Disease & Treatment Midterm

Critical pH for enamel

5.5, below is demineralization, above is remineralization

enamel critical pH with fluoride

4.5, below is demineralization, above is remineralization

Remineralization of enamel pH

ph > 5.5

Saliva functions

• saturate with Ca and PO4

• clearing substrates and acids

• buffering with bicarbonate

• antibacterial saliva proteins

Use of buffering system in saliva

system that prevents changes in pH

Antibacterial properties of saliva

• IgA reduces strep

• lysozyme lyses gram +

• lactoferrin holds iron to stop growth of S. mutans

• histatins disrupt bacterial and fungal membranes

Classification order of carries

1. location (crown/apex/root)

2. anatomical site (smooth/pit & fissure)

3. presence of cavitation (cavitated/non-cavitated)

4. tissue involved (enamel/dentin/enamel)

5. activity (active/inactive)

6. presence of prior restoration (primary/secondary)

Smooth and shiny white spots indicate

arrested carries

rough and opaque lesions indicate

active carries

Characteristics of carries-affected dentin

little/no bacteria, decreased minerals, firm and leathery, can be remineralized

characteristics of carries-infected dentin

high bacteria, severe mineral loss, soft, not able to remineralize

Lesion detection

the process of looking at, observing and finding carious lesions (present - yes/no)

carries diagnosis

identifying what is happening with a carious lesion, why, and what should be done.

Diagnostic steps in identifying and diagnosing carries

1. Recognition of dental carries as an infectious disease

2. identify presence or absence of carries

3. status of carries

4. carries risk statuus

5. preventative tx and measures

Carries as an infectious disease

Carries are not contagious but are infectious within a patients mouth because of bacteria.

Use of explorer in carries dectection

to remove plague and debris with a maximum of 10-20 grams of pressure (blanching of a fingernail pressure)

visual identification of carries

Enamel carries: white, brown, or black

Dentin carries: yellow, orange, or brown

overall carries are dull and opaque.

tactile

carious dentin: tacky or mushy (scooped away with spoon excavator)

caries progression for pit and fissure

enamel: base of cone faces DEJ (point at pit)

dentin: base of cone faces DEJ (point at pulp)

caries progression for smooth surfaces

enamel: base of cone faces external surface (point at DEJ)

dentin: base of cone faces DEJ (point at pulp)

caries dx for root surface

usually after gingival recession and plaque accumulation (often in elderly adults - 46% -with recession of 3mm or greater)

Incipient lesions

non-cavitated lesions that are subsurface

more than incipient carries

caviated carious lesions

radiographs for carries dx

radiographs are indispensable, but adjunctive to examination

dental transillumination to detect carries

high intensity light passes through the tooth and illuminates it showing a darker appearance in the affected area

fluorescence to detect caries

laser induced to detect and measure bacterial products and changes in tooth structure in carious lesions

• has lots of false +

caries detection dye

increases contrast between normal and decay-altered tissues

• may lead to unecessary removal of dental tissue

• has false +

• may stain dental tissues

free surface carries

easily visually detected on teeth and dont need to be examined with an explorer (on front of tooth)

inter proximal surface examination

clinically examine visually and with floss, radiographs, transillumination, or possibly tooth separation bands

questionable lesion

discolored pits or fissures with no signs of undermining and softness of the area

white spot lesions

lesions where biofilm accumulates and carries begin to develop on enamel but still the spot can be remineralized.

Non-cavitated caries treatment

no restoration, use fluoride for remineralization

active cavitated carries treatment

restore and use prevention methods

incipient or inactive carries treatment

if already remineralization no restoration needed, use prevention metjods

arrested caries

carries are remineralizing and there is no active decay. no need to remove these carries.