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Hard Tissue Exam and Caries Classification - Vocabulary Flashcards

Hard Tissue Exam – Comprehensive Study Notes

  • Purpose of notes: summarize key ideas, concepts, and details from the transcript to prepare for the exam.

Dentition: Types and Development

  • Three divisions of human dentition:
    • Primary (Deciduous) dentition
    • Mixed (Transitional) dentition
    • Permanent dentition
  • Primary dentition (Deciduous):
    • Baby teeth begin forming in utero
    • Contains 20 primary teeth (labeled A–T)
  • Mixed (Transitional) dentition:
    • Occurs between ages 6–12 years
    • Primary teeth are shedding while permanent teeth erupt
  • Permanent dentition:
    • Consists of 32 teeth
    • Mineralization starts at birth and continues into adolescence
  • Development and eruption timelines are illustrated by figures (e.g., Tooth Development and Eruption; JADA references)

Tooth Numbering and Arch Orientation

  • Tooth numbering diagram conventions (viewed as if looking into the mouth):
    • Maxillary (upper jaw) arch uses numbers 1–16
    • Mandibular (lower jaw) arch uses numbers 17–32
  • Quadrants (spoken of as TR, TL, BR, BL in the chart):
    • Top Right (TR) — Quadrant I
    • Top Left (TL) — Quadrant II
    • Bottom Left (BL) — Quadrant III
    • Bottom Right (BR) — Quadrant IV
  • Tooth surfaces and terms:
    • Labial (lip) surface; Buccal (facial) surface; Lingual surface; Mesial; Distal; Incisal; Occlusal
  • Primary teeth labeling and anatomical mapping differ from permanent teeth (A–T vs 1–32)
  • Common reference: Adult dentition = 1–32; Child dentition = A–T
  • Example: Wisdom teeth correspond to teeth 1, 16, 17, and 32 in the permanent set
  • The diagram also shows root types (e.g., single-rooted incisors, premolars; multi-rooted molars) and specific tooth surfaces (e.g., incisal, occlusal, cusp tips)

Charting Systems and Clinical Documentation

  • Charting systems discussed:
    • UTHSCSA Charting System
    • EPIC charting System
  • Core charting objectives:
    • Chart missing teeth and existing restorations
    • Chart carious and noncarious lesions
    • Use radiographs to identify caries and other pathologies
    • Evaluate and document occlusion
    • Some clinicians use study models for treatment planning
  • Charting workflow (as described):
    • RECORD MISSING TEETH FIRST
    • Use radiographs to aid charting
    • Follow a sequence around the arch: 1 → 16, then 17 → 32
  • Radiographs:
    • Essential for confirming unerupted teeth, root tips, supernumeraries, and other deviations
  • Assessment tools:
    • Intraoral camera as a clinical assessment tool

Hard Tissue Examination Components

  • The hard tissue exam includes:
    • Dental charting of missing teeth and restorations
    • Charting of carious and noncarious lesions
    • Radiographic identification of caries and other pathologies
    • Evaluation and documentation of occlusion
    • Use of study models as needed for treatment planning

Radiographic and Clinical Examination Workflow

  • Step 1: Use radiographs to guide clinical examination and charting
  • Clinical examination procedures are paired with radiographic findings to create a comprehensive chart
  • Document the following during examination:
    • Existing restorations
    • Developmental enamel lesions
    • Noncarious cervical lesions (NCCLs)
    • Carious lesions using a recognized classifications system
    • Any other pathology identified radiographically or clinically
  • Equipment commonly used during examination:
    • Mouth mirror
    • Shepherd Hook probe
    • Bright light
    • Proper patient positioning
    • Loupes (preferred)
    • Radiographs
  • Installations and adjuncts:
    • Air-water syringe: use controlled, steady air; dry area to improve visibility; avoid dry-cooking or drying sensitive cervical areas or carious lesions excessively
    • Interocclusal records for bite registrations when necessary (open bite, crossbite, missing teeth impact on occlusion)
  • Documentation categories:
    • Existing restorations
    • Enamel lesions (developmental and noncarious)
    • NCCLs
    • Carious lesions (using classification systems)
    • Other pathologies

