Describing Dental Caries PDF

Describing Dental Caries Oral and Dental Science Josh Hudson GDC Learning Outcomes: 1.1.2 Describe oral diseases and their relevance to preven5on, diagnosis and treatment 1.1.4 Explain the ae5ology and pathogenesis of oral disease 1.14.1 Assess and manage caries, occlusion and tooth wear, and, w...

Describing Dental Caries Oral and Dental Science Josh Hudson GDC Learning Outcomes: 1.1.2 Describe oral diseases and their relevance to preven5on, diagnosis and treatment 1.1.4 Explain the ae5ology and pathogenesis of oral disease 1.14.1 Assess and manage caries, occlusion and tooth wear, and, where appropriate, restore the den55on using minimal interven5on maintaining dunc5on and aesthe5cs Intended Learning Outcomes By the end of the session, you will be able to Explain the worldwide healthcare issues associated with dental caries Describe dental caries based on the its causa5ve factors Describe dental caries based on its anatomical loca5on Describe dental caries based on its stage of progression Explain how the basic management principles may vary for diBerent clinical presenta5ons of dental caries Pre-reading ‘Ae5ology of Dental Caries’ Lecture Suscep?ble tooth surface Caries Plaque Bacteria Time Fermentable Carbohydrate Pre-reading ‘Histopathology of enamel and den5ne caries’ lectures What is dental caries?  What is dental caries? Dental caries (e.g dental decay, roIen teeth, dental cavi5es etc) is a dynamic process of demineralisa5on and remineralisa5on. This is ini5ated by acids produced when bacteria in the mouth digest carbohydrates on the tooth surface. Fermentable These acids demineralise the tooth surface leading to destruc5on of the dental 5ssues. This is ini5ally reversible but then becomes irreversible. Because area can remineralise After a certain point - damage can not be reversed This was covered in further detail in the ‘Ae5ology of dental caries’ lecture. Why do we care about dental caries? Why do we care about dental caries? World Health Organisa5on (WHO) state that; This is the worlds most widespread non-communicable disease (non infec5ous). Decay in permanent teeth is the most prevalent (in a par5cular area at a par5cular 5me) disease in the world. Decay in deciduous teeth is the 12th most prevalent (bearing in mind you only have these teeth un5l 12/13!) Es5mated 2.3 billion people have permanent decay Es5mated 560 million children have deciduous decay Why do we care about dental caries? Main reason of hospitalisation for children in the UK World Health Organisa5on (WHO) state that; Around 5-10% of health care budgets in industrialised coun5es is spent on trea5ng dental caries. One of the main reasons for hospitalisa5on of children in developed countries. Severe caries is a frequent cause of absence from work or school. An associa5on between dental caries and undernutri5on has been reported. In the UK 23% of 5 year olds have had dental caries.  Different words used to describe same process but different location or ateiology description Descrip?ons of dental caries Arrested caries Root caries Early Childhood caries Rampant caries Pit/Mssures Secondary caries Primary caries Smooth surface caries Descrip?ons of dental caries Primary Caries Residual Caries White spot lesions Descrip?ons of dental caries Mul?ple descrip?ons can be used for the Can be described by location and aetiology - different factors same lesion 1) Arrested/Inac?ve Caries When the balance between demineralisa5on and remineralisa5on favours remineralisa5on, carious lesions may ‘heal’. This will may leave a ‘scar’ on the tooth surface if the caries had progressed prior to this. Process of demineralisation may occur due to poor oral hygiene - demineralisation favours After a while, with a change of diet and oral hygiene preventative advice, remineralisation can start to favour, balance switches, progression of lesion may stop and surface may heal, stain and discolouration will remain (scar) 1) Arrested/Inac?ve Caries Reasons that the balance has changed to favour remineralisa5on may be; Improved oral hygiene/preven5on Removal of a cause of plaque reten5on (e.g. removing an overhanging restora5on or removal of an adjacent tooth which was cause an area of stagna5on)  1) Arrested/Inac?ve Caries Below are some similari5es and diBerences between ac5ve and inac5ve caries. Ac?ve Inac?ve Enamel surface is white Enamel surface is whi_sh, brown or black Opaque and lack of lustre Shiny Feels hard and smooth when ball end probe ran Enamel Feels rough when ball end probe ran along it along it Lesion in a plaque stagna5on area Lesion in a plaque stagna5on area Inactive - Hard, shiny, not easily removed. Lesion covered in plaque bioalm Lesion not covered in plaque bioalm Active - not very shiny, soft and wet Den5ne appears moist and maIe Den5ne appears shiny and hard Den?ne Feels rough, sob, wet, leathery on probing Scratchy on probing 1) Arrested/Inac?ve Caries - treatment If caries is arrested and hence not progressing, it does not necessarily need ac5ve treatment, treatment may however include; Increase remineralisation fluoroapetite - more resistant to demineralisation 1. Fluoride applica5on 2. Restora5on with composite or glass ionomer cement if the discoloura5on is of aesthe5c concern These pa5ents need con?nued preven?on as presence of arrested caries demonstrates increased risk of future caries. Although stable now, factors that caused the ini5al lesion may return and it may become ac?ve again. 