A TEXT-BOOK OF DENTAL PATHOLOGY AND THERAPEUTICS
Part I The disease and its diagnosis 1 Chapter 1 Defining the disease: an introduction 3 Introduction 4 Terminology 5 Background literature 6 References 6 Chapter 2 Clinical appearances of caries lesions 7 What do caries lesions look like clinically? 8 Deciduous dentition 8 Permanent dentition 10 References 18 Chapter 3 Pathology of dental caries 19 Introduction 20 Enamel reactions during eruption 21 Enamel changes during early caries lesion development 23 The approximal white-spot lesion 27 Progression of the enamel lesion 32 Arrest of the caries lesion 32 Occlusal caries 35 Dentin reactions to caries progression 39 Pulpo-dentinal reactions 42 Root-surface caries 44 Background literature 47 References 48 Chapter 4 Visual–tactile caries diagnosis 49 Introduction 50 The diagnostic process 50 Why do we diagnose caries? 51 Diagnosis in a dental caries perspective 51 How early should caries lesions be detected? 53 What are the best visual–tactile caries diagnostic criteria? 53 Commonly used visual–tactile criteria 55 Differential diagnosis 60 Visual–tactile caries examination: a systematic clinical approach 62 Additional aids in visual–tactile caries diagnosis 64 Benefits and limitations of visual–tactile caries diagnosis 66 References 67 Chapter 5 Radiography for caries diagnosis 69 Introduction 70 Technical and quality aspects 70 Prescription and timing of bitewing radiography 79 References 87 Chapter 6 Additional diagnostic measures 89 Introduction 90 Methods based on X-ray 90 Methods based on light 92 Methods based on electrical current 97 Are the methods suitable for use in clinical practice or only useful for research? 98 Can the methods stand alone or are they only adjuncts to a clinical–visual examination? 99 References 99 Chapter 7 The foundations of good diagnostic practice 103 Introduction 104 The making of a dentist 104 The dental examination: in the best interest of patients 105 What are we looking for – what is caries? 106 The wealth of caries diagnostic methods 108 The evolution in caries diagnostic methods 108 Evaluating caries diagnostic methods 109 Diagnostic test assessment in the essentialistic gold-standard paradigm 109 Leaps in the essentialistic gold-standard reasoning 111 Diagnostic test evaluation in the nominalistic caries paradigm 113 Interexaminer and intraexaminer errors in caries diagnosis 114 How do we deal with the unavoidable diagnostic uncertainty? 115 The additional diagnostic yield argument 116 Concluding remarks 117 References 118 Part II Clinical caries epidemiology 121 Chapter 8 The epidemiology of dental caries 123 Introduction 124 Measuring dental caries 125 Distribution of caries 129 Summary 141 References 141 Chapter 9 The impact of diagnostic criteria on estimates of prevalence, 147 extent and severity of dental caries Introduction 148 Diagnostic criteria for dental caries: an epidemiological perspective 148 Caries diagnostic thresholds and specific epidemiological considerations 151 Impact of diagnostic criteria on estimates of caries prevalence 154 Impact of diagnostic criteria on estimates of caries extent 155 Impact of diagnostic criteria on estimates of the severity of dental caries 157 A framework for considering the choice of appropriate diagnostic criteria for 158 epidemiological studies Summary 158 References 158 Part III Dental caries in a biological context 161 Chapter 10 The oral microflora and biofilms on teeth 163 Introduction 164 The resident microflora 164 Dental biofilms: development, structure, composition and properties 166 Caries microbiology: a brief historical perspective 178 Methodological problems in microbiological studies of dental caries 178 Microbiology of caries 179 Cariogenic features of dental biofilm bacteria 182 Concluding remarks 185 Background literature 185 References 185 Chapter 11 The role of saliva 189 Introduction 190 Formation of saliva 190 Hypofunction of salivary glands 194 Oral clearance 195 Inorganic saliva composition 196 Saliva buffer capacity and pH regulation 198 Saliva proteins 200 Role of the pellicle 202 Other caries-related components in saliva 203 Saliva and the risk of developing caries lesions 204 Management of salivary gland hypofunction 206 Concluding remarks 206 Background literature 207 References 207 Chapter 12 Chemical interactions between the tooth and oral fluids 209 Introduction 210 The importance of the mineral phase in enamel 210 Enamel mineral and oral