1. Preventive Dentistry I & II
Dental caries
Dr. Caroline Mohamed
Dr.Caroline Mohamed

2. Objectives Define: Dental caries The dental caries process
The role of diet in dental caries
Classification of dental caries
Epidemiology
Incidence and prevalence and how can be measured
Caries risk
Dr.Caroline Mohamed

3. 1. Dental caries definition
Dental caries is a multifactorial microbial disease of the calcified tissues of the teeth, characterized by demineralization of the inorganic portion and destruction of the organic substance of the tooth, which often leads to cavitations.
Dr.Caroline Mohamed

4. Cariology is the study of dental caries.
Two groups of bacteria are responsible for initiating caries: Streptococcus mutans and Lactobacillus. If left untreated, the disease can lead to pain, tooth loss, infection, and, in severe cases, death.
Today, caries remains one of the most common diseases throughout the world.
Cariology is the study of dental caries.
Dr.Caroline Mohamed

5. The presentation of caries is highly variable; however, the risk factors and stages of development are similar. Initially, it may appear as a small chalky area that may eventually develop into a large cavitation.
Sometimes caries may be directly visible, however other methods of detection such as radiographs are used for less visible areas of teeth and to judge the extent of destruction.
Dr.Caroline Mohamed

6. Tooth decay is caused by specific types of acid-producing bacteria that cause damage in the presence of fermentable carbohydrates such as sucrose, fructose, and glucose.
The mineral content of teeth is sensitive to increases in acidity from the production of lactic acid. Specifically, a tooth (which is primarily mineral in content) is in a constant state of back-and-forth demineralization and remineralization between the tooth and surrounding saliva.
When the pH at the surface of the tooth drops below 5.5, demineralization proceeds faster than remineralization (meaning that there is a net loss of mineral structure on the tooth's surface). This results in the ensuing decay.
Dr.Caroline Mohamed

7. Dr.Caroline Mohamed

8. Socio-Economical Situation
Educational level
Socio-Economical Situation
FLORA
Fluoride in plaque
Lactobacilli
Oral Hygiene
Streptococci
Virulence factors
Transmissibility
HOST
Age
Fluoride
Genetics
Morphology
Nutrition
Host
SUBSTRATE
Carbohydrates
Frequency of eating
Oral clearance
Physical nature of food
Detergency of food
SALIVA pH
Flow rate
Composition
Buffering capacity
Bicarbonate levels
SALIVA
Behavior
Knowledge
Dr.Caroline Mohamed

9. Dr.Caroline Mohamed

10. The role of diet in dental caries
Dr.Caroline Mohamed

11. Substrate Readily fermentable Sucrose- arch criminal
Cariogenicity determined by
Frequency of ingestion
Physical form
Chemical composition-detergency
Texture of food
Presence of other constituents
Dr.Caroline Mohamed

12. Cariogenicity determined by
Frequency of ingestion
Dr.Caroline Mohamed

13. Frequency of ingestion
All solid and liquid foods containing fermentable carbohydrates are potentially cariogenic.  Acid-forming bacteria, such as caries-producing Streptococcus mutans, begin the immediate breakdown of sucrose from food, potentially contributing to dental caries.
Sugars on the tooth surfaces are converted to acid within seconds of ingestion.  The acid acts to demineralize the tooth.  Left undisturbed, the acid produced from the ingestion of a sugar can remain in the oral cavity up to 2 hours.  During this acid attack, the pH level of plaque drops from a normal range of down to a pH of , the level at which demineralization can occur.
Consumption of caries-producing solid and liquid foods will lower the oral pH to a level that makes the enamel susceptible to caries.  These frequent exposures can lower the pH to demineralizing levels for several hours per day.
D Caroline Mohamed

14. Tooth enamel dissolves at 5.5 ph
D Caroline Mohamed

15. Chemical composition-detergency
Cow’s milk (cheese) contains calcium, phosphorus, and casein
Wholegrain foods require more chewing
Peanuts, hard cheeses, and chewing gum
Black tea extract ( fluoride)
Dr.Caroline Mohamed

16. CARIES PROCESS NO CAVITY CA R I E S Adhesion Pulpal lesion RESTORATION
Dentin lesion
Enamel lesion
CAVITY
White spot
NO CAVITY
De-Remineralization
DIAGNOSIS
Colonization
TIME
Adhesion
Dr.Caroline Mohamed

