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Uncontrolled Dental 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
Caries in a Young Adult: on assessment and identification of indicators, primary and
modifying factors, as well as management of the plaque-biofilm
T
here has been a significant decrease in the prevalence of reported no known drug allergies. Recent blood studies were
dental caries in the United States during the last 30 years. essentially normal, but deficiencies in selenium, vitamin A,
The decrease in dental caries has been most noticeable in chromium, and glutathione were reported. The extra- and
fluoridated and economically advantaged areas. Fluoridated water, intraoral examination of the soft tissues was unremarkable;
fluoridated toothpaste, professional dental products, improved however, inflammation was noted in the areas where
dental hygiene, and increased access to dental care have led to this restoration margin conformation was biologically
decreased prevalence. Still, dental caries remains one of the most incompatible with gingival health. Mild generalized soft
common infectious diseases. The factors related to the deposits were visible. Also, several defective restorations and
development of dental caries are relatively complex in that they areas of recurrent caries were noted. Calculus deposits were
are influenced by oral hygiene, individual microbial carriage, detected associated with the lingual and interproximal surfaces
salivary composition and production, dietary habits, choice of of the mandibular incisor teeth.
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The CRA should be accomplished for all patients with a During the CRA interview for the patient in this case report,
dentition, as it is the dentists responsibility to provide he disclosed that he did snack frequently between meals and
comprehensive care based upon the principles of restoring oral did not always have the opportunity to brush his teeth, nor did
health, form, and function in as noninvasive a manner as possible. he floss with regularity. He also admitted to drinking high
By evaluating the caries balance through risk assessment specific carbohydrate content sodas and juices without the benefit of
to each patients condition, a personalized preventive protocol and rinsing or brushing his teeth after consumption. As the patient
treatment plan aimed at disease removal and rehabilitation can be appeared to exhibit signs of parotid salivary gland dysfunction,
provided for each patient.14,15 these patient interview reports and clinical findings should be
documented. Based upon the findings from this interview and
Caries Diagnosis the clinical findings (caries, salivary dysfunction, frequent
Traditional methods of caries detection involve visual, tactile, nonhealthy snacking, etc), a classification of high-risk caries may
and radiographic interpretation. Surfaces should be clean and be determined.
dry so that changes represented by the demineralization/ When considering where to start in the management of the
remineralization processes in pits, fissures, and smooth surface high-risk caries patient, one must first consider his/her own
enamel can be readily identified. Probing should be avoided, but modifiers as a dentist. Trained by advocators of the principles of G.
if used, exploration should only be accomplished for the V. Black, it is very easy to maintain the modalities of a surgical
purpose of removing debris from the depths of pits and fissures intervention which originally involved the concept of extension
and other retentive surfaces. Care is imperative with the for prevention (currently, the concept of extension for prevention
probing technique in order to avoid the transmission of is not an evidenced-based view). During the last 20 to 30 years, the
cariogenic bacteria and iatrogenic trauma to demineralized and medical model of caries management, with dental caries regarded
weakened enamel. Therefore, it is important to consider that as an infection, has evolved into a number of strategies aimed at
visual inspection is preferred over the use of probing, and that minimal surgical intervention. Impediments to these conservative
probing is less accurate than the visual approach to caries concepts have a negative impact on therapeutic success; namely,
identification.16 Caries is a dynamic process with periods of lack of a comprehensive understanding of what conservative
remineralization followed by demineralization; identification therapy actually involves, lack of support on the part of insurance
of small or incipient lesions is of great importance.3,11,17 agencies in remunerating dentists for preventive protocol
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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.
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Uncontrolled Dental Caries in a Young Adult: A Therapeutic Perspective and Case Report
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