Cariology Part 7 Types of Caries
Summary
TLDRThis dental lecture explores the dynamic caries process, emphasizing the balance between demineralization and remineralization. It categorizes caries based on location, structure involved, time relative to treatment, presence of cavitation, and activity level. The speaker discusses various types of caries, such as pit and fissure, smooth surface, interproximal, and root caries, highlighting their unique characteristics and challenges in diagnosis and treatment. The importance of distinguishing between arrested and active lesions is underscored, with a focus on evidence-based approaches to dental care.
Takeaways
- 🦷 The caries process is a dynamic balance between demineralization and remineralization, which can be either protective or pathologic in nature.
- 📍 Caries can be classified by location, such as pit and fissure, smooth surface, interproximal, and occlusal caries, each with distinct characteristics.
- 🏷 Caries can also be defined by the structure involved, such as enamel, dentin, coronal, or root caries, indicating the stage and severity of decay.
- ⏳ Time relevance to treatment is another way to classify caries, including primary, secondary, residual, and rampant caries, each with different implications for treatment.
- 🕳 Caries can be cavitated, where there is a physical hole in the tooth, or non-cavitated, where the tooth structure is still intact despite demineralization.
- 🔬 The activity of caries can be active, where the bacterial process is ongoing and can lead to cavitation, or arrested, where the process has stopped and the lesion is stable.
- 🌿 Pit and fissure caries often occur in teeth with less than ideal occlusal anatomy, making them prone to bacterial accumulation and decay.
- 🦷 Interproximal caries typically starts below the contact point between teeth and can be a precursor to facial and lingual caries, often requiring good oral hygiene practices like flossing.
- 👴 Root caries is a significant issue in older populations or those with gingival recession, as it progresses rapidly, can be large before detection, and is close to the pulp tissue, making it difficult to treat.
- 🦴 Enamel caries often starts as a white spot lesion and can remineralize if the demineralization process is halted, potentially preventing the need for a filling.
- 🔎 Diagnosis of caries, especially interproximal, can be challenging as up to 40% demineralization may be required before it's visible on radiographs, emphasizing the importance of regular check-ups.
Q & A
What is the caries process and why is it significant in dental health?
-The caries process is the continuous cycle of demineralization and remineralization of the tooth structure. It is significant because it can lead to either protective or pathologic outcomes, depending on the balance of factors in the mouth that influence this process.
How can caries be classified based on its location in the mouth?
-Caries can be classified by its location as pit and fissure caries, smooth surface caries, interproximal caries, and occlusal caries. These terms help to define the specific area of the tooth affected by the caries.
What does it mean to classify caries by the structure involved?
-Classifying caries by the structure involved refers to identifying whether the caries affects enamel, dentin, the crown of the tooth, or the root surface. This helps in understanding the depth and severity of the caries.
What is the difference between primary and secondary caries?
-Primary caries refer to the initial occurrence of caries in a tooth. Secondary caries develop around or near a previous filling or restoration, indicating a recurrence of the disease process in that area.
What is residual caries and why might it be left untreated during a dental procedure?
-Residual caries are the portions of caries that remain in the tooth after a dental treatment, often intentionally left to avoid complications such as pulp exposure. The decision to leave residual caries is based on a clinical judgment to protect the tooth's vitality.
How can caries be described in terms of its physical presentation on the tooth?
-Caries can be described as cavitating, where a physical hole has formed in the tooth, or non-cavitating, where the tooth structure is still intact despite the presence of demineralization.
What is the significance of classifying caries by its activity?
-Classifying caries by its activity (active, non-active, or arrested) helps determine the current state of the disease process. An active lesion is progressing and requires treatment, while an arrested lesion has stopped progressing, potentially due to changes in oral hygiene or other factors.
What is meant by rampant caries and what does it indicate about a patient's oral health?
-Rampant caries refers to the widespread occurrence of cavities on multiple teeth. It indicates a severe oral health issue, often resulting from poor oral hygiene, high sugar diet, or lack of fluoride exposure.
Why are pit and fissure caries considered the primary location for caries development?
-Pit and fissure caries are considered the primary location because the anatomy of these areas, with grooves and fossa, can harbor bacteria more effectively, making them more susceptible to the caries process.
How does the progression of interproximal caries differ from other types of caries?
-Interproximal caries often starts broad at the surface and narrows as it extends into the tooth, unlike pit and fissure caries which start narrow and broaden out. This v-shaped progression makes it a common area for caries to develop, especially in areas that are difficult to clean.
