Dental caries


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  • All solid and liquid foods containing fermentable carbohydrates are potentially cariogenic.  Acid-forming bacteria, such as caries-producing Streptococcus mutans, begin the immediate breakdown of sucrose from food, potentially contributing to dental caries. Sugars on the tooth surfaces are converted to acid within seconds of ingestion.  The acid acts to demineralize the tooth.  Left undisturbed, the acid produced from the ingestion of a sugar can remain in the oral cavity up to 2 hours.  During this acid attack, the pH level of plaque drops from a normal range of 6.2-7.0 down to a pH of 5.2-5.5, the level at which demineralization can occur. Consumption of caries-producing solid and liquid foods will lower the oral pH to a level that makes the enamel susceptible to caries.  These frequent exposures can lower the pH to demineralizing levels for several hours per day.
  • There is some intersting contrast concerning the nature and distribution of caries in adults, particularly older adults, as compared with children. Adults continue to experience primary dental caries, but they also experience a significant amount of secondary caries around existing restorations. Children today have comparatively few, if any restorations and experience mostly primary caries of the noncavitated type. Between 40 and 76% of dental carie in adults are arrested, a condition uncommoly observed in children.
  • Frequent , more than 3 times a day, snacking between meals, this increases the acid challenge to the teeth for a high level.
  • .  The keystone of visual inspection of caries is based on the phenomenon of light scattering. Sound enamel is composed of densely-packed, modified hydroxyapatite crystals which give it a transparent structure. Hence, tooth colour is largely influenced by the underlying dentin shade. When enamel is disrupted in the presence of demineralization, the penetrating photons of light are scattered, which results in an optical disruption. In normal visible light, this appears as a ‘white spot’ – an area which looks whiter than the rest of the tooth. The appearance is enhanced in a dried lesion, as water has a similar refractive index (RI) to enamel, but air has a lower RI thus the lesion is more clearly seen. FOTI makes use of these optical properties of enamel and enhances them by using a high intensity white light shone through a small aperture (e.g. 0.3-0.5 mm) of a dental handpiece. The light that is shone through the tooth scatters and observed shadows may indicate the presence of a carious lesion. The reason why shadows may indicate caries is because demineralized areas of enamel or dentine scatter light more than sound areas. Hence, caries appear as darker areas under FOTI. (Pretty, 2006) The Method . However, the system is subjective. Analysis is done by the examiner who makes the call based on the appearance of scattering. There is also no continuous data output and it is not possible to record what is seen in the form of an image. Furthermore, FOTI can only be used for coronal tooth surfaces (occlusal, interproximal, and smooth) and not below the gingiva. (Pretty, 2006)
  • Dental caries

    1. 1. Preventive Dentistry I & II Dental caries Dr.Caroline Mohamed 1 Dr. Caroline Mohamed
    2. 2. Objectives  Define: Dental caries The dental caries process The role of diet in dental caries Classification of dental caries Epidemiology Incidence and prevalence and how can be measured Caries risk Dr.Caroline Mohamed 2
    3. 3. 1. Dental caries definition Dental caries is a multifactorial microbial disease of the calcified tissues of the teeth, characterized by demineralization of the inorganic portion and destruction of the organic substance of the tooth, which often leads to cavitations. Dr.Caroline Mohamed 3
    4. 4. Two groups of bacteria are responsible for initiating caries: Streptococcus mutans and Lactobacillus. If left untreated, the disease can lead to pain, tooth loss, infection, and, in severe cases, death. Today, caries remains one of the most common diseases throughout the world. Cariology is the study of dental caries. Dr.Caroline Mohamed 4
    5. 5. The presentation of caries is highly variable; however, the risk factors and stages of development are similar. Initially, it may appear as a small chalky area that may eventually develop into a large cavitation. Sometimes caries may be directly visible, however other methods of detection such as radiographs are used for less visible areas of teeth and to judge the extent of destruction. Dr.Caroline Mohamed 5
