Cariology

____ is the name of the disease, a result of imbalance in the resident bacterial flora (biofilm) of the oral cavity (shift towards the cariogenic types) and an associated intra-oral low pH condition

dental caries

____ is a detectable change in tooth structure, the consequence and manifestation of the disease (signs and symptoms)

caries lesion

The caries process is ___

dynamic (demineralization and remineralization)

Caries lesion ____ is a process involving the recognition and recording, traditionally by optical or physical means, of changes in enamel, dentin, or cementum, which are consistent with having been causes by the caries process.

detection

T/F diagnosis and detection can be used synonymously

false

caries ___ is the human professional summation of all signs and symptoms of disease to identify the past or present occurrence of the disease caries

diagnosis

What process uses various sources of information and is deductive?

diagnosis

what ICDAS codes are early carious lesions and are considered non cavitated?

Code 1 and 2

Some non carious non cavitated lesions include?

fluorosis and developmental defects

causes of decalcification?

active caries lesions (early stage)

causes of fluorosis?

excess fluoride

causes of hypo calcification?

ameloblasts affected, caused by trauma, fever, malnutrition, or hypocalcemia during teeth formation

often due to deciduous tooth being accessed or physically forced into enamel organ of permanent tooth

causes of hypoplasia?

developmental enamel defect

caused by genetic disorders, malnutrition, low birthweight, prematurity, maternal illness, smoking, drug abuse, liver disease

results in caries due to difficulty in oral hygiene

what condition makes it hard to maintain oral hygiene?

hypoplasia

location of decalcification?

plaque stagnation areas along gingiva and gingival to interproximal areas

location of fluorosis?

incisal edges and cusp tips

location of hypo calcification?

centered in smooth surface, may affect entire crown

front teeth and six-year molars ---> occurred first year of life

bicuspids and second molars ---> occurred around age 3

location of hypoplasia?

defect can be small pit or so widespread that whole tooth is mis-shaped

often results in subsequent caries

shape of decalcification?

well defined borders, follows contour of gingival tissues

shape of fluorosis?

lines correspond to perikymata to lattice pattern

borders blend into adjacent normal enamel

shape of hypo calcification?

often oval or round, well defined borders and differentiated from normal enamel

shape of hypoplasia?

rough pitted area in enamel, not well defined or complete loss of enamel

color of decalcification?

light white to dark brown

not present at eruption

color of fluorosis?

light white to dark brown

cusp tips may appear frosted

may not show stain at time of eruption

color of hypo calcification?

creamy yellow to dark reddish orange

can be white or brown spots as well

usually pigmented at eruption

what lesion is pigmented at eruption?

hypocalcification

color of hypoplasia?

white, yellow or brown pitted and rough spot lesions

what teeth are usually affected by decalcification?

canines, pre-molars, and molars

what teeth are usually affected by fluorosis?

teeth that calcify slowly (canines, premolars, molars)

often in same spot on contralateral tooth

what teeth are usually affected by hypocalcification?

any tooth, frequently on labial surface of incisors

often occurs singly

what lesions occur contralaterally? singular?

contra: fluorosis and hypoplasia

singly: hypocalcification

what teeth are affected by hypoplasia?

contralateral tooth and opposite arch

ex: all central incisors or all first molars

excess fluoride causes what in terms of enamel proteins? how does the color form?

excessive retention of enamel proteins and disrupts mineralization

in porous enamel, proteins pick up color

most likely combination of non-cavitated lesions?

decalcification and fluorosis

examples of cavitated non carious lesions?

tooth wear (erosion, abrasion, attrition, abfraction)

enamel and dentin dysplasias

trauma

examples of cavitated carious lesions?

cavitation of enamel or dentin and rampant caries

ICDAS code for cavitation of enamel?

3 and 4

ICDAS code for cavitation of dentin?

5 and 6

what three things lead to abfraction?

bruxism, parafunction, and occlusal function

abfraction causes what type of lesion?

wedge-shaped cervical lesion

what is evidence of attrition? (where, shape, due to what, affects)

occlusal and incisal surfaces

shiny, well defined facets

patient may have myofacial pain disfunction and stiff jaw

often due to bruxism (grinding teeth)

what is evidence of erosion? (where, shape, due to what, affects)

glazed, smooth and round edged surfaces

looks scooped out

no well defined facets

patient has sensitivity

often due to bulimia and GERD

what is evidence of abrasion? (where, shape, due to what, affects)

pitted, scratched out surface

facet or scooped out dentin if extreme

no sensitivity

often due to toothbrush and abrasives in tooth paste

T/F abfraction usually occurs in multiple teeth

false --> single tooth

abfraction is most common where?

buccal of canines and posterior teeth

important clinical factors to consider for differential diagnosis?

age of patient, diet and lifestyle, oral hygiene techniques, occlusion, habits, bruxism and parafunction

three requirements for formation of caries?

susceptible host, microbes, and substrate

what percentage of plaque is bacteria?

60-70%

bacterial product that causes demineralization?

acid in plaque matrix

time periods for the peak incidence of caries?

6-8 years, 11-19 years, and 56-65 years

early childhood, teenage, and cemental

what three things have decreased the caries incidence?

fluoridated water, fluoridated dentrifices, and improved oral hygiene

what is the radiograph of choice for interproximal posterior caries?

BW

50% of caries would be missed without BW

full mouth radiographic series includes?

