The cumulative results of the de- and remineralization processes can be a net loss of mineral and a carious lesion that can be seen. The process takes place in the biofilm at the tooth or cavity surface; the interaction of the biofilm with the tooth tissue leads to the lesion in the tooth.
Pathogenic properties of cariogenic bacteria
Which plaque bacteria cause caries?
Where does caries occur?
A red dye has been used to color the plaque so that the patient can see the plaque clearly. Note that they are formed in an area of plaque stagnation and this can be shown to the patient to demonstrate the importance of plaque removal.
Is dental caries an infectious, preventable, disease?
Radiation to the area of the salivary glands used to treat malignant tumors is the most common cause of an acute reduction in salivary flow. This patient has received radiation to the area of the salivary glands for the treatment of a malignant tumor.
Measuring caries activity
An epidemiologist determines the frequency and severity of health problems based on factors such as age, gender, geography, race, economic status, diet, and nutrition.
Practical problems with DMF and def indices
In addition, there are probably differences between dentists in recording the disease. Epidemiologists conducting national surveys may have limited access to clinical settings because these surveys are not necessarily conducted in a dental office.
The relevance of diagnostic thresholds 4
In many populations there is a large filled component to the indices, and the dentists who performed the fillings are not standardized in their disease diagnosis. Dentists do not practice and monitor their diagnostic reproducibility in the same way as epidemiologists.
Caries prevalence 5
The reasons for the decline in caries prevalence are not fully understood, but experts consider the regular use of fluoride toothpaste, preferably twice a day, to be the single most important factor.7. For example, in Norway the decline appears to have started several years before the widespread use of fluoride toothpaste.
The position in the UK Children
Northern Ireland, Scotland and the north of England remain the parts of the UK with the worst dental health.12. The basis of preventive, non-operative treatment is modification of one or more of the factors involved in the caries process.
Further reading and references
- What is happening histologically?
- Appearance of the white spot lesion in polarized light In Figure 2.5 a white spot lesion on a smooth surface has been sectioned
- Arrest of lesions
- Clinical implications of subsurface porosity
- The shape of the lesion and its clinical implication
- Symptoms of pulpitis
Removal of the biofilm will stop both the dentin lesion and the enamel lesion. The body of the lesion (B) appears dark beneath a relatively intact surface zone (SZ). b) The same section as in (a), now examined in quinoline with the polarizing microscope.
Further reading
Free smooth surfaces
Active lesions are usually covered with plaque, close to the gingival margin and may have a matte appearance, indicating surface tissue loss (see Figure 1.4 on page 6). Sedentary lesions are hard and often located in a plaque-free area coronal to the gingival margin (Figure 3.6).
Pits and fissures (Figure 3.7) Clinical-visual and radiographic examination
This lesion was visible in dentin on a bitewing radiograph. f) The lesion seen in 3.7e is now approximated with an air rotor. The reproducibility of the machine has been shown to be very high. g) Cavitated occlusal lesion is a first molar.
Approximal surfaces 2 Clinical-visual examination
As shown schematically in Figure 3.10, the approximal enamel lesion appears as a dark triangular area in the enamel on the bitewing radiograph. A bitewing radiograph showing caries in enamel and dentin on the mesial aspect of the upper first molar.
Secondary or recurrent caries 2
After a few minutes, the deposited material can be removed with a probe and the impression examined for a cavity (Figure 3.14d). Discoloration around restorations with clinically intact margins also does not reliably predict new caries under the restoration (Figure 3.16).
Medical history
At the individual patient level, the best predictor of caries risk is current caries experience. The formation of lesions in areas such as lower incisors and buccal surfaces of molars, where the flow of saliva is relatively fast, also indicates a high risk of caries progression.
Medical history
Dental history
Oral hygiene
Diet
Fluoride
Saliva
Social and demographic factors
Dental history
It has been proven that these patients are at high risk for caries, and the dentist and patient must work together to determine why this is so. Maybe it is the saliva production, maybe the diet, but here too, detective work is needed to determine the cause.
Oral hygiene
Diet
Saliva
When the secretion rate is very low, the collected saliva may also be foamy and difficult to measure. Unstimulated salivary secretion rate. The patient sits quietly in the dental chair for 10 minutes, without chewing or swallowing, but spits into a disposable cup.
