OPERATIVE EXAM 1

intertubular dentin

Dentin located between the dental tubules

peritubular dentin

Dentin that surrounds and lines the dental tubules

peritubular

dentin with HIGHER mineral DENSITY

hardness and texture

what is the most reliable clinical factor to distinguish caries affected/infected dentin?

slow, focused, asymptomatic

caries progression in ENAMEL

lateral spread, faster, asymptomatic

caries progression at DEJ

lateral and axial spread, follows dentinal tubules, pulpal communication, becomes symptomatic

caries progression in DENTIN

rapid, symptomatic

caries progression in PULP

symptomatic, swelling, infection (systemic)

caries progression in PERIAPICAL TISSUE

caries affected dentin

DEMINERALIZED by bacterial acids, reduced permeability zone to protect pulp, REMINERALIZABLE

caries infected dentin

BACTERIA PRESENT, significantly SOFTER than normal dentin, destruction by enzymatic and acidic activity for AMORPHOUS MASS

enamel surface and crystal network disrupted

why is complete remineralization not possible once lesion is CAVITATED?

lactic acid

MOST POTENT cariogenic acid produced by STREP MUTANS

small molecules (ex: lactate and hydrogen peroxide)

what is enamel permeable to?

enamel tufts

bush-like HYPOMINERALIZED regions extending from DEJ into ENAMEL

enamel lamellae/ craze lines

HYPOMINERALIZED defects extending from ENAMEL —> DEJ

more permeable closer to pulp

how does the PERMEABILITY of DENTIN change?

higher density and larger diameter tubules

why is deeper dentin more permeable?

critical enamel pH

highest pH at which there is a LOSS of mineral from tooth surface

carious lesion

what forms at pH 4.5-5.5

erosion

what forms at pH <4.5

acid-attack creates porosites that scatter light

why is initial demineralization white?

cavitation

loss of surface enamel layer due to continued demineralization

sound

no surface change

initial

earliest clinically detectable lesion, MILD DEMINERALIZATION, limited to ENAMEL or shallow dentin

moderate

early cavitation with localized enamel break down (code 3) or underlying shadow (code 4)

advanced

distinct cavity with visible dentin

initial (and up to D1 non-cavitated)

what lesions are reversible?

false negative diagnosis

missing lesion due to inadequate detection methods (ex: not cleaning or air drying) or errors in assessment

false positive diagnosis

incorrectly identifying a lesion that isn't present due to misinterpretation or over-diagnosis

don’t use x-ray radiation

common feature of QLF, FOTI, OCT, and diagnodent caries diagnostic aids

clinical observation that can be subjective

what are common caries classification method initial caries activity assessment mainly based on

combination of visual assessment, x-rays, and OCT

method for better diagnostic outcome of caries detection

comparing older and newer xrays

what can help in assessment of lesion activity

initial

radiolucent lesion may extend to DEJ or outer 1/3 of enamel

moderate

radiolucent lesion extends into middle 1/3 of dentin

advanced

radiolucent lesion extends into inner 1/3 of dentin

after cleaning and drying

when should caries assessment be done?

#, surface, origin, stage, activity

how are caries documented?

diagnodent

A laser fluorescence device used to detect carious lesions in teeth by measuring the fluorescence emitted by decayed tooth structure, HIGHER=more decay

quantitative light-induced fluorescence (QLF)

A diagnostic method that uses light to detect dental caries and assess enamel changes by measuring the amount of light reflected from tooth surfaces, decay appears DARK

fiber-optic transillumination (FOTI)

uses visible light to illuminate tooth structure, allowing for the detection of caries and cracks based on the patterns of light passage

optical coherence tomography (OCT)

crreate 3D image nased on NIR light reflection to visualize internal tooth structure and identify carious lesions with high precision

fluorohydroxyapatite

more resistant to acid than hydroxyapatite

Ca, P, F

elements ESSENTIAL in REMINERALIZATION

true

T/F carious lesion excavation and filling DOES NOT eliminate caries progress

severity, activity, quantity, distribution, and history

what should be taken into account in caries risk assessment?

at least outer 1/3 dentin (D1) with high caries risk (or at any higher stage)

when is restoration indicated?

false

T/F dental caries undergoes ONLY demineralization during lesion. development

resin infiltration technique

a minimally invasive method for treating early carious lesions by infiltrating the lesion with a resin material to halt progression

sodium fluoride

which fluoride has the LOWEST antimicrobial property

esthetic restore of front teeth

when would silver diamine fluoride NOT be used?

true

T/F exposed to high conc. fluoride there may be acute or chronic fluoride toxicity

chlorhexidine di-gluconate

cavity cleansing agent effective against a broad spectrum of bacteria

5000 ppm sodium fluoride

prescription strength tooth paste for high-risk caries contains?

salivary flow, sealants, fluoride,good diet, antibacterials

CAMBRA system PROTECTIVE factors

bacteria, absence of saliva, poor diet

CAMBRA system RISK FACTORS

white spot, restorations, enamel lesions, cavities

CAMBA system DISEASE INDICATORS

caries experience

strongest predictor of caries risk

false

T/F caries risk has NO role in restorative treatment planning for existing lesions

adhesive dentistry

what is largest contributor to minimally invasive dentistry

caries experience, systemic health, diet, plaque amount, bacteria, saliva flow and buffering, dentist judgment

caries risk factors considered using EUROPEAN system

true

T/F more complex dental restoration cost more, require more time, and are more likely to fail

false

T/F cavity preparation design and principle are the same for all restorative materials whether they use adhesive or not

false

T/F ICON resin infiltration is indicated for the majority of moderate interproximal caries lesions with cavitation

hydrochloric acid

what type of acid is used to remove. the surface layer of lesions in resin infiltration technique

up to E2 not cavitated lesions

what can resin infiltration be used for

true

T/F retreatment ALWAYS leads to a LARGER resttoration

extent of disease and existing groove patteerns

primary determinants of OUTLINE FORM in minimally invasive dentistry

caries-free dentin everywhere

what is the in restorations

pulpal health (over complete caries removal)

what should be prioritized when working close to pulp florrs

true

T/F xylitol gums are usually more effective than regular sugar-free gums in remineralizing white spot lesions

saliva, fluoride conc, surface layer, activity

factors that affect initial lesion REMINERALIZATION

oreserve healthy tooth structure

primary goal of minimally invasive dentistry