CONTINUING EDUCATION

Course Number: 187

Uncontrolled Dental Caries

in a Young Adult:
A Therapeutic Perspective and
Case Report
Authored by Cheryl E. Fryer, DDS, MS, MA; Ronald S. Brown, DDS, MS;
Sandra D. Osborne, RDH, MS
Upon successful completion of this CE activity, 2 CE credit hours may be awarded

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 CONTINUING EDUCATION
Uncontrolled Dental
Caries in a Young Adult:
A Therapeutic Perspec-
tive and Case Report
Effective Date: 07/01/2015 Expiration Date: 07/01/2018
Learning Objectives: After reading this article, the individual
will learn: (1) factors involved in the etiology and diagnosis of
uncontrolled dental caries, and (2) how to manage the patient
with uncontrolled dental caries.
About the Authors
Dr. Fryer is on faculty at Howard University
College of Dentistry, where she serves as
director of faculty development and director of
the caries management clinic for third-year dental
students. She can be reached via email at
cfryer@howard.edu.
Dr. Brown is a professor in the department of clinical dentistry at Howard
University College of Dentistry and a clinical associate professor in the
department of otolaryngology at Georgetown University Medical Center,
Washington, DC. He can be reached via email at rbrown@howard.edu.
Ms. Osborne is an instructor in the department of dental hygiene at
Howard University College of Dentistry. She teaches introduction to
periodontics, periodontics, nutritional counseling, clinical dental hygiene
theory II, a research practicum, and a clinical practicum. She can be
reached at sdosborne@howard.edu.
Disclosure: The authors report no disclosures.
T
here has been a significant decrease in the prevalence of
dental caries in the United States during the last 30 years.
The decrease in dental caries has been most noticeable in
fluoridated and economically advantaged areas. Fluoridated water,
fluoridated toothpaste, professional dental products, improved
dental hygiene, and increased access to dental care have led to this
decreased prevalence. Still, dental caries remains one of the most
common infectious diseases. The factors related to the
development of dental caries are relatively complex in that they
are influenced by oral hygiene, individual microbial carriage,
salivary composition and production, dietary habits, choice of
1
restorative materials, fluoride exposure, and social, cultural, and
economic status. With the advent of minimally invasive dentistry,
dentists have been able to take advantage of techniques that focus
on assessment and identification of indicators, primary and
modifying factors, as well as management of the plaque-biofilm
interface in an effort to carry out prevention and enamel
remineralization strategies. While caries prevalence in the upper-
and middle-class populations has been reduced by public health
prevention strategies, the treatment of young adults with
uncontrolled dental caries in this urban socioeconomic setting can
be sometimes problematic, as many dentists in these settings see
few cases represented by this patient population, and thus have
little experience in the care and maintenance of these patients oral
conditions.1-10
The purpose of this article is to present a case of uncontrolled
dental caries and discuss issues to be considered in diagnosing
and determining the etiology and management of the high-risk
caries patient. The individual oral presentation will be reviewed.
Primary factors (biological predisposing and protective risk
factors) and secondary modifying factors (socioeconomic,
education, attitudes, behaviors, and abilities) will be discussed,
as they influence the maintenance of the equilibrium among the
following 3 prerequisites involved in development of the caries
process: plaque/biofilm, tooth, and diet.
CASE REPORT
A 24-year-old male patient was referred by his periodontist to
an oral medicine clinician with a diagnosis of uncontrolled
dental caries. The patient did not have periodontal disease, but
was referred by his mother, who believed that she was not
receiving satisfactory information and success from the
patients general dentist regarding the treatment of her son.
The patient presented with an unremarkable medical
history and nothing was gleaned from the patient interview
that would appear to be contributory to the chief complaint,
which was multiple cavities continue at the regular checkups.
The patient did not smoke cigarettes and drank alcohol in
moderation. The patient was not taking any medications and
reported no known drug allergies. Recent blood studies were
