Cariology.txt

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emm64
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153406
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Cariology.txt
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2012-05-11 04:26:49
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Cariology others
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Cariology others
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  1. Root Caries Factors
    • Poor oral hygiene, attachment loss and inappropriate plaque control
    • Gingival recession exposed CEJ (highly irregular surface)
    • Plaque retention
    • Lesion development
  2. RC Factors in the Elderly
    • Aging population
    • Increased tooth retention into old age
    • Chronic medical conditions
    • More medications
    • Cognitive impairment
  3. Do lesions originate in deep pockets?i.
    • No, pH of pocket exudate is >7 (basic)
    • ii.
    • More likely:
    • 1. Lesion initiated near FGM
    • 2. Gingival inflammation and swelling
    • 3. Gingiva covers lesion
  4. Diet and Root Caries
    • Minimize fermentable dietary substances
    • Non-fermentable sweeteners
    • Aspartame, saccharine
    • Polyols (xylitol, sorbitol)
    • Anticariogenic?
    • Reduced acid production by S. mutans
    • Better than chlorhexidine in elderly? Maybe!
    • Diarrhea--> dehydrationi)
    • Caution! Adverse GI effects
  5. Clinical presentation Root Caries
    • Occurs where plaque accumulates
    • Soft (active caries)
    • Hard/leathery (arrested caries)
    • Transition from active to arrested can be slow (years!)
    • 1)Hard upon gentle probing
    • 2)Shiny
    • 3)Dark/black
    • 4)No plaque
    • 5)Variable color-- yellowish, brownish, blackv.
  6. How can we treat RC?
    • non-operatively
    • Active recurrent root caries lesions
    • Plaque control
    • Topical fluoride
    • Polish restoration margins
  7. How do root caries arrest?
    • 1. Diet Management
    • 2. Plaque control
    • 3. Remineralization therapy
    • Restorations not always needed
    • Restorations may even cause more harm and increase risk of recurrence!
  8. Restorative Considerations for Root Surface Caries Lesions.
    • Esthetics
    • Reduce plaque retention
    • Replace lost structure (volume)
    • Tradition
    • Ability to monitor
  9. Amalgam Properties
    • Durable
    • Good resistance to microleakage Not tooth-colored
    • Mildly tolerant of moisture contamination
    • Disadvantages:
    • INVASIVE-Retention/Resistance form
    • Not-tooth colored
  10. Composite Resin properties:
    • Polymerization shrinkage will try to open up the margins.a)
    • Durable
    • Adhesive: Less invasive
    • Highly esthetic
    • Excellent resistance to microleakage on enamel
    • •Disadvantages
    • Hydrophobic
    • Intolerant of moisture contamination
    • Polymerization shrinkage
    • Long-term resistance to microleakage on dentin? Not really!
  11. Glass Ionomer Advantages
    • (releases fluoride)3)
    • Excellent seal on enamel AND dentin
    • Chemical bond to tooth structure
    • Can uptake and release fluoride over time
    • Hydrophilic
    • Rechargeable fluoride release
    • Mildly tolerant of moisture contamination
    • Tooth-colored
    • Transitional restorations
    • Better resistance to microleakage at dentin margins vs. resin
    • Less technique sensitive
    • Inhibitory activity on cariogenic bacteria
  12. Glass Ionomer Limitations
    • Handling
    • Surface finish
    • Opacity (some types)
    • Shrinkage may cause problems with seal of margin
  13. "Sandwich Technique"
    • Use glass ionomer to replace dentin
    • Use composite resin to replace enamel
  14. Composite vs. Glass Ionomer
    • For a deep region, you will have to put the composite material in several increments (layers) and will take longer.
    • Incremental layering will compensate for polymerization shrinkage
    • Wide variability in how the resin is going to bond to the dentin.
    • Need to etch the dentin
    • What happens if you don't get a perfect seal?
    • This problem has been associated with pain and sensitivity
  15. Glass Ionomer
    • Using a base of glass ionomer into the deep region means you don't have to use the phosphoric acid etching
    • Glass ionomer will bond to the calcium of the tooth structure
    • Can put all material in with one load
    • Can put the composite resin over top of the glass ionomer
  16. Etiology of Non-Carious Cervical Lesions
    • Entire etiology has not been determined
    • Some controversy over possible causes and their degree of involvement
    • Evidence and consensus for this in dental scientific literature
    • Cause is most likely MULTIFACTORIAL!
