Cariology Midterms and Finals (Dent3A 1st Sem 2022-2023) PDF

Subject Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Lecture Prof | Laboratory Prof GENERAL GUIDELINES MODULE # - TITLE Page Size 8.5” by 11”...

Subject Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Lecture Prof | Laboratory Prof GENERAL GUIDELINES MODULE # - TITLE Page Size 8.5” by 11” LESSON # - TITLE Page Sub-lesson 0.5 (All) Margin ○ Text Subtext Page Portrait Orientation TOPIC Font Style Arial, Justified Subtopic ○ Text Title and Topic - 12 Subtext Font Size Text and Subtext - 10 INSERT TABLE TITLE Table Cell Padding - 0.5 Properties Alignment - Middle Text Text Modules Text Text Color Lessons Topics Text Text Spacing Single Highlight - Terms INSERT FIGURES Text Format Bold - Meaning/Description Italicized - Important Details IMPORTANT QUESTIONS 1. Question ○ Answer 2. Question ○ Answer  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores TOPIC OUTLINE OF SUBJECT MODULE 1 - INTRODUCTION TO CARIOLOGY THE DENTAL CARIES MIDTERMS FINALS PROCESS AND ITS ETIOLOGY A. Introduction to C. Diagnosis of Dental Cariology The Dental Caries LESSON 1 - DEFINITION OF DENTAL Caries Process and its 1. Primary Etiology Procedures in the CARIES THE DISEASE AND SOME 1. Definition of Dental Diagnosis RELATED TERMINOLOGIES Caries the Disease Process The word ‘Caries’ (Latin meaning ‘dry rot’) implies and Some Related 2. Caries Risk slow disintegration of any biological hard tissue as Terminologies Assessment a result of bacterial action. Dental caries have 2. The Caries 3. Tools and affected humans since prehistoric times – from the Balanced Methods in the Australopithecines (over a million years ago) to the a. Contributing Diagnosis of Neolithic (12th BC), carious lesions have been Factors to the Dental Caries found in almost every population studied. Development of 4. Classification However; the documented reference of tooth Dental Caries Systems in the decay and toothache appeared around the 14th b. Etiology and Diagnosis of century BC, when oracle bone inscriptions Theories of Dental Caries excavated from the ruins of the Ying Dynasty Dental Caries D. Current Concepts in showed the character meaning ‘caries’. Hence it is 3. Aspects of Dental Managing the caries only appropriate to describe dental caries as Caries process: Prevention, ubiquitous - it is omnipresent in all populations and a. Clinical Control and Therapy is as old as mankind. b. Histologic 1. Caries Control WHO - defined it as a localized posteruptive, 4. Epidemiology of and Prevention pathological process of external origin involving Dental Caries a. Non-invasive softening of the hard tooth tissue and proceeding a. DMF Index b. Micro invasive to the formation of a cavity b. Incidence and 2. Caries Therapy GV Black - defined it as the chemical dissolution Prevalence of Approach of the calcium salts, first of the enamel then of the Dental Caries a. Minimally dentin by lactic acid B. The Caries Lesion and Invasive Shafer - gave his definition as an irreversible Its Biological Approach microbial disease of the calcified tissues of the Determinants b. Operative teeth characterized by demineralization of the 1. The Microbiology of Therapy inorganic portion and destruction of the organic Dental Caries substance of the tooth 2. Saliva and Dental Kess and Ash - Dental caries is a disease Caries involving hard portions of the teeth exposed in the 3. Biofilm and Dental oral cavity and is characterized by disintegration of Caries enamel, dentin, and cementum forming open 4. Diet and Dental cavities. Caries Last - defined dental caries as an illness due to 5. The Role of specific infectious agents or toxic products that Fluoride arise through the transmission of that agent or its products from an infected person, animal, or CARIOLOGY reservoir to a susceptible host. Sturdevant - defined it as an infectious microbiologic disease of the teeth that results in localized dissolution and destruction of calcified tissues. GJ Mount - Caries is perceived to be a prolonged imbalance in the oral cavity such that the factors favoring demineralization of enamel and dentin overwhelm the factors that favor remineralization and repair of those tissues. Cawson - Dental caries can be defined as progressive, irreversible bacterial damage to teeth exposed to the oral environment. C. Suiza 1  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores Kidd and Smith - Caries is a disease of the calcified tissues of the teeth caused by the action RELATED TERMINOLOGIES of microorganisms on fermentable carbohydrates. Caries may be classified in several ways: based Lundeen - Dental caries is an infectious on their location, cavitation status, and activity microbiological disease that results in localized status. dissolution and destruction of the calcified tissues Caries Lesion. Tooth demineralization as a result of the teeth and progresses as a series of of the caries process. Other terms used are exacerbations and remissions. carious lesion or in layman’s term- cavity. Ernest Newburn - Dental caries or tooth decay, is Smooth-surface caries. A caries lesion on a a pathological process of localized destruction of smooth tooth surface. tooth tissues by microorganisms. Pit-and-fissure caries. A caries on a pit and Ostrom - Dental caries is a process of enamel or fissure area dentin dissolution that is caused by microbial Occlusal caries. A caries lesion on an occlusal action at the tooth surface and is mediated by the surface. physiochemical flow of water dissolved ions. Proximal caries. A caries lesion on a proximal Hume - Dental caries is essentially a progressive surface. loss by acid dissolution of the apatite (mineral) Enamel caries. A caries lesion in enamel, component of the enamel then the dentin, or of the typically indicating that the lesion has not cementum, then dentin. penetrated into dentin. Fejerskov and Nyvad - Dental caries is a Dentin caries. A caries lesion into dentin. complex disease caused by an imbalance in Coronal caries. A caries lesion on any surface of physiologic equilibrium between tooth mineral and the anatomic tooth crown. biofilm fluid. Root caries. A caries lesion in the root surface. Selwitz - Dental caries is a multifactorial disease Primary caries. A caries lesion not adjacent to an that starts with microbiological shifts within the existing restoration or crown. complex biofilm. It is affected by salivary flow and Secondary or Recurrent caries. A caries lesion composition, exposure to fluoride, consumption of adjacent to an existing restoration, crown or dietary sugars, and preventive behaviors, like sealant. It contains microleakage in the tooth. cleaning the teeth. However, it is mainly a disease Residual caries. Refers to carious tissue that was that dates back to antiquity and has also occurred not completely excavated prior to placing a in populations that have never used sugar or restoration. Sometimes it is difficult to differentiate