    6. 6. Tooth decay is caused by specific types of acid- producing bacteria that cause damage in the presence of fermentable carbohydrates such as sucrose, fructose, and glucose. The mineral content of teeth is sensitive to increases in acidity from the production of lactic acid. Specifically, a tooth (which is primarily mineral in content) is in a constant state of back-and-forth demineralization and remineralization between the tooth and surrounding saliva. When the pH at the surface of the tooth drops below 5.5, demineralization proceeds faster than remineralization (meaning that there is a net loss of mineral structure on the tooth's surface). This results in the ensuing decay. Dr.Caroline Mohamed 6
    7. 7. Dr.Caroline Mohamed 7
    8. 8. Socio-Economical Situation Knowledge Host 8 SALIVA pH Flow rate Composition Buffering capacity Bicarbonate levels SALIVA Educational level SUBSTRATE Carbohydrates Frequency of eating Oral clearance Physical nature of food Detergency of food FLORA Fluoride in plaque Lactobacilli Oral Hygiene Streptococci Virulence factors Transmissibility HOST Age Fluoride Genetics Morphology Nutrition Behavior Dr.Caroline Mohamed
    9. 9. Dr.Caroline Mohamed 9
    10. 10. The role of diet in dental caries Dr.Caroline Mohamed 10
    11. 11. Substrate Readily fermentable Sucrose- arch criminal Cariogenicity determined by 1. Frequency of ingestion 2. Physical form 3. Chemical composition-detergency 4. Texture of food 5. Presence of other constituents Dr.Caroline Mohamed 11
    12. 12. Dr.Caroline Mohamed Cariogenicity determined by Frequency of ingestion 12
    13. 13. Frequency of ingestion D Caroline Mohamed 13
    14. 14. Tooth enamel dissolves at 5.5 ph D Caroline Mohamed 14
    15. 15. Dr.Caroline Mohamed Chemical composition-detergency Cow’s milk (cheese) contains calcium, phosphorus, and casein Wholegrain foods require more chewing Peanuts, hard cheeses, and chewing gum Black tea extract ( fluoride) 15
    16. 16. CARIES PROCESS Dr.Caroline Mohamed 16 De- Remineralizatio n Enamel lesion Dentin lesion Pulpal lesion White spot TIME C A R I E S NO CAVITY DIAGNOSIS RESTORATION CAVITY
    17. 17. Depending on the extent of tooth destruction, various treatments can be used to restore teeth to proper form, function, and aesthetics, but there is no known method to regenerate large amounts of tooth structure, though stem cell related research suggests one possibility. Instead, dental health organizations advocate preventive and prophylactic measures, such as regular oral hygiene and dietary modifications, to avoid dental caries. Dr.Caroline Mohamed 17
    18. 18. Epidemiology Definition of Epidemiology The word epidemiology comes from the Greek words: epi , meaning on or upon  demos , meaning people, and  logos , meaning the study of "the study of what is upon the people", 18Dr.Caroline Mohamed
    19. 19. Incidence and prevalence and how can be measured Prevalence • Number or proportion of persons in a population affected by a condition at a given point of time • Can be expressed as, count, proportion or percentage. • Incidence Number of new cases of condition over a given point of time. Change in prevalence or severity. The period of time depend on time needed to disease to be observed expressed as a rate (case per the population per time) Determine the progress of condition Dr.Caroline Mohamed 19
    20. 20. Different Age Groups Key risk groups from ages Age-Three peaks 4-8yrs 11-18yrs 55-65yrs 1 to 2 years ( baby bottle caries) 5 to 7 years ( primary caries) 11 to14 years Key risk age group in young adults  and adults ( secondary caries/ root caries)  Sex- both sexes early eruption in females 20Dr.Caroline Mohamed
    21. 21. Adults continue to experience primary dental caries, but they also experience a significant amount of secondary caries around existing restorations. Children today, in developed countries, have comparatively few, if any restorations and experience mostly primary caries of the noncavitated type. Between 40 and 76% of dental carie in adults are arrested, a condition uncommoly observed in children. Dr.Caroline Mohamed 21
    22. 22. Variation within dentition: Dr.Caroline Mohamed 22  Early plaque formation occurs faster. 1.In lower jaw, compared to upper jaw. 2.In molars areas. 3.On buccal tooth surfaces, compared to oral sites. 4.In interdental regions compared to strict buccal or oral surface.
