Download - Chapter 14
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Chapter 14Chapter 14DENTAL CARIESDENTAL CARIES
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DIAGNOSIS &TREATMENTDIAGNOSIS &TREATMENT
3 Major Steps3 Major StepsData gatheringData gathering
Examination of PatientExamination of PatientPreparing & PresentingPreparing & Presenting
Treatment PlanTreatment Plan
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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
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METHODSMETHODS Manual: Manual: Assistant records data Assistant records data
on patient charton patient chartColor coded pencils Color coded pencils
indicate condition indicate condition of of teethteeth
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
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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
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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
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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
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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
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PREREQUISITES / DECAYPREREQUISITES / DECAY Plaque on tooth surfacesPlaque on tooth surfaces
Shelter areas between teeth: interpoximal Shelter areas between teeth: interpoximal 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
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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
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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
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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 pulpARRESTED caries: shows no tendency for ARRESTED caries: shows no tendency for
further progress into toothfurther progress into tooth
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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”
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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
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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
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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
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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
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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
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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
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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
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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, gold, porcelianCrown: cap, SSC, gold, porcelian Denture: fullDenture: full
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ABBREV. TOOTH SURF.ABBREV. TOOTH SURF. Basic terms cont.:Basic terms cont.:
Drifting: over-erupted-arrows pointing direct.Drifting: over-erupted-arrows pointing direct. Incipient: beginning decay- “watch”Incipient: beginning decay- “watch” Overhang: excessive materialOverhang: excessive material Partial denturePartial denture RestorationRestoration Root canalRoot canal SealantSealant
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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
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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
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QUESTIONS?????QUESTIONS????? When in doubt about charting ASKWhen in doubt about charting ASK ACCURACY MATTERSACCURACY MATTERS