Exam 4 POC draft

G.V. Black Class I

Pits and fissures; includes posterior grooves, molar buccal/lingual pits, and anterior lingual pits.

G.V. Black Class II

Proximal surfaces of molars and premolars. Clue: posterior + between teeth.

G.V. Black Class III

Anterior proximal surface WITHOUT incisal edge/angle involvement.

G.V. Black Class IV

Anterior proximal surface WITH incisal edge/angle involvement.

G.V. Black Class V

Cervical third of facial/buccal or lingual surfaces. Clue: near gumline.

G.V. Black Class VI

Cusp tips and incisal edges.

Class III vs. IV

Both are anterior proximal; III has no incisal involvement, IV does.

Class IV vs. VI

IV involves anterior proximal surface AND incisal edge; VI is at cusp tips/incisal edges.

Anterior lingual pit classification

Class I, even though the tooth is anterior.

G.V. Black use at FSDH

Charting restorations only; caries has separate severity/activity recording.

G.V. Black vs. Angle

Black = tooth surface/restoration location. Angle = relationship between upper and lower teeth.

Non-carious tooth loss

Irreversible tooth loss from physical or chemical forces, rather than caries-causing bacteria.

Physiological wear

Slow wear from normal function and aging.

Pathological wear

Faster wear associated with forces such as bruxism or acid exposure.

Erosion

Chemical tooth loss from acid, without bacteria. Examples: acidic drinks, GERD, bulimia.

Attrition

Tooth-to-tooth wear. Clue: matching smooth, polished facets on opposing teeth.

Abrasion

Mechanical wear from an external object/habit. Examples: hard brushing, pens, nails, appliances.

Abfraction — lecture description

V-shaped cervical notch associated with tooth stress/flexing.

Attrition vs. abrasion

Attrition = tooth against tooth. Abrasion = external object against tooth.

Erosion vs. caries

Erosion = acid-related loss without bacteria. Caries = biofilm bacteria + fermentable carbohydrates + acid.

Bruxism and wear

Can be associated with attrition and, in the lecture, abfraction; use the lesion appearance to distinguish them.

Enamel hypoplasia

Enamel matrix development is disrupted; associated with injury, illness, or nutritional deficiency.

Hypomineralization

Too little mineral in developing enamel; enamel is porous, soft, weak, and may have white/yellow/brown patches.

Hypoplasia vs. hypomineralization

Hypoplasia = enamel matrix development problem. Hypomineralization = mineral-content problem.

Amelogenesis imperfecta

Genetic enamel-development disorder affecting primary and permanent teeth; enamel may be thin, pitted, grooved, or missing.

Fluorosis

Too much ingested fluoride during tooth development; lecture window: birth to age 8.

Mild fluorosis

Faint white lines or specks.

Moderate fluorosis

Mottled or discolored enamel.

Severe fluorosis

Brown staining or pitting.

Tetracycline staining

Permanent yellow/gray/brown discoloration from antibiotic exposure during development; appears at eruption.

Tetracycline exposure window in lecture

During pregnancy or up to age 8.

Enamel fracture

Fracture limited to enamel.

Crown fracture without pulpal involvement

Broken crown without involvement of the pulp.

Crown fracture with pulpal involvement

Broken crown involving the pulp.

Crown-root fracture

Fracture involving the crown and root near the tooth's neck.

Root fracture locations

Coronal, middle, or apical portion of the root.

Concussion

Tender tooth; not loose and not displaced.

Subluxation

Tender, loose tooth; not displaced.

Extrusion

Tooth displaced coronally, partly out of the socket; marked loosening.

Intrusion

Tooth pushed apically into the socket.

Lateral luxation

Tooth displaced sideways; lecture describes displacement without loosening.

Avulsion

Tooth completely out of its socket.

Infraction

Hairline crack/craze line.

Concussion vs. subluxation

Both can be tender without displacement; subluxation has loosening.

Intrusion vs. extrusion

Intrusion = pushed in/apically. Extrusion = moved out/coronally.

Extrusion vs. avulsion

Extrusion = partly out. Avulsion = completely out.

Radiographic trauma signs

Widened PDL space, radiolucent fracture line, tooth displacement.

Hard tissue exam components

Morphology, eruption, deposits/stains, developmental variations, wear, caries, restorations, occlusion.

Caries detection instruments

Air-water syringe, magnification, ball-ended probe, dental mirror.