Why is root caries considered more alarming than caries on other parts of the tooth?
-Root caries is more alarming due to its rapid progression, lack of initial symptoms, close proximity to the pulp tissue, and the difficulty in treating the affected area, especially in the presence of gingival recession.
How can the appearance of enamel caries be distinguished from hypocalcified lesions?
-Enamel caries, or demineralized lesions, may appear less opaque and more glossy when the tooth is wet, becoming chalky white when dry. Hypocalcified lesions, often related to developmental conditions, appear opaque or chalky white regardless of the tooth's moisture level.
What is the significance of sclerotic dentin in the context of dentin caries?
-Sclerotic dentin is a protective response of the tooth where the dentin becomes more mineralized and darker in color to slow down the demineralization process and protect the tooth from further caries progression.
How can the terms 'infected dentin' and 'affected dentin' be differentiated in the context of dental treatment?
-Infected dentin contains bacteria and has irreversibly damaged collagen, requiring removal during restorative procedures. Affected dentin, while softened, does not contain bacteria and the damage is reversible, so it may not need to be removed.
What is the clinical significance of the study mentioned in the script regarding radiographic lesions?
-The study provides a correlation between the radiographic appearance of caries and the likelihood of physical cavitation, offering a guide to determine whether a lesion is likely to be cavitated and thus in need of intervention.
How does the classification of radiographic caries into E1, E2, D1, and D23 groups affect clinical decision-making?
-This classification helps clinicians assess the likelihood of cavitation and decide whether to proceed with restorative treatment or to monitor the lesion for changes over time, based on the extent of demineralization visible on radiographs.
Why is it important to consider a patient's caries risk level when interpreting radiographic findings?
-A patient's caries risk level influences the likelihood of cavitation. High-risk patients are more likely to have cavitated lesions, even when radiographic signs are less indicative, thus affecting the decision to proceed with preventive or restorative measures.
Outlines
🦷 Understanding the Caries Process and Its Classification
The speaker begins by explaining the caries process, emphasizing its dynamic nature between demineralization and remineralization. They clarify that caries can be either protective or pathologic. The paragraph delves into various ways to classify caries, including by location (e.g., pit and fissure, smooth surface, interproximal, occlusal), by the structure involved (enamel, dentin, coronal, root), and by the timing relative to treatment (primary, secondary, residual). Additionally, caries can be cavitated or non-cavitated and active or arrested. The speaker introduces the concept of rampant caries, where extensive decay is present on multiple teeth, and provides examples to illustrate these classifications.
🦷 Anatomy and Occurrence of Pit and Fissure Caries
This paragraph focuses on the development of teeth and how imperfections in the occlusal surface, such as grooves and fossa, can lead to pit and fissure caries. The speaker explains that these imperfections can harbor bacteria, making them prone to caries. The caries process in pits and fissures often starts narrow and broadens out, forming an inverted V shape. The speaker also discusses the importance of recognizing variations in occlusal anatomy that may predispose teeth to pit and fissure caries and touches on the second most common area for caries development: interproximally, which is considered a smooth surface caries.
🦷 Characteristics and Challenges of Interproximal and Root Caries
The speaker discusses interproximal caries, which typically occurs in hard-to-clean areas, and how it often precedes facial and lingual caries. They describe the v-shaped cross-section of interproximal caries and the importance of regular flossing to prevent it. Root caries, especially in older populations or those with gingival recession, is highlighted as a significant issue due to its rapid progression, large size before detection, close proximity to pulp tissue, and difficulty in treatment. The speaker also explains the cross-sectional appearance of root caries as a u-shaped lesion, which can be helpful for diagnosis.
🦷 Enamel and Dentin Caries: Diagnosis and Treatment Considerations
The paragraph delves into enamel caries, which often begins as a white spot lesion and can be remineralized to prevent cavity formation. The speaker differentiates between demineralized and hypocalcified lesions, the former being reversible and the latter related to developmental conditions. They also discuss the possibility of arrested enamel caries, which may appear unsightly but do not require treatment for the caries process itself. Dentin caries is also covered, including the tooth's protective mechanisms such as sclerotic dentin and reparative dentin. The speaker explains the difference between infected and affected dentin and the implications for restorative procedures.
