Introduction to Cariology

Cariology

the branch of dentistry concerned with the study of dental caries (tooth decay)

Cariology, Dental caries

_____ is a young discipline, whereas _____ is an old disease.

Dental caries

a biofilm-mediated, diet modulated, multifactorial, non-communicable, dynamic disease resulting in net

mineral loss of dental hard tissues

determined by biological, behavioral, psychosocial, and environmental factors

Caries diagnosis

clinical judgment integrating available information, including the detection and assessment of caries signs

(lesions), to determine presence of the disease

main purpose is to achieve the best health outcome for the patient by selecting the best management

option for each lesion type, to inform the patient, and to monitor the clinical course of the disease

Caries activity

concept that reflects the mineral balance, in terms of net mineral loss, net mineral gain, or stasis over time

Active caries

Initiation/progression

Inactive caries

Caries arrest/regression

Dental biofilm

a consortium of microorganisms that stick to a tooth surface. The microorganisms are embedded in an

extracellular polymeric matrix

Dental plaque

clinical term used commonly when referring to the dental biofilm

Demineralization

the loss of tooth mineral, due to acids. In dental caries, this process is biofilm-mediated, while in erosion, the acid comes from other sources

Biofil-mediated

In dental caries, the process of demineralization is

Acid comes from other sources

In erosion, this process of demineralizatiom

Remineralization

the net gain of mineral in previously demineralized tissue

Cariogenic

describes substrates or microorganisms capable of promoting dental caries

Cariogenecity

potential of substrates or microorganisms to promote dental caries

Cariostatic

describes substances or procedures capable of arresting dental caries

Caries risk

probability that caries lesions will appear or progress if conditions remain the same within a stated period

of time

Modifiable risk factor

a determinant that can be modified by intervention, thereby reducing the probability of caries

Caries risk management

measures taken to reduce the caries risk to which an individual or population is subject

Caries lesion

clinical sign of caries

can be categorized according to their anatomical location on the tooth (coronal or root/cementum surface), their severity (e.g., non-cavitated, cavitated), depth of penetration into the tissue (e.g., enamel, dentin, pulp), and their activity status (active, inactive)

Caries lesion detection

identification of the signs of dental caries

can be detected clinically at various detection thresholds and stages, e.g., non-cavitated, micro-cavitated, and cavitated

Radiography and optical and electrical methods

What are the supplementary detection tools for caries lesion?

histology, transmission and scanning electron microscopy, as well as confocal laser scanning microscopy

What includes the vitro caries lesion detection?

Initial caries lesion

frequently used term for noncavitated caries lesion

Although the term implies an early-stage lesion, the lesion could have been present in the mouth for a lifetime. The term refers to the stage of severity and does not inform about lesion activity

White spot lesion (white spot)

popular term for non-cavitated lesions in the past

The term refers solely to the color of the lesion, has no bearing on the activity of the lesion, and may be confused with other types of pathology such as dental fluorosis

Dental fluorosis

White spot lesion may be confused with other types of pathology such as?

Sound enamel/dentin

Tooth structure without clinically detectable alterations of the natural translucency, color, or texture

Primary caries

caries lesion on previously sound tooth surface

Secondary caries (recurrent caries)

caries lesion developed adjacent to a restoration

Recurrent caries

What is the other term for secondary caries?

Residual caries

a demineralized carious tissue left in place before a restoration is placed

Rampant caries

a historic term used to describe multiple caries lesions in the same patient, often used in association with early childhood caries or radiation caries

Early childhood caries

early onset of caries in young children with often fast progression, which can finally result in complete destruction of the primary dentition. the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled surfaces in any primary tooth of a child under age of 6

Caries lesion transition

change in caries lesion severity and/or activity stage in response to changes of lesion environment, for example mediated by caries control measures or changes in lifestyle

Tactile assessment

atraumatic tactile evaluation of the surface integrity and texture of a caries lesion by use of a dental manual instrument

should not be confused with the historical practice of lesion detection by catching of the probe (no longer recommended)

Radiographic detection

the identification of a radiolucency interpreted as a caries lesion on a dental radiograph

Operative (restorative) caries treatment

a surgical intervention to place a restoration to control caries, to aid biofilm control, and typically to restore form and function

Non-operative caries treatment

• non-surgical measures interfering with the initiation of new caries lesion and the rate of caries lesion progression

• key elements can include brushing with fluoride toothpaste, other fluoride treatments, dietary modification, oral hygiene measure

Topical fluorides

all methods of fluoride applied locally to teeth. It can be divided into self-applied (toothpaste, rinses, gels) or professionally applied (gels, varnishes, foams, solutions)

Systemic fluorides

ingested fluorides

historically referred to a supposed systemic effect currently, these methods of fluoride delivery such as fluoridated water and salt are used as public health measures that act through a topical effect when in contact with teeth

Minimal intervention dentistry

holistic caries management philosophy that integrates caries lesion control and minimal operative intervention

main objective is tissue preservation, including early caries detection and non-operative treatment, combined with minimally invasive restorative procedures

Preventive sealant/sealing

application of a thin physical barrier over a clinically sound caries predilection site, in order to prevent the initiation of a caries lesion.

can be applied to pits, fissures, and fossae using resin composite or glass ionomer cement

Caries infiltration

micro-invasive intervention by which the pores of a non-cavitated caries lesion are infiltrated with low-viscosity resin after treating the surface with hydrochloric acid.

Atraumatic restorative treatment (ART)

tissue-saving caries management approach that uses hand instruments for opening caries cavities and removing decomposed carious dentine, followed by restoration with a high-viscosity glass ionomer does not require access to electrically driven equipment and running water

Caries removal

removal of carious tissue by the use of burs, hand excavators, or other techniques

Complete caries removal

excavation to hard dentine in the entire cavity

this technique is no longer recommended

Partial caries removal (selective caries removal)

excavation method by which carious dentine is removed from the peripheral walls of a deep cavitated caries lesion (excavated to hard dentine), followed by partial removal of soft dentine from the pulpal wall with hand excavator or round bur

indicated for deep dentin lesions to avoid pulp exposure

Selective caries removal to firm / leathery dentin

excavation to firm / leathery dentin (physically resistant to hand excavation) in the pulpal aspect and periphery of the cavity

Stepwise caries removal

caries excavation in two (or more) steps, with a time interval between the steps, to stimulate mineral deposition in the dentine prior to final excavation. The first step is partial caries excavation followed by additional caries removal to firm dentine at a later date