Chapter 14

1. Chapter 14 DENTAL CARIES

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

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

4. 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 METHODS

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

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

7. 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

8. 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

9. PREREQUISITES / DECAY • Plaque on tooth surfaces • Shelter areas between teeth: interpoximal 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

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

11. 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

12. 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

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

14. 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

15. 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

16. 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

17. TYPES OF CHARTS • Anatomical • 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

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

19. 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

20. 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

21. 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, gold, porcelian • Denture: full

22. ABBREV. TOOTH SURF. • Basic terms cont.: • Drifting: over-erupted-arrows pointing direct. • Incipient: beginning decay- “watch” • Overhang: excessive material • Partial denture • Restoration • Root canal • Sealant

23. CHARTING • Charting Colors: • 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

24. 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

25. QUESTIONS????? • When in doubt about charting ASK • ACCURACY MATTERS