Cariology Lecture 8

lesions on unrestored surfaces

primary caries

lesions that develop adjacent to a restoration

recurrent or secondary lesions

why are you more likely to get secondary caries with composite vs amalgam

amalgam has silver in it which has anti-caries properties

(active/inactive) caries lesion is considered to have a greater likelihood of transition (progress, arrest, or regress)

active

(active/inactive) caries lesion is considered to have less likelihood of transition to a carious state

inactive

In active caries rate of progression is ____

rapid

in active caries, the floor of the cavity is ____ to touch

soft

in inactive caries, the caries progress is ____

slow

inactive caries often involves the collapse of enamel that may result in an open cavity that is ____-______

self -cleansing

How does the cavity floor look in inactive caries

hard and leathery

what color is the cavity in inactive caries

dark in color

an inactive cavity was _____ at one time

active

initial lesion

First sign of enamel lesion that can be detected with the naked eye

a non-cavitated lesion

white spot lesion

incipient lesion

Rampant caries

patient has multiple active extensive carious lesions

examples of rampant caries

early childhood caries

bottle or nursing caries

mountain dew mouth

meth mouth (dry mouth that causes increase in pH)

soft/infected zone of the lesion involves the (outer/inner) layers

outer

the soft/infected zone characteristics

high level of contamination

complete demineralization of the dentin

how does the soft affected zone affect the dentin tubular structure

collapse of tubular structures

leathery/firm affected zone includes the deeper _____ area

pulpal

affect of the affected zome on the dentin tubular structure

it has sufficient mineral context to retain dentin tubular structure

____ dentin will deform when a hard instrument is pressed into it and can be easily scooped up with little force being required

soft

Although the dentin does not deform when an instrument is pressed into it, ______ dentin can still be easily lifted without much force being required

leathery

there may be little difference between leathery and firm dentin with leathery being the transition between soft and firm dentin

____ dentin is physically resistant to hand excavation and some pressure needs to be exerted through an instrument to lift it

firm

for ____ dentin, a pushing force needs to be used with a hand instrument to engage the dentin and only a sharp cutting edge or a bur can lift it

hard

Non surgical goals

prevention and remineralization

surgical goals

tooth preserving selective removal and replacement of tooth structure

Steps of a visual examination

1. clean the teeth (note plaque buildup)

2. Thoroughly dry teeth (5 seconds each)

3. magnigication visualization with light

   1. probe/explorer (consistency/texture of the lesion

why should you not use an explorer to determine softness within the tooth structure?

can damage the enamel

can transfer microorganisms from one spot to another 

using an explorer has/has not shown to improve the accuracy of caries diagnosis

has not

visual appearance of pit and fissure lesions

opaque

chalky

white, yellow, brown, grey discoloration

what does staining show

that demineralization did occur at some point, but did not progress further

After entry through a pit/fissure lesion, the caries progresses along ____ ____ affecting a larger area of the ___ than a smooth surface lesion

enamel rods

DEJ

in a cross section of a pit/fissure lesion, the enamel appears as an ______ __ with a narrow entrance and wider area of development closer to the DEJ

inverted V

In pit/fissure lesions, a cross section of the lesion in the dentin appears as a __ from dentin to pulp

V

_____ lesions within the enamel and outer dentin are difficult to detect radiographically

small

____ lesions may appear as a radiolucent area spreading laterally under the occlusal enamel

Large

Where are you most likely to find caries on a smooth surface?

In plaque stagnant areas

What are plaque stagnation areas?

• gingival to proximal contact area that can only be reach by floss

• ginigival surface to the height of contour on the buccal and lingual (anything along the gumline)

• erupting posterior teeth (occlusal surface)

shape of smooth surface lesion

progresses from the surface towards the DEJ due to progression along enamel rods in a V shape

root surface active lesions look

soft and leathery, may be discolored

Root surface inactive caries looks

commonly discolored, the darker the color the greater the greater the remineralization

• dark and shiny

Caries code ___ and __ = initial caries

1 and 2

Caries code ___ and __ = moderate caries

3 and 4

Caries code ___ and __ = initial caries

5 and 6

Initial stage caries

first or distinct visual changes in enamel seen as a carious opacity or visible discoloration

moderate stage caries

a white or brown spot lesion with localized enamel breakdown without visible dentin exposure

extensive stage caries

a distinct cavity in opaque or discolored enamel with visible dentin