Protocols for Prevention and Control of Dental Caries (Chapter 27 Wilkins)

What is dental caries?

infectious, transmissible disease caused by acidogenic bacteria with dissolution of enamel and dentin (coronal caries) and cementum and dentin (root caries)

Is dental caries preventable or non-preventable?

Preventable

What does the acidogenic bacteria in dental biofilm metabolize?

-Fermentable carbohydrates ingested by patient

What two groups of bacteria predominate in the caries process?

-mutans streptococci (Streptococcus mutans & Streptococcus sobrinus)

-lactobacillus

What type of bacteria is associated with childhood caries?

-Bifidobateria

When are Mutans streptococci and BIfidobacteria most active?

During the initial stages of demineralization and cavity formation

When are the lactobacillus active?

During the progression of the cavity

What is the most commonly consumed fermentable carbohydrates?

-sucrose

-glucose

-fructose

-cooked starch

Acids produced during the metabolic process includes what?

-acetic

-lactic

-formic

-proprionic

Acid formed passes freely into what?

Tiny diffusion channels between enamel rods or into exposed root surfaces

Acids can dissolve the enamel crystals into what ions?

calcium and phosphate

What is demineralization?

major stage in the dental caries process in which minerals, primarily calcium and phosphorous, are removed from tooth structure by acids formed by acidogenic bacteria

What is remineralization?

-healing process in which minerals are redeposited in the demineralized tooth structure;

How is remineralization accomplished?

by protective factors of the saliva and action of fluoride to inhibit demineralization and interfere with the enzymatic requirements of bacteria

What has happened to patient's teeth if there is a cavitated carious lesion?

-when the tooth demineralization outpaces the remineralization

What has happened, when a patient has smooth surface caries and pit fissure carious lesions?

-when cariogenic nutrients are available

During remineralization, minerals move back into the subsurface of the what?

enamel

What provides protective factors to promote remineralization?

Saliva

What are the functions of salvia?

-Buffer acids

-Supply minerals to replace calcium and phosphate ions dissolved from the tooth during demineralization

What is xerostomia?

-dry mouth

-low saliva flow

What reduces buffering capacity and aids the demineralization process?

xerostomia

What does the pH need to be in order to maximize remineralization?

neutral or basic

Fluoride accumulation in saliva comes from many sources such as?

-Water

-Denifrice

-Mouthrinse

-Professionally applied therapies

Does fluoride inhibit or encourage demineralization?

Inhibit

Fluoride in biofilm and salvia flow into the enamel diffusion channels and root surface and attach in the form of what?

hydrogen fluoride

Fluoride enhances or inhibits remineralization?

Enhances

The buffering properties of saliva can do what to the acid pH?

Neutralize

Change in pH reverses equilibrium driving what elements into the tooth surface?

-calcium

-phosphate

-fluoride

What makes a stronger tooth surface?

Fluorapatite bonds

(Flourapatite bond are stronger than hydroxyapatite bonds)

What are the functions of fluoride?

-Inhibit demineralization

-Enhance remineralization

-Inhibit bacterial growth

Is hydrogen fluoride in the biofilm?

yes

Hydrogen fluoride diffuses through the cell membrane of what type of bacteria?

acidogenic

In bacterial cell wall, fluoride ions interfere with what?

enzyme activity

When dental caries made its way through the enamel into dentin is called?

coronal caries

When dental caries made its way through the cementum into the dentin?

root caries

When dental caries are unrestored, what happens to dental caries?

-will continue to pulp

-cause toothache

-it will need root canal or extraction

Dental caries is treated as an infection. True or false?

True

What is the end stage of the infection of dental caries?

hole or cavity that requires therapy for restoration

What are some requirements in order to detect carious lesions?

-Adequate lighting

-Sharp eyes / loupes

-Blunt probes

-Air-water

-Bitewing radiographs

Should sharp explorers be used to detect carious lesions?

No

-Remineralizing surfaces must not be explored

Is bitewing radiographs useful to detect proximal carious lesions?

yes

Is bitewing radiographs useful to detect early remineralizable lesions?

No

What type of bitewing radiograph is effective for detection of root caries?

Vertical bitewing radiograph

What do acidogenic bacteria do?

-Cling to smooth tooth surface

-Creates a biofilm

-Produce acid from available fermentable carbohydrates

Acids produced by acidogenic bacteria diffuse through?- initial infection:invisible lesion

-Micro channels between enamel rods

-Then dissolves tooth minerals

-Then create the subsurface lesion

What are the stages of dental carious lesion development?

-Initial infection : invisible lesion

-White area lesion : early stage

-White area : Later stage (White spot lesion)

-Cavitated lesion

What is the appearance of a early stage white area lesion?

Dull

What is the surface of a early stage white area lesion?

