Chapter 14 DENTAL CARIES

DIAGNOSIS &TREATMENT 3 Major Steps Data gathering Examination of Patient Preparing & Presenting Treatment Plan

ASSISTANTS ROLE Aid patients in completing forms Generating diagnostic aids Radiographs Diagnostic casts Recording Dentists findings during exam ACCURATELY

METHODS Manual: Assistant records data on patient chart Color coded pencils indicate condition of teeth BLUE = Existing/comp. RED = Needs to be done Computerized Patients charts are stored on computer some are voice activated Others require Asst. or Hygienist to enter

CLINICAL EXAM Dentist looks for: Oral lesions Dental decay Fractured teeth Periodontal disease Other dental anomalies

CLINICAL EXAM cont. Intra oral imaging or camera assist dentist’s explanation with visual Computers may show enlarged x-rays for easy viewing

CLINICAL EXAM cont. Detailed scrutiny each tooth Mal-positioned teeth Structural defects, stains, fractures Decalcified areas & small breaks in enamel Carious lesions/indications recurrent decay Overhangs of Amalgam or Cast Restoration Poor fitting prosthesis Abnormal wear patterns of teeth

CLINICAL EXAM cont. Dental caries is a disease initiated by microbial activity involving hard portions of teeth Caries is a disintegration of enamel, dentin, cementum, forming open lesions, commonly known as: CAVITIES & DECAY

PREREQUISITES / DECAY Plaque on tooth surfaces Shelter areas between teeth: interproximal surfaces, embrasures, or defects in teeth such as pits and fissures are a breeding ground Microorganism in plaque ferment carbohydrates form food to produce acid. Acid attacks enamel = demineralization = destruction

RATE OF DECAY Depends on Abundance of plaque Type Number of organisms Amount of carbohydrates available for conversion Resistance of the tooth structure

DECALCIFICATION First step in decay- loss of calcium salts from enamel Enamel is weakened / eventually destroyed INCIPIENT caries have not progressed Appear slightly chalky or opaque Surface is rough and granular Pits & Fissure may be a darkened, shaded outline

CARIOUS PROCESS Reaches the dentin: Spreads rapidly Spreads laterally Undermines the enamel (often not visible until extensive destruction occurs) Unless arrested will continue to pulp ARRESTED caries: shows no tendency for further progress into tooth

CARIOUS PROCESS Recurrent caries: occur beneath existing restorations due to Improper cavity prep Inadequate cavity restoration Faulty sealing of the restoration, “leaky margin”

CARIOUS PROCESS Rampant decay: Wide spread decay Usually found in high risk patients Baby bottle syndrome Nursing bottle syndrome Babies put to bed + bottle + sugary liquids Saliva production slows while sleeping Sugar + bacteria + dental plaque = Acid Acid attacks enamel

CARIOUS PROCESS Root caries: CEJ exposed = very susceptible to decay Cervical abrasion or erosion: not caused by bacteria, but by chemical or mechanical influences Tooth brushing Bulimia Attrition Sucking lemons

DENTAL CHARTING Dental charting: Part of Patient legal record Initial charting done on first visit Indicate existing first, what has been done and what needs to be done. Record used for diagnosis, consults w/other Drs., accounting purposes Forensics

TYPES OF CHARTS Anatomical Geometric Shows complete tooth buccal or facial Crown or incisal edge Crown only of lingual surface Includes primary dentitions in some form Geometric Shows circle:each circle section into 5 areas Generally includes primary dentition

NUMBERING SYSTEMS Universal / National system International Palmer What we use 1-32, A-T International Used in Europe and Canada Palmer Used in orthodontics

CAVITY CLASSIFICATION Developed by GV Black Class I : pits & fissures Class II : posterior only, involves a proximal surface, usually 2 or more Class III:anterior only, involving interproximal Class IV:anterior only, interproximal & incisal Class V: occur cervical or gingival third both lingual & facial/buccal all teeth Class VI: w/o Black, worn areas by abrasion

ABBREV. TOOTH SURF. Simple: one tooth surface Compound: two surfaces Complex: more than two Use first letter of word: ex. Mesial = M More than one: combine/drop al, add o Ex: mesio-occlusal, distolingual Mesial = first if present, lingual & facial last

ABBREV. TOOTH SURF. Facial replaces labial when referring to anterior teeth Basic terms: Abscess: localized infection Bridge: abutments, pontics, maryland bridge An appliance that replaces 1 or more missing Crown: “cap” SSC, FGC (Full Gold Crown), PFM (Porcelain Fused to Metal) FPC (Full Porcelain Crown) Denture: FUD (Full Upper Denture) FLD (Full Lower Denture)

ABBREV. TOOTH SURF. Basic terms cont.: Incipient: beginning decay- “watch” Overhang: excessive material Partial denture: removable prosthesis replacing one or more but less than all missing teeth Restoration: amalgam or composite filling, crown or inlay Root canal therapy: pulp in removed and replaced with filling material Sealant: material placed into pits & fissures to PREVENT caries

CHARTING Charting Colors: Periodontal charting: RED: represent work that need to be done BLUE: work that has been completed Periodontal charting: Perio screening & recording part of exam Tip of probe marked in 3mm increments Six surfaces probed: mesiofacial, buccal, distofacial, mesiolingual, lingual, distolingual

CHARTING cont. Periodontal cont. Readings of 3mm or less is normal sulcus depth, charted in Blue Readings over 3mm considered periodontal pockets & abnormal, charted in Red Other considerations during perio exam: Mobility: Roman numerals 0-3 Recession Furcations, & Mucogingival problems

QUESTIONS????? When in doubt about charting ASK ACCURACY MATTERS