Chapter 14Chapter 14

DENTAL CARIESDENTAL CARIES

DIAGNOSIS &TREATMENTDIAGNOSIS &TREATMENT

3 Major Steps3 Major Steps

Data gatheringData gathering

Examination of PatientExamination of Patient

Preparing & PresentingPreparing & Presenting

Treatment PlanTreatment Plan

ASSISTANTS ROLEASSISTANTS ROLE

Aid patients in completing formsAid patients in completing forms Generating diagnostic aidsGenerating diagnostic aids RadiographsRadiographs

Diagnostic castsDiagnostic casts

Recording Dentists findings during Recording Dentists findings during exam exam ACCURATELYACCURATELY

METHODSMETHODS

Manual: Manual: Assistant records data Assistant records data

on patient charton patient chartColor coded pencils Color coded pencils

indicate condition indicate condition of teethof teeth

BLUE = Existing/comp.BLUE = Existing/comp.RED = Needs to be RED = Needs to be

donedone

ComputerizedComputerizedPatients charts arePatients charts are stored on computerstored on computer some are voice some are voice

activatedactivated Others require Asst. Others require Asst.

or Hygienist to enteror Hygienist to enter

CLINICAL EXAMCLINICAL EXAM

Dentist looks for:Dentist looks for:

Oral lesionsOral lesions

Dental decayDental decay

Fractured teethFractured teeth

Periodontal diseasePeriodontal disease

Other dental anomaliesOther dental anomalies

CLINICAL EXAM cont.CLINICAL EXAM cont.

Intra oral imaging or camera assistIntra oral imaging or camera assist

dentist’s explanation with visualdentist’s explanation with visual

Computers may show enlarged x-rays for Computers may show enlarged x-rays for easy viewingeasy viewing

CLINICAL EXAM cont.CLINICAL EXAM cont.

Detailed scrutiny each toothDetailed scrutiny each tooth Mal-positioned teethMal-positioned teeth Structural defects, stains, fracturesStructural defects, stains, fractures Decalcified areas & small breaks in enamelDecalcified areas & small breaks in enamel Carious lesions/indications recurrent decayCarious lesions/indications recurrent decay Overhangs of Amalgam or Cast RestorationOverhangs of Amalgam or Cast Restoration Poor fitting prosthesisPoor fitting prosthesis Abnormal wear patterns of teethAbnormal wear patterns of teeth

CLINICAL EXAM cont.CLINICAL EXAM cont.

Dental caries is a disease initiated by Dental caries is a disease initiated by microbial activity involving hard portions microbial activity involving hard portions of teethof teeth

Caries is a disintegration of enamel, Caries is a disintegration of enamel, dentin, cementum, forming open lesions, dentin, cementum, forming open lesions, commonly known as: commonly known as:

CAVITIES & DECAYCAVITIES & DECAY

PREREQUISITES / DECAYPREREQUISITES / DECAY

Plaque on tooth surfacesPlaque on tooth surfaces Shelter areas between teeth: interproximal Shelter areas between teeth: interproximal

surfaces, embrasures, or defects in teeth surfaces, embrasures, or defects in teeth such as pits and fissures are a breeding such as pits and fissures are a breeding groundground

Microorganism in plaque ferment Microorganism in plaque ferment carbohydrates form food to produce acid.carbohydrates form food to produce acid.

Acid attacks enamel = demineralization = Acid attacks enamel = demineralization = destructiondestruction

RATE OF DECAYRATE OF DECAY

Depends on Depends on Abundance of plaqueAbundance of plaque TypeType Number of organismsNumber of organisms Amount of carbohydrates available for Amount of carbohydrates available for

conversionconversion Resistance of the tooth structureResistance of the tooth structure

DECALCIFICATIONDECALCIFICATION

First step in decay- loss of calcium salts from First step in decay- loss of calcium salts from enamelenamel

Enamel is weakened / eventually destroyedEnamel is weakened / eventually destroyed INCIPIENT caries have not progressedINCIPIENT caries have not progressed

Appear slightly chalky or opaqueAppear slightly chalky or opaque Surface is rough and granularSurface is rough and granular Pits & Fissure may be a darkened, shaded outlinePits & Fissure may be a darkened, shaded outline

CARIOUS PROCESSCARIOUS PROCESS

Reaches the dentin:Reaches the dentin: Spreads rapidlySpreads rapidly Spreads laterallySpreads laterally Undermines the enamel (often not visible Undermines the enamel (often not visible

until extensive destruction occurs)until extensive destruction occurs) Unless arrested will continue to pulpUnless arrested will continue to pulp

ARRESTED caries: shows no tendency for ARRESTED caries: shows no tendency for further progress into toothfurther progress into tooth

CARIOUS PROCESSCARIOUS PROCESS

Recurrent caries: occur beneath existing Recurrent caries: occur beneath existing restorations due to restorations due to Improper cavity prepImproper cavity prep Inadequate cavity restorationInadequate cavity restoration Faulty sealing of the restoration, “leaky Faulty sealing of the restoration, “leaky

margin” margin”

CARIOUS PROCESSCARIOUS PROCESS

Rampant decay:Rampant decay: Wide spread decayWide spread decay Usually found in high risk patientsUsually found in high risk patients Baby bottle syndromeBaby bottle syndrome

Nursing bottle syndromeNursing bottle syndrome Babies put to bed + bottle + sugary liquidsBabies put to bed + bottle + sugary liquids Saliva production slows while sleepingSaliva production slows while sleeping Sugar + bacteria + dental plaque = AcidSugar + bacteria + dental plaque = Acid Acid attacks enamelAcid attacks enamel

CARIOUS PROCESSCARIOUS PROCESS

Root caries:Root caries: CEJ exposed = very susceptible to decayCEJ exposed = very susceptible to decay

