1. Chapter 14
DENTAL CARIES

2. DIAGNOSIS &TREATMENT 3 Major Steps Data gathering
Examination of Patient
Preparing & Presenting
Treatment Plan

3. ASSISTANTS ROLE Aid patients in completing forms
Generating diagnostic aids
Radiographs
Diagnostic casts
Recording Dentists findings during exam ACCURATELY

4. 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

5. CLINICAL EXAM Dentist looks for: Oral lesions Dental decay
Fractured teeth
Periodontal disease
Other dental anomalies

6. CLINICAL EXAM cont. Intra oral imaging or camera assist
dentist’s explanation with visual
Computers may show enlarged x-rays for easy viewing

7. 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

8. 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

9. PREREQUISITES / DECAY Plaque on tooth surfaces
Shelter areas between teeth: interproximal 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

10. RATE OF DECAY Depends on Abundance of plaque Type Number of organisms
Amount of carbohydrates available for conversion
Resistance of the tooth structure

11. 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

12. 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

13. CARIOUS PROCESS
Recurrent caries: occur beneath existing restorations due to
Improper cavity prep
Inadequate cavity restoration
Faulty sealing of the restoration, “leaky margin”

14. 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

15. 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

16. 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

17. TYPES OF CHARTS Anatomical Geometric
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

18. NUMBERING SYSTEMS Universal / National system International Palmer
What we use 1-32, A-T
International
Used in Europe and Canada
Palmer
Used in orthodontics

19. 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

20. 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

21. 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, FGC (Full Gold Crown), PFM (Porcelain Fused to Metal) FPC (Full Porcelain Crown)
Denture: FUD (Full Upper Denture) FLD (Full Lower Denture)

22. ABBREV. TOOTH SURF. Basic terms cont.:
Incipient: beginning decay- “watch”
Overhang: excessive material
Partial denture: removable prosthesis replacing one or more but less than all missing teeth
Restoration: amalgam or composite filling, crown or inlay
Root canal therapy: pulp in removed and replaced with filling material
Sealant: material placed into pits & fissures to PREVENT caries

23. CHARTING Charting Colors: Periodontal charting:
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

24. 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

25. QUESTIONS?????
When in doubt about charting ASK
ACCURACY MATTERS