3/21: Cariology Flashcards by Anita Maxwynn

What is cariology?

The study of dental caries and cariogenesis

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What are dental caries?

An infectious microbiologic disease of the teeth resulting in localized dissolution and destruction of calcified tissues

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What are the three elements of caries formation?

Teeth
- without teeth, bacteria have no habitat
Bacteria
- streptococcus mutans
Substrate
- any type of carbohydrate will support some strain of bacteria

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What is the Tldr; recipe for caries?

Tooth
Biofilm (plaque)
Food source

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Caries is ____________

Multifactorial

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What are the types of bacteria that can cause caries?

Streptococcus mutans
Streptococcus sangius
Streptococcus mitis
Bacteroides melaningenicus

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What is Considered normal oral flora- presence can actually slow the growth of Strep mutans colonies?

Streptococcus mitis

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What is bacteroids melaninogenicus?

◦ Obligate anaerobe
◦ Associated with periodontal disease

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What is dental plaque?

Gelatinous mass of bacteria adhering to tooth surface
Biofilm

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What is cariogenic bacteria metabolism?

Bacteria consume sugars, the waste product is acid

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What do acids lower pH in mouth to?

below 5.5

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What occurs at 5.5 pH?

Deminerlization of enamel begins to take place

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Since enamel is stronger, what does it require?

Higher acidity than dentin

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What pH does dentin demineralize at?

6.2

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What pH does dentin remain at after each sugar exposure?

Below 5.5 for 20-60 min

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What is the food source for caries?

Fermentable carbohydrates
- bacteria eats what we eat

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What is the preferred type of source for mutans streptococci?

Carbs - sucrose

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What are examples of simple carbohydrates and starches?

◦ Chips
◦ Soda
◦ Candy
◦ Cookies
◦ Chewing gum
◦ Fruit drinks
◦ Rice
◦ Trail mix
◦ Granola bars

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What is the epidemiology of caries in the past 30 years?

-Younger children (2-8yrs) have had minor decrease in caries prevalence
-Caries prevalence has remained constant for older children
-Minority youth still most at risk for caries
-Lower income youth still most at risk for caries

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What are some examples of things that have been introduced to DECREASE caries rates?

Fluoride toothpaste
Water
Water Pik
Electrical toothbrush

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Why do you think caries rates have not decreased significantly in the last 30 years?

Because things like soda, candy, cookies, baby bottles, sippers, drug users and poor brushing habits are still around

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What are sites for caries initiation?

Pits and fissures
Smooth surfaces
- interproximal contacts (Cl II and III)
- near gingiva (Cl V)
Root surfaces

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Is a white spot lesion a clinical feature of caries?

NONcavitated

Are smooth surface caries a clinical feature of caries?

Cavitated

How can you see interproximal caries?

- clinically, but more often radiographs

What are clinical features of caries?

Smooth surface caries Occlusal caries Interproximal caries Root surface caries

Describe pit and fissure caries

Class I caries Occlusal surfaces of posterior teeth Buccal surface of posterior molars ◦ Buccal pit Lingual surface of lateral incisors

What is the most prevalent location for caries?

Pit and fissure caries

How can pit and fissure caries be prevented?

By sealants

How do you detect pit and fissure caries?

◦ NOT A STICK- use explorer to drag along surface to check for softness. Use gentle pressure. ◦ Clinical visualization- shadowing ◦ Radiographs ◦ Only when large enough

What bacteria is present in pit and fissure caries?

Presence of high concentrations of mutans streptococci in pits or fissures is typically followed by a carious lesion in 6-24 months

When is it important to place sealants?

Shortly after eruption of teeth

What are types of smooth surface caries?

Buccal and lingual caries Interproximal

Describe buccal and lingual caries

Class V Diagnose visually

Describe interproximal caries

Class II Difficult to diagnose visually Diagnose with radiographs (bitewings, PA angulation = inaccurate)

How to take care of interproximal caries?

Begin gingival to contact and extend toward pulp Progress more rapidly once reach dentin

What are smooth surface caries associated with?

High sugar intake

What are smooth surface caries prevalent in?

"soda sippers" - easily restored (still a serious lesion)

Describe root surface caries

Comparatively rapid succession Often asymptomatic Closer to the pulp More difficult to restore

What are recurrent/secondary caries?

Caries developed at margin of a restoration

What are ways of diagnosing caries?

Visual Tactile Radiographs

What are visual diagnoses of caries?

Color Matte vs shiny

What are tactile features of caries?

Firm Soft - leathery

Within caries management, what are we moving away from?

"Caries prevention" and "caries treatment"

What are management ways of caries?

Surgical Non-surgical options

Waht are factors to consider regarding caries?

General health Xerostomia Fluoride exposure

What are causes of xerostomia?

- radiation and chemotherapy - medical conditions - medications

What are ways to prevent caries?

Oral Hygiene Instructions ◦ Plaque-free surfaces do not decay! Dietary Counseling ◦ Identify sources ◦ Reduce frequency and ingestion Sealants

What are sealants?

◦ Thin resin coating placed on chewing surfaces of teeth ◦ With or without enameloplasty

What are things that "arrest" (stop) caries?

Fluoride ◦ Enamel resists acids more effectively Oral hygiene improvement ◦ Reduces biofilms Dietary changes ◦ Reduces bacteria’s food source Professional cleanings ◦ May change recall intervals, more frequent assessment Address xerostomia

What is an intermediate option to managing caries?

Resin infiltration

What do we use in our clinic to infiltrate resin to manage caries?

Icon is used in our clinic ◦ Clean tooth well (pumice) ◦ Dry working field (rubber dam) ◦ Etch for at least 30 seconds 1-3 times; rinse and DRY well ◦ Icon Etch is 15% hydrochloric acid gel ◦ Acts as a “chemical” drill ◦ Infiltrate using Icon resin

What are some ways to manage caries?

- silver diamine fluoride - surgical management

Describe using surgical management for caries

◦ STILL A GREAT OPTION ◦ Cavitated carious lesions ◦ Remove carious lesion ◦ Establish resistance form in preparation ◦ Avoid fracture of tooth or restoration in the future ◦ Establish retention form in preparation ◦ Avoid restoration being dislocated or lost ◦ Restore

What classification system does UMKC SOD use?

ADA caries classification system

What is terminology of classifying caries?

◦ Sound Tooth Structure ◦ Initial Caries ◦ Moderate Caries ◦ Advanced Caries