1 - 1 - part 1 introduction and course outline (2113).txt

7/27/2019 1 - 1 - Part 1 Introduction and Course Outline (2113).txt

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Good afternoon, good morning, goodevening, wherever you are in the world.My name is John Featherstone and thiscourse is entitled CariesManagement by Risk Assessment, otherwiseknown as CAMBRA and you cansee that these letters fit with the title,and I'm goingto be talking about how to implement it inyour practice.In the broader sense which might includeimplementing it for yourself also.So this is part one of the first week andI'm going to give you an introduction andthe course outline and let you know what'scoming in the subsequent weeks.Firstly, a disclaimer.This course is designed for educationalpurposes only.Its not intended as medical advice ormedical services for youas individuals.The information provided in this course

shouldnot be used for diagnosing or treatingA health problem or a disease, nor does itqualify you as a healthcare provider.It is not a substitute for professionalcare and if you haveor suspect you have a health problem, youshould consult your healthcare provider.And for the healthcare providers who aretuned into this course,this is information That you will be ableto use in your own practice.A little about myself.

I'm a distinguished professor ofpreventive and restorative dentistryat the University of California SanFrancisco School of Dentistry.Believe it or not, in San Francisco, USA.I'm also the dean of the school.And I continue to conduct research in thearea of caries and cariology.I've been involved with this research andclinical applicationsof it for a total now of a little over 38years.So, I've been around.

I've published over 230 articles and bookchapters relating to my research andthe key items of that research and theapplication are in this course.So have fun for the next few weeks.And stay with me.Course objectives, threefold.Firstly, to understandthe process of dental caries, as aninfectious, and transmissible disease.



And I'm going to define dental caries in amoment.Secondly, to learn about pathological andprotectivefactors related to caries initiation,progression and prevention.And thirdly, to understand the principlesof clinical interventionin the caries process, and how to put thisinto dental practice.Or into your own life.Who's the audience?We have thousands of people signed up forthis course.Dental professionals, that's dentists,hygienists,dental assistants, dental therapists orwhateveryou may be called and whatever part of theworld You are.Secondly, allied health professional, suchas, pediatricians, nursepractitioners, family medicine docs,physicians assistants, et cetera.

And we hope that you'll learn somethingfromthis and be able to put it into practicein your part of medicine and dentistry.From what you've learned here.And lastly, it's open for educated laypeople who wish to learn more about dentaldecay, and how this knowledge applies tothemselves, or to their families.It wouldn't be a normal presentationwithout another disclosure.I have no personal financial interest inany company relevant to this presentation.

I will be providing you with examples ofproducts, and Iwill be describing how products are puttogether and how they work.And in no way will I be providing you witha comprehensive list of products.The products that I show you will beexamplesonly, and I'm not here to endorse anycompany.And I would like to also disclose that Ihave consulted for,or have done research funded by or

supported by a bunch of companies.Arm and Hammer, Beecham, Cadbury,Glaxosmithkline, KaVo, Novamin, etcetera,etcetera.And you can read the list.Pretty well all of the dental health care.Companies in the majority of the world.So folks to the course, what is dentalcaries?Some of you live with dental caries all



the time everyday.Others of you it may be anunusual word for you.Dental caries is simplydefined as tooth decay.But it's not as simple as that.It's a disease, it's not a hole in thetooth.The hole in the tooth is the lastmanifestation of the diseasethat we call tooth decay.And I'll be showing you numerous examplesas the weeks go on.Firstly, specific bacteria are involved.The streptococcus mutans.Streptococcus sobrinus.Lactobacilli.And several more that are on the toothsurface, and they feed on carbohydratesand make acids.As waste products.These acids travel into the tooth anddissolve the minereal of the tooth.And if this mineral loss is not halted or

reversed, a cavity is formed.And lastly, dental carriesis a transmissible bacterial infection.Interestingly enough, an outlineof this process was published in 1890.Not 1990, folks, 1890.By a man called W.D.Miller.And he demonstrated that bacteria from themouth fed upon carbohydrates and producedacids that dissolved the teeth.It's well over a hundred years since thattime.

