Cariology (Lecture 5) + Oral B presentation

What is the percentage of the population with caries within the ICDAS range of 5-6? (Extensive caries)

11%

What is the percentage of the population with caries with dentin lesions and cavitated enamel lesions (ICDAS 3 and 4)? (Moderate caries)

21-25 %

What is the percentage of the population with enamel lesions (ICDAS 1 and 2)? (Initial-stage caries)

52 %

In adults (20-64 years), over ____ had dental caries in permanent teeth.

90%

What is the percentage of UN-treated caries in the permanent dentition?

35%

What is PCCM?

Patient Centered Caries Management

Looks at the patient’s…

• Caries risk assessment

• Behavioral assessment

And looks at the tooth/surface…

• Clinical visual lesion detection

• Lesion detection aids

• Lesion activity assessment

Information collected to form a PERSONALIZED treatment plan.

Integrated with CAMBRA

What are the 2 factors for caries development in the tooth?

1. Composition of tooth

2. Mineralization Level

What are the 4 factors for caries development in one’s diet?

1. Composition

2. Frequency of food

3. Texture of food

4. Amount of food

What is the factor in caries development in bacteria?

Dental plaque

What are the 3 primary factors in caries development?

Bacteria in dental plaque

Diet

Tooth

Name some oral environmental factors that may contribute to caries development.

• Fluoride exposure

• Chewing gum

• Dental sealants

• Saliva

• Protein

• Sugars

• Calcium and phosphate ions

• Plaque pH

Name some personal factors that may contribute to caries development.

• Education

• Behavior (oral hygiene, smoking, snacking)

• Dental visits

• Income

• Sociodemographic status

• Cultural beliefs

• Dental insurance

What are the steps of diagnostic process of treating a patient?

1. Detection

2. Assessment

3. Diagnosis

4. Decision

5. Choice of therapy

If our goal is to regenerate teeth in VERY EARLY lesions, what treatment is best to do?

NONinvasive » fluoride treatments, sealants, etc.

If our goal is to repair non-cavitated lesions without complete restoration, what is the best treatment?

NONinvasive/microinvasive » fillings

(T/F) Most arrested lesion will remain as a scar in the tooth.

True

How does fluoride help remineralize teeth?

Speeds up the movement of calcium and phosphate into the tooth surface, which remineralizes the crystalline structure ( hydroxyapatite and FLUOR-apatite) »»»»»»can resist acid attack much better.

INCREASES pH

What are 3 noninvasive treat approaches?

1. Influencing biofilM

• oral hygiene, antimicrobials, probiotics

2. Influencing diet

• diet modifications and sugar substitutions

3. Influencing mineralization

• substances that provide mineralization (fluoride, calcium compounds)

• Stimulate salivation (xylitol gum)

On the occlusal surface of a tooth, if the prevention level is PRIMARY (ICDAS 0 and 1), what is the treatment approach and invasiveness?

Treatment » better oral hygiene , mineralization (fluoride), diffusion barrier (sealing)

NONinvasive

On the occlusal surface of a tooth, if the prevention level is SECONDARY (ICDAS 2,3,4) what is the treatment approach and invasiveness ?

Treatment » diffusion barrier (caries sealing)

MICROinvasive

On the occlusal surface, if the prevention level is TERTIARY (ICDAS 5 and 6) (active cavitation), what is the treatment approach and invasiveness?

Treatment » restoration

Invasive (can be minimally invasive)

How is Chlorhexidine helpful in preventing dental caries?

Effective against S. Mutants

DISRUPTS bacterial cell membranes , causing leakage and cell death.

How is Chlorhexidine substantial?

Binds to oral tissues and tooth surfaces, maintaining ANTImicrobial activity for up to 12 hours after rinsing.

How is Chlorhexidine beneficial to controlling plaque?

Indirectly LOWERS acid production from bacterial metabolism (which is main driver of enamel demineralization)

When is Chlorhexidine clinically used?

Often used in HIGH/EXTREME risk patients

OR

During orthodontic treatment when mechanical plaque control is compromised

What is the typical percentage of Chlorhexidine mouthwash?

.12 - .2%

When is Chlorhexidine most effective?

When combined with fluoride therapy and dietary control

NOT a standalone caries preventive

What are the limitations/side effects of Chlorhexidine? (3)

• Tooth staining » long term use causes BROWN discoloration

• Taste alteration » temporary changes in taste perception

• Resistance concerns » microbial resistance/imbalance in oral flora

How does baking soda rinse prevent caries?

NEUTRALIZES acids in mouth

Alkaline nature RAISES pH level

Helps remineralize enamel layer + closes micro gaps

Can help remove surface stains/whiten teeth

Baking soda is only recommended to patients who are at a ________ risk.

EXTREME risk only

What are some micro invasive measures?

Sealants in pits and fissures

Infiltration in interproximal areas

Resin, silver diamonds fluoride, curodont

What percentage of Americans have some form of gingivitis?

93.9%

Poor biofilm control leads to this

What percentage of Americans have a power toothbrush?

13%

How many Americans experience gum diseases at a point in their lives?

¾ » 75 %

How many Americans experience tooth decay at some point in their lives?

90%

What percentage of adolescents experience tooth decay?

43%

Why is stannous fluoride so beneficial?

Promotes calcium and phosphate remineralization

Decreases hypersensitivity

Anti-cavity and anti-gingivitis

ANTImicrobial because of stannous ion » TIN

Why do most people use sodium fluoride toothpaste?

Cost effective and in most CHEAP toothpaste