In essence, this chapter reviews the diverse fluoride strategies for controlling tooth decay on the crown, and outlines the best evidence-based approaches for their combined use.
Assessing caries risk (CRA) is crucial for providing individualized and precise caries management. The constrained formal evaluation and validation process applied to current computerized radiographic analysis (CRA) tools restricts the reliability of predicting new lesion occurrences. Nevertheless, clinicians should not be discouraged from evaluating modifiable risk factors in order to establish preventative measures and address unique patient needs, thereby tailoring care to individual requirements. The multifactorial and dynamic process of caries results in a complex CRA, affected by multiple variables over the entirety of life, hence requiring regular reassessment. metabolomics and bioinformatics Influences on caries risk are multifaceted, encompassing individual, family, and community factors; however, unfortunately, a history of caries continues to be a significant indicator of future risk. The development and subsequent prioritization of validated, cost-effective, and user-friendly CRA tools is critical for supporting evidence-based, minimally invasive caries management strategies for coronal caries lesions in children, adults, and older individuals. To improve CRA tools, evaluative and reporting procedures for both internal and external validation data should be included. Risk predictions in the future may be influenced by big data and artificial intelligence methods, and cost-effectiveness analyses may assist in identifying suitable risk thresholds for guiding decisions. The significance of CRA in treatment planning and decision-making warrants a focus on implementation challenges, including communicating risk to motivate behavioral change, developing quick and seamlessly integrated tools for clinical workflow, and securing appropriate reimbursement for the implementation process.
This chapter details the core principles behind diagnosing dental caries in a clinical context, using both clinical examination and radiographic imaging as complementary methods. selleck inhibitor By evaluating clinical symptoms and signs of caries lesions, complemented by radiographic analysis, dental professionals skillfully diagnose caries disease. Effective diagnosis hinges on a meticulous clinical examination, performed after dental biofilm removal from tooth surfaces, air-drying, and sufficient illumination. Severity and, sometimes, activity are the criteria used by clinical diagnostic methods to categorize caries lesions. The activity of caries lesions was determined by observing their surface reflections and textures. Assessing the presence of substantial biofilm buildup on teeth provides a supplementary clinical method for evaluating the dynamic state of carious lesions. Dental patients without any signs of caries in their teeth, which encompasses no detectable clinical or radiographic signs of caries lesions, are considered caries-inactive. Inactive caries lesions/restorations could be observed in the dentition of patients not experiencing active caries. In contrast to a caries-inactive status, a patient is classified as caries-active upon clinical presentation of any active caries lesions or the demonstration of progressive lesions through at least two bitewing radiographs taken at distinct time points. Caries lesions in caries-active patients are prone to worsening unless interventions are strategically implemented to impede their development. Clinical examination benefits from the additional information provided by bitewing radiographs, which are adjusted to individual needs. These images help find enamel and outer-third dentin lesions in close proximity, treatable with non-operative methods.
The field of dentistry has experienced considerable evolution and progress across all segments in recent decades. While operative approaches once dominated caries management, current strategies lean towards non-invasive, minimally invasive methods, and only resorting to invasive procedures when absolutely necessary. A key to achieving the most non-invasive and conservative caries treatment lies in early detection, though this remains a formidable challenge. Modern methods now effectively manage the advancement of early or non-cavitated caries lesions, in addition to successfully arresting those lesions which are halted through oral hygiene measures combined with fluorides, sealants, or resin infiltration techniques. To facilitate X-ray-free caries detection, assessment, and monitoring, dental practices now utilize methods such as near-infrared light transillumination, fiber-optic transillumination, digital fiber-optic transillumination, laser fluorescence, and quantitative light fluorescence measurements. For indirect visualization of tooth surfaces, bitewing radiography remains the standard for locating and diagnosing caries lesions. The development of artificial intelligence for the detection of caries lesions in bitewing radiographs and clinical images represents a considerable leap forward but requires a significant future research effort. This chapter's focus is on offering a broad examination of diverse approaches to pinpointing coronal caries lesions, and providing suggestions for refining this diagnostic procedure.
