Date post: | 23-Feb-2018 |
Category: |
Documents |
Upload: | eastma-meili |
View: | 216 times |
Download: | 0 times |
of 86
7/24/2019 24, 25, 26 - Dental Caries
1/86
7/24/2019 24, 25, 26 - Dental Caries
2/86
7/24/2019 24, 25, 26 - Dental Caries
3/86
An infectious microbialdisease that begins as
demineralization of
inorganic portion of tooth,
followed by destruction of
organic portions, leadingto cavity formation
7/24/2019 24, 25, 26 - Dental Caries
4/86
7/24/2019 24, 25, 26 - Dental Caries
5/86
7/24/2019 24, 25, 26 - Dental Caries
6/86
7/24/2019 24, 25, 26 - Dental Caries
7/86
7/24/2019 24, 25, 26 - Dental Caries
8/86
7/24/2019 24, 25, 26 - Dental Caries
9/86
7/24/2019 24, 25, 26 - Dental Caries
10/86
7/24/2019 24, 25, 26 - Dental Caries
11/86
7/24/2019 24, 25, 26 - Dental Caries
12/86
7/24/2019 24, 25, 26 - Dental Caries
13/86
7/24/2019 24, 25, 26 - Dental Caries
14/86
7/24/2019 24, 25, 26 - Dental Caries
15/86
7/24/2019 24, 25, 26 - Dental Caries
16/86
7/24/2019 24, 25, 26 - Dental Caries
17/86
ASYMPTOMATICuntil it reaches advancedstage.
7/24/2019 24, 25, 26 - Dental Caries
18/86
7/24/2019 24, 25, 26 - Dental Caries
19/86
WormtheoryHumour
theory
Parasitic
theory
Vital theoryChemical
theory
Acidogenic
theory
Proteolytic
theory
Proteolysis-
chelation
theory
Sucrose-
chelation
theory
7/24/2019 24, 25, 26 - Dental Caries
20/86
Time
Microorganism
HostSubstrate
7/24/2019 24, 25, 26 - Dental Caries
21/86
7/24/2019 24, 25, 26 - Dental Caries
22/86
Cavitation
Progression of carious lesion
Initial lesion
Subsurface demineralization
Acid production
Cariogenic bacteria + cariogenic diet + plaque
Continuoussucrose consumption
Repeated attack of cariogenic challenge
Destruction of organic matrixMore of mineral loss
7/24/2019 24, 25, 26 - Dental Caries
23/86
However
This progress can be arrested at any stage of
development due to
7/24/2019 24, 25, 26 - Dental Caries
24/86
7/24/2019 24, 25, 26 - Dental Caries
25/86
7/24/2019 24, 25, 26 - Dental Caries
26/86
SALIVA Comparison between solubility product (Ksp) and
ion product (Ip)
Ip > Ksp, saliva is saturated with Ca & P, promoteremineralisation
Calcium &
Phosphate
Formation of fluoroapatite crystalFluoride
Retard plaque formation
Neutralize acid in oral cavityAmmonia
7/24/2019 24, 25, 26 - Dental Caries
27/86
SALIVA
Diffuse across plaque and neutralise acid underneathitBicarbonate
Lysozyme
Lactoperoxidase
Lactoferrin
IgA
Antibacterial
substance
Remove food debris and bacteria from oral cavityQuantity and
viscosity
7/24/2019 24, 25, 26 - Dental Caries
28/86
Spread of caries
7/24/2019 24, 25, 26 - Dental Caries
29/86
Surfacelayer
Body of
lesion
Dark zone
Translucent zone
ENAMEL CARIES
Pits & fissure caries
7/24/2019 24, 25, 26 - Dental Caries
30/86
Smooth surface caries
7/24/2019 24, 25, 26 - Dental Caries
31/86
From ENAMEL
caries can spread to DENTINvia
7/24/2019 24, 25, 26 - Dental Caries
32/86
DENTINAL CARIES
Zone of decomposed dentin
Zone of bacterial invasion
Zone of decalcification
Sclerotic zone
Zone of fatty
degeneration
of Tomes fibre
7/24/2019 24, 25, 26 - Dental Caries
33/86
Inflammation of pulp
The stage where caries is associated with toothache
It may be reversibleorirreversible(pain persists whenstimulus is removed.
Reversible pulpitis may be treated with restorationwhileirreversible pulpitis is indicated for RCTor extraction
Further progression of dental caries without treatment maylead to periapical lesion.
7/24/2019 24, 25, 26 - Dental Caries
34/86
7/24/2019 24, 25, 26 - Dental Caries
35/86
Streptococcus mutans
Lactobacillus sp.
Actinomyces sp.