    23. 23. Tooth composition Dr.Caroline Mohamed 23 Mineralization- Hypomineralization/ Dentinogenese imperfecta Trace elements Fluoride/ dental fluorose
    24. 24. Dr.Caroline Mohamed 24 Dentinogenese imperfecta Dental Fluorose
    25. 25. Individual Teeth Dr.Caroline Mohamed 25 First primary molars and first permanent molars are high risk.
    26. 26. Different tooth surfaces: Dr.Caroline Mohamed 26 Are high risk: Interproximal surfaces of primary molars. Occlusal surfaces of first permanent molars.
    27. 27. Tooth morphology Dr.Caroline Mohamed 27 Pits & fissures Irregularities in arch form Crowding Overlapping
    28. 28. Dr.Caroline Mohamed 28
    29. 29. Tooth morphology Dr.Caroline Mohamed 29
    30. 30. Behavior Age 30Dr.Caroline Mohamed
    31. 31. Regularity of snaks, more than 3 times a day, snacking between meals, this increases the acid challenge to the teeth for a high level Nocturnal bottle usage- additive On pacifier during sleep Breast feeding (Kawaba et al., 1997) 31Dr.Caroline Mohamed
    32. 32. Drinking sweet beverage Brushing by mother (Kawaba et al., 1997) 32Dr.Caroline Mohamed
    33. 33. Dental Caries classification 1.based on anatomical site 2.based on progression 3.based on virginity of lesion 4.based on extend of caries 5.based on tissue involvement 6.based on chronology 7. based on whether caries is completely removed or not. 8.based on surfaces to be restored 9. WHO system 9.Black’s classification 10.Caries risk Assessement 33Dr.Caroline Mohamed
    34. 34. Classification: 1) Based on anatomic site: Crown caries Root caries Pit & Fissure Caries Smooth surface Caries
    35. 35. Dr.Caroline Mohamed 35 Pits and fissures are anatomic landmarks on a tooth where the enamel folds inward. Fissures are formed during the development of grooves but the enamel in the area is not fully fused. As a result, a deep linear depression forms in the enamel's surface structure, which forms a location for dental caries to develop and flourish. Fissures are mostly located on the occlusal surfaces of posterior teeth and palatal surfaces of maxillary anterior teeth.
    36. 36. Dr.Caroline Mohamed 37 Pits are small, pinpoint depressions that are most commonly found at the ends or cross-sections of grooves. In particular, buccal pits are found on the facial surfaces of molars. For all types of pits and fissures, the deep infolding of enamel makes oral hygiene along the surfaces difficult, allowing dental caries to develop more commonly in these areas.
    37. 37. Dr.Caroline Mohamed 38 The occlusal surfaces of teeth represent 12.5% of all tooth surfaces but are the location of over 50% of all dental caries. Among children, pit and fissure caries represent from 80 to 90% of all dental caries. Pit and fissure caries can sometimes be difficult to detect. As the decay progresses, caries in enamel nearest the surface of the tooth spreads gradually deeper. Once the caries reaches the dentin at the dentino-enamel junction (DEJ), the decay quickly spreads laterally.
    38. 38. Dr.Caroline Mohamed 39 Within the dentin, the decay follows a triangle pattern that points to the tooth's pulp. This pattern of decay is typically described as two triangles (one triangle in enamel, and another in dentin) with their bases conjoined to each other at the DEJ. This base-to-base pattern is typical of pit and fissure caries, unlike smooth-surface caries (where base and apex of the two triangles join).