essentially normal, but deficiencies in selenium, vitamin A,
chromium, and glutathione were reported. The extra- and
intraoral examination of the soft tissues was unremarkable;
however, inflammation was noted in the areas where
restoration margin conformation was biologically
incompatible with gingival health. Mild generalized soft
deposits were visible. Also, several defective restorations and
areas of recurrent caries were noted. Calculus deposits were
detected associated with the lingual and interproximal surfaces
of the mandibular incisor teeth.
 CONTINUING EDUCATION
Uncontrolled Dental Caries in a Young Adult:
A Therapeutic Perspective and Case Report
A clinical photograph was taken (Figure 1). Upon evaluation
of oral hygiene practices, the patient reported brushing with use
of a soft electronic toothbrush, twice a day. He denied being a
regular flosser. The patient reported that he did experience
periods of dry mouth, but did not feel dry all of the time. He
admitted to recommended use of a remineralizing paste
prescribed by his dentist, with application through use of
fabricated flexible trays.
An extraoral examination revealed an absence of palpable
lymphadenopathy. The parotid salivary glands did not
demonstrate function upon stimulation. Normal function of
the submandibular salivary glands was evident. Clinical
examination and evaluation of bite-wing and periapical
radiographs revealed generalized restorative treatment in
varying degrees of repair (open and poorly contoured margins
and surfaces) and primary and recurrent carious lesions present
anteriorly and posteriorly in both arches.
The radiographs (Figure 2) revealed teeth Nos. 1, 17, and 32 to
be impacted. Tooth No. 14 appeared to be missing. A diastema was
present between teeth Nos. 11 and 12. Teeth Nos. 15 and 16 had
migrated mesially into contact with tooth No. 13. Several white
spots in the enamel surface were noted; the majority appeared to
be associated with enamel hypoplasia as evidenced by their
generalized position. However, at the cervical aspects of teeth Nos.
28 and 29, there appeared to be white spot lesions with roughened
surfaces that were characteristically different from the generalized
white areas that appeared to be smooth, hard, and consistent with
a diagnosis of enamel hypoplasia.
The patients history, radiographs, and clinical evaluation
demonstrated interproximal dental caries, gingival inflammation,
and a history of restorations completed during the last 3 years. He
also demonstrated inadequate oral hygiene, decreased salivary
flow, and problematic dietary habits. The patient was counseled
and given home care strategies regarding oral hygiene and diet, and
their impact on the existing condition of xerostomia and its
management. He was also educated about his restorative needs to
correct existing restorations and treatment of his existing carious
lesions. Finally, he was directed to return to the referring perio-
dontist and ultimately advised to seek rehabilitation for his current
condition through care given by a general dentist.
DISCUSSION
Caries Risk Assessment
When a patient presents for examination and dental treatment
with the clinical picture that this patient did, it is important to
gather as much information as possible in order to determine
2
Figure 1. Preoperative clinical photograph of 24-year-old male patient with
uncontrolled dental caries.
the specific factors involved in the progression of the condition.
Featherstone et al11 first introduced the concept of caries
balance and presented a simplified approach to understanding
the key factors involved in the development and reversal of
dental caries. The balance pertains to the ratio between factors
of pathologic origin (plaque, frequent snacks, diminished
salivary flow, high bacterial count) and of a causal nature (deep
pits and grooves, recreational drugs, medications and
conditions affecting salivary function, exposed roots, and
prostheses [orthodontic and prosthodontic]) as compared to
protective factors (biologic or therapeutic) impacting
pathologic challenges.11,12
These variables, collected in a structured format, are used to
complete the caries risk assessment (CRA) form, which can be
preformatted. Forms can be developed for the clinicians use or
retrieved from websites, such as ada.org (if the clinician is an
ADA member), for use for a child aged zero to 6 years or
individuals > 6 years of age.13
As previously stated, this process enables assessment of
causative and protective factors, as well as the indicators which
provide evidence of disease (cavitations, radiographic proximal
lesions, white spot lesions, and a history of recent restorations).