🦷 Radiographic Diagnosis and Management of Interproximal Caries
The speaker discusses the use of radiographs for diagnosing interproximal caries and the limitations of this method, as significant demineralization is required before it can be detected. They explain that interproximal caries can arrest but still appear as caries on radiographs, necessitating careful monitoring and assessment of activity. A study from 1992 is referenced, which correlated radiographic appearances with the physical presence of cavitation. The speaker provides a detailed analysis of different radiographic classifications (E1, E2, D1, D2) and their likelihood of cavitation, advising a cautious approach to treatment based on the patient's caries risk profile.
Mindmap
Keywords
💡Caries
💡Democratization and Remineralisation
💡Pit and Fissure Caries
💡Smooth Surface Caries
💡Interproximal Caries
💡Root Caries
💡Primary, Secondary, and Residual Caries
💡Cavitating Caries
💡Active and Arrested Caries
💡Rampant Caries
💡Demineralized and Hypo Calcified Lesions
Highlights
The caries process involves a constant battle between demoralization and remineralisation of the tooth.
Caries can be classified by location, structure involved, time relevance to treatment, cavitation, and activity level.
Pit and fissure caries often occur due to less than ideal occlusal anatomy that harbors bacteria.
Interproximal caries is considered a smooth surface caries and typically occurs in hard-to-clean areas.
Root caries is a significant issue, especially in older populations, due to its rapid progression and close proximity to the pulp.
Enamel caries often presents as a white spot lesion and can be remineralized to prevent cavity formation.
Dentin caries can lead to the formation of sclerotic dentin, a protective mechanism of the tooth.
The difference between infected and affected dentin is crucial for determining the extent of restorative procedures.
Interproximal caries lesions can arrest but still appear as caries on radiographs, requiring careful monitoring.
A study in 1992 correlated radiographic appearances of caries to the presence of physical cavitation.
E1 caries lesions have a 0% chance of cavitation when halfway through the enamel.
E2 caries lesions have about a 10% chance of cavitation at the enamel-dentin junction.
D1 caries lesions have a 40% chance of cavitation when in the outer half of the dentin.
D23 caries lesions have a 100% chance of cavitation and require restorations.
High caries risk patients may require more aggressive treatment approaches despite radiographic findings.
Low caries risk patients may benefit from monitoring lesions rather than immediate intervention.
The importance of distinguishing between arrested and active caries lesions for appropriate treatment planning.
Transcripts
[Applause]
okay so next we're gonna talk about
different types of carries what do I
mean right different types of carries I
thought there was just like you got a
cabbie or you don't have a cavity right
well keep in mind the carries process
it's just that it's a process right it's
a constant battle between demoralization
and remineralisation so anytime that
carries process occurs it's either going
to be protective in nature or it's gonna
be pathologic in nature so that process
of the tooth of losing and gaining
minerals I mean that really is the
Carrey's process right it's it's those
four big things we discuss with all
those influencing factors contributing
to pathologic or protective factors in
the mouth so as a result of this dynamic
complex process there's different ways
that we can actually classify or define
caries in the mouth so one of those ways
is by looking at where it occurs the
location of the caries right so if you
think about you know just talking to
patients or even talking to your
colleagues about where caries is located
what kind of terms do you use well you
may say things like pit and fissure
caries smooth surface caries
interproximal caries occlusal caries
right those are all terms or definitions
that we use to define the location of
the caries another way we can classify
caries is by the structure involved this
could be a couple of different things
this could be like enamel caries dentin
caries or this could be like coronal
caries or root carries right different
structures involved with that carries
disease process so a third way we could
actually classify or define the caries
process is by the time relevant to the
treatment what I mean by that so like if
you have caries for the first time the
patient may have what we call primary
caries but then the patient
she's a feeling and then years later
they developed caries near that filling
site right or around the filling and we
call that secondary caries so we could
also classify caries as residual carries
meaning that when we go in to treat the
tooth we remove some of the caries but
we leave some of the caries present for
whatever reason maybe we're trying to
avoid a pulp exposure so we leave
residual caries present right so that's
another definition of the caries process
and the other thing you could think
about is is the caries cavitating
meaning that there's actually a physical
hole in the tooth or is it non capitated
meaning that the two structure is intact
but the caries hasn't actually caused
enough demineralization to occur where
there is now a physical hole in the
tooth and probably the last way we could
classify or define caries is by its
activity meaning like is the bacteria
that's present in the caries active or
is it non active or arrested right it's
a disease process and so that process
can be occurring or it could actually be
non occurring so if we say lesion is
active that means that it's actively
