Cariology Lec 68: Caries Therapy

-ability to process sugars efficiently,
-maintain sugar metabolism in an extreme environment (low pH)
-produce intra/extracellular polysaccharides

For bacteria to play a role in the carious process, they must possess certain characteristics:

false

t/f: although they are adjacent, the pulp and the dentin are two different entities who's repair and pathologies are independent of each other

dentinal tubules

the information of caries bacteria aggression is communicated via _____ to odontoblasts

tertiary dentin

The initial response of the pulp includes an increase of secretory activity by the odontoblast leading to increase of the formation of:

necrotic zone

ID the ZONE:
•most superficial zone of carious dentin
•characterized by intense caries activity.
•severe bacterial invasion with high acidic levels and hydrolytic enzymes.
•very low mineral content à demineralization.
•denatured collagen fibrils.
•referred to as infected, necrotic and contaminated dentin
•cannot self-repair.
•appears soft, lacks structure and can be easily excavated with hand or rotary instruments.

contaminated zone

ID the ZONE:

•The tubules are invaded by bacteria

•Bacteria multiply within the tubule lumen.

•The bacteria dissolve the proteins (like collagen) within the tubules. AKA proteolysis

•This zone can be removed by bur, gentle pressure at a slow speed.

demineralization zone

•Caused by the bacterial produced acid that traveled down through the dentinal tubules
•There are no bacteria in this region.
•The zone of demineralization is the advancing front of the carious lesion,
•May be very small area
•Dentin is relatively easily dissolved/demineralized by acid, at pH 6.7.

contaminated zone

what is the last layer of carious dentin that contains bacteria?

demineralization zone

what is the 1st layer of carious dentin that lacks bacteria and most superficial?

sclerosis

what is the dentin response to the early (or slow) insult by increasing the deposition of crystalline material from the intertubular dentin into the lumen of the dentinal tubules making their lumen narrower and less permeable?

translucent zone

what zone is sclerotic dentin located?

firm dentin

describe the texture of the sclerotic dentin in the translucent zone:

necrotic zone

what is the 1st histological layer of carious lesion?

contaminated zone

what is the 2nd histological layer of carious lesion?

demineralization zone

what is the 3rd histological layer of carious lesion?

translucent zone

what is the 4th histological layer of carious lesion?

sound dentin

what is the 5th histological layer of carious lesion?

tertiary dentin

what is the 6th last histological layer of carious lesion?

necrotic and/or contaminated zones

which carious lesion zones MUST be removed?

false

t/f: tooth vitality is negligible, if there is soft and leathery tissue, it should be removed

removal of soft dentin + temp restoration

what is the 1st step of the Stepwise carious tissue excavation method:

removal of firm dentin + perm restoration

what is the 2nd step of the Stepwise carious tissue excavation method:

moderate and advanced caries

Selective carious tissue removal is reserved for what type of caries?

primary molars

the Hall technique or No dentinal carious tissue removal is a treatment reserved for:

Hall technique

•indicated for primary molars only.
• involves placing a SS crown without any carious tissue removal
No tooth preparation.

non-selective to hard dentine

Pulpal floor and cavity periphery carious tissue removal aims to remove all demineralized dentine to reach hard dentine, leaving no softened dentine

sealants

for initial lesions, if clinical intervention is needed, what procedure should you do?

selective caries excavation to firm dentin

If initial lesion in need of a restoration, what procedure should you do?

selective caries excavation to firm dentin

For moderate lesions do not reach 1/3 of dentin, what procedure should you do?

selective caries removal to soft dentin

For advanced/deep caries lesions that DO reach the deepest 1/3 of dentin and with risk of pulpal exposure, what procedure should you do?