Cariology Lecture 10

How to diagnose caries at the patient level

Caries experience: DMFT value

Sugar consumption

Acidic exposure

Oral hygiene

Fluoride sources

Salivary flow

How to diagnose caries at the tooth level

Visual-tactile examinations: ICDAS

Bitewing radiographs

Fiberoptic transillumination

Endodontic findings: cold/heat sensitivity

What is a class I carie?

Pit and fissure

What is a class II carie?

Approximal posterior

What is a class III carie?

Approximal anterior

What is a class V carie?

Cervical third of facial or lingual

What is sealing caries sensitive to technique?

The peripheral seal is critical

Insidious leakage around restorations could lead to failure

Close monitoring with radiographs is needed to confirm lesion is arrested

Proximal lesions pose unique challenges

Technical limits to direct restorative materials

Shrinkage of composite restorations during polymerization

Occlusal wear from abrasion

Technical ability of the dentist to recreate lost dental anatomy and contacts

Contamination of material with water or saliva can prevent proper seal

Glass ionomer cements

A mixture of powdered glass and polyalkene acids

Fluoride release and chemical bond to dental hard tissue

Composite

A monomer matrix

Fillers

Salines which bind fillers

Resin-modified glass ionomer cements

Contain monomers in addition to glass ionomer cements

Compomers

Carboxylate-modified composites need to be used with an adhesive system

What do the ADA clinical practice guidelines cover?

Restorative treatments

Non-restorative treatments

Caries prevention

Detection and diagnosis

What does the AAPD provide protocols for?

Caries risk assessment

Management pathways

Special needs considerations

Preventative strategies for pts with disabilities

Fluoride tablets, gels, varnishes

Xylitol

Dietary modifications

Restorative strategies for pts with disabilities

Minimally invasive techniques like the Hall technique, atraumatic restorative treatment (ART), and SDF

Challenges of pts with disabilities

Higher rates of untreated caries

Poor oral hygiene

Limited access to care

Emphasis placed on personalized treatment plans and identifying which patients can be managed in primary care versus those needing specialist intervention

Why do older and medically complex adults face challenges with their oral health?

Cognitive decline, frailty, and xerostomia

Palliative vs comprehensive care

What are effective interventions for elderly and medically complex patients?

SDF

Fluoride varnish and mouth rinses

Chlorhexidine/thymol varnish and povidone-iodine

Pilocarpine lollipops

What is the oral cavity a mirror of?

Systemic health

What is a common thread among many systemic conditions?

Periodontal disease

How can you detect and manage systemic diseases early?

Maintaining good oral hygiene and regular dental visits

Alzheimer’s disease and dentistry

Oral bacterial may contribute to neuroinflammation and cognitive decline

Rheumatoid arthritis and dentistry

Shares inflammatory pathways with periodontal disease; patients often have higher rates of gum disease

Systemic Lupus Erythematosus (SLE) and dentistry

Can cause oral ulcers, dry mouth, and increased susceptibility to infections

Cardiovascular disease and dentistry

Periodontal bacterial can enter the bloodstream, contributing to arterial inflammation and increasing risk of heart attack or stroke

Diabetes mellitus and dentistry

Bidirectional relationship

Poor glycemic control worsens gum disease and periodontal inflammation can impair glucose regulation

Obesity and dentistry

Associated with increased inflammation and higher risk of periodontal disease

COVID-19 and dentistry

Linked to oral symptoms like dry mouth, ulcers, and taste disturbances

Poor oral health may worsen systemic inflammation

HIV/AIDS and dentistry

Causes oral lesions, candidiasis, and increased susceptibility to periodontal infections

Osteoporosis and dentistry

Reduces bone dentistry in the jaw, increasing risk of tooth loss and periodontal disease

High risk pregnancy and dentistry

Periodontal disease is associated with preterm birth and low birth weight

Infertility and dentistry

Links between chronic oral inflammation and reproductive health

Kidney disease

Can lead to bad breath, dry mouth, and altered taste due to uremia

Cancer and dentistry

Chemotherapy and radiation often cause mucositis, dry mouth, and increased risk of infection

Obstructive sleep apnea and dentistry

Oral anatomy plays a role

Mouth breathing can lead to dry mouth and increased decay

Tooth angenesis

Congenital absence of teeth

Dental anomalies

Tooth angenesis

Supernumerary teeth

Amelogenesis imperfect a

Dentinogenesis imperfects

Taurodontism

Mental illnesses and dentistry

Deprive of cognitive and emotional energy needed for personal care behaviors that sustain good oral health

Medications cause xerostomia

Tobacco and dentistry

Major risk factor for gum disease and cancers of the oral cavity and pharynx

Chewing and pouches are associated with oral cancers and dental caries

Nicotine causes vasoconstriction which limits blood flow to gingival tissues, the immune system does not respond effectively to bacterial threats and tissues heal slower

Substance use and dentistry

Meth misuse has devastating oral health consequences that severely affect salivary flow, resulting in specific patterns of extensive tooth decay, broken teeth, and diseased gums

Marijuana and dentistry

Reduced salivary flow

Higher levels of decay and gum disease

Higher consumption of carbohydrates