Sequelae of Dental Caries PDF

Sequelae of Dental Caries Oral and Dental Science Josh Hudson GDC Learning Outcomes: 1.1.4 Explain aetiology 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...

Sequelae of Dental Caries Oral and Dental Science Josh Hudson GDC Learning Outcomes: 1.1.4 Explain aetiology 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 patient assessment process 1.14.5 Explain the role of a dental therapist in restoration of teeth Intended Learning Outcomes: By the end of the session you will be able to; Define what sequelae means List the sequelae of dental caries Describe the process of the ‘restorative 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 definition: “A condition which is the consequence of a previous disease or injury” Caries will progress over time if not treated 1 2 3 4 5 Intact healthy White spot Early loss of Cavitation and Gross carious staining of enamel lesion enamel tooth surface lesion surface surface Ultimately leading to total crown destruction Therefore, what are the sequelae of dental caries? Sequelae of dental caries: Aesthetic concerns consequences Sensitivity  Direct restoration Worsening Reversible pulpitis  Cusp fracture Irreversible pulpitis  Indirect restoration Apical periodontitis  Extraction Acute dental abscess  Impaired function Cellulitis Root canal treatment/extraction 8 1) Aesthetic Concerns As the disease progresses, aesthetics will worsen. This may;  Reduce self-esteem  Become a barrier to employment  Have a negative effect on the patients quality of life 2) Sensitivity Due to the loss of surface enamel and exposure of dentinal tubules, some sensitivity may be observed. As you will see in the histology lectures, if a slow process, these tubules may occlude and hence this may not be an issue. Sensitivity when caries is present is likely related to reversible pulpitis.. 3) Reversible pulpitis These patients have pulpal symptoms from the tooth that resolve in a few seconds of the stimulus being removed. Short sharp pain Does not keep patient awake Is not constant Due to inflammation of superficial pulp Comes and goes often in relation to; 1. Cold 2. Hot 3. Sweet 3) Reversible pulpitis These pulpal symptoms are reversible following restoration of the tooth (hence the name) but need to be weary of pulp exposure. Healthy Inflamed 4) Irreversible pulpitis These patients have pulpal symptoms from the tooth that do not resolve in a few seconds of the stimulus being removed and last long periods. Prolonged throbbing or aching pain Keeps patient awake Is constant Due to irreversible inflammation/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 pulpitis These pulpal symptoms are not reversible following restoration of the tooth (hence the name) so the tooth will need root canal treatment or extraction. Irreversibly Necrotic inflamed 5) Further consequences of pulpal damage As the pulp becomes irreversibly inflamed, the tooth can become necrotic that can lead to; Apical periodontitis (infection around the root apices) Acute apical abscess (pus accumulation around root apices) Cellulitis (infection and inflammation of overlying skin) Ludwig’s Angina (a dental emergency that occurs when swelling extends bilaterally under the tongue causing restriction to the patient’s airway) 5) Further consequences of pulpal damage Apical Periodontitis Dental Abscess Cellulitis Ludwig’s angina What do you think is meant by the term ‘restorative spiral’? Sequelae of dental caries: Fissure sealant Caries Crown Restoration Extraction and implant/ Edentulous Bridge/denture Can you think of any sequelae of dental caries specific to the primary dentition? Disorders of development If a primary tooth has deep caries and develops an associated infection, this can affect the permanent successor. Turner’s Tooth: A permanent tooth with hypoplastic appearance due to overlying infection during development. Space closure Should a primary tooth develop caries and need extraction, 96% of cases will exhibit space closure after 12 months. Upper second deciduous molar spaces close fastest. This results in an increased chance of needing orthodontic treatment as permanent successor will not have the space to erupt. Further Reading: Kidd, E and Fejershov, O. 2016. Essentials of Dental Caries 4th Edition Fejerskov O, Nyvad, B and Kidd E. 2015. Dental caries 3rd Edition Baerjee A and Watson T. 2015. Pickard’s Guide to Minimally Invasive Operative Dentistry 10th Edition Thank You!