Occlusion: Basic Principles and Classification

  • Occlusion assessment: evaluate how teeth come together; determine ideal vs. malocclusion patterns
  • Normal (Ideal) Occlusion – Class I (Angle’s classification concept):
    • MB cusp of maxillary first permanent molar occludes with buccal groove of mandibular first permanent molar
    • Maxillary permanent canine occludes with distal half of mandibular canine and mesial half of mandibular premolar
  • Malocclusion categories:
    • Class I Malocclusion: normal molar relationship but with other alignment issues (crowding, rotation, protrusion, crossbite)
    • Class II Malocclusion (Distocclusion): mandibular teeth posterior to maxillary teeth; retrognathic profile; Division 1 and Division 2 distinctions (mandible retruded; maxillary incisors protruded in Division 1; Division 2 with retroclined/maxillary incisors)
    • Class III Malocclusion ( prognathic ): mandible protruded; underjet or edge-to-edge bite possible
  • Facial profiles:
    • Retrognathic, Mesognathic, Prognathic
  • Occlusion types and effects:
    • Functional contacts (normal contacts)
    • Parafunctional contacts (clenching, grinding, nail biting, etc.)
    • Parafunctional activities can accelerate wear and may cause tooth movement and pulpal issues
  • Functional and parafunctional contacts can affect:
    • Proximal contacts and food impaction
    • Tooth wear and occlusal trauma risk
  • Occlusal trauma terminology:
    • Primary occlusal trauma: excessive bite force on a tooth with normal bone support
    • Secondary occlusal trauma: normal or abnormal forces on a tooth with bone loss
    • Acute trauma vs. chronic trauma
  • Occlusal trauma signs and radiographic findings:
    • Clinical signs: progressive mobility, fremitus, sensitivity, tooth migration, fractured teeth
    • Radiographic signs: lamina dura thickening, widening of the PDL space, root resorption
  • Study models in occlusion assessment:
    • May be taken to assess occlusion and used as part of permanent records
  • Interocclusal records:
    • Bite registrations to align upper and lower models, important for open/cross bites and missing teeth effects

Study Models

  • Purposes and uses:
    • Permanent record of patient’s condition
    • Document tooth position and anatomy
    • Record shape and position of gingiva and interdental papillae
    • Document frenal positions
    • Assess occlusion for treatment planning

Study of Developmental Enamel and Dentin Defects

  • Developmental enamel lesions:
    • Enamel hypoplasia
    • Hypomineralization
    • Hypomaturation
  • Crown forms of enamel hypoplasia (examples):
    • Normal, ScrewdriverNotched, Hutchinson's incisors, Peg lateral, Mulberry molar
  • Developmental defects of dentin:
    • Dentinogenesis imperfecta (DI) – genetic dentin defects
  • Dentin defects references:
    • Source: Orban/Schour references and DI literature (e.g., Orban’s texts; 2021 citation in transcript)

Noncarious Dental Lesions (NCCLs)

  • Overview: Noncarious lesions include attrition, erosion, abrasion, and abfraction (ABFRACTION)
  • Attributions:
    • Attrition: wear from tooth-to-tooth contact; cumulative effect; bruxism commonly involved; early signs are wear facets
    • Erosion: chemical loss of tooth structure; commonly affects facial and lingual surfaces; can be extrinsic (e.g., wine tasters) or intrinsic (e.g., GERD)
    • Abrasion: mechanical wear; often cervical areas; causes include aggressive brushing, objects (pens), pipe smoking
    • Abfraction: V- or wedge-shaped notches at the gumline on exposed cementum/dentin; implies flexural forces
  • NCCL implications:
    • Impacts tooth integrity and esthetics
    • May retain plaque; possible sensitivity
  • Treatment and prevention themes:
    • Identify and address contributing factors
    • Desensitizing treatments as needed
    • Adjust hygiene techniques and dentifrice recommendations

