Oral Health Training & Calibration Programme

1. Oral Health Training & Calibration Programme Tooth Status

2. Tooth Status Coding:

3. Tooth Status Assessing Dental Caries • The examination should be conducted with a plane mouth mirror & Williamsexplorer • The explorer should be used to clean off any food debris • Before scoring the teeth identify which teeth are present and absent • Adopt a systematic approach to the examination: • Proceed from upper right to left & lower left to lower right • Record the crown and the root status separately. • Do not aggressively probe surfaces; visual decay may be confirmed by probing to detect the softened floor of the lesion

4. Assessing dental caries • If in doubt leave it out…score low • Don't second-guess yourself: score tooth and move on • Permanent teeth take precedence over primary teeth occupying the same space - record the status of the permanent tooth • Decay takes precedence over a filling on the same tooth: record the decay not the filling • If a filling or a cavity crosses over the dentinal-enamel junction by more than 1mm then score the condition on both. • Ignore supernumeraries

5. Assessing dental caries • A tooth should be considered present when any part of it is visible • Different fields for primary teeth 55-65 and 75-85 • Each box for each primary and/or permanent tooth must be coded For 12 year olds and older, usually code ‘6’ for all primary teeth. • Data must be entered in both the crown & root boxes for the same permanent tooth. • Root caries recorded at age 18 years and older

6. Caries Iceberg Cavitation Non cavitated dentine caries Enamel Caries Easy to diagnose • Harder to diagnose • Good Eyesight • Clean tooth • Good lighting • Aids

7. Caries Iceberg We measure a stage of caries progression: “Obvious dentinal decay” We must all measure at the same level (regardless of eyesight) Cavitation Non cavitated dentine caries Enamel Caries

8. Iceberg Cavitation Non cavitated dentine caries Enamel Caries Often no clear distinction between normal and abnormal

9. Code 1 Sound never decayed or restored • -The tooth shows no evidence of treated or untreated clinical dentinal caries. • -The following conditions are scored as sound -white or chalky spots -discoloured or rough spots -stained pits or fissures in the enamel that catch the explorer but do not have a detectably softened floor -undermined enamel, or softening of the walls -dark, shiny, hard, pitted areas of enamel in a tooth showing signs of moderate to severe fluorosis • -All questionable lesions should be coded as sound.

10. Code 2 Sound crown sealed • Never decayed or otherwise restored (crown only) and the tooth has been sealed with an unfilled resin material • Can be difficult to distinguish from preventive resin restorations • Can be difficult to distinguish from composite restorations

11. 65 is code 1, 26 is Code 2, 27 is Code 1

12. Code 1 Sound

13. Code as Sound

14. Codes 3-6, 19 Missing tooth • 3: Missing – due to orthodontic treatment • 4: Missing – due to trauma • 5: Missing – due to caries or periodontal disease • 6: Unerupted tooth, congenitally missing or unexposed root teeth that are missing because they are not yet erupted congenitally missing; deciduous teeth that have been exfoliated you are unsure of the reason for the loss • 19. Implant: tooth is replaced with an implant

15. 12 is Code 6 Congenitally Missing Tooth

16. Caries Codes 7-10 Crown, 11 RootDecayed (includes temporary filling) - Crown and/or Root • Caries is recorded at the obvious dentinal level of involvement • 7. Decayed severely (+/- separate filling) lesion extending at least 2/3 of the way through the crown structure or has progressed at least ½ way through the root • 8. Decayed – pit and fissure caries (crown only). • 9. Decayed – as above smooth surface caries (crown only) • 10. Decayed – as above both smooth surface & pit and fissure caries (crown only) • 11. Decayed – smooth surface caries (root only)

17. What Code Should You Score?

18. Visual Caries 12 Code?

19. What Code Should You Score?

20. Codes 12-14Filled - Crown and/or Root • 12. Filled with amalgam, no other decay • 13. Filled with other material (resin, GIC, inlay, crown), no other decay • 14. Filled with amalgam and other material (resin, GIC, inlay, crown), no other decay

21. Code 11: Root Caries Code Crown 13 and root 13

22. Code 13Filled with resin on 11, 21

23. Codes 15-17:Filled – Defective, no other decay Crown and/or Root • 15. Filled with amalgam, no other decay, but filling is defective and needs replacement • 16. Filled with other material (resin, GIC, inlay, crown) but filling is defective and needs replacement • 17. Filled with amalgam and other material (resin, GIC, inlay, crown) but filling is defective and needs replacement

24. Defective Composite

25. Defective Amalgams

26. Codes 18 - 21 • 18. Bridge abutment, special crown or veneer (crown only): restoration placed for reasons other than caries • 20. Fractured due to trauma: Tooth is fractured as a result of trauma. Fracture has been or can be repaired and rehabilitated. (ask respondent) • 21. Other : This box allows the examiner to code and specify a condition NOT identified in the above codes. An example may be a vertically fractured tooth

27. Tooth13- Code 18 Bridge Abutment

28. Code 20

29. Code 20 Restoration not for caries

30. Code Hierarchy • Use the Codes in this order: • Sound or Sound and Sealed • Caries • Restorations for Caries • Restorations for Trauma • Restorations for Aesthetics • e.g. Tooth has restorations for trauma, aesthetics and caries – use caries codes • ***Talk to the respondent to assist in your decision