Caries and restorative part 1

I'm back here now I'm going to discuss about the carries and restate a part of the pediatric child in this discussion so first of all we need to make a note about the factors that are controlling the dental caries soaky's has given there are three main factors which are controlling dental caries into a triad that is called as key stride which includes bacteria that is dental plaque died that is the food basically carbohydrates and the host that is the tooth okay so these are the three main factors which controls the dental caries according to the keys later a fourth factor was added in which this triad was converted into that rod the fourth factor is the time okay this cat rod is called as new burnstead rod okay so it carries triad which is three factor now it's converted into fourth factor the fourth factor is the time then comes a concept that is called as carry around okay so karyogram concept was given by brothel in the year 1999 okay and they have integrated this into your software which is called as integrated sorry interactive karyogram program in which he has given that carries is controlled by five factors yes divided the pie diagram into five sectors like each factor denoted by a color coding and controls one factor so that is green color green color green is nothing but chances to avoid dental cares so green is something good next one is dark blue easy to remember D and D so dark blue is basically concerned with the dye t means the content of died and the frequency of died that we take the next comes is the red red is the danger red is something like a bacteria the amount of plaque or the the quality and quantity of plaque organisms that are present in the plant basically they have an effect on the occurrence of tentacles the next goes is the light blue sector light blue sector is nothing but systemic it is based upon the combination of the preventive measurements that we take that is the fluoride program or saliva increase in saliva secretion or improving the buffering capacity of saliva the next comes is the fifth factor that is ildo factor those are circumstances circumstances are a combination of past caries experience and related diseases okay so these are the five factors which are controlling the dental caries according to the brothel in his carrier so they can give a karyogram based like coding different colors this is different colors in green or light blue dark blue red and yellow so basing upon which the outcome of caries can be predicted so this is a five factorial so initially they have started at three factors that is caries triad followed by the fourth factor that is added that is the time that is caries cataract and now karyogram is their karyogram is a five factor one initially Keira gram has started as a three factor now it is converted into five factors so so now we have five factors but due to modifications in the lifestyle or the food habits or many other things now if a question is asked like caries basing upon the Charis Charis now is considered as a multifactorial carries now is a multifactorial multi factor means depends upon many factors like it depend not only not only like the host or the bacteria or the or other other other aspects it depends upon multi factor means it depends upon many other factors for example life stephannie lifestyle of an individual has they're all on tentacles okay the socioeconomic status of an individual has a role or dental care is the education status of an individual has a role and understand have a role on dental caries because an educated person can understand the value of prevention or value of maintenance or value of heisting so almost every factor indirectly or directly the role on dental care is now if a question is asked like Carrie says means the answer should be multifactorial according to the recent trends okay the next important aspect is the most common area that is primary window and second rib interpret window period is something like like an opening of a window so whenever window is open you have more chances of occurrence of an infection so these window periods are there for almost all the diseases means the ACE where the disease more occurrence is called as a window period of a particular disease similarly caries is a by model okay it has two window valid Sonny's primary window period simple Li you can remember primary window period occurs at the eruption of primary and secondary window prett occurs at the eruption of second radiate that is called as permanent it so primary window period mostly occurs in the duration of 7 to 31 months and I hope you know that the first is the direction to the water carrot is six months so it's going to take one more month for the bacteria to accumulate on the teeth and cause the dental caries so it is 7 to 31 months and secondary window period occurs at any is of 6 to 12 years so all these two important these two numbers are very very important what is primary period what is second repaired by 7 to 31 months is called as primary perturbing goes primary tea perhaps and the second repair it is 6 to 12 es that is the permanent develops the next comes is ok I hope you're very clear with this this is again an important question you're finally here that is the initial care is what is wide spot lesion is a question so white spot lesion is also called as an initial caries or insufficient caries okay which is most commonly seen on the smooth surface of that teeth visible as a white spot and the point to be noted the important point to be noted here is it has intact surface in the surface on the teeth is in that so it has intact surface okay and below this intact surface there is subsurface demineralization okay so below that intact surface you have sub surface demineralization you'll have subsurface diamond early chase so what is the treatment of this white spot elation the treatment of this white spot lesion is remineralization it's not it's not restorative treatment it is revitalization don't ever restore or remove a white spot relation and restore with the composite okay right spot lesion is intact surface with subsurface demineralization so what is the treatment as it is diamond relized you need to remineralize it so i play some remineralizing agents over that area so the remineralization is going to start and the white spot illusion is going to disappear so that is about this initial carries lesion or a wide spot lesion okay so we'll learn few important concepts related to the white spot lesion okay so white spot lesion is I mean how you need to how you will appreciate a white spot is not as simple II how you will appreciate a normal thing