  17. What are the causes of non-carious tooth structure loss?
    • Attrition: Tooth-tooth contact
    • Abrasion: CHEMICAL
    • Erosion: friction of exogenous agent
    • Abfraction: Loss of cervical tooth structure due to occlusal forces
  18. What are some causes of cervical abrasion?
    • Overzealous tooth brushing: opposite side of dominant hand? Not verified with clinical studies?
    • Hard tooth brush? signifacnt factor of initialtion adn progression yet degree unverified
    • Abrasive Dentrifice-no longer used
    • Tooth brusing & acid exposure more susceptible
    • biting on stuff
    • masticatory abrasion
    • differential wear rates on dentin and enamel
  19. What should you not brush after eating?
    • Enamel sensitive after demineralization (allow remineralization factors first)
    • DO NOT brush immediately after meal or acid challenge
    • 1. Wait 1 hour
    • 2. Rinse or floss (properly) first to remove food debris
    • 3. Milk, cheese, yogurt good buffers
    • 4. Floride rinse
  20. Erosion
    • Loss of tooth structure by friction between tooth and exogenous agenti)
    • Causes:
    • Extrinsic acid sources:
    • Dietary:
    • 1. Soft drinks-- most frequent source in US population
    • Per capita consumption in US in 2000=2000 53 gallons
    • 2. Wine
    • 3. Fruits and fruit juices
    • 4. Sports drinks
    • Occupational:
    • 1. Industrial gases containing acid
    • 2. Galvanizing, plating
    • Athletic: Competitive swimmers
    • Bulimia
    • Gastroesophageal reflux disease (GERD)
  21. Erostion Diagnosis
    • Dietary information
    • Diet components
    • Frequency of consumption (# of acid exposures per day)
    • Habits (ex. Soda swishers)
  22. Bulimia Clinical appearance
    • Lesion location reflects position of head when vomiting
    • Palatal surfaces of maxillary anterior teeth
    • Buccal surfaces of mandibular molars (in more severe cases)
  23. GERD Clinical Appearance
    • Slower movement of gastric acid than in bulimics
    • Longer acid exposure than in bulimics
    • Thin, translucent enamel
    • Enamel loss on palatal of maxillary anteriors and occlusal of mandibular molars
    • Cupping of exposed dentin on occlusals
    • GERD during sleep-- more lesions on favored sleeping side
  24. Dietary erosive clinical appearance
    • Broad concavities within smooth enamel
    • Labial and buccal surfaces
    • Maxillary and mandibular teeth
    • Thin, translucent enamel
    • Preservation of enamel "cuff" in gingival crevice is common
  25. Abfraction
    • Loss of cervical too structure due to occlusal forces
    • Theory: Occlusal loading forces--> tooth flexure--> microfractures--> tooth substance loss in cervical area
    • Abfraction= stress corrosion or stress-induced non-carious lesions
    • Posterior "interference" contact occurring during lateral jaw movement may cause this
    • Clinical appearance:
    • Wedge-shaped or saucer-shaped
    • Not conclusive
    • Only an aid to determining etiology
    • Association with occlusal or incisal wear facets
  26. Treating Non-carious cervical lesions
    • Don't base treatment on an assumed cause: Ex. NCCLs + wear facets = unifactorial
    • Think MULTIFACTORIAL
    • Detailed health history
    • Thorough examination (including occlusal analysis)
    • Evaluate oral hygiene
    • Diet analysis (including frequency)
    • Should inform patients of a.Possible etiologies, implications of the presence of lesions,Prevention methods, Treatment alternatives
    • First goal= eliminate primary cause(s) of NCCLs
    • Change etiologic factors where possible
    • Desensitizing teeth
    • Periodontal grafting to cover and protect affected areas
    • Restorative treatment
  27. When do you do class V restorations for NCCLs?
    • Inability to halt lesion progression by elimination of etiologic factors
    • Esthetic unacceptability of lesion to patient
    • Intolerable sensitivity to cold, food, and air
    • Threat to strength/structural integrity of tooth because of lesion depth

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