    39. 39. Dr.Caroline Mohamed 40
    40. 40. Dr.Caroline Mohamed 41 Clinical Manifestation: Entry site may appear much smaller than actual lesion, making clinical diagnosis difficult. In cross section, the gross appearance of pit and fissure lesion is inverted V with a narrow entrance and a progressively wider area of involvement closer to the DEJ. a) Initially, caries of pit & fissures appears brown or black in color & with fine explorer, it will feel soft & a catch is felt ( don´t do it ). b) The enamel which borders the pit & fissures appears opaque bluish white.
    41. 41. 42Dr.Caroline Mohamed
    42. 42. 43Dr.Caroline Mohamed
    43. 43. Shape, morphological variation and depth of pit and fissures contributes to their high susceptibility to caries. The appearance of s.mutans in pits and fissures is usually followed by caries 6 to 24 months later. Sealing of pits and fissures just after tooth eruption may be the most important event in their resistance to caries. 44Dr.Caroline Mohamed
    44. 44. Smooth surface caries Smooth surface caries occurs on the gingival third of the buccal, lingual & proximal surfaces. • On proximal surface, caries begins below the contact area & in early stage this appear as a faint white opacity of enamel without loss of continuity of surface. • As caries progresses, it appears bluish white in later stage. • Caries in cervical area are in the form of crescent shaped cavities. It appear as a slightly roughened, chalky area which gradually becomes deeper
    45. 45. Types of smooth surface caries 1. Proximal caries, also called interproximal caries, form on the smooth surfaces between adjacent teeth. 2. Root caries form on the root surfaces of teeth. 3. The third type of smooth-surface caries occur on any other smooth tooth surface. Less favorable site for plaque attachment, usually attaches on the smooth surface that are near the gingiva or are under proximal contact. 46Dr.Caroline Mohamed
    46. 46. Proximal caries are the most difficult type to detect. Frequently, this type of caries cannot be detected visually or manually with a dental explorer. Proximal caries form cervically (toward the roots of a tooth) just under the contact between two teeth. As a result, radiographs (bitewings) are needed for early discovery of proximal caries. Dr.Caroline Mohamed 47
    47. 47. Dr.Caroline Mohamed 48 In very young patients the gingival papilla completely fills the interproximal space under a proximal contact and is termed as col. Also crevicular spaces in them are less favorable habitats for s.mutans. Consequently proximal caries is less lightly to develop where this favorable soft tissue architecture exists.
    48. 48. Proximal surfaces Caries The proximal surfaces are particularly susceptible to caries due to extra shelter provided to resident plaque owing to the proximal contact area immediately occlusal to plaque. Lesion have a broad area of origin and a conical, or pointed extension towards DEJ. V shape with apex directed towards DEJ. After caries penetrate the DEJ softening of dentin spread rapidly and pulpally 49Dr.Caroline Mohamed
    49. 49. Dr.Caroline Mohamed 50
    50. 50. 51Dr.Caroline Mohamed
    51. 51. 52Dr.Caroline Mohamed
    52. 52. Root surface caries  The proximal root surface, particularly near the cervical line, often is unaffected by the action of hygiene procedures, such as flossing, because it may have concave anatomic surface contours (fluting) and occasional roughness at the termination of the enamel.  These conditions, when coupled with exposure to the oral environment (as a result of gingival recession), favor the formation of mature, caries-producing plaque and proximal root-surface caries. 53Dr.Caroline Mohamed
    53. 53.  Root-surface caries is more common in older patients. Caries originating on the root is alarming because: 1. It has a comparatively rapid progression 2. it is often asymptomatic 3. it is closer to the pulp 4. it is more difficult to restore Dr.Caroline Mohamed 54
    54. 54. Characteristics of root caries: Root caries lesions have less well-defined margins, tend to be U-shaped in cross sections, and progress more rapidly because of the lack of protection from and enamel covering. 55Dr.Caroline Mohamed
    55. 55. When the gingiva is healthy, root caries is unlikely to develop because the root surfaces are not as accessible to bacterial plaque. The root surface is more vulnerable to the demineralization process than enamel because cementum begins to demineralize at 6.7 pH, which is higher than enamel's critical pH. Regardless, it is easier to arrest the progression of root caries than enamel caries because roots have a greater reuptake of fluoride than enamel. Dr.Caroline Mohamed 56