Social and demographic factors
Brushing twice a day with a fluoride toothpaste has been advocated by the profession for years, and this behavior is a routine part of many people's behavior. This daily brushing with a fluoride toothpaste is believed to be the main reason for the decline in caries observed in many populations since the 1970s.
The individual site
The individual patient
The community
Professional tooth cleaning
- Seeing plaque: disclosing agents and mirrors
- Toothbrushes Manual toothbrushes
- Methods of toothbrushing
- Interdental cleaning
- Toothpastes
- Professional plaque control
- Advice to patients
- Mechanism of action, dosage, and delivery
- Side effects Staining
- The use of chlorhexidine in the control of caries
- Epidemiological evidence
- Interventional human clinical studies
- Non-interventional human studies
- Animal experiments
- Recording the diet
Parents or caregivers should 'finish' brushing, paying particular attention to the occlusal surfaces of erupting teeth. There may be individual variation in the tolerance level of the oral mucosa to chlorhexidine.
Diet Analysis
- Analysis of the dietary record
- General advice
- Sugar substitutes
- Protective foods
However, if the patient understands the purpose of the record, they can suggest how it is best kept. Unfortunately, the remains of the denture were irreparable and the patient is now edentulous.
5.11.4 ‘Safe’ snacks
- Advice to pregnant and nursing mothers
- Young children
- Chronically sick children
- Patients with dry mouths
- Dietary changes
- Monitoring the effect of dietary advice
- Deposition of fluoride in enamel
- How does fluoride work in caries control? 5
- Signs of fluorosis
- Mechanism of fluorosis 6
- Fluoride in drinking water 6,8
- Salt fluoridation
- Fluoride in toothpaste 6,9
- Fluoride mouthwashes
- High-concentration preparations for periodic use
The risk of fluorosis depends on the fluoride dose relative to the child's weight. This is a useful table as it can indicate the amount of fluoride in the trap.
Indications
Dietary advice, as well as oral hygiene instructions, should always precede a prescription for fluoride. When dental apatite is exposed to preparations containing high concentrations of fluoride, the main reaction product is calcium fluoride (CaF2).
Contraindications
Functions of saliva
Although saliva aids in swallowing and digestion and is necessary for optimal function of the taste buds, its most important role is to maintain integrity. It is able to regulate the pH of the oral cavity by virtue of its bicarbonate content as well as its phosphate and amphoteric protein components.
Causes of reduced salivary flow
In addition, the drop in plaque pH, due to the action of acidogenic organisms, is minimized. It is generally accepted that a reduction in salivary flow is the inevitable result of aging.
General consequences of reduced salivary flow
However, there is no evidence that periodontitis, which involves loss of bone support, is affected. There is also modification of the plaque flora in favor of Candida, mutans streptococci and lactobacilli.
Assessment Drug history
Consequently, in patients with dry mouth, candidal infections are frequent and rampant caries are common if preventive measures are not taken.
Conservative measures to relieve symptoms
Salivary stimulants
Saliva substitutes
Another important difference between them is that while Luborant and Saliva Orthana contain fluoride, have a pH between 6 and 7, and have been shown to have significant remineralizing capacity in vitro, Saliveze and Glandosane do not contain fluoride. Ideally, a saliva substitute should contain fluoride and be supplemented with a daily fluoride mouthwash (see page 120).
Anticariogenic actions of saliva
Radiation caries 4
This is due to a reduction in the osteocyte population and bone vascularity. Such changes make the bone susceptible to trauma and infection and impair its ability to remodel and repair after extraction.
Management of dentate patients following radiotherapy for head and neck cancers
Preventive measures for patients with dry mouths
Therefore, it is particularly important that the patient is given dietary advice (see section 5.11) after a nutritional analysis (see section 5.10). The patient must apply 1% chlorhexidine gel (Corsodyl) in custom-made applicator trays (Figure 7.2) every evening for 14 days for 5 minutes.
Actual words
To remedy this, advice and instructions should be given early in the appointment, emphasizing the most important point, and then repeated or summarized when the patient leaves the office. The specialist can now discuss the time spent and how it can be adapted to the patient's lifestyle.