There are a number of CRA forms available to document the
patients existing condition for baseline and recall reference. Based
upon the presence of carious lesions and the balance among
factors, patients may be classified as high, moderate, or low risk for
caries development. The data collected assists the clinician in
making decisions about treatment and monitoring disease
progression and resolution, and can assist in determining any other
needed diagnostic information.14,15
 CONTINUING EDUCATION
Uncontrolled Dental Caries in a Young Adult:
A Therapeutic Perspective and Case Report
Figure 2. Preoperative radiographs of the patient.
The CRA should be accomplished for all patients with a
dentition, as it is the dentists responsibility to provide
comprehensive care based upon the principles of restoring oral
health, form, and function in as noninvasive a manner as possible.
By evaluating the caries balance through risk assessment specific
to each patients condition, a personalized preventive protocol and
treatment plan aimed at disease removal and rehabilitation can be
provided for each patient.14,15
Caries Diagnosis
Traditional methods of caries detection involve visual, tactile,
and radiographic interpretation. Surfaces should be clean and
dry so that changes represented by the demineralization/
remineralization processes in pits, fissures, and smooth surface
enamel can be readily identified. Probing should be avoided, but
if used, exploration should only be accomplished for the
purpose of removing debris from the depths of pits and fissures
and other retentive surfaces. Care is imperative with the
probing technique in order to avoid the transmission of
cariogenic bacteria and iatrogenic trauma to demineralized and
weakened enamel. Therefore, it is important to consider that
visual inspection is preferred over the use of probing, and that
probing is less accurate than the visual approach to caries
identification.16 Caries is a dynamic process with periods of
remineralization followed by demineralization; identification
of small or incipient lesions is of great importance.3,11,17
3
During the CRA interview for the patient in this case report,
he disclosed that he did snack frequently between meals and
did not always have the opportunity to brush his teeth, nor did
he floss with regularity. He also admitted to drinking high
carbohydrate content sodas and juices without the benefit of
rinsing or brushing his teeth after consumption. As the patient
appeared to exhibit signs of parotid salivary gland dysfunction,
these patient interview reports and clinical findings should be
documented. Based upon the findings from this interview and
the clinical findings (caries, salivary dysfunction, frequent
nonhealthy snacking, etc), a classification of high-risk caries may
be determined.
When considering where to start in the management of the
high-risk caries patient, one must first consider his/her own
modifiers as a dentist. Trained by advocators of the principles of G.
V. Black, it is very easy to maintain the modalities of a surgical
intervention which originally involved the concept of extension
for prevention (currently, the concept of extension for prevention
is not an evidenced-based view). During the last 20 to 30 years, the
medical model of caries management, with dental caries regarded
as an infection, has evolved into a number of strategies aimed at
minimal surgical intervention. Impediments to these conservative
concepts have a negative impact on therapeutic success; namely,
lack of a comprehensive understanding of what conservative
therapy actually involves, lack of support on the part of insurance
agencies in remunerating dentists for preventive protocol
 CONTINUING EDUCATION
Uncontrolled Dental Caries in a Young Adult:
A Therapeutic Perspective and Case Report
strategies, and lack of cooperation of the patient (who may not
fully understand the concept, or may have concerns regarding the
expense of preventive treatment).3,4,18
One must take into consideration the patient as a whole and
also have a realization that dentists in middle- to upper-class
geophysical regions often do not have experience in the
diagnosis and treatment of adults with uncontrolled caries. The
demographics tend to favor less caries prevalence in
economically advantaged regions. For the treatment of such
patients, it is necessary to have an understanding of the
condition, its pathophysiology, and the structured ability to
assess the caries risk of such patients in order to formulate a
viable treatment protocol. Furthermore, it is advantageous to
