Please enable JavaScript.

Coggle requires JavaScript to display documents.

CariologyY1 (Dental Caries (Sem 1) (What (Multifactorial, Demineralization…

- - - - Indexes
        
        DMFT/DMFS
        
        deft/defs (primary dentition)
        
        Limitation (ORIENS)
        
        Intensity: No information about severity
        
        Equal: D M E have equal weightage
        
        Number: No indication for number of teeth at risk
        
        Other than caries: Index is invalid when teeth have been lost for reasons other than caries
        
        Root: N.A for root caries
        
        Sealant: No account for fissure sealants
        
        7) DMF data are of little use for estimating treatment needs
        
        Decayed/Missing/Filled teeth due to caries
        
        Not counted in DMF
        
        3rd Molar
        
        Unerrupted tooth
        
        Congenitally missing / Supernumary teeth
        
        Tooth removed not for caries
        
        Tooth restored not for caries (Accidents)
        
        Primary teeth w permanent errupted
        
        ICDAS Index
        
        ICDAS 1 (Incipient)
        
        Pit & Fissure after 5 seconsd drying + carious opacities & white spot
        
        First enamel visual change
        
        Varnish, sealant, mouthwash
        
        ICDAS 2 (Incipient)
        
        No need air dry
        
        Distinct enamel visual change
        
        Varnish, sealant, mouthwash
        
        ICDAS 3 (Incipient)
        
        No visible dentin, use probe
        
        Localized enamel breakdown
        
        Invasive
        
        ICDAS 4
        
        Shadow of discoloured dentine through intact enamel, wet obvious (reason why intact - dentin minerals flow out and remin enamel)
        
        Underlying dark shadow dentine
        
        Invasive
        
        ICDAS 5
        
        Opaque discoloured enamel, exposing dentine, less than 1/2 tooth
        
        Distinct cavitation with visible dentin
        
        Invasive
        
        ICDAS 6
        
        Involve at least 1/2 tooth surface or pulp
        
        Distinct cavitation with visible dentine
        
        Endodontics
        
        ICDAS 0 (Incipient)
        
        No changes to enamel even after 5 seconds of drying
        
        Sound
        
        Fluoride toothpaste
        
        Properties of an ideal index (VCR SQA)
        
        Validity: Measure what it is intended to measure, correspond with clinical stages of disease
        
        Reliability: Measure consistently at different times under variety of conditions
        
        Clear & Simple: Criteria clear and ambiguous, easy to memorize
        
        Quantifiable: Amendable to statistical analysis, allows status of group to be expressed by statistical measures
        
        Sensitivity: Able to detect reasonable small shifts in condition
        
        Acceptability Not painful or demeaning to subject
        
        Blacks
        
        WHO
        
        ADA
        
        Mount & Hume
      - Tools of diagnosis Sem 1
        
        Visual-Tactile
        
        Good Lighting
        
        Dry, Clean
        
        Sensible use of probe (iatrogenic)
        
        Transillumination (ICDAS) underlying shadow/cracks/fractures
        
        Fibre optic transillumination
        
        Intra-Oral Radiography
        
        Bite-wing
        
        Strictly for caries diagnosis
        
        Especially interproximal
        
        Anterior caries can use transillumination
        
        Peri-apical
        
        Complication
        
        Flurosis
        
        Smooth & Glassy vs Caries (Rough)
        
        Symmetrical (Same tooth development)
        
        Tend not occlusal pits & fissures
        
        Tend not interproximal
  - - - Incipient: Have not penetrated dentin
      - Primary: In tooth not previously affected by condition
      - Secondary: In tooth already affected by condition (Adj or under restoration)
      - Arrested caries: Inactive carious process
      - White Spot Lesion: Localized area of enamel demineralization. Observable by differing opacity. Sub-surface porousity
    - - Pits & Fissure: Fault in enamel (Class 1)
      - Smooth surface:
      - Root surface
- - - - Composition of food
        
        1st: Sucrose most potent
        
        2nd: Fructose (Fruits)
        
        3rd: Xylitol
      - Oral clearance (Starting pH, time taken to buffer back up)
      - Individual dietary habits (Time under sugar influence)
      - Plaque composition (Bacteria type in biofilm)
      - Use of fluoride
      - Socioeconomic state (SES)
      - Stephen's Curve
        