in the environment okay it's because of the refractive index difference between two mediums we are able to appreciate a thing for example if you keep water inside water can you can you can you can I differentiate water inside water no we cannot differentiate why we are not able to differentiate because water inside a water both of these waters will have same refractive index so when the refractive index is same you cannot differentiate them for example if you keep a bowl of water with a dye and a normal water inside a big big pot you can differentiate because of the color difference the color difference is basically the change in the refractive index so because a blue color will have a different refractive index this means a blue color water will have a different refractive index one compared to the white colored water so you are able to differentiate so this is a logic that is followed by The Magicians in most of the magic shows okay they use two different materials separately and the bind the material and you cannot differentiate them why you cannot differentiate them is the simple logic is they select the different materials which has same refractive index for example if you drop a police piece of glass glass inside of water inside of water most of the times you cannot differentiate the glass from the water because glass and water will have close refractive index values so when the refractive index values is different between two substances you can clearly appreciate them when they are very close you cannot differentiate them so that is a logic in identifying the white spot lesion if you see the refractive index of a the refractive index of air is one here is one and the refractive index of water is one point three three and the refractive index of hydroxyapatite hydroxyapatite is nothing but a structure that is the tooth okay your tooth refractive index is one point six six so the refractive index difference between the tooth and the water is more when compared with the refractive index between the water and the tooth that is less so the simple logic is you can easily identify a lesion with a different contrast media that is means a lesion can be easily identified if air is a media but if it is a water because water and the tooth has close refractive index for example when there is starting of demineralization saudi malaysian process starts the refractive index drops may it may hit somewhere around 1.4 or 1.5 for example so 1.5 1.4 and 1.33 the refractive index difference is very very less means a white spot lesion cannot be appreciated when water is a media added to it for example if you take a white spot lesion and apply water on it to the white spot lesion is going to DIF is going to disappear because the refractive index is almost the same okay so and the same goes like the white spot region can you clearly appreciate it now when you dry the teeth so that's the reason why when you are appreciating the white spot lesion you have to dry the teeth okay and this is the basic difference between a white spot lesion population whereas your enamel hypoplasia will not disappear when you apply water on it when I have elevated there as a white spot lesion when you wet it it's going to disappear because the water is going to occupy the porous space as you know that the water and the and then the demineralized structure has almost the same refractive index you cannot appreciate means it's just masking it's something like a magic so whenever you're right the teeth white spot lesion disappears and whenever animal hyperplasia will not disappear so and the second important thing as the as the team utilization level is not up to a level which can be appreciated on the radiograph these things cannot be diagnosed radiographically okay you cannot appreciate a white spot relation on radiograph now the only mode of diagnosing it is by a naked eye or by using a dye ignore tenth ok we'll learn what is diagnose and in further further slides ok so die ignorant is a mode by which you can appreciate a white spot lesion or initial animal kills ok there is one more thing that you have to make a note apart from the regular dental care is what we learn in operative dentistry that is linear enamel Kharis okay that is linear and Amal caries so linear enamel caries is also called as or don't ecclesia okay which is most commonly seen at the neonatal line of maxillary anterior these are most frequently asked question you can clearly see and appreciate on the on this clinical pic okay you can see a neonatal line okay this is most commonly seen in maxillary anteriors the reason is the neonatal line okay so this is basically due to the metabolic defects or metabolic change during the pre birth and post birth because it's most published in the neonatal line and those metabolic changes can be due to change in the calcium level that is that is available for the baby or it may be due to trauma during the birth and these areas are more prone for occurrence of caries that is dental caries okay so okay points to be done is the other name okay most common area is neonatal line of Mack very anterior and the reason is the metabolic defects of the metabolic change between the pre and post I hope you are very clear with us the next comes is the pH okay so the regular pH off your saliva is seven seven okay the range is six point eight to seven point two simple so whenever you take food whenever you take food and the bacteria acts on this foot particularly the food is the carboy it let's when the battery acts on this foot the bacteria is going to say great lactic acid so whenever an acid is secreted it is going to affect the pH of saliva means water now when I got a pH of saliva seven when an acid is added the pH is going to drop down to seven below seven okay so it is going to hit six sometimes it's going to hit five okay so there is something called as critical pH of animal that is five point two to five point four so whenever the pH of saliva hits the critical pH of enamel the animal cannot bear and start demineralizing okay so whenever this hits six and comes to five point two or below that the animals start losing it ions that is called as demonization when it occurs when you have sugars that is corporate it's funny how bad we are the critical pH is going to hit and the enamel is going to start demineralizing similarly the enamel is going to take the ions from the saliva also when the things are favorable when that is called as remineralization loss will be again mineralized BAC that is remineralization when it is going to happen when you have a good prevention measurements like Florida or good secretion of saliva many how good