Caries: In Depth

  • Classifications used for caries diagnosis and management:
    • ICDAS (International Caries Detection and Assessment System)
    • G.V. Black classification (carious lesions)
    • American Dental Association (ADA) Caries Classification
    • ICCMS (International Caries Classification and Management System)
  • G.V. Black’s classification (Carious Lesions):
    • Class I: Cavities in pits or fissures (occlusal surfaces of premolars/molars; facial/lingual surfaces of molars; lingual surfaces of maxillary incisors)
    • Class II: Cavities in proximal surfaces of premolars and molars
    • Class III: Cavities in proximal surfaces of incisors/canines not involving incisal edge
    • Class IV: Cavities in proximal surfaces involving incisal edge
    • Class V: Cavities in the cervical 1/3 of facial or lingual surfaces (not pit/fissure)
    • Class VI: Cavities on incisal edges of anterior teeth or cusp tips of posterior teeth
  • ICDAS and ADA Caries Classification integration:
    • ICDAS codes range from 0 to 6 (0 = sound; 1–2 = initial/noncavitated changes; 3–4 = moderate surface breakdown; 5–6 = extensive cavitation with dentin involvement)
    • ADA classification aligns with clinical presentation: Initial, Moderate, Advanced (with stages of demineralization and cavitation)
  • ICCMS categories and definitions:
    • Sound surfaces (ICDAS 0; ICCMS code 0): no visible caries after cleaning and air-drying; surface may include developmental defects and stains but is recorded as sound
    • Initial stage caries (ICDAS 1–2; ICCMS code 1/2): first visual changes in enamel; no apparent dentine involvement; may require drying/transillumination
    • Moderate stage caries (ICDAS 3–4; ICCMS code 3/4): white/brown spot lesion with localized enamel breakdown or underlying dentine shadow
    • Extensive stage caries (ICDAS 5–6; ICCMS code 5/6): clear cavity with dentine involvement
    • Confirmation aids: supragingival/pitting evaluation with a WHO ball-end probe for enamel breakdown or dentine shadow
  • ICCMS and ICDAS clinical application:
    • Caries categories help guide diagnosis, treatment planning, management, and restoration strategies
  • ADA Caries Classification specifics (clinical presentation and labels):
    • Infected dentin as a label for dentin involvement and interpretation of lesion depth
    • Radiographic presentations include E1/RA1, E2/RA2, D1/RA3 for proximal surfaces
  • Initial caries features:
    • Demineralization of enamel; may appear whitish/yellow; dull when dried; remineralization possible
  • Caries progression considerations:
    • Proximal lesions on radiographs; reversible vs irreversible changes; detection may require transillumination or drying and imaging

Pulp Vitality Testing

  • Purpose: determine whether a tooth is vital (alive) or nonvital (dead)
  • Indicators:
    • Loss of vitality can result from bacterial invasion or trauma
    • Pulp testing helps determine vitality status; lack of response suggests nonvital tooth (may require root canal therapy)
    • Exaggerated response indicates pulpitis (reversible or irreversible)
  • Methods:
    • Cold testing
    • Heat testing

Fractures and Traumatic Dental Injuries

  • Classifications of traumatic dental injuries (to permanent teeth):
    • Concussion
    • Subluxation
    • Extrusion
    • Lateral luxation
    • Intrusion
    • Avulsion
  • Radiographic signs of trauma and fracture types include enamel fractures, enamel-dentin fractures, crown-root fractures with or without pulp involvement, root fractures, and alveolar fractures
  • Visual references: Figure 16-9 (Fractures of Teeth) and related trauma figures

Eruption, Growth, and Patterns

  • Eruption data and patterns are covered in figures (e.g., Figure 16.T01; 16-27 eruption patterns of first permanent molars)
  • The transition from primary to permanent dentition is associated with age milestones:
    • Primary dentition at around age 5
    • Mixed dentition around age 9
    • Permanent dentition around age 13
  • Eruption timing and sequence are important for charting and treatment planning

