Root Surface Caries
DefinitionA root caries lesion is initiated on a root surface exposed to the oral environment. The criteria for diagnosis of root caries Banting et al (1980) identified root caries as:- A discrete well defined and discolored soft area. An explorer enters easily and displays some resistance. The lesion is located either in the cemento-enamel junction or wholly on the root.
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* Root Surface Severity Index (Billing et al (1985)
Grade 1 : Is characterized by an incipient lesion, the surface texture is soft and irregular and can be penetrated with a dental explorer, there is no surface defect and pigmentation variable from light tan to brown. Grade 2 : Is characterized by a shallow lesion, the surface texture is soft, irregular and rough and can be penetrated with a dental explorer, there is a surface defect (less than 0.5 mm in depth) and pigmentation variable from tan to dark brown. Grade 3 : Is characterized by cavitation of the surface texture which is soft and can be penetrated with a dental explorer. There is a penetrating lesion with a dental explorer. There is a penetrating lesion and cavitation is present (greater than 0.5 mm in depth), however there is no pulp involvement, pigmentation is variable ranging from light brown to dark brown. Grade 4 : Is characterized by pulpal involvement. There is a deeply penetrating lesion pulpal or root canal involvement, pigmentation is variable ranging from brown to dark brown.*
A. Intra Oral Factor: Diminished salivary flow. Diminished salivary buffer capacity. High plaque score. Periodontal pocketing. Sever attachment loss. Gingival recession. Calculus. Elevated salivary Streptococcus mutans counts. Elevated salivary Lactobacillus counts. Elevated salivary Candida alb cans counts. Un restored and restored coronal caries. Un restored and restored root caries. Over denture abutments. Retained root tips. Eight or more missing teeth.
* Dental Health of Handicapped
The Word Health Organization (WHO) has defined a handicapped person as “one over an appreciable period is prevented by physical or mental condition from full participation in the normal activities of their age groups including those of a social, recreational, educational and vocational nature”.Handicap can generally be divided into 3 categories:Mental handicap which may be either mild or sever.Physical handicap .Medical disabilities .
Many handicapped individuals are unable to maintain an adequate level of oral hygiene unaided and must depend on others for assistance in controlling dental plaque. Also soft diets, the inability to chew and abnormal muscle function may contribute to the high rate of periodontal disease seen most frequently in severely handicapped groups specially those living in institutions. In many studies mentally handicapped individuals appeared to have lower standards of oral hygiene and worse periodontal disease than physically handicapped individuals. Also there was an increasing tendency for the severity of periodontal disease to increase with increasing age.
Many studies showed that there was little differences in the prevalence of caries between mentally handicapped and normal children in school.However, there particular trends were apparent:Caries experience of mentally retarded people who lived in institutions was significantly than that of non – institutionalized patients, the difference was thought to be due to non – cariogenic diet of those living institution. The amount of restorative care provided to handicapped children was little and there was a higher proportion of affected teeth untreated, this largely depends on the handicapped person himself, attitude of the patient or parent to dental health, the skill experience and enthusiasm of the dental professional and facilities available for treatment. Down,s syndrome children have been reported to have a low prevalence of dental caries, this may be attributed to the reason that Down,s syndrome children have few permanent teeth than other normal children together with delayed eruption.
The objectives are: To relieves pain and control infection The existing untreated disease may be cured or eliminated and prevention of further disease should be instituted, this includes restorative work, periodontal treatment, orthodontic care and if required prosthetic care. Continuity of care demands that the patient should be recalled at an interval calculated by the dentist to mach the needs of the patient.
The control of dental plaque: Mechanical methods Diet Counseling Fluoride (Topical fluoride) Fissure sealant
Who may be suffering from illness or disability maintaining a healthy mouth may play a significant part in the process of rehabilitation and recovery.Barriers to dental care:Mobility: increasing mobility problems with age restrict access to services, public transport may be difficult to be used or inaccessible or unavailable.Economic resistance: high – cost of dental treatment is the most common reason for not seeing the dentist.Fear and anxiety: previous experience of dental treatment have a negative effect.Believes: they believe that teeth lost with age, so the health program for this group if by team visiting homes and institutes of elderly people, diet control and mouth rehabilitation and fluoridated.
Laser is defined as: Light Amplified by Stimulation Emission of Radiation.The general chrematistics of laser:The unidirectionality: (Collimation) the light emits, remained and contained in a narrow parallel bundle, while other sources of light emit in multi or all direction.Monochromacity: Concepts is that laser emits light in a straight wave length, white light emit the entire spectrum of colour red, yellow, green…etc.Coherence: The bundles of waves are coherent one with another.Brightness: As the laser travels in a parallel bundle, so it maintains its concentration and thus it is very intense light.
