pulpal symptoms from the tooth that do not resolve in a few seconds of the s@mulus being removed and last long periods. Prolonged throbbing or aching pain Keeps pa-ent awake Is constant Due to irreversible inTamma-on/necrosis of pulp Worsened by heat (causes pulp to swell in enclosed box) Resolved by cold (causes pulp to shrink in enclosed box) 4) Irreversible pulpi@s These pulpal symptoms are not reversible following restora-on of the tooth (hence the name) so the tooth will need root canal treatment or extrac-on. Irreversibly Necrotic inflamed 5) Further consequences of pulpal damage As the pulp becomes irreversibly inTamed, the tooth can become necro-c that can lead to; Apical periodon--s (infec-on around the root apices) Acute apical abscess (pus accumula-on around root apices) Celluli-s (infec-on and inTamma-on of overlying skin) Ludwig’s Angina (a dental emergency that occurs when swelling extends bilaterally under the tongue causing restric-on to the pa-ent’s airway) 5) Further consequences of pulpal damage Swelling blocking airways Heat Pus accumulation Apical Periodon@@s Dental Abscess Celluli@s Ludwig’s angina Bone loss due to infection What do you think is meant by the term ‘restora@ve spiral’?  Restorations do not last forever Fissure sealant Sequelae of Dental caries dental caries: Fissure sealant Caries Crown Direct restoration Crown Restoration Extraction - bridge/denture/implant Extraction and implant/ Edentulous Bridge/denture End point - no teeth left Restorative spiral - restorations of any kind do not last forever Need to do everything we can to prevent tooth from having restorative treatment in the first place through good quality education and prevention Can you think of any sequelae of dental caries speci?c to the primary den@@on?  Proactive in treating deciduous caries due to affect on permanent teeth Disorders of development If a primary tooth has deep caries and develops an associated infec-on, this can aRect the permanent successor. Turner’s Tooth: A permanent tooth with hypoplas-c appearance due to overlying infec-on during development. Primary tooth infection close to permanent successor developing - can cause it not to develop properly due to infection present at time of development Space closure Limit options of extraction as much as possible due to impact of permanent teeth Should a primary tooth develop caries and need extrac-on, 96% of cases will exhibit space closure aUer 12 months. Upper second deciduous molar spaces close fastest. Upper E’s This results in an increased chance of needing orthodon-c treatment as permanent Increased risk of malocclusion and crowding of dentition successor will not have the Teeth may erupt in wrong places or can cause damage to other teeth space to erupt. Further Reading: Kidd, E and Fejershov, O. 2016. Essen-als of Dental Caries 4th Edi-on Fejerskov O, Nyvad, B and Kidd E. 2015. Dental caries 3rd Edi-on Baerjee A and Watson T. 2015. Pickard’s Guide to Minimally Invasive Opera-ve Den-stry 10th Edi-on Thank You!