Dental Sciences & Prev Dentistry- Ch 15/16-TEST/COMPLETE

Dental caries (tooth decay) is the most common chronic disease among?

Children, teenagers and adults over 65

(Emphasis is now on preventing future caries not just dealing with already present decay)

Bacterial Infection

Two specific groups of bacteria found in the mouth are responsible for dental caries

• Mutans streptococci (MS) (Streptococcus mutans)

• Lactobacilli (LB)

They are found in relatively large numbers in dental plaque

The presence of lactobacilli in the mouth indicates a high sugar intake

Transmission of Caries-Causing Bacteria

Mutans streptococci are transmitted through saliva, most frequently the mother’s, to the infant

When a mother has a high count of mutans streptococci in her mouth, the baby has a high count of the same bacteria in his or her mouth

Women should be certain that their own mouths are healthy

When the number of caries-causing bacteria in the mouth increases, the risk of dental caries also increases

Oral Biofilm

Oral biofilm is a colorless, soft, sticky coating that adheres to the teeth

Oral biofilm remains attached to the tooth despite movement of the tongue, water rinsing, water spray, and less-than-thorough brushing

Formation of oral biofilm on a tooth concentrates millions of microorganisms on that tooth

Enamel Structure

Enamel is the most highly mineralized tissue in the body

It is stronger than bone

Enamel consists of microscopic crystals of hydroxyapatite arranged in structural layers or rods, also known as prism

The enamel crystals are surrounded by water

The water and protein components in the tooth are important because that is how the acids travel into the tooth, the minerals travel out, and the tooth structure dissolves

The Caries Process

• For caries to develop, three factors must be present at the same time​

• A susceptible tooth ​

• A diet rich in fermentable carbohydrates​

• Specific bacteria (regardless of other factors, caries cannot occur without​ Bacteria in dental plaque feed on fermentable carbohydrates (sugars, starch)​

• Bacteria produce acid as a waste product of their metabolism​

• These acids can penetrate into the hard substance of the tooth and dissolve some of the minerals (Ca, Phosphate).

• If acid attacks are infrequent and of short duration, saliva can help repair the damage.​

• by neutralizing the acids ​

• supplying minerals and fluoride to replace those lost from the tooth.​

When fermentable carbohydrates are eaten frequently, more acid is produced and the risk for decay increases

Areas for Development of Caries

Pit-and-fissure caries occurs primarily on the occlusal surfaces and the buccal and lingual grooves of posterior teeth, as well as in the lingual pits of the maxillary incisors

Smooth surface caries occurs on intact enamel other than pits and fissures

Root surface caries occurs on any surface of the root

Secondary, or recurrent, caries occurs on the tooth surrounding a restoration

Stages of Caries Development

It usually takes some time, months to years, for a carious lesion to develop​

Caries is an ongoing process characterized by alternating periods of demineralization and remineralization​

Demineralization is the dissolution of the calcium and phosphate from the hydroxyapatite crystals​

Remineralization is the redeposition of calcium and phosphate in previously demineralized areas​

It is possible for the processes of demineralization and remineralization to occur without any loss of tooth structure

Stages of Caries Development

An incipient lesion develops when caries begins to demineralize the enamel​

An overt, or frank, lesion is characterized by cavitation (the development of a cavity or hole in the tooth)​

Rampant caries describes the time between the onset of the incipient lesion and the development of the cavity; it is rapid and there are multiple lesions throughout the mouth

Secondary (Recurrent) Caries

Form in the spaces between the teeth and margins of a restoration

Not easily seen, thus diagnosis is difficult

New restorative materials may prevent recurrent decay

Root Caries

Occurs on the root of teeth that have gingival recession that exposes root surfaces​

Becoming more prevalent and is a concern for members of the elderly population, who often have gingival recession, exposing the root surfaces​

Older people often take medications known to reduce saliva flow, which contributes to caries

Carious lesions form more quickly on root surfaces than do coronal caries because the cementum on the root surface is softer than enamel and dentin ​

Like coronal caries, root caries have periods of demineralization and remineralization

Early Childhood Caries (ECC)

An infectious disease that can happen in any family

Tooth decay is the single most prevalent disease of childhood

Risk Factors:

• Lower socioeconomic status

• Particular ethnic groups (Higher caries prevalence is seen in communities experiencing structural inequities, including some marginalized racial/ethnic groups, due to reduced access to care, socioeconomic barriers, and environmental factors.)

