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Cariology - Coggle Diagram
Cariology
Determine
Protective Factors
Salivary flow and components
Fluoride (with calcium and phosphate)
Antibacterials
Pathological factors
acid producing bacteria
frequent consumption of fermentable carbohydrates
Sub-normal salivary flow and function
Patient-level caries risk
head and neck radiation
dry mouth
inadequate oral hygiene practices
deficient fluoride exposure
high frequency sugars
Low SES/health care barriers
Detect
Detection Methods
Visual tactile
Do not remove plaque initially (sticky plaque indicates carious activity)
Do not use a sharp explore probe as this could damage softened tissues
Radiographs
Indicate depth of (inter proximal) lesions
less damaging to the enamel
can be stored as records and used for comparison over time
Fibre-optics
light scattering identifies changes in enamel opacity
QLF
shows demineralisation by reduced autofluorescence by light scattering
Electrical caries monitoring
Laser fluorescence/DIAGNOdent
collects resultant fluorescence from red lasers to produce a value
Types of Caries
pit/fissure vs smooth surface
primary vs secondary
cavitated vs non-cavitated
active vs inactive
caries staging and lesion activity and intramural caries risk assessment
Caries staging and lesion actiivty
ICDAS
WHO probe
Radiographs
Intra-oral Caries risk assessment
plaque assessment
caries experience
appliances
exposed root surfaces
Dry mouth
Do/Management
Managment of Lesions
Initial Active Lesions
Non-Operative Management
Remineralise to increase resistance to subsequent demineralisation.
Non-Invasive treatment
Oral Hygiene Instruction
Topical Fluoride Treatments
Fluoride creme, foam, varnish
Duraphat: 5% wt NaF in a suspension of resins
MI varnish: 5% wt in CCP-ACP
ClinPro White Varnish: 5% wt in fTCP
Fluoride Dentrifices
Toothpaste: 1000 ppm + recommend, 5000 ppm on prescription for high caries risk individuals
Mouthwash: 220 ppm recommended for high caries risk individuals
Micro-Invasive Procedures
Sealing
Infiltration
Hall Technique (SCC)
Moderate and Extensive Active Lesions
Biological/Self-limiting, Minimally Invasive Operative Management
Stepwise Excavation: Selective removal to soft dentine caries removal in two stages
Advantages: Soft dentine becomes drier and harder.
Disadvantages: Deep lesions may have increased risk of pulp exposure on second entry.
Selective removal to Soft Dentine: Caries extending to inner third of dentine.
Advantages: Pulp exposure and injury is avoided. A tight and durable seal is still achieved from hard peripheral dentine.
Selective Removal to Firm Dentine: Caries not extended to inner third of dentine.
Advantages: Highly conservative approach
Golden Triangle: Consider the histology of the dental substrate being treated, the practical operative techniques available to excavate caries minimally, and the chemistry or handling of the adhesive materials used to restore the cavity.
Frank cavitation or demineralisation through more than the outer third of dentine.
Management of Liklihood of Progression and/or New Lesions
Overall caries-risk of the patient lowered or maintained if low
Cumulative intervention
Clinical intervention
At home care
Decide
collate and analyse information from Determine and Detect elements to diagnose the likelihood of new lesion progression
Decide best course of care