Liquid lasers: Dye lasers (organic dyes dissolved in suitable solvent mostly alcohol or glycerin).Gas lasers: Atomic He – Ne, ionic Argon or molecular Co2 , N2 , Eximer.Solid state lasers: Rnby, Nd:YAG, Nd: Glass Alexandrite.Semiconductor lasers: Ga – AL – As diode laser.Plasma lasers: X – ray laser.Clinically laser are classified in to 2 types:Soft lasers: are essentially an aid for healing and bio stimulation like diode laser.Hard surgical lasers: can cut both hard and soft tissues replacing the scalpel and drill in many areas like CO2 laser.
Which enable the present status and future needs of a population to be estimated on sound basis. Supply reliable epidemiological data for developing national or regional O.H. programs and for providing effective O.H. care. These basic survey data are particularly useful in planning manpower development. Establish or expanded preventive and restorative services.
Objective. Selection of the sample. Pilot study. Approval and scheduling. Calibrating the examiners. Organizing the survey.
The objective of a study is to determine the kinds of data that will be needed and the form in which they should be collected, unless the objective are clearly defined before a study begins, unnecessary data or data unusable form may be gathered at considerable cost, while data really needed may even be over locked. Thus, the final objectives must be kept clearly in mind when oral health assessment are being selected for inclusion in a study to ensure that each piece of information is essential for planning, evaluation or research purposes.
The experimental unit in dental epidemiology is normally the individual and the task of the epidemiologist is to obtain information on groups of individual. The size of these groups may vary in number, depending on the aims and scope of the investigation. It is impossible to examine every individual in the population because of resources in terms of time, money and manpower available. The sample selected must be truly representive of the population in all relevant respects (sex, social groups, age groups and other factors which are thought to have a possible bearing on the investigation) and it must be large enough to produce precise results. The major aim in selection of the sample must be avoid bias.
This type of survey is intended to be an economical and practical way of obtaining data by selecting a limited number of age and other groups as far as possible. The age groups selected are:5 years old children12 years15 years35 – 44 years65 – 74 years
Random sampling A. Simple Random sampling. B. Systemic Random sampling. Stratified sampling. Multistage sampling. Cluster sampling.
A. Simple Random sample Is defined as, one in which every element in the population has an equal and independent chance of being selected. Or is one in which each member of the population has the same known probability of selection ( in America random sampling is in fact called probability sampling). Random sampling is the procedure of choice whenever possible. It prevent the possibility of selection bias on the part of the researcher. One of the easiest ways of doing this to use tables of random numbers, such as are found in books of statistical tables.
B. Systemic sampling Is not a true sample because every one may not have an independent chance of being selected. This type of sample is usually obtained by drawing a number and then selecting every nth individual. This method is used when dealing with a large population numbering as several thousands.
Stratified sampling The population is divided into subgroups or strata, and each of these strata is sampled randomly to produce a known sample size.The reason for this is usually a condition under investigation is known to be related to various factors such as age, sex, socioeconomic level, educational or area of residence. Multi – stage sampling: Sampling by stageHere the sampling frame is first, sample will be divided into a series of first – stage sampling units and these are sampled randomly, then each of these selected units is subdivided into second – stage sampling units and these are sampled randomly and this process may be repeated as often as is necessary.
Cluster sampling This system is frequently used when it is impracticable to use any of the foregoing methods and also it is more convenient for administrative and economic. Pilot study: A pilot study gives all personnel associated with the regular study experience in working together and provides an opportunity (chance) for resolving any difficulties they may arise in the implementation of the study protocols (procedures). This type of study may be used for training records and the interpretation of diagnostic criteria, carry out the procedures, standardizing the examiners (technique, procedures) and calibrating their examing technique.
After preparing of primary questionnaire forms then a pilot study distributed to 20 individuals. The reason is to eliminate as much as possible limitations that could be faced during the study. Then the primary questionnaire was rearranged and new questions were added and some omitted so a modification was made so that the final form of the questionnaire was approved to be more easier understood and easy to be answered by the individual.
To get a permission to examine population groups must be obtained from a local, regional and national authority. e.g., if school population are to be examined, the school authorities should be approached and the purpose of the study explained to them, their approval for the program should be obtained to ensure full cooperation. Also in case of examination and then treating the children a written permission from parents must be obtained before children can be examined.
In any study, the preparation of an olderly schedule for data collection or carry out any procedure is very important to avoid wasting time. The researcher can estimate from pilot study or from previous experience, how much time an average examination or procedure will take, a daily and weekly schedule can then be made for the researcher and school.