17. Depending on the extent of tooth destruction, various treatments can be used to restore teeth to proper form, function, and aesthetics, but there is no known method to regenerate large amounts of tooth structure, though stem cell related research suggests one possibility.
Instead, dental health organizations advocate preventive and prophylactic measures, such as regular oral hygiene and dietary modifications, to avoid dental caries.
Dr.Caroline Mohamed

18. Epidemiology Definition of Epidemiology
The word epidemiology comes from the Greek words:
epi , meaning on or upon
demos , meaning people, and
logos , meaning the study of
"the study of what is upon the people",
Dr.Caroline Mohamed

19. Incidence and prevalence and how can be measured
Number or proportion of persons in a population affected by a condition at a given point of time
Can be expressed as, count, proportion or percentage.
Incidence
Number of new cases of condition over a given point of time.
Change in prevalence or severity. The period of time depend on time needed to disease to be observed
expressed as a rate (case per the population per time)
Determine the progress of condition
Dr.Caroline Mohamed

20. Different Age Groups Key risk groups from ages Age-Three peaks 4-8yrs
1 to 2 years ( baby bottle caries)
5 to 7 years ( primary caries)
11 to14 years
Key risk age group in young adults
and adults ( secondary caries/ root caries)
Sex- both sexes
early eruption in females
There is some intersting contrast concerning the nature and distribution of caries in adults, particularly older adults, as compared with children.
Adults continue to experience primary dental caries, but they also experience a significant amount of secondary caries around existing restorations.
Children today have comparatively few, if any restorations and experience mostly primary caries of the noncavitated type.
Between 40 and 76% of dental carie in adults are arrested, a condition uncommoly observed in children.
Dr.Caroline Mohamed

21. Adults continue to experience primary dental caries, but they also experience a significant amount of secondary caries around existing restorations.
Children today, in developed countries, have comparatively few, if any restorations and experience mostly primary caries of the noncavitated type.
Between 40 and 76% of dental carie in adults are arrested, a condition uncommoly observed in children.
Dr.Caroline Mohamed

22. Variation within dentition:
Early plaque formation occurs faster.
In lower jaw, compared to upper jaw.
In molars areas.
On buccal tooth surfaces, compared to oral sites.
In interdental regions compared to strict buccal or oral surface.
Dr.Caroline Mohamed

23. Tooth composition Mineralization-
Hypomineralization/ Dentinogenese imperfecta
Trace elements
Fluoride/ dental fluorose
Dr.Caroline Mohamed

24. Dentinogenese imperfecta Dental Fluorose
Dr.Caroline Mohamed

25. Individual Teeth
First primary molars and first permanent molars are high risk.
Dr.Caroline Mohamed

26. Different tooth surfaces:
Are high risk:
Interproximal surfaces of primary molars.
Occlusal surfaces of first permanent molars.
Dr.Caroline Mohamed

27. Tooth morphology Pits & fissures Irregularities in arch form Crowding
Overlapping
Dr.Caroline Mohamed

28. Dr.Caroline Mohamed

29. Tooth morphology
Dr.Caroline Mohamed

30. Behavior
Age
Dr.Caroline Mohamed

31. Nocturnal bottle usage- additive On pacifier during sleep
Regularity of snaks, more than 3 times a day, snacking between meals, this increases the acid challenge to the teeth for a high level
Nocturnal bottle usage- additive
On pacifier during sleep
Breast feeding
(Kawaba et al., 1997)
Frequent , more than 3 times a day, snacking between meals, this increases the acid challenge to the teeth for a high level.
Dr.Caroline Mohamed

32. Drinking sweet beverage Brushing by mother (Kawaba et al., 1997)
Dr.Caroline Mohamed

33. Dental Caries classification
1.based on anatomical site
2.based on progression
3.based on virginity of lesion
4.based on extend of caries
5.based on tissue involvement
6.based on chronology
7. based on whether caries is completely removed or not.
8.based on surfaces to be restored
9. WHO system
9.Black’s classification
10.Caries risk Assessement
Dr.Caroline Mohamed

