Академический Документы
Профессиональный Документы
Культура Документы
(CAMBRA)
Introduction
The population of individuals susceptible to carious lesion & dental caries continues to expand with increased age
CAMBRA principle: An evidence based approach to preventing or treating the cause of dental caries at the earliest
stage rather than waiting for irreversible damage to the teeth
Caries risk assessment (CRA) is essential in decision making to guide clinician in the diagnosis, prognosis and treatment
recommendation – better cost effectiveness & greater successful tx
CRA forms
o American Dental Association (2 forms; determine low, moderate or high risk)
For patients 0-6 years old
For patients >6 years old
o American Academy of Pediatric Dentistry
For children 0-5 years old
For children >5 years old
o Journal of California Dental Association
For patients aged 0-5 years old
For patient aged >5 years old
Restoration & Sealant Code (Tooth status) Caries lesion code (severity)
0 = Not sealed or restored 0 = Sound tooth surface, no/slight change after prolonged air
drying
1 = Sealant, partial 1 = 1st visual change in enamel seen after prolonged air drying
2 = Sealant, full 2 = Distinct visual changes in enamel
3 = Tooth-colored restoration 3 = Localized enamel breakdown, no dentin involvement
4 = Amalgam restoration 4 = Underlying dark shadow from dentin (not cavitated into dentin)
5 = Stainless steel crown 5 = Distinct cavity with visible dentin
6 = Porcelain, gold, PFM crown or veneer 6 = Extensive distinct cavity with visible dentin
7 = Lost or broken restoration
8 = Temporary restoration
RISK FACTORS
1) Bacteria (MS & LB)
Cariogenic bacteria reside in plaque biofilm & adhere to the tooth surface, ingested sugars from fermentable
carbohydrates are converted to weak organic acids that will cause demineralization of the hydroxyapatite structure.
There is a distinct difference between the microflora of healthy (caries free) individual compared to microflora of those
with dental caries.
Mutans streptococci – has unique ability to produce both intra- and extracellular polysaccharides that help with acid
production and survival during low nutrition periods
Lactobacilli
o An acidogenic (acid producing) & aciduric (thriving in acid)
o Live in low-pH niche – difficult to clean & near plaque biofilm accumulation
o Live in deep parts of carious lesion
o Resistant to bacteria-reducing substances than are MS
o Fluoride resistant
Bacterial testing
o If saliva contain high bacterial counts, so does the plaque biofilm
o High risk: >105 colony forming unit (CFU) of MS or LB
o To detect MS = Blue MS agar + bacitracin → small blue colonies with diameter of <1mm
o To evaluate LB = Transparent green MRS agar → appear white colonies
Component of saliva:
o Electrolyte – sodium, potassium, calcium, magnesium, bicarbonate & phosphate
o Immunoglobulin
o Protein
o Enzyme
o Mucin
o Urea
o Ammonia
Function:
o Modulate the bacterial attachment in plaque biofilm, the pH & buffering capacity
o Antibacterial properties
o Tooth surface remineralization & demineralization
Condition:
o Hyposalivation: less saliva in contact with tooth surface, reducing number of calcium & phosphate ion
o Xerostomia
Bad effect of hyposalivation:
o High caries risk
o Dental erosion
o Ulceration
o Dysphagia – difficulty in swallowing
o Dysgeusia – taste impairment
o Oral malodour
o Impaired use of removable prosthesis
o Candidiasis
Salivary flow determined by measuring
o Resting saliva – measure for 4 minutes. [Hypo= <0.1ml/min]
o Stimulated saliva – measure for 5 minutes. More practical way to measure [Hypo= <0.7ml/min]
7) Orthodontics appliances