have knowledge of appropriate restorative materials that
contribute to caries control success.3,4,11,17,19 By reviewing the
patients medical history, one can determine if there are over-
the-counter or prescribed drugs which may have an impact on
saliva production. Furthermore, a clinical evaluation of the
patients saliva production and counseling regarding dry mouth
strategies are helpful.20,21
The successful treatment of uncontrolled dental caries
necessitates an understanding of the pathophysiology of the caries
process, methods of detection and diagnosis, and contributing
factors such as xerostomia, poor oral hygiene, plaque/biofilm,
impact of diet, and demineralization/remineralization activity at
the tooth surface. Further, a knowledge of the nature of
chemotherapeutic agents, the dental materials useful in caries
prevention, and therapeutic and preventive strategies
implemented in order to restore the balance in patients with
uncontrolled dental caries are important.
A further contribution to this discussion includes cultural and
economic issues. With the advent of fluoridated water supplies,
dental cariesand particularly the uncontrolled dental caries
conditionis much less prevalent today. The case presented
represents a patient from an upper-middle-class region. Such a
patient presents an unusual case for dentists practicing in a
location where uncontrolled caries is not the norm. As such,
dentists within geophysical locations with low caries rates may
be unaccustomed to treating patients with uncontrolled
caries.18,22-24
Phased Treatment
Modern treatment planning is based upon phasing therapy. In
essence, the best outcomes occur with first controlling medical
conditions and urgent matters. Stefanac and Nesbit25 recognize
5 phases in treatment planning. The first 2 steps represent Phase
4
I: Systemic, and Phase II: Acute Aspects of the Phased Treatment
Plan. Once the medical and urgent issues are stabilized, a
comprehensive oral examination that identifies problems and
diagnoses of the existing conditions can begin.
Identifying the diseases to be controlled is the next step in the
phased treatment plan, Phase III: Disease Control. After all
diagnostic data are acquired, of which a CRA is vital, the
interpretation of such is important. From this assessment, the
factors involved in upsetting the balance among plaque/biofilm,
saliva, and diet, as well as the existing preventive activities of the
patient, can be determined. A well-planned caries control strategy
can be developed and implemented with patient approval and
commitment. Patient education and compliance with scheduled
recall and monitoring is important to maintenance strategies. Just
as periodontal disease has a firm foothold in assessment, diagnosis,
treatment, and maintenance, so should the management of dental
caries. While dental caries is not a recognized specialty, it is one of
the most commonly occurring diseases of the oral cavity and
deserves similar attention.25
In managing this disease, it is essential to develop a caries
control protocol that focuses on the etiology of the caries
condition of the individual patient before entering into Phase
IV: Definitive Care of the phased treatment plan, placing
permanent restorations. Identifying the particular etiology of
caries in patients with uncontrolled caries is especially
important and includes determining the presence of infectious
bacteria (Streptococcus mutans, lactobacillus), decreased salivary
flow, poor diet, and poor oral hygiene. In order to provide a
successful treatment outcome, it is imperative to identify the
balance between individual causative and protective factors and
successfully address these issues for each patient.2,24-30
Once the disease control phase of the plan has been
implemented and after evaluation of the outcomes of treatment
has revealed stabilization of all active disease processes, the
patient can continue to Phase IV: Definitive Care. Phase V:
Maintenance should be carried out to encompass reinforcement
of disease control prevention, as well as recall for evaluation of
restorations and prostheses placed in the definitive care phase to
confirm absence of any deleterious effects on the existing
stabilized condition.25
Treatment should begin with an oral examination and
assessment process that leads to the identification of problems
requiring diagnosis, planned treatment, and conditions to be
maintained. Oral hygiene instructions and patient education (to
include how dental caries and gingival disease happen) specific to
each individual patients needs are important to the maintenance