34. Classification: 1) Based on anatomic site: Root caries Crown caries
Pit & Fissure
Caries
Smooth surface
Caries

35. Pits and fissures are anatomic landmarks on a tooth where the enamel folds inward. Fissures are formed during the development of grooves but the enamel in the area is not fully fused.
As a result, a deep linear depression forms in the enamel's surface structure, which forms a location for dental caries to develop and flourish.
Fissures are mostly located on the occlusal surfaces of posterior teeth and palatal surfaces of maxillary anterior teeth.
Dr.Caroline Mohamed

37. Pits are small, pinpoint depressions that are most commonly found at the ends or cross-sections of grooves.
In particular, buccal pits are found on the facial surfaces of molars. For all types of pits and fissures, the deep infolding of enamel makes oral hygiene along the surfaces difficult, allowing dental caries to develop more commonly in these areas.
Dr.Caroline Mohamed

38. The occlusal surfaces of teeth represent 12
The occlusal surfaces of teeth represent 12.5% of all tooth surfaces but are the location of over 50% of all dental caries.
Among children, pit and fissure caries represent from 80 to 90% of all dental caries. Pit and fissure caries can sometimes be difficult to detect.
As the decay progresses, caries in enamel nearest the surface of the tooth spreads gradually deeper. Once the caries reaches the dentin at the dentino-enamel junction (DEJ), the decay quickly spreads laterally.
Dr.Caroline Mohamed

39. Within the dentin, the decay follows a triangle pattern that points to the tooth's pulp. This pattern of decay is typically described as two triangles (one triangle in enamel, and another in dentin) with their bases conjoined to each other at the DEJ.
This base-to-base pattern is typical of pit and fissure caries, unlike smooth-surface caries (where base and apex of the two triangles join).
Dr.Caroline Mohamed

40. Dr.Caroline Mohamed

41. Clinical Manifestation:
Entry site may appear much smaller than actual lesion, making clinical diagnosis difficult.
In cross section, the gross appearance of pit and fissure lesion is inverted V with a narrow entrance and a progressively wider area of involvement closer to the DEJ.
a) Initially, caries of pit & fissures appears brown or
black in color & with fine explorer, it will feel soft & a
catch is felt ( don´t do it ).
The enamel which borders the pit & fissures appears
opaque bluish white.
Dr.Caroline Mohamed

42. Dr.Caroline Mohamed

43. Dr.Caroline Mohamed

44. Shape, morphological variation and depth of pit and fissures contributes to their high susceptibility to caries.
The appearance of s.mutans in pits and fissures is usually followed by caries 6 to 24 months later.
Sealing of pits and fissures just after tooth eruption may be the most important event in their resistance to caries.
Dr.Caroline Mohamed

45. Smooth surface caries
Smooth surface caries occurs on the gingival third of
the buccal, lingual & proximal surfaces.
On proximal surface, caries begins below the contact area
& in early stage this appear as a faint white opacity of
enamel without loss of continuity of surface.
As caries progresses, it appears bluish white in later
stage.
Caries in cervical area are in the form of crescent
shaped cavities. It appear as a slightly roughened,
chalky area which gradually becomes deeper

46. Types of smooth surface caries
Proximal caries, also called interproximal caries, form on the smooth surfaces between adjacent teeth.
Root caries form on the root surfaces of teeth.
The third type of smooth-surface caries occur on any other smooth tooth surface. Less favorable site for plaque attachment, usually attaches on the smooth surface that are near the gingiva or are under proximal contact.
Dr.Caroline Mohamed

47. Proximal caries are the most difficult type to detect
Proximal caries are the most difficult type to detect. Frequently, this type of caries cannot be detected visually or manually with a dental explorer.
Proximal caries form cervically (toward the roots of a tooth) just under the contact between two teeth. As a result, radiographs (bitewings) are needed for early discovery of proximal caries.
Dr.Caroline Mohamed

48. In very young patients the gingival papilla completely fills the interproximal space under a proximal contact and is termed as col. Also crevicular spaces in them are less favorable habitats for s.mutans.
Consequently proximal caries is less lightly to develop where this favorable soft tissue architecture exists.
Dr.Caroline Mohamed

