4/13/2010
1
Prepared by Dr Lea Foster
1
Dental Caries is a disease of the hard tissues, characterized by the decalcification of the inorganic portions of the tooth. Loss of the mineral content is the followed by breakdown of the organic matrix. This destructive process results from the metabolism of carbohydrates by microorganisms.
2
caries (ker´ēz), n in dentistry, the decay of a tooth. Colloquial term is cavity. Advanced caries. caries, arrested, n the state existing when the progress of the decay process has halted. It is noted by its dark staining without any breakdown of tooth tissues.Caries Assessment Tool (CAT), n.pr an analysis that examines the risk factors for the development of dental caries in infants and young children. Risk factors such as the environment, family history, and general health can be identified early, thereby reducing a patient's risk for developing dental caries and other diseases of the teeth and gingival tissues.caries, baby bottle, n See caries, early childhood (EEC).caries, cemental (root surface), n the decay of the
caries, gross, n a form of caries with advanced dental decay that is easily seen clinically.caries, healed, n See caries, arrested.caries, incipient, n a decayed part of a tooth in which the lesion is just coming into existence.caries, nursing, n See caries, early childhood (EEC).caries, pit-and-fissure, n See cavity, pit and fissure. See also sealant, enamel.caries, plaque-related, n the caries associated with plaque formation. Most commonly located in the pits and fissures of the teeth, especially the molar and premolar teeth, and along the gingival tissue and also the margins associated with dental restorations.caries, proximal, n decay occurring in the mesial or , ( ), y
cementum that occurs as a result of gingival recession and exposure of the root surface. See also caries, cervical (root surface).caries, cervical (root surface), n the decay that appears on the root at the cementoenamel junction or the neck as a result of gingival recession and exposure of the root surface. See also caries, cemental (root surface).caries, chronic, n a form of caries that occurs over time and demands regular dental intervention.caries, compound, n a type of caries that affects two or more surfaces of a tooth.caries, early childhood (EEC), n a form of severe dental decay occurring in young children that is caused by long and frequent exposure to liquids that are high in sugar, such as milk or juice. Because this form can damage the underlying bone structure, it may affect the development of permanent teeth.caries, enamel, n the decay that occurs in the enamel of a tooth because of a fissure or the collection of bacterial plaque. It appears first as white spots, which later darken to brown.
distal surface of a tooth.caries, rampant, n a suddenly appearing, widespread, rapidly progressing type of caries.caries, recurrent, n the extension of the carious process beyond the margin of a restoration. Also called secondary caries.caries, residual, n (residual carious dentin), the decayed material left in a prepared cavity and over which a restoration is placed.caries, root, n tooth decay occurring on a portion of the root that is exposed. Root caries. caries, senile n older term for the decay noted particularly in the elderly when supporting tissues have receded; occurs in cementum, usually on proximal surfaces of the teeth.caries, smooth surface, n the decay that occurs on the smooth surfaces of the tooth. See also caries, proximal dental and S. mutans. 3
CavityG.V. Black
Class I
CariesMount and Hume
Site:1 – Pit and fissure2 Approximal Class II
Class IIIClass IVClass V
2 - Approximal3 – Close to Gingival Margin
Size:MinimumModerateLargeExtensive 4
Class I, II, III, IV,V
5
Class I – Originating in occlusal or buccalpits and fissures
6
4/13/2010
2
Class II – Interproximallesions – posterior teeth
Mesio-occlusal (MO)Disto-occlusal (DO)Mesio-occluso-distal (MOD)
7
Class III –Interproximallesions –anterior teeth
8
Class IV –interproximal anterior lesions involving the incisal edge
9
A Bit of EverythingA Bit of Everything
10
Pits and fissuresInterproximalsInterproximalsCervical marginsRoot surfacesRestoration margins
11 12
4/13/2010
3
A multi factorial A multi-factorial disease
13
1. Enamel lesion- no cavity
2. Enamel lesion –cavity
3 Dentine lesion
Pit and FissureApproximalCervical marginRoot cariesS h f ( l 3. Dentine lesion
4. Dentine lesion with pulpal involvement
Smooth surface (early childhood/ baby bottle)RecurrentIatrogenicArrested
14