 CONTINUING EDUCATION
Uncontrolled Dental Caries in a Young Adult:
A Therapeutic Perspective and Case Report
of a healthy oral condition. First, evaluate the patients oral hygiene
skills and demonstrate and reinforce accurate technique. Then,
impart the importance of good brushing, flossing, and frequency
associated with food intake. Next, emphasize oral hygiene as a daily
habit and the importance of compliance. Other adjuncts to therapy
used in the control of dental caries include chlorhexidine,
nutritional counseling, fluorides (varnish, pastes, rinses), calcium
phosphate-containing materials (Recaldent, MI paste [GC
America]), xylitol chewing gum, products used in managing
xerostomia, dental floss and flossing aids, electric toothbrushes,
water irrigation devices, and simply rinsing with water. After the
patient is stabilized, definitive care and maintenance plans, with
options, can be presented to the patient.25,26
With regard to dental restorative material therapies, dental
amalgam is a superior (with regard to longevity) restorative
material for posterior tooth restorations in patients with a high
caries index or a previous history of uncontrolled dental caries. In
large and deep Class II caries below the cemento-enamel junction,
bonded resin restorations may be problematic due to the
requirements for moisture control and isolation. Neither dentin
nor cementum bonding is as strong as enamel bonding, and the
thermal coefficient of expansion and contraction are less favorable
with composite restorations compared to amalgam
restorations.17,27-35 Also, oral bacteria are more problematic with
resin restorations compared to amalgam restorations.36 However,
5
several new posterior restorative materials demonstrate relative
success. In the anterior region, materials such as glass ionomer, and
restorations using the sandwich technique that utilize both glass
ionomer and composite restorative material, are useful, as is fluo-
ride rechargeable composite restorative material. The choice of
dental materials, particularly with regard to posterior restorations
for individuals with a high caries index, is an area of controversy.
Many dentists utilize Class II posterior composite restorations
because of unfounded concerns regarding the toxicity of dental
amalgam.33-35,37 Dental implants are also a good choice for
replacing teeth loss due to dental caries infection.38
CONCLUSION
Every patient in a dental practice deserves a CRA to include a
thorough evaluation of preventive and contributing pathologic
factors that may impact the ability to maintain a healthy and
disease-free oral environment. Dentists need to avail themselves
of opportunities that enhance their practice through continuing
education and dedicate themselves to lifelong learning in this
area. Through continuing educational experiences and self-
directed learning, practitioners can enhance their clinical
expertise with regard to an understanding of caries patho-
physiology, caries management by risk assessment, patient
education practices, and evidenced-based treatment modalities
in the treatment and control of dental caries.F
 CONTINUING EDUCATION
Uncontrolled Dental Caries in a Young Adult:
A Therapeutic Perspective and Case Report
References
1. Murray JJ. Efficacy of preventive agents for dental caries. Systemic fluorides:
water fluoridation. Caries Res. 1993;27(suppl 1):2-8.
2. Hicks J, Garcia-Godoy F, Flaitz C. Biological factors in dental caries: role of saliva
and dental plaque in the dynamic process of demineralization and remineralization
(part 1). J Clin Pediatr Dent. 2003;28:47-52.
3. Featherstone JD, Domjean S. Minimal intervention dentistry: part 1. From
compulsive restorative dentistry to rational therapeutic strategies. Br Dent J.
2012;213:441-445.
4. Murdoch-Kinch CA, McLean ME. Minimally invasive dentistry. J Am Dent Assoc.
2003;134:87-95.
5. NIH Consensus Development Panel. National Institutes of Health Consensus
Development Conference statement. Diagnosis and management of dental caries
throughout life, March 26-28, 2001. J Am Dent Assoc. 2001;132:1153-1161.
6. Ettinger RL. Epidemiology of dental caries. A broad review. Dent Clin North Am.
1999;43:679-694, vii.
7. Fontana M, Zero DT. Assessing patients caries risk. J Am Dent Assoc.
2006;137:1231-1239.
8. Locker D. Deprivation and oral health: a review. Community Dent Oral Epidemiol.
2000;28:161-169.
9. Bernab E, Sheiham A, Sabbah W. Income, income inequality, dental caries and
dental care levels: an ecological study in rich countries. Caries Res.
2009;43:294-301.
10. Masood M, Masood Y, Newton T. Impact of national income and inequality on