2) Root Caries Primary 5ssue aBected is cementum, rapidly followed by den5ne Starts when the root surface becomes exposed to the oral environment as a result of recession Followed by bacterial colonisa5on As the cementum is sober than enamel, progresses faster  Recession, exposure of root surfaces AND a secondary factor 2) Root Caries - Ae?ology Decreased salivary dow/xerostomia reduces clearing of sugars from the mouth and reduces the reservoir of minerals on the tooth surface for remineraliza5on Less cleansing of the mouth, teeth and oral tissues People with reduced salivary dow may suck sweets Radiotherapy can damage the salivary glands which can lead to xerostomia. This can also cause trismus which aBects the ability to brush 2) Root Caries - Treatment Preventa?ve measures: Oral hygiene instruc5on (OHI), diet advice (sugar free sweets etc), duoride use (varnish/toothpaste/mouthwash) Oral hygiene (OH) may be challenging in elderly pa5ents as physically impaired. Treatment: Restora5on with glass ionomer cement (duoride releasing) or composite resin Saliva subs5tutes, medica5on (pilocarpine) and tooth mousse (see preven5on lectures) 2) Root Caries - Treatment When to restore? Cavitated lesions that may endanger the pulp Uncontrollable sensi5vity When plaque control is inhibited If ac5ve and not arrested Treatment technique Isola5on is challenging (ideally rubber dam) If adequate enamel and able to isolate – composite If unable to isolate or no enamel - GIC Review root caries treatment alongside conven?onal management of caries lectures 3) Early Childhood Caries American dental association Deaned by the ADA as; ‘The presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or alled tooth surfaces in any primary tooth in a preschool-age child between birth and 71 months of age’  Previously termed ‘boIle caries’ or ‘nursing caries’  Essen5ally refers to any child under 6 who has decay See paediatric den?stry lectures for further informa?on and management op?ons 4) Rampant Caries  Rampant caries is an extensive form of caries where mul5ple teeth are aBected by rapidly progressing caries which are usually more immune to decay (e.g. mandibular incisors). Why may these teeth be considered more immune? Saliva has protective function, reservoir for remineralisation, clears debris from teeth; mandibular incisors, more commonly bathed in saliva  Usually ats into one of 3 subgroups; Early childhood rampant caries Xerostomia induced rampant caries Radia5on induced rampant caries 4) Rampant Caries - Treatment Treatment for a pa5ent with rampant caries may vary to treatment of single isolated lesions. 1) Preven?on – All pa5ents need preven5on, these pa5ents need extensive preven5on to prevent worsening 2) Stabilisa?on – To prevent worsening over long treatment plans, pa5ents with rampant caries are oben ‘stabilised’ with temporary restora5ons to assess response to preven5on prior to deani5ve restora5ons Review rampant caries treatment alongside conven?onal management of caries lectures 5) Caries based on anatomical posi?on  Smooth surface caries – as described  Pit and assure caries – as Pits and Fissures described  Interproximal caries – caries Interproxi between the teeth. This usually mal occurs just below the contact Surfaces Smooth point as this is where bacteria are Surfaces able to accumulate without removal 5) Caries based on anatomical posi?on GV Blacks ClassiMca?on: Technically this classiaes restora5on design (e.g. the design of the cavity prepara5on aber the decay has been removed) but can also be used to describe caries loca5on through the prepara5on design that will be used to treat it. 5) Caries based on anatomical posi?on Class I Pit and assure caries occurring in the occlusal surfaces of premolar and molars, the occlusal 2/3 of buccal and lingual surfaces and the palatal surfaces of anterior teeth. 5) Caries based on anatomical posi?on Class II Caries present on the proximal surfaces of both premolars and molars. 5) Caries based on anatomical posi?on Class III Caries on the proximal surfaces of the anterior (incisor and canine) teeth, not involving the incisal edge. 5) Caries based on anatomical posi?on Class IV Caries at the proximal surface of anterior teeth (as within class III prepara5ons) but also including some of the incisal edge of the tooth. 5) Caries based on anatomical posi?on Class V Caries on the gingival 1/3 of facial and lingual or palatal surfaces of all teeth (caries in the coronal 2/3 would at into one of the other classes). 5) Caries based on anatomical posi?on Class VI Caries on the incisal edges of anteriors or cusp 5ps of posterior teeth without involving any other surface. 6) Primary/Secondary Caries Primary caries is caries aBec5ng a tooth surface that has not previously been treated. Secondary caries (or recurrent caries) is caries aBec5ng a tooth surface that has previously been treated with a restora?on (crown/onlay/Mlling/Mssure sealant etc). 7) Residual Caries Residual caries is caries that remains aber restora5on. This may be inten?onal (stepwise excava5on if close to the pulp, sealing caries with assure sealant) or uninten?onal (missing caries removal prior to restoring). 7) Residual Caries Caries present underneath fissure sealant 8) White spot lesions and Incipient caries Incipient caries refers to the arst evidence of carious ac5vity which has not extended to the ameloden5nal junc5on (ADJ). These lesions can be remineralised with proper preventa5ve procedures.  This may also be termed reversible caries or may present as white spot lesions. Thank You! Follow up reading ‘Detec5on of dental caries’ lecture Follow up reading ‘Caries preven5on’ lectures Follow up reading ‘Caries management’ lectures