Q1 - ICS - CAMBRA (Caries Management By Risk Assessment)

Factors of disease

xerostomia, diet, bacteria, genetics (pH)

erosion

smooth surface lesion, loss of surface contour

key teeth in erosion

occlusal surfaces of 1st molar and buccal surface of upper central incisor

attrition

flat noncupped incisal/occlusal surfaces, associated with cracked teeth and clenching habits

abrasion

pure, abrasion+toothpaste, abrasion+erosion

ETW

erosive tooth wear, acid from diet/stomach with physical forces, can affect single or multiple surfaces and plaque free teeth

caries

caries: bacteria produces acids/plaque, no physical component, affects single or multiple surfaces

ETW associated medical conditions

GERD (gastro-esophageal reflux disease), eating disorders, 65% population experiences intermittent reflus symptoms

enamel dissolves at

pH 5.5

dentin dissolves at

pH 6.2

stephan curve

shows the pH levels in your mouth as time progresses

caries disease indicators (WREC)

white spots, restorations <3 years, enamel lesions, cavities/dentin

risk factors (BAD)

bad bacteria, xerostomia, destructive habits

protective factors (SAFER)

saliva and sealants, antibacterials, fluoride/Ca2+/PO3-4, effective habits, risk-based reassessment

carcinogenic bacteria + fermentable carbs (sucrose, glucose, fructose)

organic acids (penetrate enamel and dentin, dissolve tooth material)

common bacteria in plaque

s. mutans, lactobacillus

specifc plaque hypothesis

only a limited specied of bacteria in plaque can cause disease

cavitation importance

bad bacteria --> caries infection

but if bacteria doesn't get inside, then no need to restore

so, if subsurface is demineralized, it can be remineralized

white spot lesion

earliest visible sign of subsurface demineralization

surface intact so prevents bacterial penetration

brown spot lesion

The previous white spot that is more porous and exogenous stain, can still be remineralized

pit and fissure lesions

occlusal surfaces of posterior teeth, lingual pits of maxillary incisors and buccal pits of mandibular molars

cavitated lesion

salivary glands

cleanse, buffer, lube, antimicrobial, remineralize, heal

unstimulated saliva

0.3-0.4 mL/min

stimulated saliva

>1 mL/min

medications that cause xerostomia

amphetamines, narcs, anti-inflammatories, antidepressants/anxiety/histamines/microbials/psychotics, asthma drugs, ACE inhibitors, Ca2+ channel blockers, gastric acid drugs, smoking cessation drugs

treatments and conditions that lead to poor salivary flow

sjogrens syndrome, head and neck radiation/surgical treatment

dentinogenesis imperfecta

poorly formed dentin

amelogenesis imperfecta

poorly formed enamel

mutated genes

malformed teeth susceptible to decay

taste gene mutation

prefer sweets —> prone to caries

saliva enzyme mutations

decrease production of protective enzymes —> decay

ATP test - CariScreen

measure bacterial load (correlates to risk level) ATP bioluminescence

low caries risk

no incipient/cavitated primary/secondary lesions in past 3 years and NO risk factors

moderate caries risk <6

no lesions in last 3 years but at least 1 risk factor

moderate caries risk >6

at least 1 lesion in the past 3 years or 1 risk factor

high caries risk <6

any lesion in past 3 years, multiple risk factors, low socioeconomic status, suboptimal fluoride exposure, xerostomia

high caries risk >6

3 or more lesion is past 3 years, multiple risk factors, suboptimal fluoride exposure, xerostomia

extreme risk

xerostomia