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 prevention, diagnosis and treatment 1.1.4 Explain the aetiology and pathogenesis of oral disease 1.14.1 Assess and manage caries, occlusion and tooth wear, and,...

Describing Dental Caries Oral and Dental Science Josh Hudson GDC Learning Outcomes: 1.1.2 Describe oral diseases and their relevance to prevention, diagnosis and treatment 1.1.4 Explain the aetiology and pathogenesis of oral disease 1.14.1 Assess and manage caries, occlusion and tooth wear, and, where appropriate, restore the dentition using minimal intervention maintaining dunction and aesthetics 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 causative factors Describe dental caries based on its anatomical location Describe dental caries based on its stage of progression Explain how the basic management principles may vary for different clinical presentations of dental caries Pre-reading ‘Aetiology of Dental Caries’ Lecture Susceptible tooth surface Caries Plaque Bacteria Time Fermentable Carbohydrate Pre-reading ‘Histopathology of enamel and dentine caries’ lectures What is dental caries? What is dental caries? Dental caries (e.g dental decay, rotten teeth, dental cavities etc) is a dynamic process of demineralisation and remineralisation. This is initiated by acids produced when bacteria in the mouth digest carbohydrates on the tooth surface. These acids demineralise the tooth surface leading to destruction of the dental tissues. This is initially reversible but then becomes irreversible. This was covered in further detail in the ‘Aetiology of dental caries’ lecture. Why do we care about dental caries? Why do we care about dental caries? World Health Organisation (WHO) state that; This is the worlds most widespread non-communicable disease (non infectious). Decay in permanent teeth is the most prevalent (in a particular area at a particular time) disease in the world. Decay in deciduous teeth is the 12th most prevalent (bearing in mind you only have these teeth until 12/13!) Estimated 2.3 billion people have permanent decay Estimated 560 million children have deciduous decay Why do we care about dental caries? World Health Organisation (WHO) state that; Around 5-10% of health care budgets in industrialised counties is spent on treating dental caries. One of the main reasons for hospitalisation of children in developed countries. Severe caries is a frequent cause of absence from work or school. An association between dental caries and undernutrition has been reported. In the UK 23% of 5 year olds have had dental caries. Descriptions of dental caries Arrested caries Root caries Early Childhood caries Rampant caries Pit/fissures Secondary caries Primary caries Smooth surface caries Descriptions of dental caries Primary Caries Residual Caries White spot lesions Descriptions of dental caries Multiple descriptions can be used for the same lesion 1) Arrested/Inactive Caries When the balance between demineralisation and remineralisation favours remineralisation, carious lesions may ‘heal’. This will may leave a ‘scar’ on the tooth surface if the caries had progressed prior to this. 1) Arrested/Inactive Caries Reasons that the balance has changed to favour remineralisation may be; Improved oral hygiene/prevention Removal of a cause of plaque retention (e.g. removing an overhanging restoration or removal of an adjacent tooth which was cause an area of stagnation) 1) Arrested/Inactive Caries Below are some similarities and differences between active and inactive caries. Active Inactive Enamel surface is white Enamel surface is whittish, 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 stagnation area Lesion in a plaque stagnation area Lesion covered in plaque biofilm Lesion not covered in plaque biofilm Dentine appears moist and matte Dentine appears shiny and hard Dentine Feels rough, soft, wet, leathery on probing Scratchy on probing 1) Arrested/Inactive Caries - treatment If caries is arrested and hence not progressing, it does not necessarily need active treatment, treatment may however include; 1. Fluoride application 2. Restoration with composite or glass ionomer cement if the discolouration is of aesthetic concern These patients need continued prevention as presence of arrested caries demonstrates increased risk of future caries. Although stable now, factors that caused the initial lesion may return and it may become active again. 