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What is Dental Caries?
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Keyes-Jordan Diagram
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The Caries Balance
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Caries Risk Assessment
Myths Facts
Diagnosis of caries should be Diagnosis involves recognition
based upon the detection of changes between significant
cavity factors such as bacterial
infection and multifactorial
diseases rather than simply
noting cavities
Placement of restoration is Treatment of caries requires
primary effective method of behavioural modification to
treatment of caries rectify changes.
There is one treatment regime Treatment must be specific for
that can be applies to all the condition that exist in the
individuals individual’s mouth
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In order to manage caries effectively
there must be clear understanding
of:
1. All factors contributing to the
development of caries
2. Accurate diagnosis of abberant
factors
3. Detection and assessment of
active lesions
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Traffic Light system
Risk Assessment Model
• The first element of this system.
• It builds on the existing risk
assessment models as well as
including patient motivation and
lifestyle activities.
• Risk factors, scores a red light
(high), yellow light (moderate) or
a green light (low).
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Risk Factors used in the TL-M model
Saliva Diet Fluoride Oral Modifying
biofilm factors
Ability of minor Number of Past and Differential Past and
salivary gland sugar current staining current dental
to produce exposures per exposure status
saliva day
Consistency of Number of acid Composition Past and
unstimulated exposures per current medical
salive day status
pH of Compliance
unstimulated
saliva
Stimulated Lifestyle
salivary flow
rate
Buffering Sosioeconomic
capacity of status
stimulated
saliva
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The Matrix
• The second element of TL-M
model.
• Design as a means of assessing
the patient’s present disease
status and attitude to maintaining
their own dental health.
• Attitude scored as a, b, c.
• Disease scored as 1, 2, 3.
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ATTITUDE DISEASE STATUS
(a) Self-motivated (1) No apparent disease, no
treatment required at this
time but there may/may
not be restorations of past
(b) Dentally aware (2) Controlled disease, there
may be treatment required
for functional reasons
(c) Unmotivated (3) Active disease, new
lesions or disease activity
around existing restorations
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Clinical Application of TL-M
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Risk Assessment for Individual
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Classification of Dental Caries
GV Black ICDAS New Cavity
(Caries Severity) (Mount & Hume)
Class I 0 Site 1
Class II 1 Site 2
Class III 2 Site 3
Class IV 3 Size 0
Class V 4 Size 1
Class VI 5 Size 2
(modification)
6 Size 3
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G.V. Black’s Classification of Caries
• Standard method used in identification of carious
lesions according to its location on the tooth
surface.
• Originally devised 5 classifications, but a sixth
was later added.
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Class I Lesions
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Class II Lesions
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Class III Lesions
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Class IV Lesions
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Class V Lesions
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Class VI Lesions
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International Caries Detection and Assessment System
(ICDAS)
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First Digit (Restoration and Sealant Codes)
Code Description
0 Not sealed or restored
1 Partial sealant
2 Full sealant
3 Tooth-colored restoration
4 Amalgam restoration
5 Stainless steel crown
6 Porcelain, gold, PFM crown or veneer
7 Defective restoration
8 Temporary restoration
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Second Digit (Caries Severity Codes)
Code Description
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A New Cavity Classification by G.J
Mount & W.R. Hume
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Lesions of The Exposed Tooth Surface
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Size 0 Size 1 Size 2 Size 3 Size 4
• The • Minimal • Moderate • Enlarged • Extensive
earliest surface involveme beyond caries or
lesion cavitation nt of moderate bulk loss
• Initial • Some dentine • Remaining of tooth
stages of form of • The tooth structure
deminerali restoration remaining structure
zation require to tooth is is
• Not restore sufficiently weakened
require the strong to • Cusp or
further smooth support incisal
treatment surface restoration edge are
splits
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MINIMUM INTERVENTION
IN DENTISTRY
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What is MID?
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Recognition
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Reduction
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Regeneration
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Repair
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