Dental Caries Management by Risk Assessment

what is CAMBRA?

an evidence-based disease management protocol that is aimed at prevention

What type of disease are dental caries?

Multifactorial disease

What type of bacterial infection are dental caries?

A transmissible bacterial infection

Can dental caries be reversible?

Yes (SOMETIMES)

Are dental caries treatable by antibiotics?

NO

Review of pH values

pH values range from 0 (acidic) to 14 (alkaline)

pH of 7: neutral

What is Demineralization?

net loss of mineral from tooth surface that occurs around pH 5.5 and below

Acid-producing bacteria that cause caries

Mutans streptococci

Lactobacillus species

What happens when fermentable carbohydrates are ingested?

plaque biofilm pH rapidly drops;

biofilm fluid in contact with tooth is acidic

After ingestion of fermentable carbohydrates stops, when does pH level return to neutral

in 30-60 minutes
IF SALIVARY FLOW IS ADEQUATE

Remineralization

the deposition of minerals into demineralized areas of tooth structure

FLUORIDE PLAYS AN IMPORTANT ROLE

What is a white spot lesion?

demineralized area appears white

enamel remains in tact over early carious lesion

What causes white spot lesions?

by net loss of mineral in subsurface zone of enamel

Benefits of saliva

Provides calcium and phosphate for remineralization

Carries topical fluoride around the mouth for remineralization

Neutralizes organic acids produced in plaque biofilm

Discourages the growth of bacteria, inhibiting infection

Recycles ingested fluoride into the mouth

Protects hard and soft tissues from drying

Facilitates chewing and swallowing

Speeds oral clearance of food

What are the four clinical observations from clinical examination that indicate caries history and past activity? (KNOW FOR QUIZ)

Teeth with frank cavitations or lesions that radiographically show penetration into dentin

Approximal radiographic lesions confined to enamel only

Visual white spots on smooth surfaces

Any restorations placed in the last 3 years for a new patient or in the last 12 months for patient of record

What are risk factors of caries?

Medium or high S. mutans and lactobacilli counts

Visible heavy plaque biofilm on teeth

Frequent snacking between meals

Deep pits and fissures

Recreational drug use

Inadequate salivary flow

Exposed roots

Oral appliances

Caries Protective Factors

Being in fluoridated community

Uses fluoride toothpaste and mouth wash 1-2 times daily (5000 ppm fluoride toothpaste)

Had fluoride varnish applied (in the last 6 months)

Used prescribed chlorhexidine (daily for 1 week during each of the last 6 months)

Used xylitol gum or lozenges (four to five times daily for the last 6 months)

calcium and phosphate supplement (during last 6 months)

Has adequate salivary flow

Criterion for High Caries Risk: Patients Ages 6 Years and Older to Adult

Cavities

Radiographic lesions to dentin and beyond

Radiographic lesions in enamel

Recent restorations

White spot lesions on smooth surfaces

What are saliva reducing factors?

Medications
Radiation to head and neck
Systemic reasons

What risk level do you assign a patient if you cannot determine whether a patient is at high risk or low risk level for caries?

moderate risk

Silver Diamine Fluoride application

Applied directly to affected (decayed) area of tooth dropwise

(according to manufacturer's instructions)

What concentration of SDF does the panel support?

of 38% SDF

for arrest of cavitated caries lesions in children, adolescents, or individuals with special healthcare needs

Caries risk in AxiUm

under "forms" -> use dropdown -> Caries Risk

can also access under dental history form