In this chapter, a global analysis of clinical data on coronal caries distribution is provided, with a focus on sociodemographic drivers affecting children, adults, and older individuals. A worldwide assessment of caries prevalence exhibited significant variation, with noteworthy instances of high rates in several nations. The disease's manifestation within each group is quantified by prevalence at various ages, and the mean number of affected teeth. The varied rates of dental caries between developed and developing nations are likely influenced by multiple factors, which include not only discrepancies in the targeted age groups but also the significant disparities in ethnicity, culture, geography, and developmental stage. Further contributing to this disparity are differences in accessibility to dental care, healthcare systems, oral hygiene practices, dietary factors, and personal lifestyles. A decrease in the rate of tooth decay among children and adults in Western nations is observed, yet the uneven distribution, directly attributable to individual and community factors, remains a substantial issue. Among older individuals, the incidence of dental caries has been reported to be exceptionally high, sometimes exceeding 98%, and displaying considerable diversity between and within different nations. A decline in tooth loss was apparent, despite its continued high prevalence. A pattern emerges from the interplay of sociodemographic indicators and caries data, demanding a reform of the global oral healthcare system that considers life-course caries inequalities. Essential for bolstering national oral healthcare policies, developed using epidemiological models of care, is the production of primary oral health data to assist policymakers.
Despite the extensive research and understanding of cariology, the challenge of making dental enamel resistant to caries continues to drive current research. Enamel's mineral-based structure necessitates the implementation of strategies to improve its resilience to the acids originating from dental biofilm, especially when subjected to dietary sugars. Once believed to be a micronutrient influencing caries resistance by interacting with tooth mineral, fluoride's current role is acknowledged to be more intricate, encompassing complex interactions with the mineral surface. The environment dictates the behavior of each slightly soluble mineral, enamel not being an exception, with saliva and biofilm fluid playing a crucial role specifically in the context of the dental crown. Enamel's minerals can be maintained in a balanced state or experience loss, yet these minerals can be regained. biocybernetic adaptation Physicochemically, saturating, undersaturating, and supersaturating conditions describe the processes of equilibrium, and loss or gain, in accordance with Le Chatelier's principle, respectively. Calcium (Ca2+) and phosphate (PO43-) concentrations in saliva, and even in biofilm fluids, surpass the solubility limits of enamel, causing enamel to naturally absorb minerals; this action of mineral gain bestows saliva with a remineralizing function. Although, the decrease in pH and the presence of free fluoride ions (F-) will ultimately be the determining factors in the enamel's response. Reducing the medium's pH level creates an imbalance, but fluoride at micromolar concentrations counteracts the resulting acidification. This chapter presents a current, evidence-driven comprehension of enamel's relationship with oral fluids.
Bacteria, fungi, archaea, protozoa, viruses, and bacteriophages interact within the oral cavity, producing the oral microbiome. The harmonious interplay of diverse microorganisms and the equilibrium of microbial populations within a given site hinges upon the synergistic and antagonistic actions of the microbial community members. This healthy microbial equilibrium actively suppresses the growth of possible pathogens, usually maintaining their concentration at a minimum in the regions colonized. A healthy condition's compatibility is established by the harmonious microbial community coexistence within the host. Instead, stressors impose selective pressures on the microbial population, disrupting the harmonious balance within the microbiome, thus giving rise to dysbiosis. Within this process, the concentration of potentially pathogenic microorganisms elevates, consequently impacting the properties and functions of microbial communities. Once the body enters a dysbiotic condition, a greater chance of developing illnesses is projected. The emergence of caries is dependent on the establishment of biofilm. A crucial understanding of microbial community composition and metabolic interactions is fundamental for the development of effective preventive and therapeutic interventions. An in-depth understanding of the disease process necessitates the study of both health and cariogenic factors. The latest omics techniques offer a remarkable capacity to discover new insights into the nature of dental caries.