processed foods. it from secondary caries. Sikri - Dental caries is an infectious disease Cavitated caries lesion. A caries lesion that caused by an imbalance of oral microorganisms results in the breaking of the integrity of the tooth, leading to acid production and subsequently or a cavitation. dissolving the hard tissues of the tooth. Non-cavitated caries lesion. A caries lesion that Earlier definitions of dental caries by has not been cavitated. In enamel caries, unidentified authors: non-cavitated lesions are also referred to as “white ○ Dental caries, also known as tooth spot” lesions. decay/cavity, is a disease where bacterial Active caries lesion. A caries lesion that is processes damage hard tooth structures considered to be biologically active, is a lesion in (enamel, dentin, and cementum). These which tooth demineralization is in frank activity at tissues progressively break down, the time of examination. producing dental cavities (holes in the Inactive caries lesion. A caries lesion that is teeth). considered to be biologically inactive at the time of ○ A disease of the teeth resulting in damage examination, that is, in which tooth to the tooth structure. demineralization caused by caries may have ○ The bacterial disease known as tooth happened in the past but has stopped and is decay/cavities causes demineralization of currently stalled. Also referred to as arrested teeth through exposure to sugars and caries meaning that the caries process has been starches. arrested but that the clinical signs of the lesion ○ Decay of teeth due to penetration of itself are still present. bacteria through the enamel to the dentin. Rampant caries. A term used to describe the ○ Disease of teeth in which micro-organisms presence of extensive and multiple cavitated and convert sugar in the mouth to an acid that active caries lesions in the same person. Typically erodes the tooth commonly called a cavity. associated with “baby bottle caries,” “radiation ○ Destructive process causing therapy caries,” or “meth-mouth caries.” These decalcification of tooth enamel and leading terms refer to the etiology of the condition. Also to the continued destruction of enamel and known as Early Childhood Caries wherein the dentin. anterior teeth and first molars are affected. C. Suiza 2  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores ○ If there is a broken tooth, what is the LESSON 2 - THE CARIES BALANCED target of the dental caries? Tooth If there are no teeth, there are no DENTAL CARIES dental caries. In babies, you do not kiss the Is an infectious microbiologic disease of the baby directly to the mouth so you teeth that results in localized dissolution and will not transfer microorganisms destruction of the calcified tissues. into the mouth of the baby ETIOLOGY – It is the study of where the disease ○ If the bacteria goes into your body, will it came from be able to live? It depends on your diet. PATHOLOGY – It is the study of diseases ○ Even if you have the normal flora of ○ Pathos – diseases microorganisms in the mouth, they are ○ Logos – study not able to reproduce and not cause EPIDEMIOLOGY – It an be defined as the study disease. of the distribution and determinants of health ○ If you are exposed to the microorganism in related states or events in specified population a short period of time, you will most likely and the application of this study to control the not accumulate disease. This goes the health problems same with dental caries. FLUOROSIS OR DENTAL FLUOROSIS – appearance of faint white lines or streaks on the CONTRIBUTING FACTORS TO THE teeth that only occurs when younger children consume too much fluoride DEVELOPMENT OF DENTAL CARIES What will you first do to a patient who came to your clinic? Dental Health Education GENERAL MECHANISM OF DENTAL CARIES – DENTAL CARIES TETRALOGY TETRALOGY – “tetra” means four In the previous era, there are only 3: host, bacteria, and diet C. Suiza 3  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores 1. MICROORGANISM ○ Food is converted into simple sugar by the ○ Streptococcus Mutans – enamel salivary amylase. This sugar will be the (coronal) caries food of the microorganism. If the ○ Lactobacillus Acidophilus – dentinal microorganism has food, they are able to caries do their activity and be able to reproduce. ○ Actinomyces Actinomycetemcomitans ○ The byproduct of the activities of the – root caries microorganisms is ACID. ○ Saliva is the vehicle by which transfer of ○ This acid demineralizes and eventually microorganism occurs decay. ○ Can be transferred through kissing. ○ DEMINERALIZATION Mechanism of Disease Formation With acid, minerals and inorganic – virulence of microorganism, time substances are removed and exposure, environment/food, host. cause decay afterwards. For example, if you are exposed It's not the bacteria that causes to COVID-19, you will not demineralization, but the acid. immediately have COVID-19 the ○ In the mouth, there is a normal flora of next day. It depends on your microorganisms. It only becomes resistance to infection, time you pathologic or pathogenic or are exposed, and how strong is disease-causing if they are able to the microorganism reproduce and increase in numbers. ○ DENTAL PLAQUE ○ Microorganisms brought into contact A gelatinous mass of bacteria with the tooth surface via a bacterial adhering to the tooth surface. plaque, creates a parasitic relationship. A transparent film (without color) 3. TOOTH and looks like a thick saliva, but ○ Host/Tooth – Susceptible tooth surface it’s inhabited by the bacteria. Susceptible – how prone are After several or 24 hours, that you to be able to get the would already be inhabited by the disease? bacteria ○ Newly erupted teeth have immature ○ PELLICLE enamel making them susceptible to 30 minutes after toothbrushing, a caries film is already formed in your teeth The tooth can easily decay if it is but without bacteria newly erupted because they are ○ What is the main/primary composition not yet submerged in minerals in of plaque? Bacteria or Microorganism the saliva. Fluorodization is recommended with kids to strengthen the enamel and increase the mineral content (mineralization) ○ Tight contact areas Building up of plaque ○ Morphology Self cleansibility of tooth surface ○ Location Posterior tooth – not reachable ○ Composition Caries susceptibility of tooth is inversely proportional to its fluoride and calcium content ↑ F & Ca — ↓ Caries Susceptibility 2. CARBOHYDRATES ↓ F & Ca — ↑ Caries Susceptibility ○ Sucrose = Sugar = Environment 4. TIME ○ This will be the food of the ○ It’s not what you eat. microorganism ○ It’s how many times (frequency) you eat and for how long (duration) the food stays in your mouth after eating that causes the development of cavities. ○ The frequency of in-between meals or snacks counts C. Suiza 4  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores ○ pH Scale Dental caries is multifactorial because its