Other: S. salivarius, S. sanguis, Veilonella sp.
etc
7/24/2019 24, 25, 26 - Dental Caries
36/86
Initiation of caries is associated with S. mutans
Because it can attach to tooth surface by 2 mechanisms:
1. Sucrose-independent adsorptionthrough specificextracellular proteins on its fimbriae
2. Sucrose-dependent mechanismsit converts sucroseto sticky extracellular polysaccharide (glucan)
It is also:
1. Can produce lactic acid from sugar substrates
2. Can resist aciduric & acidogenic environment due tophosphoenolpyruvate-phosphotransferase mechanism
3. Can produce intracellular polysaccharide (reservoir)
While progression of caries is associated with Lactobacillussp.
7/24/2019 24, 25, 26 - Dental Caries
37/86
Type of caries Microorganisms
Pits & Fissures S. mutans
S. sanguisLactobacillus sp.
Actinomyces sp.
Smooth surface S. mutans
S. salivarius
Root surface A. viscosus
A. naeslundii
S. mutans
S. sanguis
Deep dentinal caries Lactobacilli sp.
A. naeslundii
Other filamentous rods
7/24/2019 24, 25, 26 - Dental Caries
38/86
PERIODIC SURVEYS OF ADULTS & ITS
FINDINGS
7/24/2019 24, 25, 26 - Dental Caries
39/86
Caries Prevalence
90.3%, with female(91.4 %) > male (88.9%) Rural (90.9%) > urban (89.9%)
Chinese (92.6 %) > Ibans (92.1%) > Malays
(90.9%) >Bumiputeras (89.3%) Indians/Pakistani(82.5%).
Almost similar in all 3 education level, Level 1
89.7, Level 2 88.8%, Level 3 91.1%.
7/24/2019 24, 25, 26 - Dental Caries
40/86
Caries prevalence by age group
7/24/2019 24, 25, 26 - Dental Caries
41/86
Caries Severity
Measured using the DMFX(T) index.
Age Group
Mean
D M F X DMFX
15 - 19 0.66
(0.04)
0.29
(0.06)
1.63
(0.06)
0.27
(0.03)
2.85
(0.10)
35 - 44 1.03
(0.03)
7.77
(0.20)
2.11
(0.10)
1.20
(0.07)
12.11
(0.21)
65 - 74 0.41
(0.04)
21.17
(0.50)
0.25
(0.05)
1.36
(0.11)
23.20
(0.46)
Total
0.85
(0.02)
7.87
(0.15)
1.68
(0.05)
0.94
(0.03)
11.34
(0.15)
Mean D,M,F and X components of DMFX Per Subject byIndex Age Group, 2000
7/24/2019 24, 25, 26 - Dental Caries
42/86
Mean DMFX was:
higher for female(12.4) than male(10.0).
Higher for rural population(12.1) than urban
population(10.8).
Highest in Chinese(13.2), simlar in Malays and
Ibans(11.3) and lowest in Kadazans(6.3).
Higher in Level 3 subjects(13.5), while Level 1
and 2 subjects exhibit almost similar mean
DMFX of 7.5 and 7.7 respectively.
7/24/2019 24, 25, 26 - Dental Caries
43/86
INTERNATIONAL DATA
Since 1990, continued change in global patternof oral diseases.
Dental caries found to increasein developing
countries, while in developed countries thecaries situation seems to be stable or ondecline.
Summarised that preventive measures,
especially flouride from a variety of sources,have brought about the decline in developedcountries.
WHO Oral Health Country/Area Profile Programme
7/24/2019 24, 25, 26 - Dental Caries
44/86
WHO Oral Health Country/Area Profile Programme
for various age groups has archived invaluable date
on oral health status.
A comparison of dental caries data in the 1990s
between Malaysia and other countries is shown.
7/24/2019 24, 25, 26 - Dental Caries
45/86
7/24/2019 24, 25, 26 - Dental Caries
46/86
IMPACTS OF ORAL CONDITION
7/24/2019 24, 25, 26 - Dental Caries
47/86
Oral health related quality of life
Disruption of daily activities
Socialisation
7/24/2019 24, 25, 26 - Dental Caries
48/86
Socialisation
7/24/2019 24, 25, 26 - Dental Caries
49/86
Disruption of daily activities
7/24/2019 24, 25, 26 - Dental Caries
50/86
Utilization of oral Health services
Utili ti f l h lth i 2000
7/24/2019 24, 25, 26 - Dental Caries
51/86
Utilisation of oral health services 2000
Last dental check up and reasons for
7/24/2019 24, 25, 26 - Dental Caries
52/86
Last dental check-up and reasons for
last dental check up
Rank Reason Percentage1
2
3
4
5
67
8
Something wrong
Part of the school dental programme
Thought it was time
Part of a series of treament
Antenatal programme
ReferralReinders
Other reasons
44.5
18.5
13.3
11.4
2.8
2.40.6
6.6
Male and female did not differ in reasons.