secretion of saliva this pH is going to get neutralized and the pH is going to back to seven so that is called as remineralization so a process of remineralisation demineralization cycle occurs which moves around the critical page that is five point two to five point four so what is the advantage of adding a florid very simple when you add fluoride to the tip the teeth regularly contains hydroxyapatite okay when you add fluoride to it it is going to convert into fluoro hydroxyapatite fluoro hydroxy apatite flora hydroxyapatite or floor apatite so when compared with the normal critical page normal critical pH is five point two to five point four that is hydroxylate when you add fluoride flora hydroxyapatite enamel will have a critical pH of four point two to four point four means whenever the critical page is going to hit four point two to four point four then only the flora hydroxyapatite is going to occur a process called assimilation until then it will not hit so that is the advantage of adding a fluoride so that is the critical pH the critical pH things which moves around okay you can see this the critical pH of normal and I am L is five point two to five point five whereas the critical pH of flora hydroxyapatite is is it's around like four that is four point two to four point five it is five point two to five point five above below there is a process of remineralization and demineralization cycle okay so we'll learn few important aspects related to the florets there is something called as fluoride bump or fluoride syndrome okay something called as fluoride bomb or fluoride syndrome few people they call it as hidden kills when it's going to occur hidden caries there is a Keres because of fluoride the process of remineralization occur okay the process of remineralization occur and there is remineralisation only to the for example if you take this is a crown and this is the case how care is here but the fluoride content has increased and the upper part has undergone three metallization so lost but the lower you're not able to reach your florid levels are not able to reach the lower half and there is something called as he didn't get us which is not seen which is buried okay that is chlorine fluoride syndrome or florid caries you can call it as awkward caries also okay which can be seen on radiograph but cannot be seen clinically because there is an intact animal okay so already learned that the device that is used to identify the white spot lesion is die ignorant okay so this is a picture of die ignorant which is given in aims once okay they have given identify this diagram or they can ask you to identify the wavelength of light that is used in this diagram or the principle that is used in diagram of the scientist that is concerned with or or the range of numbers they can give you the number here and they can ask you the that diagnosis so all we are going to learn so this diagram diagram is very very important so coming to this diagnosis was given by Lucy at all okay so Lucy Etta and what they have used they have used a new laser fluorescence system in this okay they have named it as die ignorant which helps in diagnosing or identifying the dental cares the numbers varies from book to book but basically you can make a note okay a few people they say it is from 0 to 99 and in in your shop at and then it is from minus 9 to 99 if you have minus 9 to 99 in the options go for it if not you can go for the second-best option that is 0 to 99 the range is 0 to 99 or minus 9 to 99 minus 9 is minus 9 reading is that tooth with the highest value okay truth with the highest value so these are the Rangers okay so these are the Rangers if the value is from five to twenty five then you can call it as initial carries lesion okay if it is greater than that particular range then it is called as early dental caries okay if it is greater than 35 okay if it is greater than thirty feather then it is called as advanced dental caries okay so these are the ranges and the more most reason that is Keo has given these ranges okay that is 0 to 13 is called as no caries 14 to 20 is enamel caries but the treatment they can give they can ask you they can just give you the number they can ask you what is the what is the treatment here it is prevention care is advised 21 to 30 that is dental caries or prevention or operator care basing upon the wrist when it is the value is more than 30 then you can go for an operator to care okay so they can give me simply okay this particular device have a has a reading score when I played on a carries lesion the value is 45 what is the treatment procedure that you are going you have to go for a cavity restoration you have to remove the caries by an operative procedure when invasive procedure and then you have to fill it with some composite or gic so basing upon which they can ask some questions related to the numbers also so there is one more device called as mini D carries something looks like a pen okay when it when I keep the pen you will have a reading reading here reading or with a with a color coding okay so basing upon that they can ask you a question this was question that is given in one of the recent examinations of need so a color coding of green color is something like a safe job an orange color is a limitation of the safe zone means your approach you're approaching okay and a red color is is going to be the danger of penetrating through the dentin layer so this mini D carries has this principle of identifying which type of carries it is and the same color coding is also applicable for few a rotors okay for a few air orders like if you use a rotors right so these aerators will have a color coding which is going to give the approximation of the pulp oh okay like for example if it is approaching Tenten it will have a different color coding if it is approaching the pulp it's going to give a right red color signal that yeah we are approaching the pulp don't go very deep you may have a pump explosion the same color coding the same methodology is being approached that is basically because of the difference in the temperature the temperature change when you approach the palaver that will be different so because of the thermostat there will be variation in the in the color coordinate system okay so I'll be posting one more video based basing upon the classifications that that are that will be noted like apart from GV black classification there are many other classifications that are very very important in examination point you feel which will be uploaded further in the next part of this carries and rest at a part of periodic change thank you all signing off from TM MDS conquer