49. Proximal surfaces Caries
The proximal surfaces are particularly susceptible to caries due to extra shelter provided to resident plaque owing to the proximal contact area immediately occlusal to plaque.
Lesion have a broad area of origin and a conical, or pointed extension towards DEJ.
V shape with apex directed towards DEJ.
After caries penetrate the DEJ softening of dentin spread rapidly and pulpally
Dr.Caroline Mohamed

50. Dr.Caroline Mohamed

51. Dr.Caroline Mohamed

52. Dr.Caroline Mohamed

53. Root surface caries
The proximal root surface, particularly near the cervical line, often is unaffected by the action of hygiene procedures, such as flossing, because it may have concave anatomic surface contours (fluting) and occasional roughness at the termination of the enamel.
These conditions, when coupled with exposure to the oral environment (as a result of gingival recession), favor the formation of mature, caries-producing plaque and proximal root-surface caries.
Dr.Caroline Mohamed

54. 1. It has a comparatively rapid progression
Root-surface caries is more common in older patients. Caries originating on the root is alarming because:
1. It has a comparatively rapid progression
2. it is often asymptomatic
3. it is closer to the pulp
4. it is more difficult to restore
Dr.Caroline Mohamed

55. Characteristics of root caries:
Root caries lesions have less well-defined margins, tend to be U-shaped in cross sections, and progress more rapidly because of the lack of protection from and enamel covering.
Dr.Caroline Mohamed

56. When the gingiva is healthy, root caries is unlikely to develop because the root surfaces are not as accessible to bacterial plaque.
The root surface is more vulnerable to the demineralization process than enamel because cementum begins to demineralize at 6.7 pH, which is higher than enamel's critical pH.
Regardless, it is easier to arrest the progression of root caries than enamel caries because roots have a greater reuptake of fluoride than enamel.
Dr.Caroline Mohamed

57. Root caries are most likely to be found on facial surfaces, then interproximal surfaces, then lingual surfaces.
Mandibular molars are the most common location to find root caries, followed by mandibular premolars, maxillary anteriors, maxillary posteriors, and mandibular anteriors.
Dr.Caroline Mohamed

58. 2) BASED ON THE PROGRESSION OF THE LESION:
Progressive caries
Arrested caries
Rapidly progressive - Acute
Slowly progressive-
Chronic
Nursing caries
Radiation caries

59. Acute caries
Acute caries is a rapid process involving a large number of teeth.
These lesions are lighter colored than the other types, being light brown or grey, and their caseous consistency makes the excavation difficult.
Pulp exposures and sensitive teeth are often observed in patients with acute caries.
It has been suggested that saliva does not easily penetrate the small opening to the carious lesion, so there are little opportunity for buffering or neutralizaton
Dr.Caroline Mohamed

60. Nursing caries Nursing caries can also be called as:
1. Nursing bottle caries
2. Nursing bottle syndrome
3. Milk bottle syndrome
4. Baby bottle tooth decay
5. Early childhood caries
The new name given for early childhood caries is “maternally derived streptococcus mutans disease (MDSMD)”
Dr.Caroline Mohamed

61. NURSING CARIES This is the type of acute carious lesion,
which occurs among those children who
take milk or fruit juices by nursing bottle, for a considerably longer duration of time, preferably during sleep.
As the child takes larger amount of easily fermentable sugars along with the milk, the sugar facilitates the cariogenic bacteria to produce caries at a rapid pace by fermenting those sugars. Nursing bottle caries commonly occurs in the upper anterior teeth (as these are constantly coming in contact with the sweetened milk); while the lower teeth are not usually affected as they remain under the cover of the tongue.

62. Radiation caries
Radiotherapy is frequently associated with xerostomia due to decreased salivary secretion
This and other cause of decreased salivation may lead to a rampant form of caries, indicating the significance of saliva in preventing caries.
Dr.Caroline Mohamed

63. Radiation caries
Dr.Caroline Mohamed

64. Three types of defects due to irradiation
Lesion usually encircling the neck of teeth amputation of crowns may occur
Begins as brown to black discolouration of tooth .occlusal surface and incisal edges wear away
Spot depression which spreads from any surface