And how far have we advanced?We've still got people with decay.In fact, a much higher percentage nowthan, in W.D.Miller's time.So I'm going to give you some cold, hardfacts about dental caries, that you needto know.And each week, I will addsome more.Facts about dental caries and the sciencethat goes behind it.And in case you're interested, this

photograph I took in the Antarctic.Why am I showing it?It's somewhat like a decayed tooth in theearly stages.It has this intact surface, just like atooth.And underneath, there are decayed areas.And I'm going to describe how that worksduring the dental decay process.It's an interesting phenomenon.



And eventually, cavitation occurs in thetooth.We can avoid that.We can stop that.We can intervene and reverse it.So folks, demineralization.That means loss of mineral.That's stepone in the dental carries process.We have our cariogenic bacteria.And the cariogenic bacteria means they arebacteria that cause dental carries, hencethe name cariogentic.Most of you will have heard of strepmutans.Most of you will not have heard of strepsobrinus.Streptococcus sobrinus is related veryclosely to strep mutans.It's a species that is particularlyvirulent, as we call it, produces lotsof acid and is present in many people withhigh levels of decay.And then we have lactobacilli which are

bacteria that everyone is familiarwith most likely, appears in various formin our everyday lifeand also appears in the plaque bio-film inthe mouth, plus,and I'll describe those in a little bit,numerous other bacteria.Any bacteria that produce acid by feedingupon fermentable carbohydrates.We as humans need fermentablecarbohydrates to live.And, we like the taste.What are they?

The most common one is sucrose, sugar.Glucose.You're all familiar with glucoseand fructose.Fructose is interesting,because in the US it comes from highfructose corn syrup.And then we have cooked starch.So complex starch isnot able to be metabolized by thesecariogenicbacteria.However, when we take starch and cook it,

it breaks down the complex carbohydrate,and turns it into simplecarbohydrates that our cariogenic bacteriacanfeed upon.And once the bacteria feed upon anyof these fermentable carbohydrates, theyproduce organic acids.And those organic acids penetrate into thetooth, through the



enamel, through the dentin, and I'm goingto describe later what enamel and dentinare, and those acids dissolve the toothmineral, partly,and that calcium and phosphate flows outof the toothand that's what we call demineralization,or loss of mineral.The second stage of demineralizationis when our dental mineral here onthe left, which is called a carbonatedhydroxyapatite.I'm going to describe what that means in alittle bit, also.That carbonated hydroxyapatite isacid-soluble, And it's dissolved by theseorganic acids that came from thisfermentation.And those organic acids.which I willdescribe in a little more detail later.Readily dissolved the calcium and thephosphate out of the tooth.It comes into solution in the plaque on

thetooth's surface and is flushed away by thesaliva.So if demineralization continues, itproduces what we call decalcified areas.And if thatcontinues, those decalcified areasshow up as cavities.Here's the firstexample of an early stage of toothdecay, and what we see here, circled inblue and now circled in green is a whitespot lesion.

It's called a white spot because it lookslike a white spot and indeed it is.So here's a regular tooth.Another tooth next door.And so on.And this area here.That's the white spot has shown up becausethe tooth between this oneand this one, what we call exfoliated.It was a deciduous tooth that came out,from here,leaving a gap,allowing us to see thiswhite spot lesion.

And that white spot lesion is earlydecay, early demineralization, that's notyet cavitated.In other words, it's not yet a hole in thetooth.If we leave it long enough and don'tintervene, it will become a holein the tooth.It will become a cavity.It will have to be drilled and filled or



it might go beyond that.Leading to infection and the tooth eitherhaving to be extracted.Or being drilled out and a root canalbeing filled.If this white spot lesion continues.In this case, in the occlusal or bitingsurface of the tooth, we end up with whatwe call frank, or obvious, dental decay.That's a huge cavity, right here in thistooth.Difficult to understand how this personwas walking aroundand able to just continue to function withthis cavity.We can'treverse this chemically, we have to drilland fill itand put a filling in or, otherwise knownas arestoration, and all of my dentalprofessional audience will understandand know and do this every day of theweek.

