hygiene the international C.E. magazine of dental hygiene

I 13hygiene 1_2013 C.E. article_ caries management I _Over the years, there has been a remark- able reduction of dental caries in the United States. Fluoridation of water, fluoridated toothpastes, pro- fessional dental products, improved oral hygiene, sealants and better access to care have contributed to this improvement. Unfortunately, despite the advancements, dental caries remains a significant problem, particularly in large segments of the popu- lation with the lowest access to care. Early research models involving caries were sim- plistic and limited to investigating the interactions of plaque, diet and tooth structure. Interventions to arrest the caries process were surgical and only occurred after tooth cavitation. Today, the caries process is viewed as a disease entity that can be prevented or treated before the need for surgical intervention. Because of this, early detection, pre- vention, behavior modification and remineralization have become a major part of modern management of dental caries. _Early detection To properly treat a patient, prevent decay and make product recommendations, an assessment process is essential. Previously, in order to assess tooth structure, a traditional method of exploring, radiographs and clinical exam took place. Today, this methodisstillusedbutwithmodifications.Thesetra- ditionalstepsarecombinedwithanewerapproachof “caries management by risk assessment” (CAMBRA), an evidence-based approach to preventing or treat- ing dental caries at the earliest stages. This new ap- proach also includes additional options for testing and adjunctive detection devices. The change in ap- proachrequiresclinicianstoredirectassessmentand treatment from being only a surgical or restorative approach to being a medical-model approach. This strategy is risk-based and implements appropriate therapeutic intervention (Featherstone, 2000). Modificationsinthetraditionalmethodofexplor- ingarenecessarytopreventcavitationofdemineral- ized areas. The idea is to implement a soft, mapping approach with a blunt tip explorer rather than using a sharp explorer with a firm and pressing method. Changes in assessment and evaluations for radio- graphsincludeusingtheparalleltechniquewithaim- ing devices versus use of the bisecting angle with no aimingdevices.Theparallelsystemismoreconsistent and reliable for a diagnostic or ideal radiograph that depicts accurate size and shape — with good detail, density and contrast (JADA, 2006). Because dental caries is a chronic, transmissible and bacterial infection, it is regarded as a silent epi- demic. A large portion of the population is affected early in life, and the disease continues throughout a lifetime (Bagramian, 2009). Because people are living longer and retaining their teeth longer, the implementation of the medical-model approach enables clinicians to be proactive instead of reactive, preventative instead of surgical. Augmentationofthetraditionalmethodincludes butisnotlimitedtoarisk-basedapproachofassess- ment:identifyingriskfactorsandthenmanipulating Should caries management be a mystery? Author_ Reneé C. Graham, RDH, MEd This article qualifies for C.E. credit.TotaketheC.E.quiz,log on to www.dtstudyclub.com. Subscribers to the magazine may take this quiz for free and willbeemailedanaccesscode after the magazine’s release. If you do not receive the code, contact support@dtstudyclub. com. Non-subscribers may take the quiz for $20. You can accessthequizbyusingtheQR code below. _c.e. credit part II