fluids 213 Demineralization and remineralization of the dental hard tissues 217 Remineralization 220 Dentin caries 221 Fluoride reactions in the oral environment 225 Dental calculus 229 Background literature 230 References 230 Chapter 13 Erosion of the teeth 233 Introduction 234 Clinical manifestations and diagnosis 234 Histological and chemical features 236 Classification by depth of the lesion 237 Classification by etiology 237 Erosion caused by food and drinks 238 Erosion caused by stomach contents 243 Erosion caused by airborne acids 243 Idiopathic erosion 244 Prophylaxis and treatment of erosion 244 Conclusion 246 Background literature 246 References 246 Part IV Non-operative therapy 249 Chapter 14 The control of disease progression: non-operative treatment 251 Introduction 252 Can the caries process be prevented? 252 Controlling disease progression 252 Should disease control be considered as ‘treatment’ of the caries lesion? 253 Why use the term ‘non-operative treatment’? 254 Does the approach work? Is it cost-effective? 254 References 254 Chapter 15 Role of oral hygiene 257 Introduction 258 Some theoretical considerations 258 The biological effect of tooth cleaning 258 The clinical effect of tooth cleaning 259 The effect of professional tooth cleaning 262 The effect of dental flossing 263 Concluding remarks 263 References 263 Chapter 16 Antimicrobials in caries control 265 Dental plaque: the biofilm lifestyle and the rationale for antimicrobial intervention 266 Biological activity and mode of action 267 Modification of dental biofilm biochemistry and ecology 269 Vehicles for administration of caries-prophylactic agents 269 Specific agents 270 Other agents proposed for caries prophylaxis, but without documented anticaries effect 273 Concluding remarks and future approaches 275 Background literature 276 References 276 Chapter 17 Might caries control involve immunization and gene therapy? 279 Introduction 280 Dental caries vaccine 280 Alternative approaches to targeting cariogenic bacteria 284 Natural defense mechanisms of the tooth 284 Conclusion 285 References 285 Chapter 18 Fluorides in caries control 287 Introduction 288 How fluoride came into dentistry 288 Physiological and toxicological aspects of fluoride delivery 293 Current methods of fluoride delivery 304 Appropriate use of fluoride in caries control 319 Summary of recommendations for fluoride-delivery methods 322 Background literature 323 References 323 Chapter 19 The role of dietary control 329 Introduction 330 Diet and dental caries in humans 330 Influence of different intake patterns 333 Influence of fluoride on the relationship between sugars and caries 334 Groups at increased risk of dental caries in relation to diet 336 Relative cariogenicity of different carbohydrates 338 Novel carbohydrates and dental health 338 Protective factors in foods 344 Diet and dental erosion 346 Promoting good dietary habits for dental health 346 References 349 Part V Operative intervention 353 Chapter 20 The role of operative treatment in caries control 355 Introduction 356 What is happening in your dental school? 356 The outcome of non-operative treatment 356 Does this approach always work? 358 Occlusal surfaces 358 Approximal surfaces 359 Recurrent caries 359 Deciduous teeth 361 Summary 363 References 364 Chapter 21 Caries removal and the pulpo-dentinal complex 367 Introduction 368 Summary of caries lesion progression in dentin 368 The pulpo-dentinal complex and caries 371 The relevance of pulpo-dentinal reactions to operative management 373 The current operative tradition 374 The infected dentin concept and its clinical consequence 374 Studies placing fissure sealants over carious dentin 376 Stepwise excavation studies 376 Why re-enter? 377 Randomized controlled clinical trials 380 Conclusions 382 References 382 Chapter 22 Restoring the tooth: ‘the seal is the deal’ 385 Introduction 386 Materials 387 Treatment of pit and fissure caries 396 Treatment of approximal caries 402 Treatment of caries in anterior teeth and the cervical area 410 Restorative procedures in the primary dentition 416 Failure and repair of restorations 420 References 423 Chapter 23 The atraumatic restorative treatment approach 427 History of ART 428 A treatment approach of fissure sealing and minimal operative intervention 429 Atraumatic aspects 431 The ART approach step-by-step, for use with glass-ionomer restorative material 432 Survival of ART sealants and ART restorations 434 