development is dependent on the interaction of the four primary factors: the host (tooth surface), a substrate (carbohydrates), presence of oral bacteria (in the biofilm) and time. However, not all persons with teeth, biofilm and consumes carbohydrates will have caries over time. Several ○ Critical pH modifying risk and protective factors influence the dental 5.5 – 5.7 caries process as shown in the diagram below: ↓ 5.5 – 5.7 — demineralization ↑ 5.5 – 5.7 — remineralization ○ Oral pH Fluctuates Repeated consumption food → Increase acid → Increase susceptibility to caries ○ Saliva It is essential to understand that caries lesions or Flushes the oral cavity cavitation in teeth are signs of underlying conditions. In Stagnant when the clinical practice it is very easy to lose sight of this fact and person is asleep focus entirely on the restorative treatment of caries lesion. Bad breath (halitosis) is It is therefore of primary importance to identify and treat caused causes bleeding first the underlying causative factors that would allow the gums carious process to continue, rather than proceed The food that you eat immediately to restorative treatment. affect the saliva Buffering effect It raises the oral pH THE CARIES BALANCE Viscosity This is the balance between demineralization and Affects the flow remineralization of the tooth. It is illustrated in Caries susceptibility of terms of pathologic factors- or those favoring tooth is directly demineralization, and protective factors- or those proportional to its saliva favoring remineralization. At the tooth level, dental viscosity caries activity is characterized by localized Low viscosity is demineralization and loss of tooth structure, the flowable salive caries lesion. In health, the microbiome is in High viscosity is thick symbiosis, the oral commensals striving in a saliva neutral pH. ↑ Saliva Viscosity —↑ Some bacteria in the biofilm metabolize refined Caries Susceptibility carbohydrates for energy and produce organic ↓ Saliva Viscosity — ↓ acid by-products. These organic acids, if present Caries Susceptibility in the biofilm ecosystem for extended periods, can Patient undergoing radiation lower the pH in the biofilm to below a critical level therapy undergo through dry (5.5 for enamel, 6.2 for dentin). This low pH has mouth or xerostomia – ↑ Caries effects both on the biofilm composition and at the Susceptibility tooth surface level. ○ Induce Remineralization Fluoride C. Suiza 5  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores With extended periods of low pH, there is a shift in the microbiome to bacteria that are acidogenic and ETIOLOGY OF DENTAL CARIES aciduric, causing dysbiosis in the microbiome. This 1. ACIDOGENIC THEORY change in turn will lead to further acidification of ○ Dental caries are caused by acid the environment. products by microbial enzymatic action The low pH drives calcium and phosphate from on ingested carbohydrates. These the tooth to the biofilm in an attempt to reach acids will decalcify the inorganic equilibrium, hence resulting in a net loss of portion of the teeth. Then the organic minerals by the tooth or demineralization. When portion is disintegrated, creating the pH in the biofilm returns to neutral and the cavities. concentration of soluble calcium and phosphate is ○ Will decalcify the inorganic portion supersaturated relative to that in the tooth, the (enamel) of the tooth then the organic mineral can then be added back to partially portion (dentin). demineralized enamel in a process called ○ Acid targets the enamel then dentin. remineralization. 2. PROTEOLYSIS THEORY Thus, at the tooth surface and subsurface level, ○ Organic portion of the tooth is attacked dental caries lesions result from a dynamic first with certain lytic enzymes. This process of damage (demineralization) and leaves the inorganic portion without restitution (remineralization) of the tooth matter. matrix support causing it to be washed These events take place several times a day over away creating cavities. the life of the tooth and are modulated by many ○ Proteolytic-chelation Theory factors including the number and type of microbial ○ Reverse of acidogenic theory flora in the biofilm, diet, oral hygiene, genetics, 3. MICROBIOTIC SECRETIONS dental anatomy, dentin and enamel composition, ○ Metabolic products of micro-organic use of fluorides, and other chemotherapeutic ability to chelate calcium from tooth agents, saliva composition, salivary flow and substances leaving the organic matrix buffering capacity. to be disintegrated. These factors are highly individual and ○ Starts with enamel tooth-specific and will differ from person to person, tooth to tooth in the same individual, and site to EARLY THEORIES OF DENTAL CARIES site on the same tooth. (Fereira Zadona, Ritter, & Eidison, 2019) EXOGENOUS THEORY ENDOGENOUS THEORY Legend of Worm Humoral Theory Chemical Theory Vital Theory Parasitic or Septic Theory EXOGENOUS THEORY (external factors) 1. THE WORM THEORY ○ Dates back as far as 5000 BC referenced in a Sumerian text ○ They believed tooth worms bore a hole through your teeth and hid beneath the surface; drank blood of teeth and fed on roots of jaws. 2. CHEMICAL THEORY (ACID THEORY) ○ Robertson 1835- opined that caries was If the pH drops – demineralization caused by chemical disintegration of the ○ Repeated consumption of food tooth ○ Increase in acid (acidic) ○ It was believed that putrefaction of protein If the pH rises – remineralization led to formation of ammonia which was ○ Saliva is full of minerals and causes pH to subsequently oxidized to nitric acid increase 3. PARASITIC OR SEPTIC THEORY ○ Decrease in acid (basic) ○ Erdl and Ficinus 1843- filamentous ○ Using of fluoride microorganisms caused decomposition of Do not brush your teeth right after the teeth eating because the mouth is still ○ Ficinus recognized the first organic matrix acidic. Wait to remineralize first in enamel before brushing the teeth. C. Suiza 6  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores ENDOGENOUS THEORY (internal factors) ○ Proteolysis-Chelation Theory – Schatz 1. HUMORAL THEORY 1955 ○ The four elemental fluid (humors) of the i. This theory state that dental caries body – blood, phlegm, black bile, yellow is a bacterial destruction of bile organic components of enamel ○ Imbalance in this 4 humors determines the and the breakdown products of person’s physical and mental constitution this components have chelating 2. VITAL THEORY properties dissolving the minerals ○ Proposed by Hippocrates, Celsus, Galen in enamel and Auicenna in the 18th century. ii. There is simultaneous microbial ○ Postulated that tooth decay originated like degradation of organic component bone gangrene from within the tooth itself. by proteolysis and dissolution of inorganic part by chelation NEW THEORIES OF DENTAL CARIES LESSON 3 - ASPECTS OF DENTAL CARIES 1. CHEMICO-PARASITIC THEORY ○ Miller 1890 The clinical appearance of caries is