1. Early Caries Detection and Treatment
Learning Outcomes
By the end of this interactive session you should be able to:
- Discuss the carious process
- Describe how to recognise 'early carious lesions' and ways of detecting them
- Discuss the principal of management of 'early carious lesions'
- Discuss the difference between a Fissure Sealant and a Preventative Resin Restoration
- Discuss the options for restoring a buccal pit
Recommended Reading
- The lecture for this section 'Early Caries Detection and Treatment'
- Pickard's Manual of Operative Dentistry 9th edition
- Department of Health booklet - Delivering Better Oral Health - An evidence-based toolkit for prevention 2nd edition
- Practical Study Guide Demo 1 (found in your 3rd Year Cons Study Guide)
Introduction
Caries is a disease of the calcified tissues of the teeth caused by the actions of mico-organisms on fermentable carbohydrates. It is characterised by demineralisation of the mineral portion of the enamel and dentine followed by the disintegration of their organic material.
The Carious Process
With the help of the recommended reading try and answer the following questions:
Will caries definitely develop in a tooth that is covered in plaque?
What is the most important fact about an early carious lesion which makes it important to detect it as soon as possible?
Please read Chapter 5 section 6 on Moisture Control in 'Pickard's Manual of Operative Dentistry' 9th Edition.
Practical Booklet
Now complete the section on Tooth Isolation/Moisture Control in Demo 1 of the Practical Booklet.
As well as good isolation it is essential, when examing teeth, that they are clean and dry and that they are illuminated appropriately.
Question:
Look at the image below and name the piece of equipment that is being used as an adjunct to the cahir light.
Correct Answer:
Fibre Optic Trans-Illumination (FOTI) Light
Fibre Optic Trans-Illumination (FOTI) Light
Question:
Look at the image below showing a patient's lower anterior teeth numbered 1 - 6. Using your knowledge of what is meant by 'early carious lesion', choose which of the above teeth are displaying such a lesion?
Correct Answer:
The correct answer is tooth 2 as a 'white spot' lesion is clearly visible on this tooth.
Tooth 1 has no lesion visible and would be charted as sound
Tooth 3 shows a lesion that is cavitated and therefore can not be treated as an 'early carious lesion'.
Tooth 4, 5 and 6 are clearly cavitated and beyond reversal.
Question:
Using the information that you have gained from the interactive lecture on 'Early Caries', Chapter 4 of your textbook and the downloadable document from the DOH, please select from the options below which is the most appropriate treatment for a 16 year old patient who presents with 2 'white spot' lesions on the buccal surfaces of their teeth. Pt assessed at low risk.
- Give pt oral hygiene advice and review every 3 months
- Prescribe duraphat toothpaste and review every 6 months
- OHI, diet analysis, prescribe duraphat toothpaste, fluoride daily mouthwash, PRRs and 3 monthly review
- OHI, diet advise, fluoride toothpaste, fluoride mouthwash and 6 monthly review
Correct Answer:
Option 4 is correct - this combination would be suitable for a low caries risk patient.
If they were assessed as high caries risk, option 3 would be more suitable.
Oral hygiene advice alone may not be enough to reverse a 'white spot' lesion.
Toothpastes containing high concentrations of fluoride are not recommended for low risk patients and, as a stand alone measure, would not be suitable treatment option.