• Limited access to dental care

• Lack of water fluoridation

How Children Get ECC

ECC is a transmissible disease

• Bacteria in the parent’s or caregiver’s mouth are passed to the child

It is important for parents to keep their own teeth healthy to keep their children’s teeth healthy

Baby bottle tooth decay is another term for ECC

The Importance of Saliva

Physical protection involves a cleansing effect ​

Dependent on the water content of the teeth. ​

Fluid dilutes and removes acid components from the dental plaque.​

Thick, or viscous, saliva is less effective than a more watery saliva in clearing carbohydrates​

Chemical protection: Saliva contains calcium, phosphate, and fluoride​

Keeps calcium at the ready, to be used during remineralization​

Chemical protection includes buffers, bicarbonate, phosphate, and small proteins that neutralize the acids after we ingest fermentable carbohydrates

Antibacterial substances in saliva work against the bacteria. These are called immunoglobulins.​

However if the bacterial count in the mouth becomes very high, these immunoglobulins may not be able to provide enough antibacterial protection.​

If salivary function is reduced for any reason, the teeth are at increased risk for decay​

Illness​

Medication​

Radiation therapy

Caries Diagnosis

The following methods are used to detect dental caries, and each has specific limitations:

Dental explorer

Radiographs

Visual appearance

Caries Detection dyes

Laser caries detector

Explorer caries detection

When an explorer tip is pressed into an area of suspected caries, it will “stick” when it is being removed.

This has limitations on the occlusal surface. The explorer may be wedged in a pit or groove.

Radiographs for caries detection

Useful for interproximal caries.

Early caries on the occlusal surface is not visible on radiographs.

The extent of caries can be misdiagnosed because the caries is often two times deeper and more widespread than it appears on the radiograph

Indicator dye for caries detection

When the special dye is placed inside of a cavity preparation, it can indicate if decay is still present.

Caries Detection Devices

Several types of devices have been developed that can provide a higher level of discrimination in the diagnosis of dental caries

• Some detect bacterial by-products and quantify sound signals to aid in caries detection

• Some detect differences in tooth structure and display information on a screen

• Others have software that analyzes density changes on digital radiographs and outlines potential lesions

Laser Caries Detector

Used to diagnose caries and reveal bacterial activity under the enamel surface

Carious tooth structure is less dense and gives off a higher reading than noncarious tooth structure

The laser caries detector does not detect interproximal caries, subgingival caries, or secondary caries under crowns, inlays, or restorations.

It is for occlusal surfaces and can be used to monitor progression or arrestment of caries by comparing a patient's readings from visit to visit.

CAMBRA

Caries management by risk assessment

• An evidence-based strategy for preventive and reparative care for early dental caries that can be used in any dental office

A dental health professional assesses an individual’s risk factors and protective factors, then determines the level of risk for caries

• An individualized preventive plan is developed based on the determined level of risk

Caries Risk Assessment Tests

Used to identify the factors that contribute to an increased risk for dental caries

If the patient’s risk for dental caries can be determined, it is possible to prevent the caries from developing by beginning appropriate preventive treatment

One risk-assessment tests for caries are based on the amount of mutans streptococci and lactobacilli present in the saliva

• High bacterial counts indicate a high caries risk, and low counts indicate a low risk for caries.

Another risk-assessment test measures the amount of saliva in the mouth.

• A patient chews a pellet for 3-5 minutes then spits all the saliva into a paper cup, the saliva is then measured.