of great ○ The theory said that caries is caused by interest to the dental professional because it tells acids produced by oral bacteria following something of the history of a caries lesion and fermentation of sugar provides valuable information for adequate ○ Consists of 2 stages: noninvasive and invasive treatment. The histology i. decalcification of enamel, of the caries lesion provides a fundamental destruction of dentin (preliminary understanding of the disease process; hence it stage) supports the dental professional with information ii. dissolution of the softened residue necessary to make the right treatment decision of enamel & dentin (subsequent Much of today’s histological knowledge of the stage) caries process was discovered many years ago. 2. PROTEOLYTIC THEORY Besides advances in oral biology, understanding ○ Heider and Bodecker 1878 and Abbot in the role of dental biofilm and the invention of the 1879 transmitted light microscope, particularly using i. Said that the organic portion of the polarized light, has fostered our knowledge of the tooth serves as pathways for caries process. But also other techniques, such as advancing microorganisms transmission and scanning electron microscopy, causing demineralization of the fluorescence microscopy, and microradiography teeth and therefore dental caries. have added to our understanding of how caries ○ Gottlieb in 1944 develop within a tooth.. (Buchalla, 2013) i. Suggested that the initial lesion of Dental caries lesions are the outcome or the carious process is due to the symptoms of innumerable metabolic events in proteolytic enzymes attacking the biofilms that have covered the tooth surface. The lamellae, rod sheaths, tufts and shape of the lesion reflects where the biofilm has walls of tubules been allowed to grow and remain for prolonged ii. Believed that the yellow periods of time. The characteristics of a caries pigmentation characteristic of lesion vary with the nature of the surface on which caries was produced by the it develops. The progression and morphology of proteolytic organism the caries lesion vary depending on the site of (Staphylococcus) origin and the conditions in the mouth. ○ Pincus in 1949 In a clinical situation, one should never decide on i. Proposed that the first step in the the treatment by only considering a single tooth- carious process is the breakdown the tooth is part of the patient's oral environment. of dental cuticle. The choice of treatment and the assessment of ii. Nasmyth’s membrane and enamel the prognosis of the dentition must be based on a proteins are acted upon by ‘total patient assessment.’ sulfatase enzyme producing There are three distinctly different clinical sites sulfuric acid. This acid plus the for caries initiation: calcium of hydroxyapatite crystals ○ Developmental pits and fissures of destroys the inorganic component enamel, which are the most susceptible of enamel sites ○ Smooth enamel surfaces that shelter cariogenic biofilm ○ Root surfaces C. Suiza 7  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores HISTOLOGICAL ASPECTS OF DENTAL CARIES 1. ENAMEL CARIES ○ Normal enamel is composed of various structures- basic structure is enamel prism or enamel rods, prism borders, striation, incremental growth bands (Striae of Retzius) and surface zone. The changes in these structures determine the lesion. On clean, dry teeth, the earliest evidence of caries on the smooth enamel surface of a crown is a white spot. ○ Microscopically, 4 zones are seen: ○ With white spots and without cavitation i. TRANSLUCENT ZONE – is the – it is still reversible with fluorodization advancing front of the caries, the or calcium phosphate and it innermost zone remineralizes (in some cases the white ii. DARK ZONE – is immediately spots are removed) above the translucent zone, appears dark and exhibits approx. 6% mineral loss per volume of enamel. Shows positive birefringence in polarized light (normal enamel negative birefringence). (drilled) iii. BODY OF THE LESION – occupies the major portion of the lesion. It is the area of maximum ○ It has been shown experimentally and demineralization. It is positively clinically that non-cavitated caries of birefringent. This is the largest enamel can remineralize. zone which exhibits enhanced ○ Non-cavitated enamel lesions retain most striae of Retzius. (drilled) of the original crystalline framework of the iv. SURFACE OF THE LESION – enamel rods and they serve as nucleating approximately 20-100 um thick; agents for remineralization. thinner in active lesion and thicker ○ Calcium and phosphate ions from saliva in inactive ones. There is partial can penetrate the enamel surface and demineralization 10% mineral precipitate on the highly reactive loss. The characteristic feature is crystalline surfaces of the enamel lesion. the broadening of the prism ○ The presence of trace amounts of fluoride sheaths. (drilled) ions during this remineralization process greatly enhances the precipitation of calcium and phosphate, resulting in the remineralized enamel becoming more resistant to subsequent caries attack because of the incorporation of the more acid-resistant fluorapatite (hydroxyapatite crystals in some books). ○ Clinically, remineralized (arrested) lesions can be observed as intact, but discolored, usually brown or black, spots. ○ They should not be restored unless they are aesthetically objectionable. ○ Cavitated enamel lesions can be initially detected as subtle breakdown of enamel surface ○ They are very sensitive to probing and can easily be enlarged by using sharp explorers and excessive probing force. C. Suiza 8  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores 2. DENTIN CARIES These materials cause ○ Progression of caries in dentin is different the degeneration and from that of enamel because of the death of the odontoblasts structural differences of dentin. and their tubular ○ Dentin contains much less mineral and extensions, and mild possesses microscopic tubules that inflammation of the pulp. provide a pathway for the ingress of The pulp then produces bacteria and egress of minerals, and so replacement odontoblasts less resistance to acid attack. and these cells produce ○ This is the reason why caries advances reparative dentin on the more rapidly in dentin. affected portion of the ○ When the carious lesion has penetrated pulp chamber wall. the dentin, it spreads laterally along the dentino enamel junction (DEJ), undermining the enamel. ○ The pattern of invasion is a ‘V-shaped’ in cross section with a wide base at the DEJ and the apex directed pulpally. ○ As long as the pulp tissue is vital, the dentin-pulp complex reacts to caries attack by attempting to initiate remineralization and blocking off the open dentinal tubules. ○ THE THREE (3) LEVELS OF DENTINAL REACTION TO CARIES iii. Reaction to severe, rapidly i. Reaction to long-term, low-level advancing caries characterized acid demineralization by very high acid