Cervical abrasion or erosion: not caused by Cervical abrasion or erosion: not caused by bacteria, but by chemical or mechanical bacteria, but by chemical or mechanical influencesinfluences Tooth brushingTooth brushing BulimiaBulimia AttritionAttrition Sucking lemonsSucking lemons

DENTAL CHARTINGDENTAL CHARTING

Dental charting:Dental charting: Part of Patient legal recordPart of Patient legal record Initial charting done on first visitInitial charting done on first visit Indicate existing first, what has been done Indicate existing first, what has been done

and what needs to be done.and what needs to be done. Record used for diagnosis, consults w/other Record used for diagnosis, consults w/other

Drs., accounting purposesDrs., accounting purposes ForensicsForensics

TYPES OF CHARTSTYPES OF CHARTS

AnatomicalAnatomical Shows complete tooth buccal or facialShows complete tooth buccal or facial Crown or incisal edgeCrown or incisal edge Crown only of lingual surfaceCrown only of lingual surface Includes primary dentitions in some formIncludes primary dentitions in some form

GeometricGeometric Shows circle:each circle section into 5 areasShows circle:each circle section into 5 areas Generally includes primary dentition Generally includes primary dentition

NUMBERING SYSTEMSNUMBERING SYSTEMS

Universal / National systemUniversal / National system What we use 1-32, A-TWhat we use 1-32, A-T

InternationalInternational Used in Europe and CanadaUsed in Europe and Canada

PalmerPalmer Used in orthodonticsUsed in orthodontics

CAVITY CLASSIFICATIONCAVITY CLASSIFICATION

Developed by GV BlackDeveloped by GV Black Class I : pits & fissuresClass I : pits & fissures Class II : posterior only, involves a proximal Class II : posterior only, involves a proximal

surface, usually 2 or moresurface, usually 2 or more Class III:anterior only, involving interproximal Class III:anterior only, involving interproximal Class IV:anterior only, interproximal & incisalClass IV:anterior only, interproximal & incisal Class V: occur cervical or gingival third both Class V: occur cervical or gingival third both

lingual & facial/buccal all teethlingual & facial/buccal all teeth Class VI: w/o Black, worn areas by abrasionClass VI: w/o Black, worn areas by abrasion

ABBREV. TOOTH SURF.ABBREV. TOOTH SURF.

Simple: one tooth surfaceSimple: one tooth surface Compound: two surfacesCompound: two surfaces Complex: more than twoComplex: more than two Use first letter of word: ex. Mesial = MUse first letter of word: ex. Mesial = M More than one: combine/drop al, add oMore than one: combine/drop al, add o

Ex: mesio-occlusal, distolingualEx: mesio-occlusal, distolingual Mesial = first if present, lingual & facial Mesial = first if present, lingual & facial

lastlast

ABBREV. TOOTH SURF.ABBREV. TOOTH SURF. Facial replaces labial when referring to Facial replaces labial when referring to

anterior teethanterior teeth Basic terms:Basic terms:

Abscess: localized infectionAbscess: localized infection Bridge: abutments, pontics, maryland bridgeBridge: abutments, pontics, maryland bridge

An appliance that replaces 1 or more missingAn appliance that replaces 1 or more missing

Crown: “cap” SSC, FGC (Full Gold Crown), Crown: “cap” SSC, FGC (Full Gold Crown), PFM (Porcelain Fused to Metal) FPC (Full PFM (Porcelain Fused to Metal) FPC (Full Porcelain Crown)Porcelain Crown)

Denture: FUD (Full Upper Denture) FLD Denture: FUD (Full Upper Denture) FLD (Full Lower Denture)(Full Lower Denture)

ABBREV. TOOTH SURF.ABBREV. TOOTH SURF. Basic terms cont.:Basic terms cont.:

Incipient: beginning decay- “watch”Incipient: beginning decay- “watch” Overhang: excessive materialOverhang: excessive material Partial denture: removable prosthesis Partial denture: removable prosthesis

replacing one or more but less than all replacing one or more but less than all missing teethmissing teeth

Restoration: amalgam or composite filling, Restoration: amalgam or composite filling, crown or inlaycrown or inlay

Root canal therapy: pulp in removed and Root canal therapy: pulp in removed and replaced with filling materialreplaced with filling material

Sealant: material placed into pits & fissures Sealant: material placed into pits & fissures to PREVENT cariesto PREVENT caries

CHARTINGCHARTING

Charting Colors:Charting Colors: RED: represent work that need to be doneRED: represent work that need to be done BLUE: work that has been completedBLUE: work that has been completed

Periodontal charting:Periodontal charting: Perio screening & recording part of examPerio screening & recording part of exam Tip of probe marked in 3mm incrementsTip of probe marked in 3mm increments Six surfaces probed: mesiofacial, buccal, Six surfaces probed: mesiofacial, buccal,

distofacial, mesiolingual, lingual, distolingualdistofacial, mesiolingual, lingual, distolingual

CHARTING cont.CHARTING cont.

Periodontal cont.Periodontal cont. Readings of 3mm or less is normal sulcus Readings of 3mm or less is normal sulcus

depth, charted in Bluedepth, charted in Blue Readings over 3mm considered periodontal Readings over 3mm considered periodontal

pockets & abnormal, charted in Redpockets & abnormal, charted in Red Other considerations during perio exam:Other considerations during perio exam:

Mobility: Roman numerals 0-3Mobility: Roman numerals 0-3 RecessionRecession Furcations, & Mucogingival problemsFurcations, & Mucogingival problems

QUESTIONS?????QUESTIONS?????

When in doubt about charting ASKWhen in doubt about charting ASK ACCURACY MATTERSACCURACY MATTERS