65. Chronic caries
These lesions are usually of long-standing involvement, affect a fewer number of teeth, and are smaller than acute caries.
Pain is not a common feature because of protection afforded to the pulp by secondary dentin
The decalcified dentin is dark brown and leathery.
Pulp prognosis is hopeful in that the deepest of lesions usually requires only prophylactic capping and protective bases.
The lesions range in depth and include those that have just penetrated the enamel.
Dr.Caroline Mohamed

66. Dr.Caroline Mohamed

67. Arrested caries
Caries which becomes stationary or static and does not show any tendency for further progression
Both deciduous and permanent affected.
With the shift in the oral conditions, even advanced lesions may become arrested .
Arrested caries involving dentin shows a marked brown pigmentation and induration of the lesion (the so called ‘eburnation of dentin’).
Sclerosis of dentinal tubules and secondary dentin formation commonly occur.
Dr.Caroline Mohamed

68. Arrested caries
Exclusively seen in caries of occlusal surface with large open cavity in which there is lack of food retention.
Also on the proximal surfaces of tooth in cases in which the adjacent approximating tooth has been extracted
Dr.Caroline Mohamed

69. 3) BASED ON THE VIRGINITY OF THE LESION:
Primary Caries Secondary or Recurrent caries
Recurrent caries is that occurring immediately next to a restoration. It may be the result of poor adaptation of a restoration, which allows for a marginal leakage, or it may be due to inadequate extension of the restoration.
In addition, caries may remain if there has not been complete excavation of the original lesion, which later may appear as a residual or recurrent caries.

70. Primary caries
A primary caries is one in which the lesion constitutes the initial attack on the tooth surface.
The designation of primary is based on the initial location of the lesion on the surface rather than the extent of damage.
Dr.Caroline Mohamed

71. Secondary caries (Recurrent)
This type of caries is observed around the edges and under restorations.
The common locations of secondary caries are the rough or overhanging margin and fracture place in all locations of the mouth.
It may be result of poor adaptation of a restoration, which allows for a marginal leakage, or it may be due to inadequate extension of the restoration.
In addition caries may remain if there has not been complete excavation of the original lesion, which later may appear as a residual or recurrent caries.
Dr.Caroline Mohamed

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75. 4.Based on the extend of the lesion- severity
INCIPIENT CARIES
CAVITATION
OCCULT CARIES
Dr.Caroline Mohamed

76. Incipient caries Remineralised with fluoride application
The early caries lesion best seen on the smooth surfaces of the teeth, is visible as a ‘White Spot’
Histologically, the lesion has an apparently intact surface layer overlying subsurface demineralization.
Significantly many such lesions can under go remineralization & thus the lesion is not an indication for restorative treatment
Remineralised with fluoride application
D/d: developmental defects of enamel
Dr.Caroline Mohamed

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78. Occult caries
Occult or hidden caries is used to describe such lesion, which is not clinically diagnosed but detected only on radiographs.
It is believed that bitewing & OPG radiographs along with other noninvasive adjuncts like fibrooptic transillumination (FOTI), LASER luminescence, electrical resistance method(ERM) are used for diagnosing these occlusal lesions.
Prevalence-0.8%-50% in age range of yrs
Dr.Caroline Mohamed

79. Dr.Caroline Mohamed

80. Cavitation…
Dr.Caroline Mohamed

81. Cavitation
Once it reaches the dentinoenamel junction, the caries process has the potential to spread to the pulp along the dentinal tubules and also spread in lateral direction.
Thus some amount of sensitivity may be associated with this type of lesion.
This may be generally accompanied by cavitation
Dr.Caroline Mohamed

82. 5. Based on tissue involvement
Initial caries- demineralization
Superficial caries- enamel
Moderate caries- dentin caries
Deep caries – dentin close to the pulp
Deep complicated caries – pulp involvement
Dr.Caroline Mohamed

83. Dental caries can be divided into 4 or 5 stages
1. Initial caries: Demineralization without structural defect.
This stage can be reversed by fluoridation and enhanced mouth hygiene
2. Superficial caries (Caries superficialis):Enamel caries, wedge-shaped structural defect.
Caries has affected the enamel layer, but has not yet penetrated the dentin. Includes larger lesions with adequate tooth structure to support the restoration
Dr.Caroline Mohamed