levels associated with a slowly Rapidly advancing caries advancing lesion. bringing high acid levels 1-In slowly advancing overpowers the dentinal caries, the vital pulp can defenses and results in repair demineralized infection, abscess, and dentin by remineralization death of the pulp. of the intertubular dentin and apposition of peritubular dentin. ii. Reaction to a moderate-intensity attack There is already bacterial invasion of dentin Infected dentin contains a wide-variety of pathogenic materials or irritants, including high acid levels, hydrolytic enzymes, bacteria and bacterial cellular debris. C. Suiza 9  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores ○ ZONE OF DENTINAL CARIES 3. CEMENTUM CARIES ○ This is usually seen where there is gingival recession and the oral hygiene is poor. ○ Clinically, the lesion appears as saucer-shaped cavities and U-shaped in cross sections and progress rapidly because of the lack of enamel covering. ○ The microorganisms involved in root caries are chiefly actinomyces and they appear to invade the cementum either along Sharpey’s fibers or between bundles of fibers comparable to invasion along ○ NORMAL DENTIN – the deepest area of dentinal tubules. the zone where the tubules with odontoblastic processes are smooth and no crystals are present in the lumens. No bacteria. ○ AFFECTED DENTIN i. It is also known as carious inner dentin. It has demineralization of the intertubular dentin and initial formation of fine crystals in the tubule lumen. There is damage to the odontoblastic process; no bacteria found (subtransparent 4. PITS AND FISSURE CARIES zone) ○ The carious lesion starts on the lateral ii. It is softer than normal dentin; walls of the fissures that eventually flare there is further loss of minerals laterally at the bottom of the pit. from intertubular dentin, many ○ The carious lesion follows the path of the large crystals are present in the enamel rod; hence a characteristic angular tubule lumen, stimulation ‘V’-shaped lesion is formed with the base produces pain; no bacteria towards the dentin and the apex towards present (translucent zone) the outer enamel surface. capable of self-repair provided the ○ Gram positive cocci, S. sanguis are pulp remains vital. commonly found in pits and fissures of ○ INFECTED DENTIN (a.k.a. OUTER newly erupted teeth. While S. mutans are CARIOUS DENTIN) found in carious pits and fissures. i. Zone of bacterial invasion marked 5. SMOOTH SURFACE CARIES by widening and distortion of the ○ Smooth surfaces present a less favorable dentinal tubules, which are filled site for cariogenic biofilm attachment. with bacteria. cannot ○ If cariogenic biofilm attached it is usually remineralize,. turbid dentin. near gingiva or are under proximal ii. Consists of decomposed dentin contacts, which are protected sites for teeming with bacteria; no mechanical cleaning from the tongue, recognizable dentin structure and cheek movement and toothbrushing. collagen and minerals seem to be ○ Lesions starting on smooth surfaces have absent. Great number of bacteria a broad area of origin and a conical, or are dispersed in this granular pointed extension toward the DEJ. The material and should be removed ‘V-shaped” pattern follows the direction of to prevent spreading the infection the enamel rods and are wide on enamel zone of destruction side tapering as it goes into the portion of the dentin, then spreads rapidly laterally and pulpally. C. Suiza 10  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores PATTERN OF DENTAL CARIES ENAMEL RODS, which are the basic unit of the enamel structure, run perpendicularly from the surface of the tooth to the dentin. Demineralization of enamel by caries generally follows the direction of the enamel rods. The structure of dentin is an arrangement of microscopic channels, called DENTINAL TUBULES, which radiate outward from the pulp chamber to the exterior cementum or enamel border FIG. 2-15 Progression of caries in pits and fissures. (A) The initial lesions develop on the lateral walls of the fissure. Demineralization follows the direction of the enamel rods, spreading laterally as it approaches the dentinoenamel junction (DEJ). (B) Soon after the initial enamel lesion occurs, a reaction can be seen in the dentin and pulp. Forceful probing of the lesion at this stage can result in damage to the weakened porous enamel and accelerate the progression of the lesion. Clinical detection at this stage should be based on observation of discoloration and opacification of the enamel adjacent to the fissure. These changes can be observed by careful cleaning and drying of the fissure. (C) Initial cavitation of the opposing walls of the fissure cannot be seen on the occlusal surface. Opacification can be seen that is similar to the previous stage. Remineralization of the enamel because of trace amounts of fluoride in the saliva may make progression of pit-and-fissure lesions more difficult to detect. (D) Extensive cavitation of the dentin and undermining of the covering enamel darken the occlusal surface. DECAY PATTERN OF PIT AND FISSURE IN ENAMEL: Cone-shaped with the apex (smallest area) at the external opening IN DENTIN: Cone-shaped with the apex (smallest area) toward the pulp IN PIT AND FISSURE CARIES: the triangles of decay are positioned base to base. DECAY PATTERN OF SMOOTH SURFACE IN ENAMEL: cone-shaped with the apex (smallest area) at the dentino-enamel junction. IN DENTIN: cone-shaped with the apex toward the pulp IN SMOOTH SURFACE CARIES: Decay is apex to base. C. Suiza 11  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores IMPORTANT QUESTIONS LESSON 4 - EPIDEMIOLOGY OF DENTAL 1. If there is a broken tooth, what is the target of the CARIES dental caries? Epidemiology is the study of origin and cause ○ Tooth of diseases in a community. Epidemiology has 2. What is the main/primary composition of plaque? been defined by various authors. The accepted ○ Bacteria or Microorganism definition is the study of the distribution of health 3. A gelatinous mass of bacteria adhering to the states or events in specified populations and the tooth surface. application of this study to control the health ○ Dental Plaque problems. Epidemiology is also defined as the 4. Enamel Caries study of the frequency, distribution and ○ Streptococcus Mutans determinants of morbidity and mortality in human 5. Dentin Caries population. It is a branch of public health ○ Lactobacillus Acidophilus concerned with human populations and seeks to 6. Root Caries understand and explain health related problems in ○ Actinomyces Actinomycetemcomitans a defined community. Epidemiological studies are 7. True or False. You are more likely to get dental performed for the purpose of: (1) understanding caries if you eat 3 chocolate bars in one sitting disease dynamics (2) controlling disease and (3) than eating 5 times a day. promoting health. ○ False (frequency > in getting caries) Epidemiology in oral health is