1. Clinical Trends In The Diagnosis And The Treatment Of Dental Caries
dr shabeel pn

2. LOW RISK PATIENT No cavitated lesions
May have inactive white spots (smooth shiny).
Bacteria MS levels are low
Diet is normal sugar levels low
Normal Saliva levels
Low DMF (Hx)

3. MODERATE RISK PATIENT No cavitated lesions
Some active white spot lesions (rough/chalky)
Bacterial MS levels elevated
Moderate sugar use
Saliva normal or reduced (xerostomia)
Moderate DMF (Hx)

4. HIGH RISK PATIENT One or more cavitated lesions
May have white spot lesions (active or inactive)
Bacterial MS levels are very high
Sugar intake very high
Saliva levels low (xerostomia)
High DMF (Hx)

5. 1. Bacterial Control A. Surgical Antimicrobial Tx
Treat cavitated lesions first.
Fill with glass ionomer, compomer, composite or IRM.
Very large lesions may require temporary crowns (sub-gingival margins),RCT, or EXT.
Place sealants as needed:
Occlusal surfaces with chalky white spots
Deep grooves and Old fillings with poor margins
Molars > Premolars
Surgical choices based on Site(pit & fissures vs. smooth surface), Activity and Risk.

6. Treatment Plan Medical Model
Bacterial Control
Surgical Antimicrobial Tx (Restorations) Wound debridement / I&D = Fill/Temporize cavitated lesions/Place sealants
Chemotherapeutic Antimicrobial Tx(meds) Fluoride Varnish, CHX, and Xylitol Gum
Reduce Risk Level of At-Risk Patients
Reverse Active Sites = Remineralization
Long Term Follow Up and Maintenance
Home maintenance
Office Recall/Continuing Care
Heal Vs.Cure (Process/Relationship)

7. 1. Bacterial Control A. Surgical Antimicrobial Tx
Treat cavitated lesions first.
Fill with glass ionomer, compomer, composite or IRM.
Very large lesions may require temporary crowns (sub-gingival margins),RCT, or EXT.
Place sealants as needed:
Occlusal surfaces with chalky white spots
Deep grooves and Old fillings with poor margins
Molars > Premolars
Surgical choices based on Site(pit & fissures vs. smooth surface), Activity and Risk.

8. 1. Bacterial Control B.Chemotherapeutic Antimicrobial Tx
Fluoride Varnish 1-3 initial applications upon completion of Surgical Tx. Use 3 applications in 10 day period for patients who need remineralization or for patients with CHX issues or compliance problems (possible use of Iodine rinse).
CHX = Chlorhexidine Rinse 0.12% take ½ oz. before bed for 2 weeks. Repeat in 2-3 months
Xylitol Gum. Use 2 pieces for 5 minutes minimum 5 times a day.
Mutans Test for Very High Risk patients

9. 2. Reduce Risk Levels of At Risk Patients
Reduce Sugar !!!!!!!!!!!!!!!!! (Xylitol/Sucrose substitutes)
Reduce Bacteria (antimicrobials, Xylitol gum, and OHI) and MS test PRN.
Increase Saliva (Xylitol gum and mints, Rinses, change medications if possible).
Increase Home Fluoride use.

10. 3. Reverse Active Sites Remineralization Tx
In Office – Fluoride varnish 3 applications in 10 day period (if not done as a part of Step 1B)
At Home – Fluoride
Moderate or High Risk Patient: Toothpaste (1000 ppm) qd ppm dentifrice or gel qd +OTC (over the counter) rinse 250 ppm several times a day especially hs.
Very High risk Patient: Toothpaste 5000 ppm dentifrice or gel qd ppm dentifrice or gel in a tray qd +OTC (over the counter) rinse 250 ppm several times a day especially hs.
Xylitol gum: 2 pieces 5 times a day.
Calcium Source: Cheese or new gums with amorphous Calcium Phosphate.

11. 4. Long Term Follow Up A. Home Maintenance
At Home – Fluoride
Moderate or High Risk Patient: Toothpaste (1000 ppm) qd ppm dentifrice or gel qd +OTC (over the counter) rinse 250 ppm several times a day especially hs.
Very High risk Patient: Toothpaste 5000 ppm dentifrice or gel qd ppm dentifrice or gel in a tray qd +OTC (over the counter) rinse 250 ppm several times a day especially hs.
Xylitol gum 2 pieces 5 times a day.
Decreased use of sucrose between meals
Calcium Source.

12. 4. Long Term Follow Up B. In Office Continuing Care
3 Month Visit
Polish (If this is also a 3 mo perio maint patient do perio probing/scaling first)
Exam / evaluate white spots for remineralization / return to steps 1-3 PRN (D0140)
Fluoride varnish (D1204)
6 Month Visit (3 months later)
PSR or Perio Probing / Scaling / Polish
Exam / evaluate white spots for remineralization / return to steps 1-3 PRN (D0120)
9 Month Visit (3 months later)
1 Year Visit (3 months later)
Bite wing + other x-rays PRN
Exam / Evaluate Activity Levels I.e. white spot and interprox x-rays (D0120)
Exam / Evaluate Risk Level for next years CC schedule (Low Risk 6mo CC / Moderate or High risk 3mo CC if active: 6mo CC if inactive/ Very High Risk 3mo CC)

13. Treatment Groups by Risk/Activity Status.
Low Risk (LR)
Moderate Risk Inactive (MRI)
Moderate Risk Active (MRA)
High Risk Cavitated (HRC)
High Risk Cavitated Active (HRCA)
High Risk Inactive (HRI)
Very High Risk (VHR)

14. 6 + 3 2 1 ++ 12 TREATMENT GROUP # Home Fluoride Low Risk LR
Filling
Temp Cr
Seal #
1st
FLV
Per Yr
CHX
Xylitol CC
Interval
Months
Remin Ca
Home
Fluoride
Low Risk LR 6
1000 ppm Paste
Moderate Risk
Inactive
MRI +
5000 ppm Paste
+ Rinse
Active
MRA 3 2
High Risk
Cavitated
HRA 1
Cavitated Active
HRCA
HRI
Very High Risk
VHR ++ 12
In a Tray