    56. 56. Root caries are most likely to be found on facial surfaces, then interproximal surfaces, then lingual surfaces. Mandibular molars are the most common location to find root caries, followed by mandibular premolars, maxillary anteriors, maxillary posteriors, and mandibular anteriors. Dr.Caroline Mohamed 57
    57. 57. Progressive caries Arrested caries Rapidly progressive - Acute Slowly progressive- Chronic Nursing caries Radiation caries 2) BASED ON THE PROGRESSION OF THE LESION:
    58. 58. Acute caries Acute caries is a rapid process involving a large number of teeth. These lesions are lighter colored than the other types, being light brown or grey, and their caseous consistency makes the excavation difficult. Pulp exposures and sensitive teeth are often observed in patients with acute caries. It has been suggested that saliva does not easily penetrate the small opening to the carious lesion, so there are little opportunity for buffering or neutralizaton 59Dr.Caroline Mohamed
    59. 59. Nursing caries Nursing caries can also be called as: 1. Nursing bottle caries 2. Nursing bottle syndrome 3. Milk bottle syndrome 4. Baby bottle tooth decay 5. Early childhood caries  The new name given for early childhood caries is “maternally derived streptococcus mutans disease (MDSMD)” Dr.Caroline Mohamed 60
    60. 60. NURSING CARIES This is the type of acute carious lesion, which occurs among those children who take milk or fruit juices by nursing bottle, for a considerably longer duration of time, preferably during sleep. As the child takes larger amount of easily fermentable sugars along with the milk, the sugar facilitates the cariogenic bacteria to produce caries at a rapid pace by fermenting those sugars. Nursing bottle caries commonly occurs in the upper anterior teeth (as these are constantly coming in contact with the sweetened milk); while the lower teeth are not usually affected as they remain under the cover of the tongue.
    61. 61. Radiation caries Radiotherapy is frequently associated with xerostomia due to decreased salivary secretion This and other cause of decreased salivation may lead to a rampant form of caries, indicating the significance of saliva in preventing caries. Dr.Caroline Mohamed 62
    62. 62. Radiation caries Dr.Caroline Mohamed 63
    63. 63.  Three types of defects due to irradiation 1. Lesion usually encircling the neck of teeth amputation of crowns may occur 2. Begins as brown to black discolouration of tooth .occlusal surface and incisal edges wear away 3. Spot depression which spreads from any surface
    64. 64. Chronic caries These lesions are usually of long-standing involvement, affect a fewer number of teeth, and are smaller than acute caries. Pain is not a common feature because of protection afforded to the pulp by secondary dentin The decalcified dentin is dark brown and leathery. Pulp prognosis is hopeful in that the deepest of lesions usually requires only prophylactic capping and protective bases. The lesions range in depth and include those that have just penetrated the enamel. 65Dr.Caroline Mohamed
    65. 65. Dr.Caroline Mohamed 66
    66. 66. Arrested caries Caries which becomes stationary or static and does not show any tendency for further progression Both deciduous and permanent affected. With the shift in the oral conditions, even advanced lesions may become arrested . Arrested caries involving dentin shows a marked brown pigmentation and induration of the lesion (the so called ‘eburnation of dentin’). Sclerosis of dentinal tubules and secondary dentin formation commonly occur. 67Dr.Caroline Mohamed
    67. 67. Arrested caries Exclusively seen in caries of occlusal surface with large open cavity in which there is lack of food retention. Also on the proximal surfaces of tooth in cases in which the adjacent approximating tooth has been extracted 68Dr.Caroline Mohamed
    68. 68. 3) BASED ON THE VIRGINITY OF THE LESION: Primary Caries Secondary or Recurrent caries Recurrent caries is that occurring immediately next to a restoration. It may be the result of poor adaptation of a restoration, which allows for a marginal leakage, or it may be due to inadequate extension of the restoration. In addition, caries may remain if there has not been complete excavation of the original lesion, which later may appear as a residual or recurrent caries.