Patients in Whom a Caries Risk Test Is Indicated

New patients with signs of caries activity

Pregnant patients

Patients experiencing a sudden increase in the incidence of caries

Individuals taking medications that may affect the flow of saliva

Xerostomic patients

Patients about to undergo chemotherapy

Patients who frequently consume fermentable carbohydrates

Patients suffering from diseases of the autoimmune system

Methods of Caries Intervention

Fluoride

• A variety of types are available to strengthen the tooth against solubility to acid

Antibacterial rinses

• Products such as chlorhexidine rinses are effective

Decreased fermentable carbohydrates

• Reduce the amount and frequency of ingestion

Increased salivary flow

• Chewing sugarless gum—for example, one with a nonsugar sweetener such as xylitol

How to control tooth decay

Diet: Limit quantities of sugary and starchy foods.

Fluorides: Fluoride helps make the tooth resistant to being dissolved by acids

Remove plaque: By removing plaque, you are removing large amounts of bacteria

Saliva: Saliva neutralizes acids and provides minerals and proteins that protect the tooth.

Antibacterial mouth rinse: Reduces the numbers of bacteria that cause tooth decay.

Dental sealants: Sealants protect pits and fissures where bacteria/plaque cannot be brushed away.

What is periodontal disease?

Periodontal disease is an infectious disease process that involves inflammation of the structures of the periodontium

Causes a breakdown of the periodontium, resulting in loss of tissue attachment and destruction of the alveolar bone

Periodontal disease is the leading cause of tooth loss in adults

47%+ of adults 30+ have a form or periodontal disease; 70%+ of adults 65+

Almost all adults and many children have calculus on their teeth

Structures of the Periodontium

Gingiva

Epithelial attachment

Sulcus

Periodontal ligaments

Cementum

Alveolar bone

Signs of healthy gum tissue

Healthy gum tissue appears firm and resilient and can be tightly adapted to the tooth and underlying bone.

It has a stippled appearance.

The color is pink or coral but may vary according to a person’s skin pigmentation

Signs of Periodontal Disease

Unhealthy gum tissue has red or swollen gum tissue

There is bleeding gingival from brushing or flossing

The gums are loose or separating from the teeth

There may be pain or pressure when chewing

There may be pus or suppuration around the teeth or gingival tissues

Causes of Periodontal Disease

Bacterial plaque (dental plaque, oral biofilm)

Plaque is the primary factor causing periodontal disease

The type of bacteria and length of time the bacteria is left undisturbed on the tooth are also factors in the risk for periodontal disease.

The patient’s immune response to the bacteria is a factor in the risk for periodontal disease.

Bacterial plaque causes inflammation which produces enzymes and toxins that destroy periodontal tissues.

There are three types of soft deposits on the teeth

• Acquired pellicle – film of protein that quickly forms on teeth. Can be removed by coronal polishing.

• Materia alba – soft mixture of bacteria and salivary proteins, also known as “white material.” It is visible without the use of a disclosing solution and is common in individuals with poor oral hygiene.

• Food debris – Food particles that are impacted between the teeth after eating.

Calculus (tartar)

Provides a surface to which biofilm can attach

Two types:

• Supragingival calculus found above the margin of the gingiva

• Subgingival calculus on root surfaces below the gingival margin that can extend into periodontal pockets

The Systemic Connection

Chronic inflammatory periodontal disease may significantly affect health conditions such as coronary heart disease, stroke, or preterm birth

• Chronic inflammation appears to do harm to the entire body

Certain systemic conditions increase the patient’s susceptibility to periodontal disease

• Periodontal disease may actually increase a patient’s susceptibility to certain systemic conditions

Cardiovascular disease

• Individuals with periodontal disease have a greater incidence of coronary heart disease

Preterm/low birth weight (PLBW)

• Women with severe periodontal disease have seven times the risk of PLBW infants

Respiratory disease

• Individuals with periodontal disease may be at increased risk for respiratory infection

Diabetes

• Uncontrolled blood sugars make it difficult for healing.

