detection, diagnosis and prevention of dental caries

DIAGNOSIS AND

PREVENTION OF

DENTAL CARIESDR TAZEEN ZEHRA

DEVELOPMENT OF DENTAL CARIES

The main features of the caries process are:

(1) fermentation of carbohydrate

(2) rapid acid formation

(3)pH rise when carbohydrate is no longer available

(4) dental caries progressesion

FEATURES

Early enamel lesion is subsurface

Dental plaque 70% microorganisms

Mutans streptococci good at metabolizing sugars

Enamel breaks down as caries progress through amelodentinejunction

Precavitation carious lesions' remineralize

Etching vs bacterial acid attack?

Plaque as partial barrier

pH in erosion

1st stage is 'white spot'

precavitation lesion Stage

Occur within a few weeks if

conditions are favourable

2-4 years for caries to

progress through enamel

into dentine at approximal

sites

Enamel breaks down as

caries progress through

amelodentine junction

Saliva is natural defence

CARIES DETECTION AND

DIAGNOSIS

Systematic examination of clean dry teeth

The basic equipment consists of

i. adequate lighting

ii. compressed air for drying

iii.dental mirror

iv. Blunt or ball ended probe

CARIES DETECTION AND DIAGNOSIS

Radiograph: bitewing are 1st

choice

CARIES DETECTION AND DIAGNOSIS

Fibre-optic transillumination

(FOTI)

Consists of the placement of

a 0.5 mm light source in the

embrasure

If a carious lesion is present it

will show as a dark shadow

CARIES DETECTION AND DIAGNOSIS

Temporary tooth

separation

placement of an

orthodontic elastameric

separator between the

teeth

CARIES DETECTION AND DIAGNOSIS

Laser fluorescence devices

Electronic caries meters

The presence of a bleeding

papilla

Phenomenon which may help the

clinician, suggesting the presence of

an approximal cavity. This occurs

because the cavity will be full of

plaque, which will cause gingivitis

and thus the bleeding papilla

Carries Detection

Sharp probe are contra-indicated:

• 'sticky' fissure means the probe fits the fissure.

• Probing a demineralized lesion will break the

enamel matrix making remineralization

impossible

• The probe may transfer cariogenic bacteria

from one site to another

Characteristic of Caries

1st visible sign is white spot

lesion

Seen when surface is dried

As lesion progress seen

without drying

White spot is lesion or

fluorosis?

Active VS Inactive lesion

PREVENTION OF DENTAL CARIES

Plaque control/toothbrushing

Diet

Fluoride

Fissure sealing

High Caries Risk Patient

High caries-risk' groups comprising:

• The caries prone⎯especially early childhood

caries (nursing bottle caries).

• The handicapped⎯medical and physical.

• The socially deprived, that is, low socio-economic

groups.

• Ethnic minority groups usually residing in inner city

areas

Low Caries Risk Patient

Low caries-risk children:

Caries-free or have well-controlled caries

Have good oral and dietary habits,

Highly motivated

Attend their dental appointments

regularly

Plaque control and toothbrushing

plaque disclosing tablets and

solutions

Plaque charts

demonstrating the plaque

disclosing procedure

Tooth brush with cartoon

characters

Children below 5yrs need help with

tooth brushing

At which age a child will have

manual dexterity

Plaque control and toothbrushing

Small smear of fluoride toothpaste

Not to rinse with water

Brush your teeth first thing in the

morning and last thing at night

Nutrition and diet in Caries control

Intrinsic (sugar within cell membrane,

for example, fruits)

Extrinsic (readily available sugars, for

example, refined sugars)

Bacteria need a fermentable source of

carbohydrate to produce acid

Dietry advice

Make sure patient eat sensibly and safely

Positive reinforcement

Baby drinks given in baby bottles led to 'nursing bottle' caries

only milk or water is given to children in a baby bottle

children drinks consumed from trainer cups, beakers, or straws

Safer foods Cheese, fruit,

vegetables, crisps and peanuts

Frequency of eating

3-day diary record

INTRODUCTION

Use of fluorides for the prevention and control of

caries is documented to be both safe and highly

effective.

Fluoride has several caries-protective mechanisms

of action, including enamel remineralization and

altering bacterial metabolism to help prevent

caries.