    69. 69. Primary caries A primary caries is one in which the lesion constitutes the initial attack on the tooth surface. The designation of primary is based on the initial location of the lesion on the surface rather than the extent of damage. 70Dr.Caroline Mohamed
    70. 70. Secondary caries (Recurrent) This type of caries is observed around the edges and under restorations. The common locations of secondary caries are the rough or overhanging margin and fracture place in all locations of the mouth. It may be result of poor adaptation of a restoration, which allows for a marginal leakage, or it may be due to inadequate extension of the restoration. In addition caries may remain if there has not been complete excavation of the original lesion, which later may appear as a residual or recurrent caries. 71Dr.Caroline Mohamed
    71. 71. Dr.Caroline Mohamed 72
    72. 72. 73Dr.Caroline Mohamed
    73. 73. 74Dr.Caroline Mohamed
    74. 74. 4.Based on the extend of the lesion- severity INCIPIENT CARIES OCCULT CARIES CAVITATION 75Dr.Caroline Mohamed
    75. 75. Incipient caries The early caries lesion best seen on the smooth surfaces of the teeth, is visible as a ‘White Spot’ Histologically, the lesion has an apparently intact surface layer overlying subsurface demineralization. Significantly many such lesions can under go remineralization & thus the lesion is not an indication for restorative treatment Remineralised with fluoride application D/d: developmental defects of enamel Dr.Caroline Mohamed 76
    76. 76. 77Dr.Caroline Mohamed
    77. 77. Occult caries Occult or hidden caries is used to describe such lesion, which is not clinically diagnosed but detected only on radiographs. It is believed that bitewing & OPG radiographs along with other noninvasive adjuncts like fibrooptic transillumination (FOTI), LASER luminescence, electrical resistance method(ERM) are used for diagnosing these occlusal lesions. Prevalence-0.8%-50% in age range of 14 -20 yrs Dr.Caroline Mohamed 78
    78. 78. Dr.Caroline Mohamed 79
    79. 79. Dr.Caroline Mohamed 80
    80. 80. Cavitation Once it reaches the dentinoenamel junction, the caries process has the potential to spread to the pulp along the dentinal tubules and also spread in lateral direction. Thus some amount of sensitivity may be associated with this type of lesion. This may be generally accompanied by cavitation 81Dr.Caroline Mohamed
    81. 81. 5. Based on tissue involvement 1. Initial caries- demineralization 2. Superficial caries- enamel 3. Moderate caries- dentin caries 4. Deep caries – dentin close to the pulp 5. Deep complicated caries – pulp involvement 82Dr.Caroline Mohamed
    82. 82. Dental caries can be divided into 4 or 5 stages 1. Initial caries: Demineralization without structural defect.  This stage can be reversed by fluoridation and enhanced mouth hygiene 2. Superficial caries (Caries superficialis):Enamel caries, wedge-shaped structural defect.  Caries has affected the enamel layer, but has not yet penetrated the dentin. Includes larger lesions with adequate tooth structure to support the restoration 83Dr.Caroline Mohamed
    83. 83. 3. Moderate caries (Caries media): Dentin caries. Extensive structural defect. Caries has penetrated up to the dentin and spreads two-dimensionally beneath the enamel defect where the dentin offers little resistance. 4. Deep caries (Caries profunda): Deep structural defect. Caries has penetrated up to the dentin layers of the tooth close to the pulp. 5. Deep complicated caries (Caries profunda complicata) :Caries has led to the opening of the pulp cavity (pulpa aperta or open pulp). 84Dr.Caroline Mohamed
    84. 84. 6. Based on chronology EARLY CHILDHOOD CARIES ADOLESCENT CARIES ADULT CARIES 85Dr.Caroline Mohamed
