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‫بسم ال الرحمن الرحيم‬ Lec. Cons # 1 Wednesday24/9/08 Dr.zakrYA

1st of all I wanna say that it's my first lecture and it’s a very easy lecture U will see that all of information is repeated from last year Unfortunately doctor didn’t give us the slides so I added few pictures from the internet

?Why do we restore teeth ♦ It’s a very important question you must know to restore its function_1 to restore esthetic of the tooth_2 to restore integrity of tooth (keep the tooth_3 (as one unit (to remove the disease (dental caries_4

There are four conditions that can♦ result in defective tooth structure dental caries_1 trauma_2 developmental defects_3 (tooth wear (ex. Bruxism_4

♦Dental caries Defined as: Posteruptive (very rare in uneruptive teeth) pathological process of external origin (not internal) involving softening of the hard dental tissue and

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proceeding to cavitate the tooth (form a (cavity in it

Epidemiology ♦ Dental caries more in industrialized than 3rd * world countries (Love to eat chocolate and (sweet things Decay missing filled teeth (DMFT): the * number of DMFT In 3rd world countries (2) in developed countries (5_2) in Jordan (2.51) In Saudi Arabia (2) Water fluoridation decreases the * prevalence of dental caries and there is .evidence Ex: ???? (sorry its not clear ) Population produce water fluoridation and dental caries incidence dropped to 50% In Denmark it felled down from 6.4 in 1978 to 1.6 in 1988 because of water fluoridation

♦Dental caries Any body who is willing to talk about caries * should know about dental plaque (Suitable carbohydrate (mainly sugar * (Susceptible tooth structure (surface * in time they should give dental caries * These four factors if they meet together provided with sufficient time the resultant is for sure dental caries 2

How to prevent dental caries ♦ Eliminate one of previous four factors so no caries occur Tooth: you can't remove the tooth Carbohydrate (sugar): you can interfere with it, don’t give the boy sweets so it's less likely to develop dental caries in his teeth or substitute the carbohydrate so it's less likely to develop dental caries How I am going to play around with time, if you brush your teeth (leave the plaque for 24 hrs then brush… plaque is gone) you eliminate the plaque other factors may be there but they need time so there is no dental caries This is the famous circle* Plaque

Susceptib le tooth

substrate

time

Meeting point between all of these four circles is caries if not meet there is no caries ♦ Signs of dental caries opaque enamel surface_1 3

rough tooth surface_2 sticky fissure_3 hole in a tooth_4 To examine dental caries I have to have ♦ light_1 dry field-2 explorer_3 All of these are requirements for the diagnosis of dental caries …The doctor show us a picture of a Fissure* The bristle of the brush can't go in, so when you brush your teeth don’t think that you have eliminated the plaque of all surfaces of the tooth, plaque may be inside this fissure you can't remove

the Use of explorer ♦

You have to be careful when you use your ,explorer If you have incipient lesions take the tip of explorer of the explorer try to force it on, it will be transfer from incipient to vast(not sure) lesion ‫بواسطة‬incipient lesion ‫)بمعنى راح تكسر الغطاء القشره الموجودة على‬ (explorer

You have to use alight pressure when you* use your explorer ?How do I determine the light pressure Its just pressure enough to make your finger (blanch (go white 4

The uses of the explorer ♦ remove plaque_1 feel the surface of the tooth_2 see if the fissure is sticky or not_3 Remember sometimes the explorer are misled because you have very narrow fissure, when you insert the explorer in this very narrow fissure it will stick because of its anatomical configuration rather than because of dental caries

Most susceptible surfaces to ♦ dental caries enamel pits and fissures_1 approximal enamel smooth surfaces_2 enamel at cervical region_3 margins of restorations_4 Somebody who was genius in past and he ♦ was an oral pathologist classified for us (dental caries (cavities Class 1 caries on occlusal surfaces and buccal and lingual pits of posterior teeth and lingual pits of anterior teeth Class 2 caries on approximal surfaces of posterior teeth Class 3 caries on interproximal surfaces of anterior teeth (cuspid to cuspid) without involving incisal angle

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Class 4 caries on interproximal surfaces of anterior teeth involving incisal angle Class 5 caries on buccal and lingual surfaces not on pits Class 6 caries on cusp tips This is Black's classification of carious lesion and still standing to this time Carious lesion on the pits of palatal surfaces * of central incisor its class 1 because it's on a pit although it's on anterior teeth

