Lesson 28

RAMPANT CARIES

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Read the text carefully. Pay attention to words in the bold print

The term "rampant caries" has been used since the early part of last century to describe an aggressive and rapidly progressing type of disease. Rampant caries is defined as a rapid carious attack involving several teeth, including teeth and toothsurfaces that are usually at low risk of caries. Examples given for rampant caries include nursing bottle caries, nursing caries, bulimic caries and radiation caries. However, these are terms that speak more of the etiology than the severity of the disease.

The patient with rampant caries who is likely to be seen in dental practice may present with the following signs and symptoms:

■ The patient may present with a history of frequent replacement and/or new fillings or a recent change in social or medical history or medication use.
■ Multiple lesions at different stages of progression, from early enameldecalcification to larger lesions and cavitation.
■ The dentinal base of cavities is usually soft and a yellowish brown colour.
■ Lesions can develop anywhere often including surfaces that are usually at low risk of caries.
■ Dentinal sensitivity from untreated carious lesions.

The first step in management is to diagnose rampant caries. It is not possible to treat any disease if the problem is not correctly diagnosed. Also recognition and immediate response to the early signs that may lead to rampant caries may prevent its full onset.

The next important and often difficult step is to find the causes of the disease. Dental professionals need to know their patients and to understand their disease. It is the responsibility of the dental professional to put together an appropriate preventiveapproach that is tailored for the individual patient's needs.

No two patients are the same and no two preventive treatment plans will look alike. For in office procedures there are sealants, topical fluoride procedures, and counseling patients to change to preventive dental behaviours. The dental clinician's highest level of intervention would include: the daily at home use of a topical fluoride gel for four minutes, daily brushing with a high fluoride concentration dentifrice, periodic use of a chlorhexidine rinse and use of a fluoride varnish applied by a dental professional twice weekly for at least one month.

Changing dental behaviours is a difficult and often a long-term process which is necessary in treatment and prevention of rampant caries. It is important not tooverload a patient with too many changes to their lifestyle. Remember little steps are more likely to be remembered and followed. As use of fluoridated toothpaste and dietary control measures improve, it may be possible to reduce the concentration and frequency of topical fluoride use.

Permanent restorative treatment should ideally not commence until there is evidence of reduction in caries activity, which hopefully can be observed at the first three month recall visit. However, if the patient insists on immediate permanent treatment without implementing necessary behavioural changes, he/she needs to be fully aware of the likelihood of treatment failure.

GLOSSARY
approach – podejście, nastawienie 
appropriate – właściwy 
be likely to – prawdopodobny 
be tailored for – dopasowany, ‘szyty na miarę’ 
carious – próchnicowy 
century – wiek (100 lat) 
commence – rozpocząć, wszcząć 
daily – codzienny 
decalcification – odwapnienie 
dentifrice – środek do czyszczenia zębów 
etiology – etiologia 
implementing – realizacja, wdrażanie, wprowadzanie 
involving – z udziałem, obejmujący 
lesion – zmiana, uszkodzenie 
multiple – liczny 
nursing – karmiony, służący do karmienia
overload – przeciążyć
permanent – stały, permanentny
progressing – postępujący, pogarszający się
rampant caries – próchnica kwitnąca
rapid – gwałtowny, szybki
recall visit – wizyta kontrolna
recent – niedawny, ostatni
recognition – rozpoznanie
rinse – środek do płukania jamy ustnej
surface – powierzchnia
varnish – lakier

Complete the sentences with words from the GLOSSARY section in proper forms. The first letter has been provided for you

1. We can wait no longer. We must C__________ the treatment at once. 
2. D____________ is the process of losing calcium from one’s teeth.
3. Patients who are bulimic or taking some psychiatric drugs are L__________ to develop rampant caries.
4. Please use this chlorhexidine mouth R____________ twice daily.
5. The treatment has’t worked. The conditions keeps P____________.
6. Because of preventive methods and higher level of education on the issue, the number of cases of rampant carries declined in the R__________ C__________.
7. You have to change your diet. I___________ a proper diet and eliminating cariogenic food groups is crucial.
8. I’m afraid that damage to this tooth is P____________.
9. The changes in patient’s lifestyle should be gradual. You can’t O___________ him or her. 
10. Bottle caries are a form of rampant caries in N__________ babies.

WORD FORMATION: Fill in the text using derivative of the words in CAPITALS:

1.Untreated caries may ultimately lead to ………………………………….. necrosis PULP 
2. A process of …………………………….…….. starts with a build-up of plaque. CAVITY 
3. Streptococci mutants is particularly ……………………………… to the teeth. CARIES 
4. Caries are formed as a result of ……………………….. of enamel by acids. DISSOLVE 
5. The enamel loses calcium in the process of ………………………………… CALCIUM 
6. The tooth repair may be achieved via natural ……………….……………… MINERAL

COMMUNICATING WITH THE PATIENT: Match the beginnings and endings of the sentences:

1. If you leave your caries untreated A. you may also need to undergo a dental x-ray
 
2. In order to confirm the diagnosis  B. can help with recalcification
 
3. The flow of saliva C. it can lead to long-term tooth sensitivity, abscesses , and even tooth loss.
 
4. Using fluoride treatment  D. you will experience severe pain
 
5. Caries are not hereditary E. naturally protects your teeth by washing acids away
 
6. If the dentine gets infected F. but may also be passed to other people
 
7. The caries are not only potentially harmful to your health

G. it is the hygiene that puts you at risk to develop them.

Look at this short text complete it with words in brackets in a proper forms (adjective, verb, adverb, gerounds etc.)
Several categories of foods in regard to dental health include:

Cariogenic foods contain 1)_________ (FERMENT) carbohydrates(any carbohydrate susceptible to 2)__________ (SALIVA) amylase) that decrease salivary pH and 3)____________ (PROMOTION) dental caries. These can be found in healthy food groups, including the grains, fruit and dairy, as well as products with added sugars. Several factors affect how 4)_______________(CARIES) foods may be: the 5)___________ (FREQUENT) of fermentable-carb consumption; food form (solid vs. liquid); sequence of eating; combinations of foods; and nutrient composition.

Cariostatic foods do not contribute to decay. These include proteins, most vegetables, fats and 6)_____________ (SUGAR) gum. Non-carbohydrate sweeteners (saccharin, cyclamate and aspartame) are cariostatic.

Anticariogenic foods prevent plaque from recognizing an acidogenic food when it is consumed first. Xylitol cannot be 7)_________ (METABOLISM) by bacteria and is thought to have two mechanisms that protect the enamel: antimicrobial activity against Streptococcus mutans, and salivary 8)________________(STIMULATE) from chewing xylitol-containing gum that increases the clearance of fermentable carbs from the tooth surface. The 9)___________ (RECOMMEND) dose is two pieces of xylitol-containing gum after consuming fermentable carbohydrates. There is some evidence xylitol can also produce a 10)_____________ (MINERAL) effect. Other anticariogenic foods include cheeses, such as aged Cheddar, Monterey Jack and Swiss, due to their calcium, phosphate, casein and lipids.


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