Comprehensive Notes on Dental Caries Management CH25

Vocabulary flashcards covering key concepts from the lecture notes on the history, biology, risk assessment, and management of dental caries.

Community water fluoridation

Reductions in caries incidence (40–60%) since 1945 in the US for communities with fluoridated water.

Fluoride dentifrices and mouthrinses

Home-use fluoride products that contributed to decreased caries prevalence in the 20th century.

Lack of access to care

Contributed to stable or rising caries prevalence in some US populations in the early 21st century.

Untreated dental caries in preschoolers (2011–2014)

Decreased prevalence of untreated caries; no change in the prevalence of no caries in permanent teeth in children/adolescents.

Dental caries process

A biofilm-mediated, diet-modulated, multifactorial, noncommunicable, dynamic disease causing net mineral loss of hard tissues.

Vertical transmission

Cariogenic bacteria are not present at birth and are often transmitted mother-to-child.

Extended ecological plaque hypothesis

Caries results from a shift in dental plaque toward a more cariogenic flora.

Acidogenic bacteria

Bacteria that produce acid by metabolizing fermentable carbohydrates, contributing to demineralization.

Aciduric bacteria

Bacteria that tolerate acidic environments and persist in cariogenic biofilms.

Mutans streptococci

Group including S. mutans and S. sobrinus; key organisms in biofilm formation and caries initiation.

Lactobacillus

Bacteria more active during caries progression.

Actinomyces

Bacteria associated with the caries process alongside other species.

Bifidobacteria

Bacteria associated with early childhood caries.

Candida albicans

Fungus detected with S. mutans in plaque from children with early childhood caries.

Fermentable carbohydrates

Sugars (sucrose, glucose, fructose) and processed starches that fuel caries-causing acids.

Acids produced in caries

Acetic, lactic, formic, and propionic acids.

Demineralization

Mineral loss from tooth structure due to acids; can form subsurface white spot lesions.

Remineralization

Natural repair process where minerals are redeposited; saliva and fluoride promote it.

Saliva protective factors

Buffers acids, clears debris, supplies calcium/phosphate, maintains pH, and acts as a fluoride reservoir.

Fluoride mechanisms — inhibit demineralization

Fluoride in biofilm/saliva forms HF and reduces diffusion-driven mineral loss.

Fluoride mechanisms — enhances remineralization

Fluoride promotes deposition of calcium, phosphate, and fluoride, forming fluorapatite.

Fluoride mechanisms — inhibits bacterial growth

Fluoride diffuses into bacteria and interferes with essential enzymes.

ICCMS Initial Stage Caries

Noncavitated, reversible caries lesion (initial stage).

CCS Initial Caries lesion

Early reversible caries lesion without cavitation (CCS/ICCMS initial stage).

ICCMS Moderate Stage Caries

Cavitation of the enamel indicating irreversible progression.

ICCMS Extensive Stage Caries

Lesion extends into dentin.

Caries Risk Assessment (CRA)

Clinical process estimating probability of new caries or lesion change over time to guide prevention.

ADA Caries Risk Assessment (CRA)

CRA tool with age-based forms (0–6; >6) assessing fluoride exposure, sugary diet, dental home, health, radiographic/clinical findings; risk levels: low/moderate/high.

AAPD Caries-Risk Assessment Tool (CAT)

Tool for infants–adolescents; factors include biologic factors, protective factors, clinical findings; risk levels vary by provider type.

Cariogram

Visual risk model showing interactions of bacteria, diet, susceptibility, and circumstances; represented as a pie chart.

CAMBRA

Caries Management by Risk Assessment; assesses disease indicators, biologic factors, protective factors; risk levels: low to extreme.

ICCMS CRA

ICCMS-based assessment including medical history, radiation exposure, sugars, fluoride exposure, caregiver caries history, and other factors; risk levels: low/medium/high.

Implementation of CRA

Select CRA system, review medical/dental history, assess diet, clinical/radiographic findings, saliva/bacteria as needed, identify modifiable risk factors.

Planning care by risk level

Individualized care plan addressing existing lesions, personal behavior changes, and family involvement; Table 25-1 provides details.

Low caries risk plan

Primary prevention, positive feedback, maintain good habits, continue routine care, fluoride toothpaste/water exposure.

Moderate caries risk plan

Motivational interviewing; reduce acid/beverage/sugar intake; enhance protective factors (fluoride varnish, sealants); include protective foods.

High/extreme caries risk plan

Improve biofilm removal; dietary counseling to reduce fermentables; initial fluoride varnish (1–3 applications) then every 3 months; diamine fluoride as alternative.

Continuing care

Biofilm control assessment, reassess CRA, check demineralization areas and margins, radiographs as indicated, assess and adjust adherence.