So if we go back one slide, thisearly white spot lesion, if it'sin here, ends up right here.Thisslide is a photograph takenby my colleague, Dr.LingZhan, in the operating room.It's a child with decay throughouther mouth.And you can see particularly theseupper teeth are way decayed.Almost gone.

And in the lower teeth you'll see areas ofseveredecay.If this was decay in a younger child,this, this child's about nine years old,the younger child would be called earlychildhood caries.Here, we call it childhood caries.Doesn't matter, it's dental decay, it'sseveredecay, and this child's being treated inthe operation room under generalanesthetic for

about three hours while the mouth isreconstructed.Costs many thousands of dollars.It's all avoidable, and it's all the sameprocess thatI'm describing to you as today, and thecoming weeksgo on.This slide is root caries.That's decay of the tooth root.



So here's the enameland here's the tooth root which isunderneath the gingivaunderneath the gums.And you'll see we've got decay ofeach of these roots showing up in thisparticular patient.It's the same process, fermentablecarbohydrates plusbacteria-producing organic acidsdissolving the mineral.And I'm going to describe to you in moredetail root caries in the coming weeks.The therapy is similar, and I'll alsodescribethe therapy, how we can prevent rootcaries.Here we have, courtesy of another of mycolleagues at UC San Francisco.A totally destroyed mouth.Well, not totally destroyed, but veryclose.Dr.Curtis is a prostedontist who did a full

mouth reconstruction of this patient.But before he did that he took all of thedecay that you'll see here.In fact, there's too much for me tohighlight it.Every one of these tooth, teeth is loadedwith bacteria.Those bacteria are again producing organicacids dissolving the teeth.How this patient can walk around with hismouth in this condition is quite amazing.But, he came to Dr.Curtis, was referred to Dr.

Curtis, who firstly got his decay undercontrol.And then dealt with all the prosthodonticwork to turn this mouthinto a mouth of teeth that the patientreally wanted to have.Here we have a radiograph,radiographic images of a couple of theteeth in the mouth of this patient.And you 'll see, we've got some rootcanals,and we've got some decayed areas showingup right here.

So, it's very easy to tell that thispatient is way from under control.He's got decay continuing.His risk of decay continuing is extremelyhigh.And I'm going to talk a lot more aboutcaries risk assessment as the weeks go on.But we'll have to learn some of thefundamental.Science behind it before we get to that



point.Caries risk assessment is the basis forcaries management.Caries management is not just drilling andfilling.In fact, we must manage the disease beforewe go to restorative work.You will learn the science behind dentalcaries enough to use in yourpractice, and you'll be able to understandthe disease that you see everyday.In many of your patients in your practice.You will learn how to assess the risk ofthe patient having new carious lesions.A carious lesion is a demineralized area,or a cavity, in the future.You will learn what chemical therapy touse to reduce the risk leveland to prevent progression, or evenreverse the early lesions.So folks, there's a lot more in store foryou.So, now atthe end of this segment, I have a multiple

choice question for you.You don't have to write the answer down.You don't have to send it in.This is just to help you think about whatyou've hear in the last few minutes.And the question is, what is thebasis for demineralization during thecaries process.During this disease we call dental caries.Firstly, bacteria on the surface of theteeth feed upon proteins and fats fromour diets, producing acids that diffuseinto the tooth and dissolve the mineral.

Is it that, oracids in the diet and in beverages Arehelped by the bacteria to diffuseinto the teeth and dissolve the mineral.Think about that.That might be acidic drinks.It might be an apple.And oral bacteria helping those acids togo into the teeth.[INAUDIBLE].Or thirdly, specific bacteria on thesurface of the tooth ferment

carbohydrates.Producing acids that dissolve the toothmineral.I'll let you ponder for a couple ofseconds on this.Just think about which one is correct.Based upon what you just heard.Thereit is, that's the correct answer, folks.Specific bacteria ferment carbohydrates,



producing acid that diffuses into thetooth, and dissolves the tooth mineral.So folks, section one nowcomplete.Take a break andcome back and see section two.

1 - 1 - part 1 introduction and course outline (2113).txt

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