7/24/2019 24, 25, 26 - Dental Caries
53/86
Urban population were more likely to seek carebecause it was time as compared to rural
population, which sought care more becausesomething is wrong or as part of the antenatalprogramme.
The more highly educated population were morelikely to seek care because of reasons such as itwas time, a reminder from the dentist, or otherreason.
Lower education level population were morelikely to seek treatment as part of the schoolprogramme or only when they sensedthatsomething was wrong.
A t th i th i
7/24/2019 24, 25, 26 - Dental Caries
54/86
Amongst the various age groups, the main
reason for the last dental check-up were
invariably something is wrong except for the
15-19 age group whom treatment were mostly
related to school dental programme.
The 20-24 and 25-29 age groups have the
highest proportions that sought treatment
because the thought it was time for
examination/cleaning.
Reasons for not seeking treatment
7/24/2019 24, 25, 26 - Dental Caries
55/86
Reasons for not seeking treatment
within the last 2 years
Rank Reason Percentage
1
2
3
45
6
7
8
9
10
11
12
13
14
No problem
Problem not serious
Too busy
No teeth/ False teethFear treatment
Other reason
Expected problem to go away
Location too far
Bad experience
Physical problems
Cannot afford
Did not want to spend money
Required appointment
Dentist would not give appointment
61.7
10.7
9.5
6.65.0
2.4
1.3
0.8
0.6
0.5
0.3
0.2
0.2
0.1
7/24/2019 24, 25, 26 - Dental Caries
56/86
Facility Used
7/24/2019 24, 25, 26 - Dental Caries
57/86
7/24/2019 24, 25, 26 - Dental Caries
58/86
In radiotherapy patients, rampant caries occur
due to decrease in salivary flow.
Prevention at earliest level should be done to
control the caries. Extraction of tooth inradiotherapy patients may lead to
7/24/2019 24, 25, 26 - Dental Caries
59/86
Avoid smoking, alcohol & caffeine-based drinks
1% chlorhexidine gel in custom made tray for 5 mins, every night
Daily 0.05% Sodium Fluoride mouthrinse
Use of saliva substitute
Reinforce the importance of avoiding sweet drinks & snacks
Measure stimulated salivary flow every 3 months
Dental visit every 3 months
*sodium lauryl sulphate*
7/24/2019 24, 25, 26 - Dental Caries
60/86
MANAGING CARIES IN GERIATRICPATIENTS
In elderly, caries often progresses slowly along
7/24/2019 24, 25, 26 - Dental Caries
61/86
the CEJ resulting in root caries.
This is due to exposed root surface, poor oral
hygiene, reduced salivary flow and high sugar
diet.
May cause sensitivity and pain
May progress and eventually affect the vitality of
the tooth.
7/24/2019 24, 25, 26 - Dental Caries
62/86
Management
Effective brushing using flouride toothpaste.
Use of dental floss and interdental sticks toclean between teeth.
Reduce sugar intake.
Regular dental check-up.
7/24/2019 24, 25, 26 - Dental Caries
63/86
Managing caries in diabetic
patients
7/24/2019 24, 25, 26 - Dental Caries
64/86
Effect of diabetes on dental caries rate?
since most diabeticpatients limit their
intake of fermentablecarbohydrateless
cariogenic diet
associated withxerostomia and
increased gingivalcrevicular fluidglucose level
7/24/2019 24, 25, 26 - Dental Caries
65/86
Caries management consideration
Preoperative IntraoperativeDiabetic
EmergencyPostoperative
7/24/2019 24, 25, 26 - Dental Caries
66/86
Preoperative
Medical history
- ask pt about recent blood glucose level
- frequency of hypoglycemic episodes
- antidiabetic medications, dosage and time of administration
Scheduling of visit
- should receive dental treatment in the morning (higher cortisol
level)
- pt under insulin therapyavoid period of peak insulin activity
Di t
7/24/2019 24, 25, 26 - Dental Caries
67/86
Diet
- ensure patient has eaten normally and take medications as usual
- if patient skip meals but has taken insulin as usualincreased riskfor hypoglycemia
Blood glucose monitoring
- Check the pretreatment blood glucose level using glucometer
- Lowblood glucose level (
7/24/2019 24, 25, 26 - Dental Caries
68/86
Intraoperative
Adequate control and stress reduction
- Anesthesia- reduces pain and minimize endogenous
epinephrine release
- Conscious sedation for extremely anxious patient
7/24/2019 24, 25, 26 - Dental Caries
69/86
Diabetic emergency
Terminate dental treatment
Administer 15g of fast acting oral carbohydratesglucosetablets, sugar, candy, soft drinks, juice