an increasing field of 8. True or False. Are newly erupted teeth from knowledge for scientific research, providing a tool children susceptible to caries. that combines clinical dental care models to ○ True optimal protocols. Moreover, it deepens 9. True or False. As fluoride and calcium content discussions about oral pathologies and the increases, caries susceptibility increases. association with bio-psychosocial factors. Dental ○ False caries and periodontal disease are one of the 10. True or False. Can microorganisms be transferred major public health problems, therefore through kissing? epidemiological studies are useful for identifying ○ True and monitoring their prevalence among different 11. True or False. Can caries be transferred through age and geographical groups, giving new kissing? treatment perspectives. It is understood that ○ False epidemiology can confer a predictive significance 12. What is the study of diseases? to clinical data, becoming very useful in ○ Pathology implementing preventive strategies to reduce the 13. What is the study which determines where the incidence of dental problems. diseases came from? Studies conducted in the field of oral epidemiology ○ Etiology provide information on normal biological 14. What is the study of the distribution and processes and on diseases of the oral cavity, determinants of health-related states or events? identify populations at risk of oral disease or in ○ Epidemiology need of specific care, and compare regional, 15. What will you first do to a patient who came to environmental, social, and access similarities and your clinic? differences in dental care between populations. ○ Dental health education Oral epidemiology also tests preventive 16. What is the other term for baby bottle caries? (3 interventions for controlling disease and evaluates words) the effectiveness and quality of interventions and ○ Early childhood caries oral health programs. Dental caries is a serious 17. It refers to the mottled enamel which occurs due to public health issue and collecting data on its the overconsumption of fluoride. prevalence, incidence, and trends is an important ○ Dental fluorosis or fluorosis field in oral epidemiology. The DMF index is a standard method for assessing dental caries experience in populations. While linear increases in caries with age in both children and adults indicate that caries affect individuals throughout life, longitudinal surveys indicate a decline in dental caries experience over the past two decades, yet dental caries remains a prevalent oral disease among children and adults. C. Suiza 12  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores EPIDEMIOLOGY RELATION OF CARIES AND Epidemiology can be defined as the study of EPIDEMIOLOGY the distribution and determinants of health DENTAL CARIES related states or events in specified population ○ May be considered a disease of modern and the application of this study to control the civilization health problems – John Last 1988 ○ Since prehistoric man rarely suffered from this form of tooth IMPORTANCE OF EPIDEMIOLOGY Epidemiology provides some quantitative measures of the tendency of populations to 1. Provides basis for describing disease occurrence develop dental caries which is essential to in a community delineate the magnitude of the problem 2. In public health, provides basis for developing, It helps us in studying the causative factors, prioritizing and evaluating public health programs assessing the effectiveness of preventive 3. Significant reduction in risk-taking behavior and measures and recognizing the pattern of disease incidence of disease or mortality Epidemiological studies have made it possible to test hypothesis and to evaluate concepts and BASIC COMPONENTS OF EPIDEMIOLOGY assess the effectiveness of health services 1. FREQUENCY OF DISEASE ○ Rates and ratios (prevalence, incidence, EPIDEMIOLOGY OF CARIES: SPECIAL etc.) of any disease CONSIDERATIONS 2. DISTRIBUTION OF DISEASE Dental caries is age related ○ concerned with when (time), where (place) Dental caries exists in all populations and whom (person) of health related Caries is a irreversible disease (???) events The profile of caries vary for different population 3. DETERMINANTS OF DISEASE groups with different socioeconomic levels and ○ factors responsible for causation of the environmental conditions disease – the answer to “why” MEASUREMENTS OF EPIDEMIOLOGY FACTORS INFLUENCING EPIDEMIOLOGY OF CARIES 1. Numerator – number of events (disease, deaths, etc) 1. SEX 2. Denominator – population going to be affected ○ Females in spite of higher average level of 3. Rate – measure of frequency oral hygiene have consistent or higher 4. Ratio – indicates how many times one number level of caries as compared to males contains another (Brunelle & Carlos, 1982) 5. Proportion – expresses relationship between a 2. RACE part and the whole ○ Influenced by cultural characteristics and 6. Percentage – proportion multiplied by 100 individual habits 7. Morbidity – describe the % of population suffering 3. HEREDITY from any disease ○ Several genes likely influence individual 8. Incidence –measures the rate of appearance of susceptibility to caries new cases in a population 4. GENETIC EFFECTS 9. Prevalence – refers to all current cases (old + ○ Mouth/dental abnormalities (anomalies) new) are caused by defective genes (G20A, variant of beta defensin 1 DEFB1-vital to IMPORTANCE OF THE body’s immune response, 5x more likely to get caries MEASUREMENTS OF EPIDEMIOLOGY 5. PREGNANCY 1. Provides basis for describing disease occurrence ○ Lead to hormonal fluctuations, salivary in a community alterations, immune suppression and other 2. In public health, provides basis for developing, physiological changes that may adversely prioritizing and evaluating public health programs affect the host resistance to caries 3. Significant reduction in risk-taking behavior and 6. DIET incidence of disease or mortality ○ Frequent consumption of fermentable carbohydrates that have low oral clearance rates increases the risk for caries C. Suiza 13  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores 7. SYSTEMIC DISTURBANCES ○ Caries may be related to lots of systemic UNIQUE ASPECTS OF DENTAL CARIES diseases, such as head and neck cancer, children growth and cardiovascular Most carious dental lesions are restricted to disease, immune system disease, kidney specific anatomical sites diseases, etc As caries disproportionally affect certain groups of individuals, the same is true for certain groups of teeth GLOBAL SCENARIO Caries affect molars more than incisors Caries still a major health problem in most More prevalent in occlusal surfaces as compared industrialized countries to free and smooth surfaces Affects 60-90% of school children & vast majority of adults DENTAL MORPHOLOGY Most prevalent oral disease – most Asian countries and Latin America Mandibular central incisors are least likely to Less common