10. Errors

10. Errors and complications in the diagnosis and treatment nof dental caries. Prevention of tooth decay. The value of individual and nsocial prevention. Means of dental caries prevention.

 

During treatment of ndental caries, doctor performs a nvariety of manipulations, nnot very thorough or improper performance nof which can lead to nsome kind of complications. These errors caoccur both during the nactual surgical treatment, preparatioof carious cavities and non the stages of carious cavity filling and at na different times after sealing. It nis therefore advisable to divide nthem into complications arising during nthe preparation of carious cavities nand during filling of ncarious cavity, and the complications that narise after treatment of ncaries.

Knowledge of npossible mistakes and errors during carious cavity preparation and filling nmaterial placement will prevent young clinician from the complications arising nas the result of mistakes.

 

Table n1.                                                                     ERRORS AND COMPLICATIONS ARISING DURING CARIOUS CAVITY

PREPARATION

 

1. Insufficient carious cavity preparation may lead to secondary caries, thus nprogressing of caries process and possible development of pulpitis or filling nloss.

2. Perforation of the carious cavity bottom or carious ncavity wall and fracture of the carious cavity wall may happen due to not nproper fixed hand of clinician  thus leading to such complications. nPerforation of carious cavity floor may happen in the case of acute deep dental ncaries, when bottom is softened and thin layer of demineralised ndentine separates carious cavity from tooth cavity.

4. Injury of adjacent tooth crown by bur may happen when visible ncontrol of operative field is not provided.

5. Injury of  gingival margin by bur may happeduring preparation of carious cavities that goes deep under the gums or good nvision of operative field was not provided.

 

 

Table n2.                                               ERRORS AND nCOMPLICATIONS ARISING DURING CARIOUS CAVITY FILLING

 

 

1. Absence of a contact point, hanging edges of a filling and placement nof a single filling in adjacent carious cavities will lead to inflammation of intradental papilla, thus causing pain to the patient and ndevelopment of periodontal diseases. That’s why during restoration of II class nby Black (proximal cavities) it is necessary to use matrix holder and matrices nin order to restore contact point, thus preventing these complications.

2. Formation of high occlusion usually happen when filling is not nadjusted to the bite, when high spots are left, this will lead to development nof apical periodontitis in future, such tooth will change its color to grey nshades and will be painful while biting (diagnostic feature).

 

Table 3. n                                              ERRORS AND nCOMPLICATIONS ARISING AFTER DENTAL CARIES TREATMENT

 

 

                     

Figure. n(a) This amalgam restoration has nditched margins and the enamel

around the filling is nstained. (b) The amalgam has now beedissected out of the

cavity. The dentine beneath is nstained brown and in places has a dry and crumbly

texture. This is residual caries nthat the dentist left when the tooth was originally restored.

 

The main task of therapeutic dentistry is to prevent dental ncaries and its complications (pulpitis and apical periodontitis).

 

Primary nprevention

Primary nprevention protects individuals against disease, such as immunisation, and nprevention of the initiation of the disease, as in dietary advice and plaque ncontrol within dentistry. Primary prevention is aimed at keeping an individual nand a population healthy and at minimising the risk of disease or injury. It is nthis stage that seeks to implement programmes, procedures or measures to nprevent a disease, before it actually occurs. Programmes designed to prevent npeople from starting to use tobacco (primary prevention) or to help them quit nif they have already started (secondary prevention) can help prevent oral ncancer and periodontal diseases, and can also be an effective general health npromotion strategy. Additionally, plaque control and diet are effective primary nprevention methods for both the prevention of dental caries and periodontal ndisease. Other primary prevention methods include the provision of fissure nsealants, water fluoridation and routine dental examinations and ndiagnostic radiographs.

Secondary prevention

Secondary nprevention aims to limit the progression and effect of a disease at the nearliest possible opportunity after onset. It refers to the cessation of the ndisease process and preventing its progressive activity to more advanced nstages, as well as preventing the recurrence of the disease, with further nprimary prevention interventions and advice. Therefore, to stop disease nprogression and recurrence, once a condition has been recognised, actions are nneeded to control and eliminate the further spread of that condition. Removing ncarious tooth tissue and restoring structure and function at an early stage of nthe caries process can prevent tooth loss or the need for more extensive ntreatment. This intervention may be in the form of preventive resirestorations or the placement of more extensive restorations. Secondary nprevention measures to diagnose and treat periodontal diseases include nperiodontal probing and diagnostic radiographs, professional removal of hard nand soft deposits, and the local application of antimicrobial agents. Oral nexaminations of the soft tissues, in addition to obtaining a comprehensive nsocial history to assess past and present tobacco and alcohol use, are also neffective measures for detecting oral cancer at its early, most treatable nstages.

Tertiary nprevention

Tertiary nprevention is concerned with limiting the extent of disability once a disease nhas caused some functional limitation. At this stage, the disease process will nhave extended to the point where the patient’s health status has changed and nwill not return to the pre-diseased state. Tertiary disease prevention refers nto the rehabilitation of an individual and, with respect to oral disease, the nreestablishment and maintenance of the integrity of the oral cavity. In the ndental caries process, tertiary prevention is aimed not only at restoring ncarious teeth but also must include further primary and secondary prevention iorder to prevent further carious attack. This means that in addition to the nplacement of a restoration, the causes of caries must also be addressed as part nof a clinically effective caries management programme. When considering periodontal ndisease, periodontitis can be treated by a variety of interventions and nsurgical procedures or by administering antimicrobial agents either locally or nsystemically, but again the aetiology must be identified.