sugar and caries relationship. Caries Res. 2012;46:581-588.
11. Featherstone JD, Domejean-Orliaguet S, Jenson L, et al. Caries risk assessment in
practice for age 6 through adult. J Calif Dent Assoc. 2007;35:703-713.
12. Jenson L, Budenz AW, Featherstone JD, et al. Clinical protocols for caries
management by risk assessment. J Calif Dent Assoc. 2007;35:714-723.
13. American Dental Association. Caries risk assessment form (age >6).
asplegacy.ada.org/sections/professionalResources/pdfs/topic_caries_over6.pdf.
Accessed April 9, 2015.
14. Zero D, Fontana M, Lennon AM. Clinical applications and outcomes of using
indicators of risk in caries management. J Dent Educ. 2001;65:1126-1132.
15. Ismail AI, Tellez M, Pitts NB, et al. Caries management pathways preserve dental
tissues and promote oral health. Community Dent Oral Epidemiol.
2013;41:e12-e40.
16. Ekstrand K, Qvist V, Thylstrup A. Light microscope study of the effect of probing in
occlusal surfaces. Caries Res. 1987;21:368-374.
17. Kidd EA, Ricketts DN, Pitts NB. Occlusal caries diagnosis: a changing challenge for
clinicians and epidemiologists. J Dent. 1993;21:323-331.
18. Ammari MM, Soviero VM, da Silva Fidalgo TK, et al. Is non-cavitated proximal
lesion sealing an effective method for caries control in primary and permanent
teeth? A systematic review and meta-analysis. J Dent. 2014;42:1217-1227.
19. Bernardo M, Luis H, Martin MD, et al. Survival and reasons for failure of amalgam
versus composite posterior restorations placed in a randomized clinical trial. J Am
Dent Assoc. 2007;138:775-783.
6
20. Plemons JM, Al-Hashimi I, Marek CL. Managing xerostomia and salivary gland
hypofunction: executive summary of a report from the American Dental
Association Council on Scientific Affairs. J Am Dent Assoc. 2014;145:867-873.
21. Ram S, Kumar S, Navazesh M. Management of xerostomia and salivary gland
hypofunction. J Dent. 2011;39:656-659.
22. Cho HJ, Lee HS, Paik DI, et al. Association of dental caries with socioeconomic
status in relation to different water fluoridation levels. Community Dent Oral
Epidemiol. 2014;42:536-542.
23. Ditmyer M, Dounis G, Mobley C, et al. Inequalities of caries experience in Nevada
youth expressed by DMFT index vs. Significant Caries Index (SiC) over time. BMC
Oral Health. 2011;11:12.
24. Ravaghi V, Quionez C, Allison PJ. Comparing inequalities in oral and general
health: findings of the Canadian Health Measures Survey. Can J Public Health.
2013;104:e466-e471.
25. Stefanac SJ, Nesbit SP. Treatment Planning in Dentistry. 2nd ed. St. Louis, MO:
Mosby/Elsevier; 2007:89-213.
26. Reid E, Sam FE, Jones RL, et al. Treating the individual tooth, not the patient: case
reports. Dent Today. 2008;27:94-99.
27. van Palenstein Helderman WH, Matee MI, van der Hoeven JS, et al. Cariogenicity
depends more on diet than the prevailing mutans streptococcal species. J Dent
Res. 1996;75:535-545.
28. Carlsson P. Distribution of mutans streptococci in populations with different levels
of sugar consumption. Scand J Dent Res. 1989;97:120-125.
29. Korenstein K, Echeverri EA, Keene HJ. Preliminary observations on the relationship
between mutans streptococci and dental caries experience within black, white,
and Hispanic families living in Houston, Texas. Pediatr Dent. 1995;17:445-450.
30. Lenander-Lumikari M, Loimaranta V. Saliva and dental caries. Adv Dent Res.
2000;14:40-47.
31. Moynihan P, Petersen PE. Diet, nutrition and the prevention of dental diseases.
Public Health Nutr. 2004;7:201-226.
32. Wahl MJ. Amalgamresurrection and redemption. Part 2: The medical mythology
of anti-amalgam. Quintessence Int. 2001;32:696-710.
33. Bohaty BS, Ye Q, Misra A, et al. Posterior composite restoration update: focus on
factors influencing form and function. Clin Cosmet Investig Dent. 2013;5:33-42.
34. Tan CL, Santini A. Marginal microleakage around class V cavities restored with
glass ceramic inserts of different coefficients of thermal expansion. J Clin Dent.
2005;16:26-31.
35. Opdam NJ, van de Sande FH, Bronkhorst E, et al. Longevity of posterior composite
restorations: a systematic review and meta-analysis. J Dent Res.
2014;93:943-949.
36. Bourbia M, Ma D, Cvitkovitch DG, et al. Cariogenic bacteria degrade dental resin
composites and adhesives. J Dent Res. 2013;92:989-994.
37. Scholtanus JD, Ozcan M. Clinical longevity of extensive direct composite
restorations in amalgam replacement: up to 3.5 years follow-up. J Dent.
2014;42:1404-1410.
38. Al-Khadhari M. Comprehensive strategy for a compromised esthetic case: a
multidisciplinary approach. Oral Health Dent Manag. 2014;13:552-557.
 CONTINUING EDUCATION