and less severe in most African experience caries countries Maxillary and mandibular molars demonstrate the The WHO records a Global DMFT of 1.61 for 12 highest caries rates year old in 2004, a reduction of 0.13 as compared Maxillary teeth are more susceptible to caries than to a DMFT of 1.74 in the year 2001 mandibular teeth Studies conducted in different countries at different Proximal surfaces of incisors, canines and time periods – evidence of substantial decrease in premolars have higher caries rates than other caries prevalence in the last decade sites Occlusal fissures sites in molars show the highest caries rate WHO REGIONS AND DMFT Molars were the most significantly affected at 45%. First and second maxillary molars were most WHO REGIONS DMFT susceptible to caries at 11.5%, AFRO 1.15 Mandibular central incisors were least susceptible, AMRO 2.79 at 1.7%. EMRO 1.58 Higher in the maxillary jaw (62.4%) EURO 2.57 Lower in the mandibular jaw (37.6%) Individual tooth surfaces have vastly different SEARO 1.12 susceptibilities to caries WPRO 1.48 Pit and fissure (occlusal) surfaces the most Global Average (among susceptible 1.61 188 countries) Most frequent on occlusal of first and second permanent molars DENTAL CARIES AND THE PHILIPPINES Smooth (labial and lingual) surfaces the least susceptible Prevalence of dental caries on permanent teeth has generally remained above 90% throughout the DISTRIBUTION OF CARIES years About 92.4% of Filipinos have tooth decay and ACCORDING TO JAW 78% have gum diseases (DOH, NMEDS 1998) DMFT is 4.48 TOOTH # MAXILLA MANDIBLE TOTAL 2006 National Oral Health Survey (NOHS): 1 241n(10.1) 40 (1.7) 281 (11.8) ○ 97.1% of six-year-old children suffer from 2 229 (9.6) 62 (2.6) 291 (12.2) tooth decay 3 119 (4.6) 71 (3) 181 (7.6) ○ 78.4% of twelve-year-old children suffer 4 172 (7.2) 97 (4.1) 269 (11.3) from dental caries ○ 8.4 dmft for the six-year-old age group 5 178 (7.8) 103 (4.3) 290 (12.2) ○ 2.9 DMFT for the twelve-year-old age 6 275 (11.5) 261 (11) 536 (22.5) group 7 274 (11.5) 261 (11) 535 (22.5) TOTAL 1488 (62.4) 895 (37.6) 2383 (100) C. Suiza 14  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores INDEX CALCULATING DMFT “Numerical value describing the relative status of The teeth not counted are unerupted teeth, the population on a graduated scale with definite congenitally missing teeth or supernumerary teeth, upper and lower limits which is designed to permit teeth removed for reasons other than dental and facilitate comparison with other population caries, and primary teeth retained in the classified with the same criteria and the method” permanent dentition. Counting the third molars is An expression of clinical observation in numeric optional. When a carious lesion(s) or both carious values lesion(s) and a restoration are present, the tooth is Used to describe the status of individual or group recorded as a D. When a tooth has been extracted with respect to a condition being measured due to caries, it is recorded as an M. When a permanent or temporary filling is present, or when DMF INDEX a filling is defective but not decayed, this is counted as an F. Teeth restored for reasons other Most widely used measure of dental caries than caries are not counted as an F. Decayed, Missing, Filled (DMF) index has been used for almost 80 years and is well established as the key measure of caries experience in dental CALCULATING DMFS epidemiology. The DMF Index is applied to the There are 5 surfaces on the posterior teeth: facial, permanent dentition and is expressed as the total lingual, mesial, distal, and occlusal. There are 4 number of teeth or surfaces that are decayed (D), surfaces on anterior teeth: facial, lingual, mesial, missing (M), or filled (F) in an individual. and distal. The list of teeth not counted is the When the index is applied to teeth specifically, it is same as for DMFT calculations, and listing D, M, called the DMFT index, and scores per individual and F is also done in a similar way: When a can range from 0 to 28 or 32, depending on carious lesion or both a carious lesion and a whether the third molars are included in the restoration are present, the surface is listed as a scoring. When the index is applied only to tooth D. When a tooth has been extracted due to caries, surfaces (five per posterior tooth and four per it is listed as an M. When a permanent filling is anterior tooth), it is called the DMFS index, and present, or when a filling is defective but not scores per individual can range from 0 to 128 or decayed, this surface is counted as an F. Surfaces 148, depending on whether the third molars are restored for reasons other than caries are not included in the scoring. counted as F. Total count is 128 or 148 surfaces When written in lowercase letters, the dmf index is a variation that is applied to the primary dentition. CALCULATING dmft AND dmfs The caries experience for a child is expressed as the total number of teeth or surfaces that are For dmft, the teeth not counted are unerupted and decayed (d), missing (m), or filled (f). The dmft congenitally missing teeth, and supernumerary index expresses the number of affected teeth in teeth. The rules for recording d, m, and f are the the primary dentition, with scores ranging from 0 to same as for DMFT. The total count is 20 teeth. For 20 for children. The dmfs index expresses the dmfs, the teeth not counted are the same as for number of affected surfaces in primary dentition dmft. As with DMFS, there are five surfaces on the (five per posterior tooth and four per anterior posterior teeth and four surfaces on the anterior tooth), with a score range of 0 to 88 surfaces. teeth. The total count is 88 surfaces. Because of the difficulty in distinguishing between teeth extracted due to caries and those that have LIMITATIONS OF DMF INDEX naturally exfoliated, missing teeth may be ignored While DMF indices can provide powerful data and according to some protocols. In this case, it is perspectives on dental caries, they also have called the df index. some limitations. For one, researchers have noted a significant amount of inter-observer bias and variability. Other criticisms include that the values do not provide any indication as to the number of teeth at risk or data that is useful in estimating treatment needs; that the indices give equal weight to missing, untreated decay, or well-restored teeth; that the indices do not account for teeth lost for reasons other than decay (such as periodontal disease); and that they do not account for sealed teeth since sealants and other cosmetic restorations did not exist in the 1930s when this method was devised. C. Suiza 15  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores DMFS AND DMFT TOTAL NUMBERS G.V. BLACK’S CARIES CLASSIFICATION DMFT – Decayed, Missing, Filled Teeth for G.V. Black – Father of Operative Dentistry permanent teeth ○ Has a total of 28 TEETH inspected 4 third molars are not included DMFS – Decayed, Missing, Filled Surfaces for permanent teeth ○ Anterior Teeth = 48 ANT. TEETH 4 (surfaces) x 12 (ant. teeth) ○ Posterior Teeth = 80 POST. TEETH 5 (surfaces) x 16 (post. teeth) ○ Has a total of 128 SURFACES inspected 48 Anteriors + 80 Posteriors Surfaces of the third molars are not included dft – Decayed, Filled Teeth for deciduous teeth ○ dfs – Decayed, Filled Surfaces for deciduous teeth DMFT and DMFS – third molars, all deciduous teeth, and non-carious teeth are not included in the computation of the total number. DMFT and DMFS ratios are obtained by dividing the total DMFT/DMFS over the total number of teeth/surfaces inspected John Snow – Father of Public Health EXAMPLE CASE A 15-year-old male presented with the following conditions: CONDITIONS DMFT DMFS Amalgam filling on tooth #16 MO 1 2 Caries on 46 MODB 1 4 Extracted 14 and 24 for 0 0 orthodontic treatment, non-caries Retained #55 non-carious 0 0 Fracture on 11 DILF 0 0 Caries on 12 ML 1 2 TOTAL 3 8 RATIO COMPUTATION 3/28 8/128 RATIO 0.11 0.06 PERCENTAGE 11% 6% C. Suiza 16  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores CLASS I CLASS IV Class I – Pits and Fissures Class IV – Cavities on the proximal surfaces of Location of Pits and Fissures: incisors and canines that involve the incisal ○ Occlusal Surface of Molars angle ○ Occlusal Surface of Premolars Significance: If the incisal angles are involved, it ○ Buccal Surface of Mandibular Molars is already the stress-bearing area – if you bite, the ○ Lingual Surface of Maxillary Molars stress is concentrated in the incisal angle ○ Buccal Pits of Mandibular Molars ○ Class III is a non stress-bearing area ○ Lingual Pit of Maxillary Lateral Incisors because when you chew, the restoration is If the case is not included in the description of not stressed Class I-VI, you will classify it as Class I. CLASS V Class V – Cavities on the gingival 1/3 of the facial and lingual surfaces of all teeth (not on the pit and fissure) CLASS II Class V Cavities are common in patients with poor oral hygiene – does not want to brush near Class II – Cavities on the proximal surfaces of the gum line due to gingivitis causing cavities in posterior teeth (premolars and molars) the gingival third. If there is proximal and there is occlusal (2 Class II, III, IV Cavities are common in patients surfaces of caries), choose the severe who do not want to use floss. The only and most classification – Class II, in this case, is more effective way to clean in between teeth is by the severe use of dental floss. 2 Surfaces: ○ MO – Mesio-occlusal ○ DO – Disto-occlusal 3 Surfaces: ○ MOD – Mesio-occlusal Distal ○ MOL – Mesio-occlusal Lingual ○ MOB – Mesio-occlusal Buccal CLASS VI Class VI – (This was only added to G.V. Black’s Classification). Cavities on the incisal edges or cusps of all teeth due to attrition, abrasion, or erosion. Class VI Cavities are common in patients with CLASS III bruxism (grind, gnash or clench your teeth). Class III – Cavities on the proximal surfaces of ○ Sleep Bruxism incisors and canines that do not involve the ○ Removal of veneer due to bruxism incisal angles 1 Surface Involved – Simple 2 Surfaces Involved – Compound 3 or More Surfaces Involved – Complex ○ Distal, Facial, and Lingual Surfaces (pic) C. Suiza 17  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores INTERNATIONAL CARIES DETECTION AND CARIES STATUS ASSESSMENT SYSTEM (ICDAS) Code 1: First visual change in enamel – In ICDAS, you will know how severe the case is non-cavitated; if you air dry for around 5 seconds, TWO DIGIT SYSTEM there is a visual change because if it is wet, you ○ 1st Digit represents the Restoration Status cannot see any visual change or Sealant Status Code 2: Distinct visual change in enamel – ○ 2nd Digit represents the Caries Status even if it is wet, you can see white or colored spots RESTORATION OR SEALANT STATUS Code 3: Localized enamel breakdown – there is a cavitation Pits and Fissures Sealant (PFS) ○ When you let your probe pass through, ○ In the form of syringe or nail polish-like there is a cavitation or depression already ○ It is recommended for the newly erupted ○ White spots are removed by fluorodization teeth because of the immature enamel (using topical fluoride application) or by If you put sealant and there is no broken teeth yet, using calcium phosphate to remineralize it will not stick to the tooth the enamel Sealant is recommended for deep grooves Code 4: Underlying dark shadow from dentin – Examples of Tooth Colored Restorations (3): there is a black or gray area Composite Resin, Glass Ionomer Code 5: Distinct cavity with visible dentin – ○ The main purpose of the use of Glass Difference of Code 4 and 5: Ionomer is for the release of FLUORIDE – ○ Code 4 – there is an enamel breakdown acts and makes the teeth resistant to acid and shadow from the dentin Amalgam (4) – silver, but if it is copper, it looks ○ Code 5 – there is an enamel breakdown grayish or black looking and the dentin is seen already and visible PFM – Porcelain Fused to Metal Crown Code 6: Extensive distinct cavity with visible Temporary Filling Material (8) - Zinc-oxide dentin – for RCT or extraction of the teeth Eugenol or commercial name as Intermediate Uses ball-ended point probe – WHO (World Restorative Material (IRM) Health Organization) Probe or CPTIN If you don’t know if the tooth is unerupted without (Community Periodontal Index of Treatment a radiograph, ask the patient if he/she was Needs) Probe – with 0.5 mm tip to feel the cavity nabunutan already before DESCRIPTION OF THE SECOND DIGIT USED FOR TABLE 1. SUGGESTED RESTORATION OR SEALANT CODING THE CORONAL PRIMARY CARIES CODING SYSTEM OF ICDAS II 0 Sound 0 Surface not restored or sealed 1 First visual change in enamel 1 Sealant, partial 2 Distinct visual change in enamel 2 Sealant, full 3 Localized enamel breakdown (without clinical 3 Tooth colored restoration visual signs of dentinal involvement) 4 Amalgam Restoration 4 Underlying dark shadow from dentin 5 Stainless Steel Crown 5 Distinct cavity with visible dentin 6 Porcelain or gold PFM crown or veneer 6 Extensive distinct cavity with visible dentin 7 Lost or broken restoration 8 Temporary restoration 9 Used for the following conditions: 96: Tooth surface cannot be examined 97: Tooth missing because of caries 98: Tooth missing for reasons other than caries 99: Unerupted C. Suiza 18  Cariology Midterms | Finals Dent3A - 1st Sem - S.Y. 2022-2023 Dr. Marjorie C. Quieng-Flores IMPORTANT QUESTIONS IMPORTANT QUESTIONS 1. Caries on Tooth #16 Mesial Gingival Third Area 1. If the tooth #36 rotated and the distal area is on ○ Class II the cheek, would you still classify that as Class II? 2. Cavity on Tooth #41 DIFL (Distoinciso- ○ Yes, because that is still the distal area Faciolingual) of the tooth. ○ Class IV 2. Is the fracture on the incisal edge considered as 3. Caries on Tooth #11 Facial Middle Third Area Class IV? ○ Class I (not included in the description) ○ The fracture shoul