2) Root Caries Primary tissue affected is cementum, rapidly followed by dentine Starts when the root surface becomes exposed to the oral environment as a result of recession Followed by bacterial colonisation As the cementum is softer than enamel, progresses faster 2) Root Caries - Aetiology Decreased salivary flow/xerostomia reduces clearing of sugars from the mouth and reduces the reservoir of minerals on the tooth surface for remineralization People with reduced salivary flow may suck sweets Radiotherapy can damage the salivary glands which can lead to xerostomia. This can also cause trismus which affects the ability to brush 2) Root Caries - Treatment Preventative measures: Oral hygiene instruction (OHI), diet advice (sugar free sweets etc), fluoride use (varnish/toothpaste/mouthwash) Oral hygiene (OH) may be challenging in elderly patients as physically impaired. Treatment: Restoration with glass ionomer cement (fluoride releasing) or composite resin Saliva substitutes, medication (pilocarpine) and tooth mousse (see prevention lectures) 2) Root Caries - Treatment When to restore? Cavitated lesions that may endanger the pulp Uncontrollable sensitivity When plaque control is inhibited If active and not arrested Treatment technique Isolation 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 conventional management of caries lectures 3) Early Childhood Caries Defined by the ADA as; ‘The presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a preschool-age child between birth and 71 months of age’  Previously termed ‘bottle caries’ or ‘nursing caries’  Essentially refers to any child under 6 who has decay See paediatric dentistry lectures for further information and management options 4) Rampant Caries  Rampant caries is an extensive form of caries where multiple teeth are affected by rapidly progressing caries which are usually more immune to decay (e.g. mandibular incisors). Why may these teeth be considered more immune?  Usually fits into one of 3 subgroups; Early childhood rampant caries Xerostomia induced rampant caries Radiation induced rampant caries 4) Rampant Caries - Treatment Treatment for a patient with rampant caries may vary to treatment of single isolated lesions. 1) Prevention – All patients need prevention, these patients need extensive prevention to prevent worsening 2) Stabilisation – To prevent worsening over long treatment plans, patients with rampant caries are often ‘stabilised’ with temporary restorations to assess response to prevention prior to definitive restorations Review rampant caries treatment alongside conventional management of caries lectures 5) Caries based on anatomical position  Smooth surface caries – as described  Pit and fissure 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 position GV Blacks Classification: Technically this classifies restoration design (e.g. the design of the cavity preparation after the decay has been removed) but can also be used to describe caries location through the preparation design that will be used to treat it. 5) Caries based on anatomical position Class I Pit and fissure 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 position Class II Caries present on the proximal surfaces of both premolars and molars. 5) Caries based on anatomical position Class III Caries on the proximal surfaces of the anterior (incisor and canine) teeth, not involving the incisal edge. 5) Caries based on anatomical position Class IV Caries at the proximal surface of anterior teeth (as within class III preparations) but also including some of the incisal edge of the tooth. 5) Caries based on anatomical position 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 fit into one of the other classes). 5) Caries based on anatomical position Class VI Caries on the incisal edges of anteriors or cusp tips of posterior teeth without involving any other surface. 6) Primary/Secondary Caries Primary caries is caries affecting a tooth surface that has not previously been treated. Secondary caries (or recurrent caries) is caries affecting a tooth surface that has previously been treated with a restoration (crown/onlay/filling/fissure sealant etc). 7) Residual Caries Residual caries is caries that remains after restoration. This may be intentional (stepwise excavation if close to the pulp, sealing caries with fissure sealant) or unintentional (missing caries removal prior to restoring). 7) Residual Caries 8) White spot lesions and Incipient caries Incipient caries refers to the first evidence of carious activity which has not extended to the amelodentinal junction (ADJ). These lesions can be remineralised with proper preventative procedures.  This may also be termed reversible caries or may present as white spot lesions. Thank You! Follow up reading ‘Detection of dental caries’ lecture Follow up reading ‘Caries prevention’ lectures Follow up reading ‘Caries management’ lectures