Chapter 14
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Chapter 14. DENTAL CARIES. DIAGNOSIS &TREATMENT. 3 Major Steps Data gathering Examination of Patient Preparing & Presenting Treatment Plan. ASSISTANTS ROLE. Aid patients in completing forms Generating diagnostic aids Radiographs Diagnostic casts

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Chapter 14

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Chapter 14

Chapter 14

DENTAL CARIES


Diagnosis treatment

DIAGNOSIS &TREATMENT

  • 3 Major Steps

    Data gathering

    Examination of Patient

    Preparing & Presenting

    Treatment Plan


Assistants role

ASSISTANTS ROLE

  • Aid patients in completing forms

  • Generating diagnostic aids

    Radiographs

    Diagnostic casts

    Recording Dentists findings during exam ACCURATELY


Methods

Manual:

Assistant records data on patient chart

Color coded pencils indicate condition of teeth

BLUE = Existing/comp.

RED = Needs to be done

Computerized

Patients charts are

stored on computer

some are voice activated

Others require Asst. or Hygienist to enter

METHODS


Clinical exam

CLINICAL EXAM

  • Dentist looks for:

    Oral lesions

    Dental decay

    Fractured teeth

    Periodontal disease

    Other dental anomalies


Clinical exam cont

CLINICAL EXAM cont.

  • Intra oral imaging or camera assist

    dentist’s explanation with visual

    Computers may show enlarged x-rays for easy viewing


Clinical exam cont1

CLINICAL EXAM cont.

  • Detailed scrutiny each tooth

    • Mal-positioned teeth

    • Structural defects, stains, fractures

    • Decalcified areas & small breaks in enamel

    • Carious lesions/indications recurrent decay

    • Overhangs of Amalgam or Cast Restoration

    • Poor fitting prosthesis

    • Abnormal wear patterns of teeth


Clinical exam cont2

CLINICAL EXAM cont.

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

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

    CAVITIES & DECAY


Prerequisites decay

PREREQUISITES / DECAY

  • Plaque on tooth surfaces

    • Shelter areas between teeth: interpoximal surfaces, embrasures, or defects in teeth such as pits and fissures are a breeding ground

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

    • Acid attacks enamel = demineralization = destruction


Rate of decay

RATE OF DECAY

  • Depends on

    • Abundance of plaque

    • Type

    • Number of organisms

    • Amount of carbohydrates available for conversion

    • Resistance of the tooth structure


Decalcification

DECALCIFICATION

  • First step in decay- loss of calcium salts from enamel

  • Enamel is weakened / eventually destroyed

  • INCIPIENT caries have not progressed

    • Appear slightly chalky or opaque

    • Surface is rough and granular

    • Pits & Fissure may be a darkened, shaded outline


Carious process

CARIOUS PROCESS

  • Reaches the dentin:

    • Spreads rapidly

    • Spreads laterally

    • Undermines the enamel (often not visible until extensive destruction occurs)

    • Unless arrested will continue to pulp

      ARRESTED caries: shows no tendency for further progress into tooth


Carious process1

CARIOUS PROCESS

  • Recurrent caries: occur beneath existing restorations due to

    • Improper cavity prep

    • Inadequate cavity restoration

    • Faulty sealing of the restoration, “leaky margin”


Carious process2

CARIOUS PROCESS

  • Rampant decay:

    • Wide spread decay

    • Usually found in high risk patients

    • Baby bottle syndrome

      • Nursing bottle syndrome

      • Babies put to bed + bottle + sugary liquids

      • Saliva production slows while sleeping

      • Sugar + bacteria + dental plaque = Acid

      • Acid attacks enamel


Carious process3

CARIOUS PROCESS

  • Root caries:

    • CEJ exposed = very susceptible to decay

  • Cervical abrasion or erosion: not caused by bacteria, but by chemical or mechanical influences

    • Tooth brushing

    • Bulimia

    • Attrition

    • Sucking lemons


Dental charting

DENTAL CHARTING

  • Dental charting:

    • Part of Patient legal record

    • Initial charting done on first visit

    • Indicate existing first, what has been done and what needs to be done.

    • Record used for diagnosis, consults w/other Drs., accounting purposes

    • Forensics


Types of charts

TYPES OF CHARTS

  • Anatomical

    • Shows complete tooth buccal or facial

    • Crown or incisal edge

    • Crown only of lingual surface

    • Includes primary dentitions in some form

  • Geometric

    • Shows circle:each circle section into 5 areas

    • Generally includes primary dentition


Numbering systems

NUMBERING SYSTEMS

  • Universal / National system

    • What we use 1-32, A-T

  • International

    • Used in Europe and Canada

  • Palmer

    • Used in orthodontics


Cavity classification

CAVITY CLASSIFICATION

  • Developed by GV Black

    • Class I : pits & fissures

    • Class II : posterior only, involves a proximal surface, usually 2 or more

    • Class III:anterior only, involving interproximal

    • Class IV:anterior only, interproximal & incisal

    • Class V: occur cervical or gingival third both lingual & facial/buccal all teeth

    • Class VI: w/o Black, worn areas by abrasion


Abbrev tooth surf

ABBREV. TOOTH SURF.

  • Simple: one tooth surface

  • Compound: two surfaces

  • Complex: more than two

  • Use first letter of word: ex. Mesial = M

  • More than one: combine/drop al, add o

    • Ex: mesio-occlusal, distolingual

  • Mesial = first if present, lingual & facial last


Abbrev tooth surf1

ABBREV. TOOTH SURF.

  • Facial replaces labial when referring to anterior teeth

  • Basic terms:

    • Abscess: localized infection

    • Bridge: abutments, pontics, maryland bridge

      • An appliance that replaces 1 or more missing

    • Crown: cap, SSC, gold, porcelian

    • Denture: full


Abbrev tooth surf2

ABBREV. TOOTH SURF.

  • Basic terms cont.:

    • Drifting: over-erupted-arrows pointing direct.

    • Incipient: beginning decay- “watch”

    • Overhang: excessive material

    • Partial denture

    • Restoration

    • Root canal

    • Sealant


Charting

CHARTING

  • Charting Colors:

    • RED: represent work that need to be done

    • BLUE: work that has been completed

  • Periodontal charting:

    • Perio screening & recording part of exam

    • Tip of probe marked in 3mm increments

    • Six surfaces probed: mesiofacial, buccal, distofacial, mesiolingual, lingual, distolingual


Charting cont

CHARTING cont.

  • Periodontal cont.

    • Readings of 3mm or less is normal sulcus depth, charted in Blue

    • Readings over 3mm considered periodontal pockets & abnormal, charted in Red

    • Other considerations during perio exam:

      • Mobility: Roman numerals 0-3

      • Recession

      • Furcations, & Mucogingival problems


Questions

QUESTIONS?????

  • When in doubt about charting ASK

  • ACCURACY MATTERS


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