History, Clinical Examination and Diagnostic aidsand Diagnostic aids
15
Pre-disposing factorsDietFluid consumptionOral Hygiene habitsLevel of understanding and motivationDrug therapy impacting on saliva flowMouth-breathing
16
17 18
4/13/2010
4
Visual diagnostic features
19
Deep retentive fissure pattern
Dark staining
White enamel
20
21
Visual diagnostic features
22
Non-cavitated• Shadowing• White ‘reverse caries’
C it t d i l i d tiCavitated – involving dentine• Shadowing and reverse caries indicate the
extent of the lesion
Cavitated – involving pulp
23 24
4/13/2010
5
Visual Diagnostic Features
25
White spot lesion –not cavitated
Cavitated –involving dentine
Extensive
26
27 28
Visual diagnostic features
29
May occur in conjunction with TBA/abfraction
lesions
Occurs below the level of the enamel
30
4/13/2010
6
31
Includes Early Childhood caries(AKA Baby bottle caries)Visual diagnostic features
32
Affects primary upper anterior
teeth
As well as primary lower
4’s and 5’s33 34
Secondary CariesVisual diagnostic featuresVisual diagnostic features
35
Affecting the margins of restorations
May occur as a fuction of failure of the restorative material
Or as a function of microleakage
36
4/13/2010
7
37 38
Damage caused by the operator in the process of treating other teeth
39
Damage to the approximal surface of adjacent teeth during tooth preparation and the finishing of restorations can result in the formation of cariesVarious studies show the incidence of this type of damage being from 50 -90% (1-3)
Scratching/pitting of the surface of sound enamel at the contact Scratching/pitting of the surface of sound enamel at the contact will remove the fluoridated surface layer and leave a rough surface which retains plaqueFlattening of the adjacent tooth results in the creation of flat contacts – makes it impossible to restore a natural rounded contact area between teethLeads to food traps – new caries, recurrent caries in restorations & periodontal pocket formation
40
41 42
4/13/2010
8
How does caries feel to the probe?
43 44
Probe may not stick –or there may be a catch
45
Probe may or may not catch.
46
47
Surface feels sound
48
4/13/2010
9
Chalky feelPitting of the enamel surface.Pits within the white spot lesion
49
Loss of overlying enamelDentine is soft – probe tip can penetrate
50
Lesions are dark and feel hard or very ‘leathery’P b ti d t t t il if t llProbe tip does not penetrate easily if at all
51 52
Not able to reach these with a probeOther diagnostic aids?g
53
Rather obvious – no mystery here
54
4/13/2010
10
RadiographyLaser induced fluorescenceFibreoptic transillumination
55 56
DescriptiveIncipientModerate
Stages12ORModerate
AdvancedSevere
234
OR
57
IncipentUp to half way through enamel
ModerateMore than halfway through enamel up to DEJ
Stage 1 Stage 1
Stage 2
58
AdvancedFrom DEJ up to halfway through dentine
SevereMore than halfway through dentiney g
Stage 3
Stage 4
59 60
4/13/2010
11
61 62
63 64
65 66
4/13/2010
12
67
Diagnosis of interproximal caries
68
69 70
Laser- Stimulated Fluorescence
71 72
4/13/2010
13
The tooth surface is illuminated by a red light(excitation wavelength at 655 nm, modulated) that is produced by a laser diode and transmitted by an optical fiber.The laser induces fluorescence in mineralized tooth tissues, at a greater intensity in carious than in sound tooth tissuesTh i d b i l fib h di d i h l Then transmitted by an optical fiber to a photodiode with a long pass filter (wavelength >680 nm) in the detection deviceNumerical value of the digital display (in units related to a calibration standard) correlates quantitatively with the intensity of the fluorescence detected and thus indicates the extent of caries (colour graphics have been developed also)Lussi et al. (5) suggested that a score of 20 indicates caries extending into the dentin, and this reference has been used in other studies using DIAGNOdent (6,7)
73
11
74
11
75
General decline in the prevalence of dental caries owing to the increased use of fluoride in the form of fluoridated water, fluoride toothpaste, and fluoride agents that are applied professionally or at home.Pattern of caries has also changed: the proportion of caries found in occlusal fissures has risen and pit and fissure caries are now perceived as the predominant typesmain reason for these changes is that fluoride inhibits enamel breakdown, so caries reaching the dentin tend to progress beneath a clinically intact enamel surfacedifficulty in visually inspecting the fissures of molars - such cases of occlusal dentinal caries, known as “hidden caries”, are commonly missed on visual examination and carious cavities are seen only at a late stage of disease.Is regarded as a useful adjunct to other forms of conventional diagnosisReproducible and therefore excellent aid to monitor changes