    85. 85. Early childhood caries Early childhood caries would include, two variants: Nursing caries and rampant caries. The difference primarily exist in involvement of the teeth (mandibular incisors) in the carious process in rampant caries as opposed to nursing caries. 86Dr.Caroline Mohamed
    86. 86. Teenage caries (adolescent caries) This type of caries is a variant of rampant caries where the teeth generally considered immune to decay are involved. The caries is also described to be of a rapidly burrowing type, with a small enamel opening. The presence of a large pulp chamber adds to the woes, causing early pulp involvement. 87Dr.Caroline Mohamed
    87. 87. Adult caries With the recession of the gingiva and sometimes decreased salivary function due to atrophy, at the age of 55-60 years, the third peak of caries is observed. Root caries and cervical caries are more commonly found in this group. Sometime they are also associated with a partial denture clasp. 88Dr.Caroline Mohamed
    88. 88. 7.Based on whether caries is completly removed or not during treatment RESIDUAL CARIES Residual caries is that which is not removed during a restorative procedure, either by accident, neglect or intention. Sometimes a small amount of acutely carious dentin close to the pulp is covered with a specific capping material to stimulate dentin deposition, isolating caries from pulp. The carious dentin can be removed at a later time.
    89. 89. 8.Based on surfaces to be restored Most widespread clinical utilization O for occlusal surfaces M for mesial surfaces D for distal surfaces F for facial surfaces B for buccal surfaces L for lingual surface Various combinations are also possible, such as MOD –for mesio-occluso-distal surfaces.
    90. 90. 9.World health organization (WHO) system In this classification the shape and depth of the caries lesion scored on a four point scale D1. clinically detectable enamel lesions with intact (non cavitated) surfaces D2. Clinically detectable cavities limited to enamel D3. Clinically detectable cavities in dentin D4. Lesions extending into the pulp
    91. 91. 10. Assessement tools Stepwise progression toward diagnosis & treatment planning depends on thorough assessment of the following  Patient History  Clinical examination  Nutritional analysis  Salivary analysis  Radiographic assessment 92Dr.Caroline Mohamed
    92. 92. Conventional techniques of measuring and recording decay Dr.Caroline Mohamed 93 Visual exam Mirror and explorer Dental radiographs Dyes Transillumination Dmfs/dmft
    93. 93. VISUAL-TACTILE METHODS Visual methods: Detection of white spot, discoloration / frank cavitations. Unable to detect subsurface caries. Magnification loupes- Head worn prism loupes (X 4.5) or surgical microscopes (X 16) may be used. Use of temporary elective tooth separation. 94Dr.Caroline Mohamed
    94. 94. Tactile methods: Explorers,Dental floss. Use of explorer is not advocated because; Sharp tips physically damage small lesions with intact surfaces. Probing can cause fracture & cavitation of incipient lesion. It may spread the organism in the mouth. Mechanical binding may be due to non-carious reasons Shape of fissure Sharpness of explorer Force of application Path of explorer placement Explores should be used to clean debris from teeth. 95Dr.Caroline Mohamed
    95. 95. X-rays + non –destructive + can detect subsurface caries - limited safety - unable to detect incipient demineralization - low resolution Dr.Caroline Mohamed 96
    96. 96. Bitewings/ Periapical Dr.Caroline Mohamed 97 Radiographic imaging of pit and fissures is of minimal diagnostic value because of the large ammount of sorrounding enamel enamel. It is detrimental if used for non-invasive remineralization methods.