84. 3. Moderate caries (Caries media): Dentin caries
3. Moderate caries (Caries media): Dentin caries. Extensive structural defect. Caries has penetrated up to the dentin and spreads two-dimensionally beneath the enamel defect where the dentin offers little resistance.
4. Deep caries (Caries profunda): Deep structural defect. Caries has penetrated up to the dentin layers of the tooth close to the pulp.
5. Deep complicated caries (Caries profunda complicata) :Caries has led to the opening of the pulp cavity (pulpa aperta or open pulp).
Dr.Caroline Mohamed

85. 6. Based on chronology EARLY CHILDHOOD CARIES ADULT CARIES
ADOLESCENT CARIES
Dr.Caroline Mohamed

86. Early childhood caries
Early childhood caries would include, two variants: Nursing caries and rampant caries.
The difference primarily exist in involvement of the teeth (mandibular incisors) in the carious process in rampant caries as opposed to nursing caries.
Dr.Caroline Mohamed

87. Teenage caries (adolescent caries)
This type of caries is a variant of rampant caries where the teeth generally considered immune to decay are involved.
The caries is also described to be of a rapidly burrowing type, with a small enamel opening.
The presence of a large pulp chamber adds to the woes, causing early pulp involvement.
Dr.Caroline Mohamed

88. Adult caries
With the recession of the gingiva and sometimes decreased salivary function due to atrophy, at the age of years, the third peak of caries is observed.
Root caries and cervical caries are more commonly found in this group.
Sometime they are also associated with a partial denture clasp.
Dr.Caroline Mohamed

89. 7.Based on whether caries is completly removed or not during treatment
RESIDUAL CARIES
Residual caries is that which is not removed during a restorative procedure, either by accident, neglect or intention.
Sometimes a small amount of acutely carious dentin close to the pulp is covered with a specific capping material to stimulate dentin deposition, isolating caries from pulp.
The carious dentin can be removed at a later time.

90. 8.Based on surfaces to be restored
Most widespread clinical utilization
O for occlusal surfaces
M for mesial surfaces
D for distal surfaces
F for facial surfaces
B for buccal surfaces
L for lingual surface
Various combinations are also possible, such as MOD –for mesio-occluso-distal surfaces.

91. 9.World health organization (WHO) system
In this classification the shape and depth of the caries lesion scored on a four point scale
D1. clinically detectable enamel lesions with intact (non
cavitated) surfaces
D2. Clinically detectable cavities limited to enamel
D3. Clinically detectable cavities in dentin
D4. Lesions extending into the pulp

92. 10. Assessement tools
Stepwise progression toward diagnosis & treatment planning depends on thorough assessment of the following
Patient History
Clinical examination
Nutritional analysis
Salivary analysis
Radiographic assessment
Dr.Caroline Mohamed

93. Conventional techniques of measuring and recording decay
Visual exam
Mirror and explorer
Dental radiographs
Dyes
Transillumination
Dmfs/dmft
Dr.Caroline Mohamed

94. VISUAL-TACTILE METHODS
Visual methods:
Detection of white spot, discoloration / frank cavitations.
Unable to detect subsurface caries.
Magnification loupes- Head worn prism loupes (X 4.5) or surgical microscopes (X 16) may be used.
Use of temporary elective tooth separation.
Dr.Caroline Mohamed

95. Use of explorer is not advocated because;
Tactile methods:
Explorers,Dental floss.
Use of explorer is not advocated because;
Sharp tips physically damage small lesions with intact surfaces.
Probing can cause fracture & cavitation of incipient lesion. It may spread the organism in the mouth.
Mechanical binding may be due to non-carious reasons Shape of fissure
Sharpness of explorer
Force of application
Path of explorer placement
Explores should be used to clean debris
from teeth.
Dr.Caroline Mohamed

96. X-rays + non –destructive + can detect subsurface caries
- limited safety
- unable to detect incipient
demineralization
- low resolution
Dr.Caroline Mohamed

97. Bitewings/ Periapical
Radiographic imaging of pit and fissures is of minimal diagnostic value because of the large ammount of sorrounding enamel enamel.
It is detrimental if used for non-invasive remineralization methods.
Dr.Caroline Mohamed

