Smooth surface lesions

• Who invented the classification system for Caries?

  GV Black (1836-1915)
• What are the set backs with Blacks classification system?

  1) Ignores biological basis of modern dental treatment

  2) Ties up the presence of disease in a certain place with providing a filling of a certain shape without considering cause of disease or if a filling is needed
• Why is Blacks classification system useful?

  For the communication between Dentists
• Types of smooth surface lesions

  1) Carious Lesions 2) Non-Carious Lesions
• What is smooth surface lesions on the root surface?

  • Root structure dissolution at pH < 6.7ish
  • Easier to get, disease of older people
  • Medications, diet change increase risk
  • Drug Users on Methadone (enamel or root surface)
• Why is Dentine caries easier to get than smooth surface caries?

  Gums may recede and expose dentine esp in older patients
• Why is root caries NOT common in younger people?

  Because the roots are covered by gums
• What are non-carious smooth surface lesions?

  • slow onset: tooth wear
  • fast onset: trauma
  • developmental: hypoplastic teeth
• Examples of non-carious tooth surface loss

  1) Erosion - acid not from plaque dissolves tooth 2) Abrasion - tooth is worn away - e.g brushing 3) Abfraction - tooth surface loss is multifactoral 4) Attrition - teeth wear each other away e.g bruxism
• What are the types of erosion and what causes this?

  Extrinsic - Yoghurt, Orange juice, Beer

  Intrinsic - Stomach acids (very destructive)
• How do you manage smooth surface lesions?

  1) Diagnosis e.g enamel caries buccal UR3 2) Aetiology (causes) e.g diet, toothbrushing 3) Treatment plan
• .What choices are there for restorations?

  1) Composite Resin

  2) GIC
• What are the advantages and disadvantages of Composite Resin?

  Advantages – Generally more aesthetic than GIC – Stronger than GIC

  Disadvantages – Moisture sensitive – Requires a bonding agent
• What are the advantages and disadvantages of GICs over composites?

  Advantages over composite– Releases Fluoride – Inherently Adhesive – Low setting shrinkage - Low thermal expansion - Bond to tooth does not break down over time (it just gently wears away...)

  Disadvantages over composite – Acid soluble – Low resistance to abrasion – Less aesthetic than composite – So easy to handle that you forget it is very technique sensitive if you want along lasting result.– Best with a butt join - can look a bit obvious
• What is a compomer?

  Combination of composite and glass ionomer
• What are the positives and negatives of Compomers?

  - Combines the BEST qualities of composites AND GI's

  - Combines the WORST qualities of composites AND GI's
• Disadvantages of Compomers?

  - Its not self adhesive - Doesn't give out much fluoride - Doesn't look good after a few years