caries

• PROTOCO


  For treatment of caries and its complications
• Lesion management


  3 approaches
• Approach 1: No removal of carious lesion


  1. Reach the sound dentin

  2. Applicable in both dentitions, more applicable in primary dentition
• Types of carious lesions

  • Cleanable
  • Potentially cleanable
  • Non-cleanable
• It is essential to prevent and control caries in the treatment of primary and permanent dentition
• Cleanable lesions


  Lesions where the biofilm on the surface is accessible
• Potentially cleanable lesions


  Lesions where the biofilm can be disrupted and removed to become cleanable
• Non-cleanable lesions


  Lesions where the biofilm cannot be completely removed
• Caries is not just a lesion, it is a process that needs to be controlled to achieve success
• The most important thing is to distinguish lesions based on the patient's and parent's compliance
• In limited cooperation cases, the main aim is to limit the destruction of hard structures and pulp, and buy time until the patient becomes more cooperative
• In primary dentition, no removal of carious tissue is done as the teeth will exfoliate
• Approach in primary dentition

  1. Avoid pain and infection before exfoliation

  2. Inactivate or control the disease process in carious lesions

  3. Promote tooth brushing and fluoride use

  4. Preserve the dental hard tissue

  5. Prevent new caries formation

  6. Preserve the tooth as long as possible

  7. Avoid initiating the restoration cycle

  8. Allow the patient to gain confidence in dental care
• Materials used


  • Resin glass ionomer
  • Sealant materials
• Technique for enamel lesions

  1. Don't do restorative cavity control

  2. Seal the lesion with resin or glass ionomer
• Therapeutic sealants


  Disrupt the intake of nutrients that feed the lesion, and stop the progression of the lesion
• Therapeutic sealants work on enamel lesions, not on dentinal lesions
• Problems with dentinal lesions

  • Poor oral hygiene habits
  • High caries risk
  • Plaque control and remineralizing materials are needed
• Trampoline effect


  Every time the patient chews something, the softer tissue below the enamel is deformed more than the harder enamel structure, creating cracks and fractures
• Remineralizing materials


  • 45% Sodium Fluoride Varnish
  • Silver Diamine Fluoride
• Hall Technique


  Preformed stainless steel crowns sealed with glass ionomer cement
• The most important thing is patient and parent compliance for the success of any treatment
• Forms of prevention for periodontitis


  • Primary (healthy carriers, including all children)
  • Secondary (treat the condition)
  • Tertiary (treat the consequences of the disease, after loss of attachment and bone)
• Periodontal disease


  Inflammatory conditions that affect the periodontium (supporting structures of the tooth) and can lead to tooth loss if not treated
• Dental plaque/biofilm


  Major risk factor for periodontal disease
• During exams, you will be asked to mark the location of the junctional epithelium, which starts at the bottom of the sulcus and extends about 1mm in depth
• Structures of the periodontium

  • Cementum (covers the root)
  • Periodontal ligament (connects root to bone)
  • Alveolar bone
  • Gingiva
• Parts of the gingiva


  • Marginal gingiva (free gingiva)
  • Gingival groove
  • Attached gingiva (keratinized)
  • Gingival sulcus
• Biological space


  Connective tissue attachment apparatus that connects soft tissues to hard structures
• Biological width


  Junctional epithelium (0.97mm) + Connective tissue attachment (1.07mm)
• Prevention of caries also prevents periodontal disease to some degree, as they share the same etiological factor - dental biofilm
• Epithelium lining between free gingiva and tooth

  • Sulcular epithelium (non-keratinized)
  • Junctional epithelium (non-keratinized)
• Junctional epithelium


  • Triangular shape
  • Decreasing number of cell layers from top to bottom
  • Attached to tooth surface by internal and external basal lamina and reinforced by fibers
• Connections in junctional epithelium

  Cells connected by desmosomes, to enamel by hemidesmosomes, to connective tissue by hemidesmosomes
• Junctional epithelium is where periodontal diseases start due to prolonged exposure to dental biofilm
• Characteristics of the gingiva


  • Pointed gingival papillae
  • Gingival margin 1-1.5mm thick
  • Gingival sulcus up to 2mm deep
  • Attached gingiva has orange peel appearance
  • Probing without bleeding
  • Attached gingiva at least 2mm wide in upper incisor area
• Differences between gingiva in childhood vs adulthood

  • Marginal gingiva: Pale pink, thick/rounded vs Colar pink, knife-edge
  • Attached gingiva: More flaccid/less dense vs Firm/resilient
  • Gingival sulcus: Deeper vs Shallower
  • Interdental gingiva: Tent-shaped vs Pyramidal
  • Alveolar mucosa: More red/movable vs Pink/resilient
  • Periodontal ligament: Thicker vs Thinner
  • Alveolar bone: Less dense, more vascular vs Denser, less vascular
• Width of attached gingiva varies in different areas of the mouth, being widest in the anterior maxilla and lingual mandibular molar regions
• Gingival sulcus depth can vary during tooth eruption, so it's important to observe this rather than just measure depth
• Periodontal pathology is milder in childhood due to differences like more keratinized gingival papillae and wider interdental spaces