OPERATIVE AND RESTORATIVE DENTISTRY

Tooth destruction can occur from dental caries (decay), attrition or abrasion, erosion and fracture. Dental caries, known more commonly as tooth decay, is the most common cause of tooth destruction. Caries (which literally means «rotten») results from the demineralization of mineralized tooth structures (that is the loss of minerals or inorganic content from enamel, dentin, and cementum).

Demineralization can be reversed if plaque is removed frequently enough through good oral hygiene measures, if sweets in the diet are limited, and minerals (especially calcium in healthy saliva and fluoride) are available for uptake (remineralization) into the porous demineralized tooth. This tug-ofwar between demineralization and remineralization is constant and is the basis for prevention methods that are applied and taught by dental professionals.

Patient education and preventive treatment are important aspects of dental patient care. Prevention and treatment should be based on personalized risk-based assessment of each patient's caries history, which includes their history of fluoride use, their salivary flow rate, and the frequency of sugar uptake (especially snacks). Fluoride applied to teeth in appropriate concentrations has been shown to reduce dental caries incidence because it increases the tooth's resistance to breakdown by caries-forming acids. Therefore, caries prevention includes daily use of fluoride-containing paste and fluoride-containing mouthwashes (either prescription or over-the-counter), as well as office applied fluorides that contain higher concentrations. Further, when saliva flow is reduced (from damage to salivary glands due to radiation therapy, or as a side effect to many medications), the teeth are more susceptible to tooth decay. Artificial saliva or sugarless chewing gum could be used to alleviate this problem. Finally, snacks provide the ingredients that, with certain bacteria found in dental plaque, form acids that contribute to demineralization. Therefore, frequent snacking must be curtailed.

A number of reports have shown a worldwide decrease in the incidence of coronal caries, especially in children and adolescents, ranging from 10 to 60%. However, the number of adults older than 65 is expected to double by 2025, and people are keeping their teeth longer (53% of persons older than 65 still have at least 20 natural teeth). Further, the prevalence of root caries in the elderly is increasing, with one study reporting 75% of elderly women with clinically detectable root caries. Therefore, the restoration of damaged teeth (from caries and other reasons) will continue to be a part of practice of general dentistry for some time to come.

Operative dentistry is the phase of dentistry involving the art and science of the diagnosis, treatment and prognosis of defects in teeth which do not require restorations that cover the entire tooth (full coverage).

Restoring conservative tooth defects, such as those resulting from small carious lesions usually requires placement of intracoronal restorations

whose preparations are cut within the tooth and, if located occlusally, are narrower buccolingually than the distance between the cusps.

As tooth destruction increases in size, extracoronal restorations may be a more appropriate restoration of choice. These larger extracoronal restorations surround and cover all or part of the exposed tooth, and include crowns (also known by many as «caps») or onlays (which have an intracoronal component but also include coverage of cusp tips). Treatment with extracoronal and intracoronal restorations should result in the restoration of proper tooth form, function and esthetics while maintaining the physiological integrity of the teeth in harmonious relationship with the adjacent hard and soft tissues, all of which enhances the general health and welfare of the patient.

Restorative dentistry is the phase of clinical dentistry that includes not only the prevention and treatment of defects of individual teeth, but also the replacement of teeth that were lost or never formed. Lost teeth can be replaced using a fixed partial denture (also known as a bridge), a removable partial denture, an implant (surgical insertion or placement of artificial root over which a crown may be constructed), or complete dentures (also known as false teeth). Thus, restorative dentistry involves the restoration of lost tooth structure and/or lost teeth with the ultimate goal of reestablishing a healthy, functioning, and comfortable dentition.

Date: 2016-03-03; view: 1880