Class 3

♦Classification according to the sites Pits and fissure caries (from book: caries in_1

occlusal surfaces of molars and premolars and buccal and lingual surfaces of molars and lingual surfaces of maxillary ( incisors

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Smooth surface caries (from book: occurs on the_2 approximal surfaces and on gingival third of buccal and ( lingual surfaces

Root caries_3

Advanced root caries

we don’t know if Caries properly started in crown then spread down to root, but there is a combination of caries in crown and root Recurrent caries around old fillings_4 There was carious cavity the dentist removed it and filled it with amalgam, after 5 years he examine his filling and found that there is now again dental caries neighboring(beside) the filling *:Look at this picture

there is caries beside amalgam

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the doctor show us a picture where there is * broken Amalgam filling because of advanced recurrent caries when there is Non cavitated carious enamel* but you can see discoloration ?Do I drill it or not You have to evaluate the other situations inside the oral cavity if it’s a neglected mouth do it if there is fine oral hygiene wait for it(not do it) properly this is arrested caries

Classification based on extent of ♦ dental caries (how much the dental caries (advances in tooth structure Only in enamel (incipient):just in enamel,_1 there is no cavity Enamel_2 Dentineal_3 Cemental (from book: occurs when the root surface_4 is exposed to oral environment as a result of periodontal (disease

More advanced carious lesion the more it approach the pulp How do you know if caries only in enamel or * dentine or approach the pulp? by taking x-ray *Important note

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In clinic you can't work on class 2 without having an x-ray you have to be able to see what you are doing We can read x-ray and determine the type of *caries a_ Enamel caries: radiolucency not reach DEJ it's confined to enamel tissues b_ Dentine caries: radiolucency reach DEJ or in dentine

You can see a hole approach dentine this mean the caries is already inside the dentine

c _ If It's at the border of DEJ radiographicly , be sure that histologicaly and clinically it has penetrated definitely the dentine d_ If you see no radiolucency at all then the tooth is sound there are a number of cases where the* patient has a grossly carious lesion on anterior teeth

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If you look histologically at the carious ♦ lesions you can see the surface zone and body of the lesion This is incipient lesion you can't detect it by x-ray If you do sectioning and look at it at the* microscope level you will see the body of lesion where mineral has been lost but the surface zone is intact and there is no cavity at all this is called subsurface lesion or incipient lesion Surface zone relatively is infected by carious* attack the cause in enamel are low and surface is in contact with saliva so its hypermineralized, serve as a barrier to bacteria and mineral lose is minimal just 1_2% of mineral of the tooth tissue Look at the body of lesion mineral loss is* about 25% so the surface zone is intact while the body is not intact Looking at the cause in the surface zone* they are fewer and they are in the size lower than the cause of the body of the lesion, also we have dark zone and advanced translucent zone (From book these zones are confined to enamel caries) Here doctor skip few slides, to more information about) (these zones you can return to oral patho book page 26

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♦ Classification based on rate Acute (rapidly progressing caries involving many or_1 (all of the erupted teeth chronic (progress slowly and involves the pulp much_2 (than in acute caries

rampant_3 radiation_4 arrested (caries become static and show no tendency_5 (for further progressing

nursing_6

:look at this picture*

Rampant caries affecting all surfaces of the tooth_

When you are older than what you are now_ you get married and you get a baby and he wake you up…. you take bottle put nipple in sugar or honey and give it to him…. only one month all his teeth destroyed because of nursing bottles syndrome

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Management of dental caries ♦ History * Clinical examination by visual and take file * and doing Special investigations Bitewing radiograph *

Show you the crowns of upper and lower teeth

periapical radiographs: show you the root* and area around apex (Fiber optic transillumination (foti * THE END ;I would like to thank my lovely friends ESRA2 '3ZLAN ( elskot b2tol bs elklam ma 3m nt5ylo… love u )ZAIN( 2keed mktob

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3leeke l2no mo 9odfeh wrak wrak…bs ya ( 7zek MARAM BATIHA( kol she 2esmeh o n9eeb wafre 27lamek lshe tane)RUBA( kteer heek 5leha bebalek el7yah fora9…thanks '3lbtek)HEBA( lazem men hla2 tet3wde (☺n9e7ah

.………… O kol 3am o ento b5air RAWAN RAHHAL

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