    97. 97. Direct fiberoptic transillumination 98Dr.Caroline Mohamed Enhanced visual technique that uses the principle of illuminating teeth to detect the presence of caries. . (Pretty, Maupomé, 2004)
    98. 98. Dental Caries Index DMF-T Decayed, Missed, Filled Teeth D = Decayed / not treated yet M = Missed / extracted because decayed F = Filled / restored after decay T = Permanent teeth dmf-t = Primary teeth S = Surface DMF-S / dmf-s ( Mesial/ Distal/ Vestibular / Occlusal) 99Dr.Caroline Mohamed
    99. 99. DMF-T CHART Dr.Caroline Mohamed 100
    100. 100. 10. G. V. BLACK CLASSIFICATION:
    101. 101. Dr.Caroline Mohamed 102 CLASS 1: pit and fissure cavities that occur in the occlusal surfaces of bicuspids and molars, the occlusal two thirds of the buccal and lingual surfaces of the molars, and the lingual surfaces of incisors. Cavities beginning in structural defects that occasionally occur on the occlusal or incisal two third of all teeth.
    102. 102. Dr.Caroline Mohamed 103 CLASS 2: cavities in the proximal surfaces of bicuspids and molars
    103. 103. Dr.Caroline Mohamed 104 CLASS 3: Cavities in the proximal surfaces of incisors and cuspids, not involving the incisal angle
    104. 104. Dr.Caroline Mohamed 105 CLASS 4: Cavities in the proximal surfaces of incisors and cuspids involving the incisal angle
    105. 105. CLASS 5: Cavities in the gingival third, not pit and fissures cavities, of the labial, buccal and lingual surfaces of all teeth
    106. 106. Dr.Caroline Mohamed 107 CLASS 6: Cavities on both mesial and distal proximal surfaces of bicuspid and molars that when restored will share a common isthmus; or cavities on the incisal edges of anterior or cusp tip of posterior teeth.
    107. 107. Dr.Caroline Mohamed 108
    108. 108. HIGH RISKHIGH RISK LOW RISKLOW RISK Social HistorySocial History Socially deprivedSocially deprived High caries in siblingsHigh caries in siblings Low knowledge of cariesLow knowledge of caries Middle classMiddle class Low caries in siblingLow caries in sibling High dental aspirationsHigh dental aspirations Medical HistoryMedical History Medically compromisedMedically compromised XerostomiaXerostomia Long-term cariogenicLong-term cariogenic medicinemedicine No such problemNo such problem Dietary habitsDietary habits Sugar intake: frequentSugar intake: frequent InfrequentInfrequent 109Dr.Caroline Mohamed
    109. 109. HIGH RISKHIGH RISK LOW RISKLOW RISK Use of fluorideUse of fluoride Non-fluoridated areaNon-fluoridated area No fluoride supplementsNo fluoride supplements Fluoridated areaFluoridated area Fluoride supplements usedFluoride supplements used Plaque controlPlaque control Poor oral hygienePoor oral hygiene maintenancemaintenance Good oral hygieneGood oral hygiene maintenancemaintenance SalivaSaliva Low flow rate& bufferingLow flow rate& buffering capacitycapacity ↑↑ S.mutans & lactobacillusS.mutans & lactobacillus countscounts Normal flow rate& bufferingNormal flow rate& buffering capacitycapacity ↓↓ S.mutans & lactobacillusS.mutans & lactobacillus countscounts 110Dr.Caroline Mohamed
    110. 110. HIGH RISKHIGH RISK LOW RISKLOW RISK Clinical evidenceClinical evidence New lesionsNew lesions Premature extractionsPremature extractions Anterior caries restorationsAnterior caries restorations Multiple/repeatedMultiple/repeated restorationsrestorations No fissure sealantsNo fissure sealants Multi-band orthodonticsMulti-band orthodontics No new lesionsNo new lesions No extraction for cariesNo extraction for caries Sound anterior teethSound anterior teeth No/few restorationsNo/few restorations Fissure sealedFissure sealed No appliancesNo appliances 111Dr.Caroline Mohamed
    111. 111. Thank you Dr.Caroline Mohamed 112
    112. 112. Activity What is a fluoride bomb or fluoride syndrome? Dr.Caroline Mohamed 113