capable of producing that disease
process and if left untreated it could
eventually lead to a cavitation of the
tooth whereas an arrested carious lesion
means that that whole process was
actually stopped for whatever reason may
be the protective factors outweighed
those pathologic factors and now the
tooth was a be able to stabilize itself
and we were able to reduce those
bacteria accounts and the patient's
hygiene got better and they expose
themselves a more fluoride and their
diet changed so now that whole disease
process actually stopped and that
carious lesion is you know arrested and
you know this is one that kind of comes
up occasionally but we also classify
caries as rampant caries right what does
that mean that's like the patient who
comes in in
and they have cavity on every single
tooth every single tooth has a big
cavity on it and so we call that ramp it
carries meaning that it's just kind of
everywhere right it's it's a huge
process its extensive it's multiple
locations in the mouth that's what we
call rampant caries all right so let's
look at a few of these examples a little
bit closer so first let's talk about pit
and fissure caries all right so if a
tooth develops normal it doesn't have
any developmental issues everything's
perfect what happens is that occlusal
surface is actually a combination of
grooves and fossa that make up that
occlusal Anatomy now a lot of people
when their teeth develop those grooves
and those fossa do not completely
coalesce perfectly so what they're left
with is anatomy that's a little less
than ideal and it's also a little bit
more capable of kind of harboring that
bad bacteria it's more suitable for
caries to occur so it's not really ideal
so we call it pits and fissures right so
pits and fissures specifically means
that the tooth really did not develop
perfectly now because of this Anatomy
pits and fissures are actually the
primary location where people typically
get caries and again it's due to that
Anatomy it's able to harbor bacteria a
little bit easier due to that specific
occlusal morphology so if you look at
the caries process and pits and fissures
it's actually going to start very narrow
and it's going to kind of broaden out as
it kind of diffuses into that dentin so
it's gonna be an inverted V shape so I
actually include the slide in the
handout that actually shows some of the
variations that can occur with the
occlusal Anatomy some of the anatomy on
the teeth is very conducive of harboring
bacteria and just creating an
environment for that bacteria to cause
pit and fissure caries so the second
most common area to develop caries is in
approximately now interproximally is
actually considered a smooth surface
carries whereas also if somebody gets
carries on the facial or the lingual of
the tooth that's also considered smooth
surface caries now patients do not get
carries on the facial or the lingual of
the tooth if they don't already have
interproximal caries
so usually interproximal caries is a
prerequisite to developing that facial
and lingual caries now specifically for
interproximal caries again it typically
occurs in those hard to clean those
areas that's a little bit more difficult
to get into
so if patients aren't flossing on a
regular basis you know they're not
really cleaning in between the teeth and
so caries typically develops right below
that point of contact right right below
that interproximal contact point where
bacteria is able to kind of collect
right there and if you look at these
lesions under a cross-section they
actually look like a v-shaped meaning
that the area at the surface is actually
very broad and as the caries extends
into the tooth closer to the dej it
actually gets more narrow so it's a
v-shape and cross-section so root
surfaces are also an area that
especially in sometimes older
populations or in people who aren't high
caries risk and they have gingival
recession root caries is a big issue and
so in these patients there's a lot of
reasons why root caries is more alarming
than it could be if they get carries on
another part of the tooth so what are
some of the reasons why root caries is
such a big deal well number one it
rapidly progresses because there's no
enamel present on the root surface
there's no real good protection there's
no first-line defense for that carries
process so it basically starts out in a
very thin layer of cementum and then it
goes into the dentin and as you know
from dentin it just progresses very
quickly through that dentin so that's a
big issue another reason why root caries
is also a problem is it's oftentimes a
pneumatic you know you can have route
carries get very large before the
patient even realizes there's something
going on they don't have any true like
signs of sensitivity or pain until
oftentimes the carry solution is very
large now another thing about route
carries is it's very close to the pulp
tissue so again like these carious
lesions can get very big and they can
get very close to that pulp tissue
before you even know what's going on so
it's very quick for things to get pulp
involvement whereas if you had a cavity
like on the occlusal or an inner
proximal it can take months sometimes
years for that to kind of make its way
to the pulp tissue on a root surface it
doesn't take that long and one of the
last reasons why root carries is so
difficult is because they're very
difficult to treat think about the
location of these you get the gingiva
right there you got you know two
structure that's not really a whole lot
of enamel present so there's just a lot
of things that impact your ability to be
able to replace a really good sound
long-lasting restoration in those areas
very difficult conditions to work in