Smooth

Should you pick or scratch a mineralizing surface?

No, it can create further remineralization

What is the appearance of a White spot lesion at a later stage?

dull

What is the surface of a white spot lesion at a later stage?

-slightly rough

Why is the surface of a white spot lesion at a later stage slightly rough?

it indicates the beginning of breakdown-do not explore

What can be visualized if you saw a cavitated lesion?

-Open lesion can be observed directly

-Open lesion has no intact tooth structure over surface

-gentle air blasts may be sufficient to clear loose biofilm and debris

What can you detect from a horizontal bitewing view?

-primarily proximal surface lesion

What can you detect from a vertical bitewing view?

-root caries detection

Is radiographs effective for early caries not extending into dentin?

No because they cannot reveal true depth.

Is radiographs effective for large open lesions?

No

Is radiographs effective for extension to pulpal involvement?

yes

How to determine status of dentition of restored and unrestored surfaces?

-existing restorations, including sealants

-cavitated carious lesions

-Secondary (recurrent) carious lesions

-Sealants in need of repair

-White spot lesions

-Radiographically detectable carious lesions

How to determine areas that require restorations?

-active carious lesions charted by hygienist

-Dentist determines restorative interventions

How to determine areas that require remineralization?

-outline appropriate strategies for patient

Define steps for remineralization program?

-Explain needs

-Discuss process of remineralization with patient

-Apply principles of motivational interviewing to assess patient understanding and gain patient acceptance

-Prepare and explain risk assessment for the patient

-With patient, select and demonstrate individualized oral self-care procedures

-Plan for evaluation and revaluation and continuing care appts.

What are some risk factors that increase the probability of a disease occurring?

-Habits

-Behaviors

-Lifestyles

-Conditions

What info needs to be collected during patient medical, dental and social history interview?

-Medication that promote dry mouth

-Systematic factors

-Patient perception

-Value placed on oral health

-Past dental experience

-Fluoride history

-Success in changing habits

What does the care plan need to provide?

-Treatment of existing nonreversible carious lesions

-framework for changes in personal care previously unrecognized by the patient to prevent development of new lesions

A plan of care is individualized depending on what?

-disease risk level

-physical abilities

-cognitive abilities

-patient/parent desire to change

What should you do for a patient with low caries risk?

-Primary prevention is top priority

-Provide positive feedback and education so health can be maintained

-Review existing habits that leaves them at low caries risk

-Recommend routine appointments

What are some habits that categorize one for low caries risk?

-good oral daily biofilm removal

-health snacking

-daily exposure to fluoride

What should you do if a patient comes in with moderate caries risk?

-Provide positive feedback and support for the protective factors they currently exhibit, such as fluoride use, healthy snacks, or sugar free gum.

-Guide them to reduce risk factors, such as acidic beverages, fermentable carbs, improved daily biofilm removal.

-Increase protective factors, such as sealants and fluoride

-Recommend continuing care schedule

What do you do when a patient has a high caries risk?

-Patient has active carious lesions

-Has history of restorations to repair carious lesions

-Medications or systemic factors that cause dry mouth

-Infection needs to be addressed and active lesions restored

-Fluoride application

-Daily biofilm removal

-Antimicrobial therapy

-Evaluation and strategies for reducing risk factors

-Strategies for increasing protective factors need to be addressed to patient

-Recommend appropriate continuing care schedule

-Assess caries risk in intervals

-Review habits and address as needed

What are some caries-preventive foods to add to diet?

-Sugar-free yogurt

-Nuts

-Cheese

What initiate daily preventive measures can be taken place to prevent caries?

-Fluoride use

-Dietary modifications

-Chewing sugar-free gum at ends of meals

What fluoride methods can a person take to prevent caries?

-Use fluoridated water

-Fluoride containing dentifrice 2-3 times a day with brushing for 3 mins

-Alcohol-free fluoride mouth rinse daily

-Use 1.1% neutral sodium fluoride dentifrice before bed with no further eating or drinking

What are some dietary modification methods that a person could do to decrease caries?

-eliminate fermentable carbs between meal and at ends of meals

-Select snacks from non fermentable carb foods

-Avoid sweetened beverages

What type of sugar free gum needs to be used at ends of meals to decrease risk of caries?

-Use sugar free gum with xylitol

Why is it important for sugar free gum to have xylitol?

-Reduces levels of mutans streptococci and promotes remineralization

What rinse might a person with high risk caries may need to add into their daily routine?

-Rinse with 0.12% chlorhexidine, once a day with 10ml for 1 min 1 week each month

-Neutral sodium fluoride 1.1% dentifrice applied twice daily for the 3 week following chlorhexidine short term rinse

What does chlorhexidine do to a patient's mouth?

-It is highly effective against mutans streptococcus infections