Comparison of ART with conventional treatment approaches 438 Causes of failure of ART restorations 439 Integration of ART into oral health services 439 References 440 Chapter 24 Longevity of restorations: the ‘death spiral’ 443 Introduction 444 Clinical assessment of restorations 444 Assessment of restoration longevity 444 The amalgam debate and its consequences for restoration longevity 447 Longevity of restorations in the primary dentition 448 Longevity of restorations in the permanent dentition 449 Factors influencing restoration longevity 451 Consequences of restoration longevity for dental health and cost 453 Concluding remarks 454 References 454 Part VI Caries control and prediction 457 Chapter 25 Clinical decision making: technical solutions to biological problems or 459 evidence-based caries management? Introduction 460 The historical bias towards dental mechanics 460 Appropriate dental care: what is it? 461 Appropriate caries management: how to get there? 462 Are we heading towards ‘cookbook’ dentistry? 464 Caries-related clinical decision making: what it is not 464 Caries-related clinical decision making: what it is 467 Appropriate caries scripts: proposal for a guideline 468 References 471 Chapter 26 Promoting oral health in populations 475 Defining oral health and health education and promotion 476 Theories of health-related behavior 477 Oral health education: does it work? 479 Practical tips for influencing individual patients’ behavior 482 Conclusions 485 References 485 Chapter 27 Caries control for the individual patient 487 Introduction 488 How are current caries activity and risk of future caries progression assessed? 488 How is the information used to categorize patients into risk groups? 491 What non-operative treatments are available? 491 How is the individual helped to control disease progression? 495 When should the patient be recalled? 496 Caries control in children and adolescents 497 Caries control in patients with a dry mouth 500 Caries control in people who cannot care for themselves 502 Failure 503 References 503 Chapter 28 Caries control for populations 505 Introduction 506 The caries decline and changes in the practice of dentistry 506 Why does caries occur? 507 Upstream or downstream: does it matter? 510 Sick individuals or sick populations? 511 Options for change: which preventive strategy should be used? 512 The high-risk approach 513 The population strategy for caries prevention 515 The directed population strategy 517 A short history of caries-preventive strategies for populations 518 A wider perspective on prevention 519 Wanted: a population-based common risk factor approach to prevention 520 Where does this leave the traditional dentist? Need for a new professionalism 521 References 523 Chapter 29 Caries prediction 527 Introduction 528 Clinicians assess risk, researchers predict 529 The course of a typical prediction study 529 Practical examples 531 What level of accuracy would be sufficient in everyday practice? 536 What level of accuracy can be achieved? 536 How valuable are the proposed measures? 540 Background literature 540 References 541 Chapter 30 Preventing dental caries: what are the costs? 543 Introduction 544 Health-care economics 544 What is a benefit? What is a cost? 545 The cost of dental caries 545 Review of economic studies of preventive approaches 546 Conclusions 550 References 551 Part VII Dentistry in the twenty-first century 553 Chapter 31 Variation in clinical decision making related to caries 555 Introduction 556 Variation in detection of caries lesions 556 Variation in caries management decisions 561 The consequences of variation 565 A long-term approach to reducing variation 568 References 573 Chapter 32 ‘for richer, for poorer, in sickness and in health …’ 575 The role of dentistry in controlling caries and periodontitis globally Introduction 576 Development of dentistry: the profession 576 Development of dentistry: the disease concepts 578 Development of dentistry: low-income countries 580 Planned dental services: wishful thinking or achievable goal? 581 The magnitude of disease burdens 583 The burden of periodontal diseases 586 Dental caries: the major oral disease burden 590 Trends in the burden of oral diseases 594 Social gradients in oral disease burdens 597 Disease burdens: whose burdens? 597 Quo vadis? Priorities in oral health care for low- and middle-income countries 599 Quo vadis? Priorities for high-income countries 601 References 602