Uncontrolled Dental Caries in a Young Adult:

A Therapeutic Perspective and Case Report
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POST EXAMINATION QUESTIONS c. Dietary imbalance.

d. None of the above.

1. The following is/are related to the development of dental 4. Caries factors of pathologic origin include:
caries: a. Recreational drugs.
a. Individual microbial carriage. b. Deep pits and grooves.
b. Salivary composition and production. c. Diminished salivary flow.
c. Dietary habits. d. Exposed roots.
d. All of the above.
5. Caries factors of a causal nature include:
2. In the case presented in this article, the patients a. Plaque.
parotid salivary glands did not demonstrate function b. Frequent snacks.
upon stimulation. c. High bacterial count.
a. True. d. Medications affecting salivary function.
b. False.
6. Indicators which provide evidence of caries disease
3. Featherstone et al first introduced the concept of include:
__________ and presented a simplified approach to a. Cavitations.
understanding key factors in caries development/reversal. b. White spot lesions.
a. Xerostomia. c. Radiographic proximal lesions.
b. Caries balance. d. All of the above.

7
 CONTINUING EDUCATION

Uncontrolled Dental Caries in a Young Adult:

A Therapeutic Perspective and Case Report
7. When diagnosing caries, visual inspection is preferred over 9. Adjuncts to therapy used in the control of dental caries
the use of probing. Probing is less accurate than the visual include:
approach to caries identification. a. Chlorhexidine.
a. The first statement is true, the second is false. b. Calcium phosphate-containing materials.
b. The first statement is false, the second is true. c. Xylitol chewing gum.
c. Both statements are true. d. All of the above.
d. Both statements are false.
10. Oral bacteria are more problematic with resin
8. Stefanac and Nesbit recognized _____ phases in treatment restorations compared to amalgam restorations.
planning for uncontrolled caries. a. True.
a. 2. b. False.
b. 3.
c. 4.
d. 5.

8
 CONTINUING EDUCATION

Uncontrolled Dental Caries in a Young Adult: A Therapeutic Perspective and Case Report
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Examination Fee: $40.00 Credit Hours: 2.0 ANSWER FORM: COURSE #: 187
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