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- Volume 4, Issue 2, 2011
Journal of Minimum Intervention in Dentistry - Volume 4, Issue 2, 2011
Volume 4, Issue 2, 2011
Aetiological factors for susceptibility : the location (number, location, activity) and the plaque (identification tools, scoring)Source: Journal of Minimum Intervention in Dentistry 4, pp 13 –16 (2011)More Less
Today, due to better understanding of caries process, the main goal is to postpone operative intervention as long as possible and to remineralize incipient non-cavitated lesions. For correct prevention and management of dental caries it is essential to determine individual's susceptibility to develop caries. Patient's susceptibility can be identified through anamnesis, oral examination and assessment of aetiological factors. Anamnesis can provide information about dental and medical history, behavioural habits (food habits, oral hygiene), social, economical and cultural status of the patient. Oral examination is essential to determine number of caries lesions, its activity and to classify each tooth surface as being sound, sealed, restored, crowned or missing. The visual examination has to be performed on clean, dryable tooth surfaces, with the advisable use of magnification and good quality lighting. Modified "International Caries Detection and Assessment system" (ICDAS-II) is used as a standardised visual scoring system for caries detection. Oral factors that influence the caries susceptibility of the patient are: oral hygiene maintenance (proper brushing technique, brushing frequency, interdental cleaning, toothpaste type, rinsing, etc), saliva and plaque. Among other tests, clinical examination of patient's susceptibility involves disclosing and collecting samples of dental plaque, which can also be used as motivation tool for improvement of oral hygiene. The patient should be educated about the dangers of plaque acid production and possible occurrence of new caries lesions and advised about the proper oral hygiene.
Source: Journal of Minimum Intervention in Dentistry 4, pp 17 –19 (2011)More Less
Saliva plays a significant role in the prevention of dental caries. Adequate salivary flow and unique composition of saliva are essential to the maintenance of health of oral tissues. Saliva lubricates and protects oral tissues, acting as a barrier against mechanical, thermal and chemical irritants. Clearance is another important function of saliva as normal salivary flow allows removal of sugars, acids and bacteria. Bicarbonate, phosphate and urea are responsible for buffering action of saliva. Of salivary electrolytes, calcium, phosphate and fluoride are of particular importance for oral health and remineralization. Saliva is supersaturated with calcium, phosphate and fluoride ions in comparison to hydroxylapatite. Thus, the main mineral of teeth will not dissolve in saliva or plaque, unless the saliva or plaque is acidified. Saliva testing includes complete assessment of resting and stimulated saliva. Salivary parameters, which are tested are hydration, viscosity of saliva, flow rate and pH of resting and stimulated saliva and buffer capacity of stimulated saliva. Samples of stimulated saliva are also used for microbial analysis of Streptococcus mutans. Salivary level of this bacterium is useful for caries susceptibility assessment in individual patients, when used in conjunction with other clinical information. If the result of the test shows high number of Streptococcus mutans, some kind of antimicrobial therapy should be introduced.
Source: Journal of Minimum Intervention in Dentistry 4, pp 20 –22 (2011)More Less
According to the patient susceptibility, two types of preventive care are available: standard and active preventive care. Preventive standard care is indicated for patient with low susceptibility for caries occurrence, in order to reduce the risk for recurrence of caries. This type of care could be compared to conventional maintenance therapy for patients who have not developed any new caries lesions in the past 2 or 3 years. For individuals highly susceptible to caries, active care is recommended. Active preventive care includes the standard care regime with addition of professional decontamination, remineralisation, management of aetiological factors and the use of fissure sealants. Decontamination is used to rebalance the oral microflora. Few actions of decontamination are available: professional mechanical tooth cleaning (PMTC), Chlorhexidine and stabilizing restorations. Remineralisation is indicated for incipient, non-cavitated lesions with a use of fluorides or more recently introduced casein derivates. When Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) or Casein Phosphopeptide-Amorphous Calcium Fluoride Phosphate (CPP-ACFP) is applied in the oral environment, it will bind to biofilms, plaque, bacteria, hydroxylapatite (tooth structure) and soft tissue localising bioavailable calcium, phosphate and fluoride ions. Therapy of aetiological factors can also be managed by some simple advice on oral hygiene, diet or saliva flow stimulation, to help rebalance the oral environment. Since dental caries is a bacteria-dependent, multifactorial disease, preventive measures such as sealants, can be implemented once patients susceptible to caries are identified. Sealants act as a barrier, protecting tooth enamel from plaque, bacteria and acid and preventing pit and fissure caries.