roof surfaces that are exposed in the
mouths of typically rough they're very
kind of plaque retentive they're very
difficult to keep clean so that's
another big issue with root surfaces and
if you look at a carious lesion that's
on a root surface in a cross-section you
know we talked about how the other areas
in the mouth are specific appearances to
that curious lesion in cross-section the
roof surface is no different for a root
surface the cross-sectional appearance
of caries is going to be a u-shaped
lesion so that can be very helpful
sometimes when you're trying to diagnose
these on a radiograph especially if the
caries is occurring in approximately
just look for that distinctive u-shape
lesion so enamel caries you know when
the caries process starts out the
majority time and a healthy person that
does not have ginger were session
they're going to have Kerry start out on
the enamel now typically the enamel will
have very distinctive appearances too
you may have a white spot lesion present
that's non capitated that's usually an
incipient or an early caries process
occurring now there is a difference
between you know a demineralized lesion
and a hypo calcified lesion now happy
calcified typically refers more to like
developmental related conditions whereas
demineralized lesions are the two
structure developed fine but due to all
these influencing factors the two
structures of losing minerals from the
tooth both of these lesions are going to
appear very white or opaque in
appearance and interestingly enough if
the tooth is a little moist it's a
little wet the demineralized lesion is
gonna be a little bit less opaque it's
gonna be a little bit more glossy but as
soon as the tooth is dried it's gonna
appear a very chalky white color now the
hypo calcified lesion is gonna look
opaque or bring chalky white regardless
of whether or not the tooth is wet or
dry so that's a good way to distinguish
those two lesions apart and if you're
dealing with a demineralized lesion
that's actually a good condition to
actually think about remineralisation of
that tooth doing things that help put
minerals back into the tooth you know
teaching the patient things they can do
to help remineralize that tooth so the
cavity never occurs and then the other
thing is enamel caries when it does have
remineralization when the disease
process stops you're actually gonna have
a resting of that caries and that can be
kind of alarming sometimes because
sometimes the enamel caries process gets
so far along and then it stops for
whatever reason you know maybe the
patient is brushing better more fluoride
exposure they're seen you know you on a
regular basis so they're doing all these
things right and the carries disease
process actually stops so what happens
is it stops and so it may leave a rough
and surface it may look like the tooth
is like a dark brown or like a black
color and a lot of practitioners
look at this and they'll say I'll look
there's a cavity there we need to treat
that when in reality it's actually an
arrested lesion
it doesn't need treatment for the sake
of the caries process because it's
actually been stopped it may need
treatment for aesthetic reasons because
it's kind of an eyesore but as far as
the caries process goes it should not
get any worse
so dentin carries dentin can have caries
once it's advanced past the enamel or in
certain situations where patients
actually lose her enamel for whatever
reason maybe they have a clue so we're
in combination with some erosion and now
they have exposed dentin on their teeth
so there's a lot of reasons why Denton
can be exposed but nonetheless when
caries process actually occurs on dentin
now you have dentin caries so oftentimes
the result of demineralization on to
structure it actually encourages the
tooth to try to fight this process so
sometimes what you can see is sclerotic
dentin or dentin that has a hyper
mineralized content a lot of minerals
present sclerotic dentin is actually
more shiny and it's darker in color
compared to normal dentin and this is
actually a protective mechanism of the
tooth to kind of slow down that
demineralization that carries
progression over time so another thing
that occurs whenever the caries process
is occurring in dentin you get hyper
mineralized you know didn't on the
surface but you also get dentin laid
down closer to the pulp reparative
dentin or tertiary dentin it's the to
stability to try to protect itself to
try to maintain its vitality and to
prevent that carries progress from
occurring more rapidly so sometimes
you'll hear the terms infected dentin
versus affected dentin essentially what
that means is infected dentin is dentin
that actually has bacteria infecting in
its present within the dentin and the
dentin collagen itself is actually
irreversibly damaged affected dentin is
actually Denton that does not contain
bacteria but it does contain collagen
that is reversibly damaged it's a little
bit softer but it's reversibly down
and it does not contain that bacteria so
when we're talking about removing dentin
during like a restorative procedure you
definitely want to remove the infected
dentin but you don't necessarily have to
remove the affected didn't so we talked
a little bit about interproximal lesions
now a common way to diagnose caries is
to look at radiographs right we usually
get bitewing radiographs and we look at
the interproximal contacts to determine
if there is caries occurring at those
interproximal contact areas
interestingly enough when the
demineralization process is occurring in
approximately for you to be able to
actually identify a change in the
radiograph to be able to identify
carries on that bitewing radiograph you
have to have up to 40% demineralization