Tone
There is a tendency to twist what we have heard and to put our own interpretation on it. Her father, who took her to her dental appointment, agreed that they would do this.
Non-verbal communication or body language Facial expression
Is there a reason for that?’ This should bring eye contact back and allow the patient to explain what they are struggling with. A hand on the shoulder of an anxious patient when the dental chair is taken back can convey care for the patient and.
Involving the patient
Making use of other senses
Amount of information given
It is wise to provide less information rather than more and check that it has been understood. For example, if a fluoride mouthwash is recommended, the patient may be asked to use it at the end of the appointment.
Short, simple, and specific advice
Timing
Many patients, either wanting to please or trying not to look foolish, will nod their heads readily when they hear the advice being given, but often they haven't really understood it.
A telephone reminder
Diagnosing the problem; skill or motivation?
Whose problem?
Attempts at motivation are more likely to be successful if the dentist first shares his or her concerns and then discovers to what extent, if any, the patient is concerned. This is an important starting point and will guide the dentist in the future.
Patients’ beliefs
Personally relevant advice
Enthusiasm
High trust—low fear
Care
Praise
Negotiation
The patient's thoughts, ideas and beliefs are considered as important as the dentist's advice and technical expertise. For example, if the dentist thinks the patient should cut our sugar in drinks and use an artificial sweetener instead, it would be best to negotiate with the patient rather than dictate it to them.
Realistic goals
In this case, it may be helpful to prepare the patient several cups of tea or coffee sweetened with various artificial sweeteners and one cup sweetened with sugar. Each cup should be marked with a letter and the patient should be asked to rate the acceptability of the drink on a scale from 10.
Regular positive reinforcement and follow-up
Scoring
The common problems that arise with behavior change are: the goal is too difficult. the consequences of the behavior are too far away. They may say, “It's the dentist's responsibility to take care of my mouth, not mine,” demonstrating something external. locus of control where the patient believes that 'powerful others' are in control of what happens.
What constitutes treatment?
The dentist may find it more difficult to explain the importance of preventive treatment when the patient is experiencing discomfort and/or a cosmetic problem (Figure 9.1a). In these cases, treating the patient's problem (such as pain or an unsightly filling) is very important if the dentist is to win the patient's trust and cooperation in future preventive management.
Why treat operatively?
When discussing the importance of preventive treatment with a patient, a useful analogy can be made to the problem presented by a building that is on fire. The cosmetic improvement can be very satisfying and the dentist will be pleased with the restoration of teeth, smiles, function and dental health (Figure 9.1).
When to treat operatively 2
Previous attempts to arrest the lesion have failed and there is evidence that the lesion is progressing (this usually requires an observation period of months or years).
Isolation
The dental assistant should gently withdraw the rubber so that the dentist can see the tooth clearly (Figure 9.6b). The dental assistant should gently pull back the rubber so that the dentist can see the tooth clearly.
Cleaning the teeth
Etching
Washing
Drying the etched enamel
Mixing the resin
Sealant application
The outer surface layer of any sealant will not polymerize due to the inhibiting effect of oxygen in the atmosphere.
Checking the occlusion
Recall and reassessment
The cost-effectiveness of sealants
However, this concept does not match the current knowledge of the caries process that occurs in the biofilm. The essence of the question is this: in the advanced dentin lesion, what drives the caries process.
Placing fissure sealants over carious dentine 6
It is the interaction of this biofilm with the dental tissues that results in the carious lesion. Is it the bacteria in the biofilm or the bacteria in the infected dentin, or both.
Stepwise excavation 6
Logic would suggest that if the process is in the biofilm and the reflection is in the lesion, then only the biofilm needs to be removed and the lesion will stop. Over several months, the heavily infected soft surface gradually wears away and the lesion becomes shiny and hard.
Why re-enter?
Caries removal in the clinic
Where it is not possible to remove soft, infected dentin (perhaps the patient is anxious or uncooperative), the infected dentin is sealed. However, if the patient has symptoms of acute apical infection, thorough debridement of. the root canal system is required prior to placement of a mild antiseptic dressing in the coronal pulp chamber and temporary restoration of the tooth.