Pulp and Root Canal Therapy

  • Root canal therapy (RCT) considerations are tied to vitality testing and traumatic injury management
  • Implants and restorative options discussed in the broader context of restorative planning

Interdental and Proximal Considerations

  • Proximal contacts:
    • Proper contacts dissipate forces, prevent tooth migration, food impaction, and interproximal bone loss
  • Tooth wear and tooth position relationships influence occlusal stability and treatment planning
  • Primates spaces: present in primary dentition; spacing patterns used as indicators during pediatric dental assessment

Interprofessional and Practical Aspects

  • Tools and equipment:
    • Mouth mirror, Shepherd Hook, bright light, patient positioning, loupes, radiographs
  • Patient education and care planning:
    • Benefits of orthodontic care
    • Chewing efficiency and diet implications
    • Habit modification and biofilm control strategies for crowded/misaligned teeth
    • Space maintenance needs in primary teeth
    • Ongoing care and maintenance considerations during orthodontic therapy
  • Practice and assessment activities include:
    • Practice time exercises for classifying occlusion (Class I, II, III)
    • Midline deviation assessment: compare maxillary midline to nose tip, then mandibular to maxillary midline
    • Occlusion of the primary teeth and primate spaces

Tips for Exam Prep and Application

  • Always start with radiographs to guide clinical assessment and charting
  • Use a consistent sequence when charting teeth (1–16, then 17–32)
  • Distinguish between caries types (pit/fissure, smooth surface, root caries) and noncarious lesions (attrition, erosion, abrasion, abfraction)
  • Apply classification systems consistently:
    • ICDAS/ICCMS for caries detection and staging
    • G.V. Black for lesion placement (Class I–VI)
    • ADA Caries Classification for clinical presentation depth
  • For occlusion, be able to identify and describe:
    • Class I vs Class II vs Class III
    • Division 1 vs Division 2 within Class II
    • Various malocclusion presentations and facial profiles
  • Be prepared to discuss punchline connections:
    • How occlusion and parafunctional habits influence wear and occlusal trauma
    • How NCCLs affect esthetics, sensitivity, and plaque retention
    • How pulp vitality testing informs treatment options (e.g., vitality vs. endodontic treatment)
  • Know practical examination steps:
    • Equipment setup and patient-friendly communication (e.g., before using air to dry surfaces)
    • Use of intraoral camera for documentation
    • Importance of study models and bite registrations when indicated

Quick Reference: Key Numbers, Codes, and Classifications

  • Permanent dentition: 32 teeth
  • Primary dentition: 20 teeth (A–T)
  • Mixed dentition: ages ~6–12 years
  • G.V. Black caries classes: Class I–VI (I: pits/fissures, II: proximal premolars/molars, III: proximal incisors/canines not incisal edge, IV: proximal with incisal edge, V: cervical facial/lingual, VI: incisal edges/cusp tips)
  • ICDAS caries codes: 0–6 (0 = sound; 1–2 initial; 3–4 moderate; 5–6 extensive)
  • ICCMS categories: Sound, Initial, Moderate, Extensive (with corresponding ICDAS/ICDAS-like codes and WHO probe confirmation)
  • Key factors in caries development (the caries process):
    • Microorganisms
    • Fermentable carbohydrate
    • Susceptible tooth surface
    • Time
    • Represented as a logical condition: ext{Caries occurs if } ext{Microorganisms} \land ext{ Fermentable carbohydrate} \land ext{ Susceptible surface} \land ext{ Time}.
  • Proximal contacts and occlusion concepts help prevent food impaction and tooth movement
  • Pulp vitality testing methods: cold testing, heat testing
  • Trauma classifications and signs: concussion, subluxation, extrusion, luxation, intrusion, avulsion; radiographic signs include PDL widening, lamina dura changes

Note: This set of notes reflects content from the hard-tissue exam transcript and is organized to function as a substitute study guide, with comprehensive coverage of terminology, classifications, procedures, and clinical implications relevant to dental hygiene and dental anatomy/physiology.