Hard tissue charting findings

Existing/missing teeth, restorations, cavitated/non-cavitated lesions, white spots, and non-carious wear.

CDT

Current Dental Terminology; standardized coding supporting documentation, communication, planning, and claims.

Good documentation

Accurate, complete, objective, and legally appropriate.

Dental caries

Biofilm-mediated, sugar-driven, multifactorial disease causing mineral loss in dental hard tissues.

Biofilm

Dental plaque containing microorganisms, mainly bacteria.

Required caries factors

Susceptible tooth + microorganisms + fermentable carbohydrate + time.

Main caries bacteria in lecture

Streptococcus mutans and Streptococcus sobrinus.

Other caries organisms listed

Lactobacilli, Actinomyces, and non-Actinomyces organisms.

Fermentable carbohydrates

Carbohydrates bacteria metabolize to produce acids; lecture examples: sugars and processed starches.

Caries process

Bacteria use carbohydrates → acid forms → pH falls → minerals dissolve → lesion may progress.

Carbohydrate exposure factor emphasized in reading guide

Frequency of ingestion.

Demineralization

Acids dissolve minerals out of tooth structure.

Remineralization

Lost minerals are redeposited into enamel.

Tooth minerals

Calcium and phosphate.

Enamel critical pH in lecture

5.5.

Dentin critical pH in fluoride lecture

6.2.

Enamel vs. dentin critical pH

Dentin: 6.2, compared with enamel: 5.5 in the lecture.

Neutral pH

7.0.

Normal oral pH range in lecture

6.2–7.6.

Average oral pH range in lecture

6.7–7.2.

Conditions favoring remineralization

Return toward neutral pH and available minerals; saliva supports recovery.

Saliva's protective functions

Buffers acid, clears food/bacteria, supplies calcium/phosphate, and may inhibit bacterial growth.

Caries progression in lecture

Sound → white spot/non-cavitated lesion → cavitated lesion → tooth destruction.

Enamel caries

Enamel demineralization, often a small white spot beneath undisturbed biofilm.

Pit-and-fissure caries

Caries beginning in small enamel faults; lecture lists molars and premolars.

Smooth-surface caries

Caries on plaque-retentive smooth surfaces, such as proximal areas and cervical thirds.

Primary caries

Caries on a previously unaffected surface.

Incipient caries

Early lesion without enamel breakthrough.

Recurrent caries

Caries adjacent to or underneath a restoration.

Arrested caries

Lesion has stopped progressing; surface is hard and may be dark brown/reddish.

Rampant caries

Rapidly spreading decay with early pulp involvement.

Three rampant-caries types in lecture

Early childhood, adolescent, and xerostomia-induced.

Root caries

Caries on exposed roots involving cementum/dentin; often shallow, soft, yellow-brown or dark.

Root caries risk factors

Age, past root caries, poor biofilm removal, periodontal disease.

Early childhood caries (ECC) — lecture wording

One or more decayed, missing due to caries, or filled primary teeth in a child under 6.

Severe ECC criterion explicitly stated in slides

Any smooth-surface caries in a child under 3; the complete age-specific definition needs clarification.

ECC contributors listed

Sleeping with bottles; high S. mutans levels; Lactobacilli and Candida may be associated.

Cavitated lesion

Loss of surface integrity that produces a cavity.

Non-cavitated lesion

Carious change without a surface cavity or enamel breakthrough.

Sound surface

No evidence of caries after 5 seconds of air-drying.

Early caries

Carious white/brown opacity or discoloration; may be visible wet or after drying.

Moderate caries

Localized enamel breakdown without exposed dentin OR an underlying dentinal shadow.

Advanced caries

Distinct cavity with visible/exposed dentin.

Dentinal shadow

Gray, blue, or brown shadow beneath enamel; best seen wet in the lecture.

Moderate vs. advanced caries

Moderate = microbreakage/shadow without exposed dentin. Advanced = exposed dentin.

Active early/moderate lesion

Dull/opaque, rough, often whitish/yellowish, with plaque stagnation.

Inactive early/moderate lesion

Shiny and smooth; may be white, brown, or black.

Active advanced lesion

Dentin feels soft or leathery on gentle probing.

Inactive advanced lesion

Dentin is shiny and hard on gentle probing.

Severity vs. activity

Severity = extent of damage. Activity = whether lesion findings suggest ongoing progression or inactivity.

Lesion color and activity

Color alone does not determine activity; assess texture, shine, and biofilm.