        Critical pH: 5.5 enamel
        
        No time for remineralization
        
        pH Change in a few minutes
  - - - Occlusal premolar
      - Occlusal molars
      - Buccal pits mandibular molars
      - Palatal pits maxillary molars
      - Proximal of all teeth (Difficult to detect)
      - Palatal of upper insicors (Pits & fossas)
    - - 1st: Mandibular 2nd molars
      - 2nd: Max 1st and 2nd molars, Mand. 1st molars
      - 3rd: Max & Mand 2nd premolars
      - 4th: Max & Mand 1st premolars
      - 5th: Max central & lateral incisors (palatal pits)
      - 6th: Max & Mand canines, Mand central & lateral incisors
    - - Diet - type, quantity, frequency
      - Oral Biofilm - type of bacteria, amount
      - Saliva - quantity, flow, buffering capacity
      - Previous caries experience
      - Use of fluoride
      - Medical conditions
- - - - Water Fluoridation
      - Salt Fluoridation
        
        Jamaica, Colombia (WHO 2005)
        
        Costa Rica (WHO 2005)
        
        Switzerland (WHO 2005)
        
        France. Germany (WHO 2005)
      - Milk Fluoridation
        
        Bulgaria (AMA 2013)
        
        UK (AMA 2013)
        
        Russian Federation (AMA 2013)
        
        Chile (AMA 2013)
        
        Thailand (AMA 2013)
    - - Professional
        
        Fluoride Gel
        
        Patient may become nauseous
        
        Prophylaxis + Drying (Cotton rolls Max 7 , under tongue)
        
        Leave or 4 minutes
        
        Not for use in children under 6-7
        
        1/3 of tray
        
        1.23% (12,300ppm F) APF - pH 3-4 most common
        
        Don't eat or drink for 30mins
        
        Fluoride Varnish (more impt)
        
        Prophylaxis + Dry teeth: retract lip, control moisture, paint on varnish (brush/cotton pellet)
        
        The varnish film should not be removed prematurely. Don't eat or drink for 30mins Patients should be advised not to brush their teeth or chew food for at least 4 hours after treatment. BUT during this time fluids and soft foods may be consumed.
        
        Temporary yellow staining
        
        5% NaF varnish (22,600ppm F)
      - Self
        
        Fluoride Mouthrinse
        
        Types
        
        Twice daily - 100ppm F
        
        Weekly rinse - 0.2% NaF (900ppm F)
        
        Daily Rinsing - 0.05% NaF (226ppm F)
        
        Precautions
        
        Recommended for those at high risk (eg. low salivary flow)
        
        Not substitute for brushing with fluoridated toothpaste
        
        Not reccommended for children <6 years (Toxicity & Fluorosis)
        
        Directions
        
        No eating or drinking for 30mins after
        
        Rinse (10-15ml) for 2 minutes and spit out
        
        Fluoride Toothpaste
        
        Efficacy
        
        Concentration F
        
        Bioavailability F
        
        Frequency of use
        
        Supervision
        
        Contact time F
        
        Time of application (Before/After breakfast) There are studies that support both
        
        Rinsing Habit (Out of cup/beaker more than tap) Recommend not rinsing or lesser
        
        Affordability
        
        Maximum off the counter: 1450ppm fluoride
    - - "Perspectives in the effective use of fluoride in Asia"
  - - - Incorporated into HA structure (Less soluble, Prevents demin) Lower critical pH 4.5, compared to 5.5
    - - Incorporated into HA structure (Less soluble, Prevents demin) Lower critical pH 4.5, compared to 5.5
      - Promotes remineralization Attracts calcium and phosphate, resulting in new mineral formation
      - Inhibits bacterial glycolysis (metabolism) reduce acid, interfere with enzyme enolase
- - - - Dentine becomes necrotic/liquefies (liquefaction foci)
      - Right angle cracks (transverse clefts)to direction of dentinal tubules where dentine liquifies
      - Rapid Caries: Soft & Yellow
      - Slow progressing: Harder & Browner
    - - Bacteria multiply within tubule lumen
      - Decalcify dentine with acid
      - Dissolve proteins (like collagen) within tubules (proteolysis)
    - - Caused by bacterial acid traveling down dentinal tubules (pH 6.7)
      - Advancing front
      - Note: There is no bacteria in this region
    - - Defense Zone
      - Odontoblast lay down calcification within tubule (Plugging)
    - - Inflammed pulp causes production of tertiary dentine