(4,8,9,10,11)
76
Transillumination
77
CURING LIGHTUseful in the anterior regionCan help to visualize the l l f level of penetration of caries into dentine
78
4/13/2010
14
All our diagnostic techniques are aimed at early detectionare aimed at early detection
79
Accurate diagnosis is the first step in determining the proper course of action
Preventive and minimum intervention strategies can then be applied
80
Is active caries present
If so…..at what rate is it progressing
81
the risk of recurrent caries increases
with marginal gap width
caries always progresses
rapidlyrestorations cure caries
1382
d
Prevention & remineralization
size and location of white spot lesions and
stained fissures
active and arrested
non-cavitatedenamel lesions
arrested non-
cavitatedlesions
within the outer third of dentin
slowly progressing
lesions within the outer third of dentin
rapidly progressing
lesions within the outer third of dentin
lesions in the inner
two thirds of dentin
secondary caries
adjacent to restorations
cavitatedlesions
13
Intervention
83
rapidly progressing
lesions within the outer third of dentin
lesions in the inner two thirds of dentin
secondary caries
adjacent to restorations
cavitated lesionsImmediate interventivetreatment
84
4/13/2010
15
Subsequent decisions about whether to place or replace restorations at other sites should be at other sites should be delayed until the most conservative options have been considered
85 86
E0 – no caries, E1- outer enamel, E2 – Inner enamelD1 - outer 1/3 dentine, D2 – middle 1/3 dentine, D3 – inner 1/3 dentine
15 87
1. Qvist, V., L. Johannessen, et al. (1992). "Progression of Approximal Caries in Relation to Iatrogenic Preparation Damage." Journal of Dental Research 71(7): 1370-1373
2. Medeiros, V. A. F. and R. P. Seddon (2000). "Iatrogenic damage to approximal surfaces in contact with Class II restorations." Journal of Dentistry 28(2): 103-110
3. Lussi, A. and M. Gygax "Iatrogenic damage to adjacent teeth during classical approximal box preparation." Journal of Dentistry 26(5-6): 435-441
4. Chu, C., E. Lo, et al. "Clinical diagnosis of fissure caries with conventional and laser-induced fluorescence techniques." Lasers in Medical Science
5. Lussi A, Megert B, Longbottom C, Reich E, Francescut P (2001) Clinical performance of a laser fluorescence device for detection of occlusal caries lesions. Eur J Oral Sci 109:14–19. doi:10.1034/ j.1600- 722.2001.109001014.x
6. Reis A, Mendes FM, Angnes V, Angnes G, Grande RH, Loguercio AD (2006) Performance of methods of occlusal caries detection in permanent teeth under clinical and laboratory conditions. J Dent 34:89–96. doi:10.1016/j.jdent.2005.04.002y j j
7. Silva BB, Severo NB, Maltz M (2007) Validity of diode laser to monitor carious lesions in pits and fissures. J Dent 35:679–682. doi:10.1016/j.jdent.2007.05.005
8. Attrill DC, Ashley PF (2001) Occlusal caries detection in primary teeth: a comparison of DIAGNOdent with conventional methods. Br Dent J 190:440–443
9. Baelum V, Nyvad B, Gröndahl HG, Fejerskov O (2008) The foundations of good diagnostic practice. In: Fejerskov O, Kidd E (eds) Dental caries. The disease and its clinical management, 2nd edn. Blackwell Munksgaard, Oxford, pp 104–118
10. Jonas A. Rodrigues & Michele B. Diniz & Érika B. Josgrilberg & Rita C. L. Cordeiro - In vitro comparison of laser fluorescence performance with visual examination for detection of occlusal caries in permanent and primary molars Lasers Med Sci (2009) 24:501–506 DOI 10.1007/s10103-008-0552-4
11. Hibst, R., R. Paulus, et al. (2001). "Detection of Occlusal Caries by Laser Fluorescence: Basic and Clinical Investigations." Medical Laser Application 16(3): 205-213
12. Small Cavities, Big Problems - Diagnosis and Treatment of Non-Cavitated Carious Lesions http://www.dentalcompare.com/dentist_profile.asp?expertid=274&headerid=36
13. Anusavice, K. (1995). "Treatment regimens in preventive and restorative dentistry." J Am Dent Assoc 126(6): 727-74314. Evans, R. W., A. Pakdaman, et al. (2008). The Caries Management System: an evidence-based preventive strategy for
dental practitioners. Application for adults. Australian Dental Journal, Blackwell Publishing Limited. 53: 83-92.15. Anusavice, K. (2001). "Clinical decision-making for coronal caries management in the permanent dentition." J Dent Educ.
65(10): 1143-1146
88