dental caries and fluoride with ICDAS

what is dental caries and dental plaque

pathological proceess resulting in localised destruction of tooth tissue

dental plaque ( a complex biofilm of mixed bacteria and the by products ) is a PRE-REQUISITE for dental caries development

sequelae of dental caries

dental plaque / microbial biofilm (prerequisitee)

frequent exposure of dietary sugar

increase in population of cariogenic bacteria

increase in organic acids

decreased ph of biofilm

enamel deminineralisation (loss of carbonated hydroxyapatite )

sequelae of pulp diseases (tg /short form)

pulpitis

pulp necrosis

infection of root canal

apical periodontitis

periapical abscess

spreading odontogenic infection

detail sequelae of pulp necrosis

reversible pulpitis

symptomatic irreversible pulpitis

asmptomatic irreversible pulpitis (pain and swelling absent )

hyperplastic pulpitis (pulp polyp )

internal resorption (till here pulp is vital )

necrobiosis (50%vital 50% non vital )

pulp necrosis ( non vital )

• symptomatic necrosis (infected dead tissue )

• asymptomatic pulp necrosis (non infected dead tissue )

apical periodontitis

• symptomatic (acute )

• asymptomatic (chronic )

apical infection

• acute infection ( localised odontogenic infection )

• spreading odontogenic infection (with/without severe systemic features )

• spreading odontogenic infection (with severe systemic features )

risk factors of dental caries

• diet

• saliva quantity and quality

• plaque characteristics

• oral hygiene habits

• use of fluoridated products

EARLY MODIFICATION OF THESE FACTORS IS THE PRIMARY PREVENTIVE STRATEGY

DENTAL CARIES MANAGEMENT STRATEGIES

• dietary modification :- avoid sucrose in sticky forms and limiting other sugars (eg acidic drinks ) and carbohydrates as snacks between meals

• plaque reduction :- by cleaning teeth , brushing twice a day with fluoride toothpaste , interdentl cleaning

• tooth surface modification :- using remineralizing agents , placing fissure sealants and other adhesive materials that protect tooth surface

• saliva modification :- adressing causes of dry mouth , using low acid sugar -free chewing gum oe lozenges . non acidic coarse foods (carrots ) to increase salivary flow and buffering capacity of saliva

• OTHER STRATEGIES :- acidulated / higher concentration fluoride products and non fluoride remineralising agents / CHX

high risk factors acc to ICCMS

• head and neck radiation (pt related )

  intraoral level caries risk factor

• hyposalivation / gross indicators of dry mouth

• PUFA ( exposed pulp , ulceration , fistula , absess )- Dental sepsis

other risk factors acc to ICCMS

pt level caries risk factor

• dry mouth ( conditions , medications/recreational drugs / self report )

• inadequate oral hygiene practices

• deficient exposure to topical fluoride

• high frequency/amount of sugary drinks /snacks

• symptomatic driven dental attendance

• socio economic stautus / health access barriers

• for children high caries experience of mothers or care givers

intraoral level caries risk factors

• caries experience and active lesions

• thick plaque : evidence of sticky biofilm in plaque stagnation areas

• appliances , restorations and other causes of increased biofilm retention

• exposed root surfaces

how will you classify pt as low risk/moderate/high risk pt ?

• low risk :- lack of any high caries risk factor and other risk factors are within safe ranges (sugary snacks, oral hygiene, fluoride )

• moderate risk :- not deemed to be drfinitely at low risk or definitely at high risk of develping new caries lesions or of lesion progression

• high risk :- any high risk factors or caregivers with very high caries experience or where several of lower risk factors suggest a combination likely to high risk status

ICDAS international caries detection and assessment system sound caries / code 0 ?

sound tooth structure (no changes in enamel )

ICDAS initial caries ?

initial caries = code 1 and code 2

• code 1 :- first visual change in enamel

  when wet - no color change

  when dry - discoloration visible limited to pit and fissures

• code 2 :- distinct visual change in enamel

  color change is seen irrespective of wet/dry

  wider than natural fissure/fossa

ICDAS moderate caries ?

code 3 or code 4

code 3

• localised enamel breakdown with no dentin visible/no dentin shadow

code 4

• underlying dentin shadow is seen (with/without enamel breakdown )

ICDAS advanced caries

code 5/6

code 5 :-

• distinct cavity with visible dentin < half of occlusal surface

code 6 :-

• extensive distinct cavity with visible dentin > half of occlusal surface

how will you differentiate active / passive lesions clinically ?