14 PA and 4 BW

optimal viewing conditions for radiographs?

view box or monitor, darkened room, and magnifying glass or magnification tools

what are acute caries?

caries in deciduous teeth

caries proceed faster in deciduous teeth than in permanent teeth

what are chronic caries?

usually in adults

slower progression with larger surface lesion

what are arrested caries?

caries become static

seen in large occlusal carious lesions that have become self-cleaning

dentin has polished blackened appearance

occasionally seen in proximal surfaces where tooth has been extracted

primary caries are?

caries originating on a non-restored surface

secondary caries are?

caries in an immediate vicinity of a restoration

hard to detect radiographically due to superimposition of restoration

what are incipient proximal caries?

less than 1/2 way through enamel

white spot clinically

cone or V shape with broad base at surface of enamel

what are moderate proximal caries?

caries extending more than 1/2 way through enamel but not involving DEJ

what are advanced proximal caries?

at or through the DEJ and extend no more than 1/2 way through the dentin to pulp

spreads along DEJ

dentinal tubules act as a tract along which microbes travel

second radiolucent triangle in dentin with base at DEJ

what are severe proximal caries?

caries of enamel and dentin extending more than 1/2 way through dentin towards pulp

when are occlusal caries evident radiographically?

once lesion has entered the dentin

occlusal caries are what shape?

diamond with base towards dentin

buccal/lingual caries look like what?

like looking into a "hole"

well-demarcated

easily detected by lineal examination

cemental/root surface caries look like?

cementum is soft and thin at CEJ

"scooped out" or

"saucer-shaped" appearance

does not involve enamel except by extension

seen in elderly

why are root surface caries seen mostly in elderly?

gingival recession, loose contacts, xerostomia

cervical burnout vs cervical caries?

burnout: radiolucent artifact caused by change in density at cervical margin, extend below level of bone

caries: scooped out or saucer shaped below CEJ, Above level of bone

what are radiation caries?

looks similar to cervical caries, does not directly affect permanent teeth

caused by xerostomia as direct result of radiation on salivary glands

extremely rapid

what does reduced saliva lead to?

rampant decay --> usually cervical

What percentage of decalcification is needed before a lesion becomes evident radiographically?

40%

the clinical lesion is (bigger/smaller) than the radiographic lesion

bigger

clinical is always in advance of radiographic lesion

what are some technical errors for radiographs?

overlapping, poor contrast, and too light

too much kVp causes what to a radiograph?

over-penetration and "peripheral burnout"

appears as open contacts

will miss incipient proximal caries

T/F an increase in density may make caries easier to see

true

what do restorations look like on radiographs?

some materials are radiolucent

"c" shaped (class III)

defined margins of restorations

recurrent caries hard to detect

what is turner's tooth?

hypoplastic incisor

dots, irregular tooth surface, infection

T/F hypoplasia makes teeth susceptible to caries but does not mimic caries radiographically

false

hypoplasia makes teeth susceptible to caries AND mimics caries radiographically

Attrition is ___ wear

physiologic

What is the mach band effect?

overlapping teeth that exaggerates the contrast between edges

what is sensitivity?

the ability of a test to detect disease when lesion is present

true pos/(true pos + false neg)

what is specificity?

ability of a test to exclude caries lesion when there is truly none present

true neg/(true neg + false pos)

what is fiber-optic-trans-illumination (FOTI)?

intense light beam transmitted through a fiber optic cable to a specially designed probe

mainly used for interproximal caries

what is digital imaging fiber-optic-trans-illumination (DIFOTI)?

uses visible light to create high resolution digital images

not quantitative, clinician must evaluate images

sensitivity high/lower than radiographs

specificity is approximately the same

what is Denis cariVu?

transillumination

for occlusal, interproximal and recurrent carious lesions and cracks

near-infrared light

-enamel appears transparent, porous lesions traps and absorb light, similar to radiographic images

what is laser fluorescence?

pyrphyrins (bacterial byproducts) reside in porous carious lesions

laser fluorescence transmits through the tooth reflecting on the porphyrins

reflected light has a longer wavelength, indicating a carious lesion

what is diagnodent?

more sensitive than visual

less specific (false-pos)

better on occlusal than interproximal

beneficial in longitudinally monitoring lesions

is diagnodent qualitative or quantitative?

quantitative

values are given

what is QLF (quantitative laser fluorescence)

laser is used to measure induced tooth fluorescence

measures changes in fluorescence that result from carious lesions scattering light

contrast between sound and pathogenic tissue

potential for longitudinal evaluation of lesions, ability to measure remineralization protocols

expensive

what diagnostic tool has the highest reproducibility?

QLF

what is the spectra caries detection aid?

uses change of frequency in fluorescence to detect caries in fissures and smooth surfaces

capture image and extent of decay is displayed as:

-color either blue, red, orange or yellow

-0-5

405 nm

green = ___ in spectra device

healthy

red = ___ in spectra device

caries lesions

what is the canary system?

PTR-LUM

low-power, pulsating laser light absorbed in tooth results in:

-laser light converted into luminescence and release of heat

-measure reflected heat

-97% sensitivity

-measures crystalline structure

higher canary number = advanced decay

what does a higher canary number mean?

more advanced decay

What is the light emitting diode?

LED

occlusal and proximal, different optics for sound and demineralized

analyzes reflectance and refraction of LEF, triggering audible electrical signal

tooth must be wet

LED is quantitative or qualitative?

qualitative

what is soprolife?

light induced fluorescence evaluator

visual = subjective

450 nm

demineralized area looks opaque

differentiate between infected and affected tissue

daylight (magnifies) and blue light (indicates demineralized tissue and signals tissue to be removed)

is soprolife superior to ICDAS?

no but better than other caries detection devices