Measure blood glucose level to confirmdetermine if
repeated carbohydrate dosing is needed If patient unable to swallow/ unconcious
give 25-30 ml of a 50% dextrose
solution i.vor 1 mg of glucagon
i.v./i.m./s.c. Hyperglycemic crisis usually have
prolonged onsetlower risk in dental
practice
Postoperative
7/24/2019 24, 25, 26 - Dental Caries
70/86
Postoperative
Patient with uncontrolled diabetes have greater risk of gettinginfectiongive antibiotic
If normal dietary intake is affectedmodify insulin or oral
antidiabetic medication dosage (consult physician)
Avoid prescribing aspirinsalicylates can increase insulinsecretion and sensitivity - hypoglycemia
7/24/2019 24, 25, 26 - Dental Caries
71/86
Caries Preventive Methods
Di
7/24/2019 24, 25, 26 - Dental Caries
72/86
Caries
PreventiveMethod
Dietarymeasures
Modifyingmicroflora
Plaquedisruption
Stimulatingsaliva flow
Modifyingtooth
surface
Eliminationnidus ofbacteria
7/24/2019 24, 25, 26 - Dental Caries
73/86
Dietary measures
Decreased frequency of meals- only eat during mealtimes
- to decrease number, duration and intensity of acid attack
- limit to 4 meals per dayreduces the retention period of sugar and
number of drops in pH
Eliminate sticky, sugar containing products with
prolonged sugar clearance times
7/24/2019 24, 25, 26 - Dental Caries
74/86
Use of sugar substitute
- xylitol, sorbitol, saccharin and aspartame
- Regular use of xylitolreduce number of
S. mutans in saliva and plaque
Protective food elements- Phosphate (cereals) :
prevent loss of phosphorus from enamel during demineralization
Helps in remineralization
Inhibit bacterial growth
7/24/2019 24, 25, 26 - Dental Caries
75/86
- Fats :
Reduce the cariogenicity of different foods
Some fatty acids have antimicrobial effect
- Cheese :
Reduce level of cariogenic bacteria
Increases flow of saliva and its buffering capacity
Provides organic phosphates for remineralization
7/24/2019 24, 25, 26 - Dental Caries
76/86
Snackings
- Choose less sticky snack and fast clearing
- No snacks in between meals- Brush the teeth immediately after eating
- Example of safe snacks?
7/24/2019 24, 25, 26 - Dental Caries
77/86
Modifying microflora
Achieved by intensive antimicrobial treatment
that is capable to:
- Inhibit bacterial colonization-adhesion
- Affect plaque growth-metabolic activity
Characteristics of ideal antimicrobial
treatment:- Not interfering in other biological process
- Harmless to mucosa
- Low toxicity
7/24/2019 24, 25, 26 - Dental Caries
78/86
Plaque disruption
Brushing
Fl i
7/24/2019 24, 25, 26 - Dental Caries
79/86
Flossing
7/24/2019 24, 25, 26 - Dental Caries
80/86
Mouthwash
7/24/2019 24, 25, 26 - Dental Caries
81/86
Modifying tooth surface
Systemically administered fluoride- Drinking water, salt, milk, tablets, lozenges, chewing gum,
drops.
- Optimal fluoride level : 1 ppm of fluoride
Topically applied fluoride
- Self-care : toothpaste, mouthwash
- Potential resevoirsplaque, gingiva, tongue, cheeks, under the
tongue, buccal sulcus
7/24/2019 24, 25, 26 - Dental Caries
82/86
- Professionally applied : fluoride paints, gels, varnish, GIC,
prophylaxis pastes
7/24/2019 24, 25, 26 - Dental Caries
83/86
Stimulating saliva flow
Function of saliva- Protect the tooth surface continuously by a film of salivary
mucins and proline-rich glycoprotein
- Pellicle protein and proline rich protein promote
remineralization by attracting calcium ions
- Pellicle proteins, phosphate and calcium ions in saliva help to
retard demineralization
- Salivary proteins prevent adherence of oral m/organisms to
enamel pellicle and inhibit their growth
- Salivary bicarbonate buffer systemrapid neutralization of
acids
7/24/2019 24, 25, 26 - Dental Caries
84/86
How to increase salivary flow?
Sugarless fluoride chewing gumsdirectly after meal for 15-
20 minutes
Fluoride or xylitol lozenges
Chewing gum containing chlorhexidineprolong fluoride
clearance, provide chemical plaque control after acid attack
Artificial saliva containing sodium fluoridegel/spray
7/24/2019 24, 25, 26 - Dental Caries
85/86
Elimination of nidus for bacteria
Pit and fissure sealant- On the basis of predicted caries risk and anatomy of fissure
- Erupting molars sealed as early as possible
Correction of defective restoration
7/24/2019 24, 25, 26 - Dental Caries
86/86