Source: Journal of Minimum Intervention in Dentistry 4, pp 23 –34 (2011)More Less
The risks of iatrogenic actions when we apply therapies to the tooth itself, or to collateral teeth, are potentially high when combined with low sensitivity and specificity of our diagnosis tools. There are therapeutic tools, both for the occlusal and proximal surfaces, in the form of infiltration products, specific inserts for cavity preparation, a fluorescent camera for magnification and early detection, and others; however, preservation of the natural tooth aesthetics also requires early detection of the carious lesion, associated with comprehensive patient care so that our therapies are perpetuated. The purpose of this article is to discuss the advantages and drawbacks of minimally invasive dental techniques, distinguishing those that preserve or reinforce the enamel and enamel-dentine structures (MIT1) from those that require minimum preparation of the dental tissues (MIT2). The discussion is rounded off by an illustration of how the natural tooth aesthetics are preserved in two clinical cases.
Cariology: Minimal Intervention Treatment Plan : from theory to practice, the GC-MI-Advisory Board approachSource: Journal of Minimum Intervention in Dentistry 4, pp 35 –38 (2011)More Less
Under the auspices of GC EUROPE, the GC-MI-Advisory Board (panel of dentists working in private practice, hospital and industry produced a treatment plan based on current scientific findings in cariology. The guide is based on the general concept of Minimal Intervention consists of four stages: Identification, Prevention, Treatment and Maintenance. A series of articles sets out to explain the different aspects of Minimal Intervention and sifts through the different stages to help incorporate this new approach into daily practice. The present manuscript describes the basics of the MI concept.
Minimal intervention in cariology - identification stage detection & classification of caries lesionsSource: Journal of Minimum Intervention in Dentistry 4, pp 38 –40 (2011)More Less
This article describes a system developed recently by a panel of experts in cariology, the International Caries Detection and Assessment System (ICDAS), and suggests a simplified version combined with a treatment protocol drawn up by the GC-MI-Advisory Board. ICDAS is a system based entirely on visual criteria confirmed to be closely related to the histological depth of lesions. It was developed to help in different aspects of cariology: epidemiology / public health, clinical research and clinical practice. However, the system appears to be difficult to use in general dentistry / everyday practice, because the double code is not very easy to handle. The GC-MI-Advisory Board proposes a system derived from ICDAS, simplified for easier application in everyday practice for the detection and classification of occlusal carious lesions.
Minimal intervention in cariology - identification stage detection of carious lesions & bitewing radiographsSource: Journal of Minimum Intervention in Dentistry 4, pp 41 –44 (2011)More Less
Minimal Intervention in cariology and the treatment protocol proposed by the GC-MI-Advisory Board are based on an identification or diagnosis stage that includes an overall assessment of the disease - caries susceptibility assessment and detection of the presence of lesions. Detection methods must be used that enable detection of carious lesions as early as possible, to allow the least invasive treatments. Currently, only two detection tools have been validated scientifically (validity, reliability, applicability): 1) visual examination (see the criteria of the International Caries Detection and Assessment System or ICDAS in a previous article or on Internet http://220.127.116.11/icdas/) and 2) bitewing x-ray examination. The present article presents the bitewing radiographs - indications, technique, and interpretation.
Source: Journal of Minimum Intervention in Dentistry 4, pp 45 –48 (2011)More Less
Sealant application is a non-invasive procedure consisting of filling the pits and fissures of a tooth. It creates a smooth, flat, impermeable barrier that stops bacterial plaque accumulating and prevents demineralisation of the protected surface. The clinical success of sealants has been described in many clinical studies. Sealants can be applied to prevent carious lesions appearing, or to treat and stop the carious process. This article sets out the indications for using this non-invasive procedure and provides some facts about protocol.