98. Direct fiberoptic transillumination
Enhanced visual technique that uses the principle of illuminating teeth to detect the presence of caries.
. (Pretty, Maupomé, 2004)  . 
The keystone of visual inspection of caries is based on the phenomenon of light scattering. Sound enamel is composed of densely-packed, modified hydroxyapatite crystals which give it a transparent structure. Hence, tooth colour is largely influenced by the underlying dentin shade. When enamel is disrupted in the presence of demineralization, the penetrating photons of light are scattered, which results in an optical disruption. In normal visible light, this appears as a ‘white spot’ – an area which looks whiter than the rest of the tooth. The appearance is enhanced in a dried lesion, as water has a similar refractive index (RI) to enamel, but air has a lower RI thus the lesion is more clearly seen. FOTI makes use of these optical properties of enamel and enhances them by using a high intensity white light shone through a small aperture (e.g mm) of a dental handpiece. The light that is shone through the tooth scatters and observed shadows may indicate the presence of a carious lesion. The reason why shadows may indicate caries is because demineralized areas of enamel or dentine scatter light more than sound areas. Hence, caries appear as darker areas under FOTI. (Pretty, 2006) The Method .
However, the system is subjective. Analysis is done by the examiner who makes the call based on the appearance of scattering. There is also no continuous data output and it is not possible to record what is seen in the form of an image. Furthermore, FOTI can only be used for coronal tooth surfaces (occlusal, interproximal, and smooth) and not below the gingiva. (Pretty, 2006)
Dr.Caroline Mohamed

99. Dental Caries Index DMF-T Decayed, Missed, Filled Teeth
D = Decayed / not treated yet
M = Missed / extracted because decayed
F = Filled / restored after decay
T = Permanent teeth
dmf-t = Primary teeth
S = Surface
DMF-S / dmf-s
( Mesial/ Distal/ Vestibular
/ Occlusal)
Dr.Caroline Mohamed

100. DMF-T CHART
Dr.Caroline Mohamed

101. 10. G. V. BLACK CLASSIFICATION:

102. CLASS 1: pit and fissure cavities that occur in the occlusal surfaces of bicuspids and molars, the occlusal two thirds of the buccal and lingual surfaces of the molars, and the lingual surfaces of incisors.
Cavities beginning in structural defects that occasionally occur on the occlusal or incisal two third of all teeth.
Dr.Caroline Mohamed

103. CLASS 2: cavities in the proximal surfaces of bicuspids and molars
Dr.Caroline Mohamed

104. CLASS 3: Cavities in the proximal surfaces of incisors and cuspids, not involving the incisal angle
Dr.Caroline Mohamed

105. CLASS 4: Cavities in the proximal surfaces of incisors and cuspids involving the incisal angle
Dr.Caroline Mohamed

106. CLASS 5: Cavities in the gingival third, not pit and fissures cavities, of the labial, buccal and lingual surfaces of all teeth

107. CLASS 6: Cavities on both mesial and distal proximal surfaces of bicuspid and molars that when restored will share a common isthmus; or cavities on the incisal edges of anterior or cusp tip of posterior teeth.
Dr.Caroline Mohamed

108. Dr.Caroline Mohamed

109. HIGH RISK LOW RISK Social History Socially deprived
High caries in siblings
Low knowledge of caries
Middle class
Low caries in sibling
High dental aspirations
Medical History
Medically compromised
Xerostomia
Long-term cariogenic medicine
No such problem
Dietary habits
Sugar intake: frequent
Infrequent
Dr.Caroline Mohamed

110. HIGH RISK LOW RISK Use of fluoride Non-fluoridated area
No fluoride supplements
Fluoridated area
Fluoride supplements used
Plaque control
Poor oral hygiene maintenance
Good oral hygiene maintenance
Saliva
Low flow rate& buffering capacity
 S.mutans & lactobacillus counts
Normal flow rate& buffering capacity
 S.mutans & lactobacillus counts
Dr.Caroline Mohamed

111. HIGH RISK LOW RISK Clinical evidence New lesions Premature extractions
Anterior caries restorations
Multiple/repeated restorations
No fissure sealants
Multi-band orthodontics
No new lesions
No extraction for caries
Sound anterior teeth
No/few restorations
Fissure sealed
No appliances
Dr.Caroline Mohamed

112. Thank you
Dr.Caroline Mohamed

113. Activity What is a fluoride bomb or fluoride syndrome?
Dr.Caroline Mohamed