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RATIONALE
Incipient enamel caries is caused by specific microorganisms
Streptoccus mutans plus sucrose reduces the pH in the plaque to a critical level of 5.0-5.5, which can overcome the buffering capacity of saliva and result in demineralization of enamel
RATIONALE
Incipient enamel caries is caused by specific microorganisms
High bacterial counts are the result of the patients diet, and be reduced by altering the diet. A high Strep mutans count generally indicates large and/or frequent ingestion of sucrose.
RATIONALE
Incipient enamel caries is caused by specific microorganisms
A high lactobacillus count generally indicates a high proportion of carbohydrates in the patients diet. A normal saliva flow rate (1-2 ml/minute) and buffering capacity (5-7pH) discourages demineralization and encourages remineralization; a low flow rate (0.7 ml/minute or less) and buffering capacity (<4pH) will encourage demineralization and caries activity
RATIONALE
A diet diary can indicate dietary intake, and dietary counseling may result in an altered diet that will decrease caries activity. Lactobacillus counts are significantly higher in patients with open caries lesions; restoration of these lesions will produce a dramatic drop in the count.
RATIONALE
Caries begins as a subsurface lesion which can be remineralized as long as the surface remains intact. Supersaturated salivary calcium and phosphates in the presence of fluoride can slowly remineralize demineralized enamel. Remineralized enamel is more resistant to subsequent demineralization than original intact enamel
RATIONALE
The effect of oral hygiene/plaque control on caries activity is controversial. Oral hygiene is much less important than diet, but complete plaque removal daily will reduce caries on exposed tooth surface
RATIONALE
Various anti-microbial mouthwashes will reduce certain cariogenic microorganisms, but may also interfere with the normal oral flora and allow overgrowth of undesirable organisms. For example, Chlorohexadine Gluconate mouthwashes may reduce Strep. Mutans counts, but will not reach organisms in deep lesions. Deep lesions should therefore be eliminated with caries control restorations before
RATIONALE
Fluoride applied in various ways (systemic, clinical and home) decreases cariogenic organisms and promotes remineralization.
RATIONALE
Vigorous treatment to a testable endpoint (the 4 lab tests of saliva at recall) is preferable to vague, ineffective treatment ad infinitum. Patient are very discouraged when they follow the dentists advice and caries activity still continues.
RATIONALE
Not all patients require the same treatment some will be over-treated and some under-treated unless proper diagnosis and treatment is done. It is important to determine which patients have the signs, symptoms and history that are indications of high caries activity and need to be placed on a Caries Risk Management Program.
Root caries:
Fluoride applications Glass ionomer restoration
A previous history of caries, demonstrated by numerous restoration, especially with recurrent caries. Numerous large carious lesion, especially those with depth greater than width.
Unpigmented demineralized areas on smooth surfaces, often on the lingual third. Lesions on the lingual surfaces indicate an even higher risk. Recent incidence of new lesions on recall examinations. Patients requiring extensive reconstructive procedure
Patients (especially the elderly) with root caries. Patients that report a history of a physical condition, medical treatment (especially radiation therapy), medication and dietary changes that would influence saliva or oral flora History of continued high quantity intake of carbonated beverages
Patients with active caries-lesions that are unpigmented, of a soft consistency, moist, sensitive to Sweets, cold or excarvation, and with depth greater than width.
DX
COLOR
ACTIVE
LIGHT
INACTIVE
DARK
FIRM
DRY NONE
DEPTH>WID WIDTH>DEP TH TH