MECHANISM OF ACTION OF

FLUORIDE

During tooth formation, makes enamel crystals

larger and stable

Inhibit plaque bacteria by blocking enzyme enolase

during glycolysis

Inhibit demineralization when in solution

Enhances remineralization by forming fluorapatite

Make pits and fissure shallower

Flourides

Fluorides

• Fluoride ion in the oral fluid is of most importance in

reducing enamel solubility rather than having a high

content of fluoride in surface enamel.

• A constant supply of low levels of intraoral fluoride,

particularly at the saliva/plaque/enamel interface, is of

most benefit in preventing dental caries.

FLUORIDE MODALITIES

Systemic use

Water fluoridation

Salt

Milk

Mineral water

Fluoride supplements

Topical use

Tooth paste

Mouth wash

Fluoride gels

Varnishes

SYSTEMIC USE

Water fluoridation

Water fluoridation continues

to be effective in reducing dental decay by 20-40%

Optimum conc is 1 ppm

Flourides Suppliment

TOPICAL USE

TOOTH PASTE 1000 to 1450 ppm fluoride

Sodium fluoride or sodium mono

floro phosphate or combination

of both

Twice daily use

For child below 6 year With low caries risk 500ppm

With high caries risk 1000ppm

For child above 6 yearWith low caries risk 1000ppm

With high caries risk 1450 ppm

MOUTH WASH

Active ingredient sodium fluoride

(Protect G)

Daily rinse 0.05% (225ppm)

Weekly use 0.2% (900ppm)

Not recommended for children

below 6 year

Recommended daily mouth rinse

for orthodontic patients

FLUORIDE GELS

Can be applied with brush or in trays

Can be for home use and professional

use

For home use in low conc. 1000-5000

ppm

At home at bedtime after regular

brushing

Do not use under 6 year of child

PROFESSIONALLY APPLIED

REMEDY

Fluoride gel

For professional use high conc.

1.23 ppm (12300 ppm)

Recommendations for preventing

fluoride toxicity

No more than 2ml per tray

Use saliva ejector

Sit patient upright

Instruct patient to spit out for 30sec

after procedure

Do not use for children under 6

years

Fluoride varnishes

Duraphat 5%(22,600ppm)

Used with cotton bud

A small pea size is

sufficient for full mouth

application in children

upto 6 year

Slow-release fluoride devices

Filling materials

Short term fluoride release

Recharging capacity of

GIC

Fluoride glass devices

PIT AND FISSURE SEALANTS

Molar teeth account for most of decay

in primary and permanent

Fissures and pits are difficult to keep

clean

These are the sites most susceptible to

developing decay

Pit and fissure sealants are materials

that are applied to the pits

and fissure surfaces of teeth to create a

thin barrier which protects

the sealed surface from decay

Categories

Resin-based sealants

Glass ionomer sealants

Patient selection

Moderate to high risk for caries

Caries limited to enamel of pits and fissure

Medically or physically compromised patients

Sufficiently erupted teeth with susceptible pits

and fissures

Tooth selection

Caries in primary molars

Caries in 1st permanent molar

Anatomy of teeth

Contraindications

A sealant is contraindicated if:

1. Patient behavior does not permit use of adequate dry

field (isolation) techniques throughout the procedure

2. There is an open occlusal carious lesion

3. Caries, particularly proximal lesions, exist on other

surfaces of the same tooth

4. A large occlusal restoration is already present.

5. If pits and fissures are well coalesced and self-cleansing

Method

STEP 1. SELECT APPROPRIATE TEETH

Sealants are not for all caries-free pits and fissures

1. overall caries susceptibility

2. existing restorations and carious lesions

3. occlusal anatomy

STEP 2. PUMICE OCCLUSAL SURFACE AND RINSE

Flour of pumice applied with a rotary brush

STEP 3. REMOVE PUMICE FROM GROOVES WITH

EXPLORER

STEP 4. ISOLATE WITH RUBBER DAM OR COTTON

ROLLS

STEP 5. DRY AND ETCH

.Thoroughly dry the tooth (30 seconds) t

.Apply etchant solution with the acid-etch brush

which is packaged with in sealant kit or a cotton

pellet.

Usual etching time for permanent teeth is 20-30

seconds

STEP 6. RINSE 20-30 SECONDS

STEP 7. RE-ISOLATE

STEP 8. DRY 20 SECONDS – CHECK ETCHED SURFACE

STEP 9. APPLY SEALANT IN 30 SECONDS

STEP 10. CHECK APPLICATION WITH EXPLORER