Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Worm theory
Humour
theory
Parasitic
theory
Vital theory
Chemical
theory
Acidogenic
theory
Proteolytic
theory
Proteolysischelation
theory
Sucrosechelation
theory
Microorganism
Substrate
Host
Time
Initial lesion
Repeated attack of cariogenic challenge
Cavitation
However
This progress can be arrested at any stage of
development due to
SALIVA
Calcium &
Phosphate
Fluoride
Ammonia
SALIVA
Bicarbonate
Antibacterial
substance
Lysozyme
Lactoperoxidase
Lactoferrin
IgA
Quantity and
viscosity
Spread of caries
ENAMEL CARIES
Surface
layer
Body of
lesion
Dark zone
Translucent zone
Pits & fissure caries
From
ENAMEL
DENTIN via
DENTINAL CARIES
Zone of decomposed dentin
Zone of decalcification
Sclerotic zone
Zone of fatty
degeneration
of Tomes fibre
Inflammation of pulp
The stage where caries is associated with toothache
Streptococcus mutans
Lactobacillus sp.
Actinomyces sp.
Other: S. salivarius, S. sanguis, Veilonella sp.
etc
sp.
Type of caries
Microorganisms
S. mutans
S. sanguis
Lactobacillus sp.
Actinomyces sp.
Smooth surface
S. mutans
S. salivarius
Root surface
A. viscosus
A. naeslundii
S. mutans
S. sanguis
Lactobacilli sp.
A. naeslundii
Other filamentous rods
Caries Prevalence
90.3%, with female(91.4 %) > male (88.9%)
Rural (90.9%) > urban (89.9%)
Chinese (92.6 %) > Ibans (92.1%) > Malays
(90.9%) >Bumiputeras (89.3%) Indians/Pakistani
(82.5%).
Almost similar in all 3 education level, Level 1
89.7, Level 2 88.8%, Level 3 91.1%.
Caries Severity
Measured using the DMFX(T) index.
Mean
Age Group
DMFX
15 - 19
0.66
(0.04)
0.29
(0.06)
1.63
(0.06)
0.27
(0.03)
2.85
(0.10)
35 - 44
1.03
(0.03)
7.77
(0.20)
2.11
(0.10)
1.20
(0.07)
12.11
(0.21)
65 - 74
0.41
(0.04)
21.17
(0.50)
0.25
(0.05)
1.36
(0.11)
23.20
(0.46)
0.85
(0.02)
7.87
(0.15)
1.68
(0.05)
0.94
(0.03)
11.34
(0.15)
Total
INTERNATIONAL DATA
Since 1990, continued change in global pattern
of oral diseases.
Dental caries found to increasein developing
countries, while in developed countries the
caries situation seems to be stable or on
decline.
Summarised that preventive measures,
especially flouride from a variety of sources,
have brought about the decline in developed
countries.
Socialisation
1
2
3
4
5
6
7
8
Reason
Something wrong
Part of the school dental programme
Thought it was time
Part of a series of treament
Antenatal programme
Referral
Reinders
Other reasons
Percentage
44.5
18.5
13.3
11.4
2.8
2.4
0.6
6.6
Reason
Percentage
1
2
3
4
5
6
7
8
9
10
11
12
13
14
No problem
Problem not serious
Too busy
No teeth/ False teeth
Fear treatment
Other reason
Expected problem to go away
Location too far
Bad experience
Physical problems
Cannot afford
Did not want to spend money
Required appointment
Dentist would not give appointment
61.7
10.7
9.5
6.6
5.0
2.4
1.3
0.8
0.6
0.5
0.3
0.2
0.2
0.1
Facility Used
Management
Effective brushing using flouride toothpaste.
Use of dental floss and interdental sticks to
clean between teeth.
Reduce sugar intake.
Regular dental check-up.
associated with
xerostomia and
increased gingival
crevicular fluid
glucose level
Preoperative
Intraoperative
Diabetic
Emergency
Postoperative
Preoperative
Medical history
- ask pt about recent blood glucose level
- frequency of hypoglycemic episodes
- antidiabetic medications, dosage and time of administration
Scheduling of visit
- should receive dental treatment in the morning (higher cortisol
level)
- pt under insulin therapy avoid period of peak insulin activity
Diet
- ensure patient has eaten normally and take medications as usual
- if patient skip meals but has taken insulin as usual increased risk
for hypoglycemia
Intraoperative
Adequate control and stress reduction
- Anesthesia- reduces pain and minimize endogenous
epinephrine release
- Conscious sedation for extremely anxious patient
Diabetic emergency
Terminate dental treatment
Administer 15g of fast acting oral carbohydrates glucose
tablets, sugar, candy, soft drinks, juice
Measure blood glucose level to confirm determine if
repeated carbohydrate dosing is needed
If patient unable to swallow/ unconcious
give 25-30 ml of a 50% dextrose
solution i.v or 1 mg of glucagon
i.v./i.m./s.c.
Hyperglycemic crisis usually have
prolonged onset lower risk in dental
practice
Postoperative
Patient with uncontrolled diabetes have greater risk of getting
infection give antibiotic
If normal dietary intake is affected modify insulin or oral
antidiabetic medication dosage (consult physician)
Avoid prescribing aspirin salicylates can increase insulin
secretion and sensitivity - hypoglycemia
Dietary
measures
Elimination
Modifying
microflora
nidus of
bacteria
Caries
Preventive
Method
Modifying
tooth
surface
Plaque
disruption
Stimulating
saliva flow
Dietary measures
Decreased frequency of meals
- only eat during mealtimes
- to decrease number, duration and intensity of acid attack
- limit to 4 meals per day reduces the retention period of sugar and
number of drops in pH
Phosphate (cereals) :
prevent loss of phosphorus from enamel during demineralization
Helps in remineralization
Inhibit bacterial growth
- Fats :
Reduce the cariogenicity of different foods
Some fatty acids have antimicrobial effect
Cheese :
Reduce level of cariogenic bacteria
Increases flow of saliva and its buffering capacity
Provides organic phosphates for remineralization
Snackings
Choose less sticky snack and fast clearing
No snacks in between meals
Brush the teeth immediately after eating
Example of safe snacks?
Modifying microflora
Achieved by intensive antimicrobial treatment
that is capable to:
- Inhibit bacterial colonization-adhesion
- Affect plaque growth-metabolic activity
Plaque disruption
Brushing
Flossing
Mouthwash