Other risk factors for periodontal disease

Periodontal disease begins as inflammation caused by an accumulation of bacteria in the biofilm

Can be triggered by other factors such as malocclusion, some medications, and serious nutritional deficiencies.

Other risk factors alter the body’s response to bacteria that are present in the mouth

These risk factors will determine the onset, degree, and severity of periodontal disease

Smoking

Diabetes

HIV/Aids

Poor oral hygiene

Stages of Periodontal Disease

Periodontal disease is an inclusive term describing any disease of the periodontium and includes the following:

• Gingivitis

• Periodontitis

Four stages:

• Gingivitis

• Early periodontitis

• Moderate periodontitis

• Advanced periodontitis

Gingivitis

Inflammation of the gingival tissue

Characterized by areas of redness and swelling; there is a tendency for the gingiva to bleed easily

Limited to the epithelium and gingival connective tissues – no tissue recession or loss of connective tissue or bone

Most common gingival disease and easiest to treat

Improved daily hygiene can reverse

Periodontitis

Periodontitis means “inflammation of the supporting tissues of the teeth”

Extension of the inflammatory process from the gingiva into the connective tissue and alveolar bone that supports the teeth

Progression of periodontitis involves the destruction of connective tissue attachment at the most apical portion of a periodontal pocket

Peri-Implant Mucositis and Peri-Implantitis

Peri-Implant Mucositis is bacterial plaque around the individual dental implant causing redness and tenderness in the gum tissue. No bone loss has occurred.

Peri-Implantitis is when it progresses further, and bone loss occurs. The dental implant can be damaged due to the deterioration of the alveolar bone.

Diagnosis

A comprehensive periodontal exam will be a part of the patient’s routine checkup.

A periodontal probe is inserted into the gingival sulcus measuring the pocket depth.

Periodontal Staging and Grading

In 2017, the American Academy of Periodontology (AAP) developed a new classification system for periodontal disease

• Staging system

• Grading system

• Will help clinicians to develop a comprehensive treatment strategy based on a patient’s specific needs

Periodontitis Staging

Stage I–Stage IV

• Severity

• Complexity

• Extent and distribution

Periodontitis Grading

Grade A: Slow rate of progression

Grade B: Moderate rate of progression

Grade C: Rapid rate of progression

cariology

The study of dental caries, their prevention, and management. It encompasses the diagnosis, treatment, and research related to tooth decay.

carious

signs of decay, such as white spots, brown spots, and decay on tooth surface

evidence based

the presence of one or more decay. the presence of one or more decayed, missing, or filled tooth surface in any primary tooth

fermentable carbohydrates

Carbohydrates that can be metabolized by bacteria in the mouth, leading to acid production and potentially causing dental caries.

incipient caries

early stage of tooth decay characterized by the demineralization of enamel without cavitation.

lactobacilli

bacteria that produce lactic acid from carbohydrates; associated with causing dental caries

pellicle

thin film coating of salivary material deposited on tooth surface

rampant caries

decay that develops rapidly and extensively, often affecting multiple surfaces of the teeth.

bacterial plague

a biofilm of bacteria that forms on teeth, contributing to tooth decay and gum disease.

calculus

hardened plaque that forms on teeth, often requiring professional cleaning to remove.

gingivitis

inflammation of the gums often caused by bacterial infection, characterized by redness, swelling, and bleeding.

periodontal disease

a serious gum infection that damages the soft tissue and destroys the bone supporting the teeth, often resulting from untreated gingivitis.

periodontitis

a severe form of periodontal disease that leads to the destruction of the supporting structures of the teeth, characterized by gum inflammation and deep periodontal pockets.

periodontium

the tissues supporting and surrounding the teeth, including gums, periodontal ligament, cementum, and alveolar bone.

subgingival

located beneath the gum line, often relating to areas where plaque and bacteria can accumulate and cause periodontal issues.

supragingival

located above the gum line, often relating to areas where dental plaque can form and become a factor in oral health.