of that tooth structure occur in that
specific area and again these lesions do
not happen overnight sometimes it can
take 3-4 years for these lesions to
occur because you have that process of
demoralization and remineralization so
you're not wrong when you see some of
these and you say you know what I don't
want to treat this right now but we're
gonna keep an eye on it we're gonna keep
watching this over time to see if that
carries gets worse so with these
interproximal caries lesions these can
also arrest
just like other curious lesions however
the only downside is is when they arrest
they still look like carries on the
radiograph so you have to be mindful if
you choose to watch these you have to
keep good notes for yourself and
understand you know is the lesion active
or is it non active you have to be able
to determine that if you're gonna choose
to watch these lesions so there was a
study done in 1992 that actually looked
at radiographic lesions and they looked
at various appearances of caries on the
radiograph and then what they did was is
they actually introduced an orthodontic
spacer or orthodontic separator between
the teeth and they allowed the teeth to
kind of slightly separate so they can do
a visual inspection of that proximal
surface
so they basically created a graph that
correlated radiographic appearance to
whether or not there was a physical
cavitation of that tooth present so for
this next part definitely refer to your
handout and look at this specific graph
that I'm talking about that correlates
lesion progression to a physical
cavitation on the tooth so let's look at
this
so it's classified or the curious lesion
is classified into four different groups
you have your E one group which is where
caries kind of extends into that outer
half of the enamel so in that specific
situation if you see a lesion extend
about halfway through the enamel
according to this article in the study
that they did when they looked at teeth
after they separated they had caries
extending halfway through the enamel
there was a 0% chance that tooth
actually being cavitate now if you look
at the e2 option which is where you have
caries extending to the inner half the
enamel so it basically goes through the
enamel and it kind of kisses that dental
enamel Junction when a lesion looks like
that according to the study it's
probably about a 10% chance that the
surface of that lesion is actually
cavitating so you know I'm thinking back
to dental school that e to presentation
was like the board lesion right when we
had to take your dental boards we were
always looking for lesions that look
like that that's like perfect right well
according to this article there's only a
10% chance that there's actually a
cavitation present which means that
there's a 90% chance that there's not
right so that means that you could
typically take the approach of
remineralizing these if you wanted to or
just watching them to see if they get
worse before you actually initiate a
irreversible procedure now let's look at
d1 so d1 means that the caries is it's
basically extended through the enamel to
the dej and now it's in that outer half
of the dentin so according to this
article
when you see that appearance
radiographically there's about a 40%
chance that the surface is cavitating so
that's even still pretty cool if you
think about it because you know most of
the time I would say especially when I
got out of dental school if I saw a
lesion that looked like that on a
radiograph it was getting a feeling 100%
of the time but if you look at
evidence-based dentistry you look at
this article there's only about a 40%
chance that the tooth even needs a
filling so pretty interesting definitely
something you want to put in your memory
bank the other thing is look at d23 okay
so that's where the carious lesion it
extends all the way through the enamel
it extends basically over halfway
through the dentin so it's really close
to that pulp tissue if you see that
appearance radiographically you have a
hundred percent chance of that tooth
being capitated according to this
article so definitely a hundred cent of
time these have to have restorations
they have to have interventions with a
burr with a filling all right so if you
think about that that typical appearance
for the radiograph you know you're
looking at the lesion it goes through
the enamel it just slightly past the dej
you can watch these lesions okay because
it's only a 40% chance it's actually
capitated
now the caveat is this if you have a
patient that is extremely high caries
risk you know as history would tell you
they've had multiple fillings currently
they have at least two or three other
fillings that need to be done and now
they have this lesion that looks like
this on one of the teeth I will tell you
that if it's a high risk patient that
basically fits that criteria I described
I will be more likely to do a filling on
that patient even though there's a 40%
chance it can be capitated because as
history has already proved this patient
has had a history of you know caries in
the past and they're at higher risk for
getting in in the future so I'm a little
bit more
aggressive in those of patients now if
you compare that to a patient who
they've never had you know a cavity and
their wife or maybe they'd only had like
one or two and they're 30 years old and
they have a lesion that looks like this
well I'm more likely to watch that
lesion in that specific person because
they're in a lower risk right their
caries risk is a lot lower compared to
the other person so that's how I
typically will use this information to
benefit me or to actually use this in
the clinic
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