ICDAS 2 classification

how to determine likelihood of caries progression

management protocol for diff carious lesioms (active/inactive and initial/moderate/extensive)

all inactive caries lesion (high/moderate/low) /sound :- preventive treatment (preventing new caries)

initial active caries- non operative care (NOC)

moderate active - tooth preserving operative care

extensive active - tooth preserving operative care (TPOC)

detailed management plan based on which area caries is in i.e. pits and fissures , mesial-distal (proximal) , free smooth

in cases of primary dentition what is the management protocol based on surface i.e. pits and fisures , mesial distal , proximal ?

how will you manage a patients risk factors eg oral hygiene , salivation etc? based on risk low risk , moderate risk , high risk

toothpastes that do not contain fluoride provides little protection against dental caries (true/false)

true

children upto a age of 8 yrs are at an increased risk of dental flourosis (t/f)

false its 6 yrs instead of 8

patients with dental flurosis the porosity of subsurface enamel is decreased and discolouration can occur (white spots, mottling) (true/false)

false porosity increases

flouride supplements recommended are in the form of mouthwashes , gels , drops, lozenges (t/f)

false fluoride supplements in the form of drops/lozenges are no longer recommended because of limited efficacy and risk of dental fluorosis instead

• varnish

• mouthwash

• gel

• foam

• toothpaste

is recommended

recommended concentration of fluoride and brushing habits according to age for low risk pts

• child younger than 18 months- (twice daily brushing without toothpaste )

• child 18 months to younger than 6 yrs - 500-550 ppm (0.5-0.55 mg/g ) fluoride twice daily pea sized

• child 6 yrs to adolecet - 1000 - 1500 ppm (1-1.5 mg/g ) fluoride twice daily

• adolescent/adult - 1000-1500ppm (1-1.5mg/g) fluoride twice daily

fluoride toothpaste concentration for people at high risk

• child younger than 18 months - twice daily brushing with fluoride may be recommended

• child 18 months to younger than 6 yrs - 1000 ppm twice daily or more frequent use of 500-550ppm fluoride

• child 6yrs to adolescent- more frequent use of 1000-1500 ppm fluoride

• adolscent /adult - 5000 ppm twice daily or more frequent use of 1000- 1500 ppm fluoride

different flouride aplications their concentrations and their use in people at elevated risk.

• REFER TG FOR USES AND AGE RESTRICTIONS pg 68-69

• neutral fluoride mouthwash (220ppm/0.22mg/ml )

• neutral fluoride mouthwash 900ppm /0.9mg/ml

• neutral fluoride 2 5000 pm / 5mg/g

• fluoride varnish 22600 ppm 22.6 mg/ml

• acidulated phosphate fluoride gel/foam 12300 ppm 12.3mg/g

• neutral fluoride gel /foam 5000- 9000 ppm / 5-9 mg/g

• silver fluoride formulations (sdf)

• fluoride + CPP-ACP 900 ppm + 10% cream

• fluoride +CPP-ACP 22600 ppm + 2% varnish

fluoride significantly reduces the incidence of dental caries (t/f)

true

fluoride ions have antimicrobial effect at very high concentration formulations withlow ph acidulated phosphate fluoride also have some antimicrobial activity (t/f)

true

full form of CPP-ACP and its formulation types and when should it be avoided

CPP-ACP casein phosphopeptide - amorphous calcium phosphate

• bioavailable calcium and phosphate ions which combine with fluoride to promote enamel remineralisation

• CPP-ACP formulations includ

• sugar free chewing gum

• paste

• varnish some of which also contains fluoride

AVOID CPP-ACP in patients with allergies to milk protiens