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BHS I > 5. Caries Prevention I > Flashcards

5. Caries Prevention I Flashcards

1
Q

Types of Caries: pit and fissure lesions

  • very ____ to remove biofilm
  • frequent locations: ____ surfaces of ____ teeth
  • followed by:
    • ____ pits of ____ molars
    • ____ pits of ____ incisors
A

difficult
occlusal
posteror

buccal
man
lingual
max

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2
Q

Assessment of Risks for Dental Decay

  • Existing disease
    • clinical and radiographic caries
    • restorations within last ____ years
    • ____ spot lesions
Biologic Factors
• Exposed \_\_\_\_
• Deep \_\_\_\_
• Rotated Teeth & Malignment
• \_\_\_\_ & Saliva Reducing Factors
• \_\_\_\_ THERAPY
Behavior Factors
• Poor Oral Hygiene
• High \_\_\_\_ Diet
• Infrequent \_\_\_\_
• \_\_\_\_ Appliances
A

3
white

roots
fissures
dry mouth
radiation

sugar
dental care
orthodontic

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3
Q

Disease indicators: WREC
Risk factors: BAD
Protective Factors: SAFE

A

WREC: white spots, restorations <3 years, enamel lesions, cavities/dentin
BAD: bad bacteria, absence of saliva, dietary habits (poor)
SAFE: saliva and sealants, antibacterals, fluoride, effective diet

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4
Q

Caries Risk Assessment Tools

  • ____
    ____
    ____
A

Cariogram
ADA
CaMBRA

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5
Q

Control Bacteria to Prevent Decay

Ways to Control Bacteria Ø____: Toothbrush, Floss
Ø ____:
Ø 0.12% Chlorhexidine, Essential Oils or
Cetylpyridium Chloride Rinse
Ø Triclosan or.0454 Stannous Fluoride Toothpaste

A

mechanical

chemical

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6
Q

Caries Balance

Demineralization v. Remineralization

Both systemic & topical fluoride enhance fluoride, calcium and phosphate uptake for increased ____

A

remineralization

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7
Q

Fluoride Mechanism of Action

Enhances Remineralization

Absorbs onto crystal surface and attracts ____ ions first, then phosphate ions.

Excludes ____ to allow more crystal growth

Speeds growth of new crystalline surface by attracting more ____ & ____

Alters hydroxyapatite to ____ crystals in both topical and systemic modes

A 
calcium
carbonate
calcium
phosphate
fluorapatite
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8
Q

Fluoride Mechanism of Action

Inhibits Demineralization

Fluoride in ____ phase collects in space and inhibits ____ of intercrystalline teeth

Fluorapatite in ____ crystal lattice is most resistant to demineralization. When ____ ion is lost and replaced by FAP, demineralization is inhibited.

A

water
acid dissolution
enamel
carbonate

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9
Q

Fluoride Mechanism of Action

Inhibit Bacterial Metabolism

Acid produced by mutans streptococcus converts topical fluoride into ____, which is incorporated in cells in biofilm

Reduces acid by inhibiting ____, enzyme necessary for ____ metabolism

Reduces ____ and inhibits ____

A 
hydrogen fluoride ion
enolase
carbohydrate
mucopolysaccharides
glycolysis
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10
Q

Fluoride to Prevent Caries

Topical Fluoride

  • Affects tooth ____ and ____ enamel of erupted teeth
  • Remineralizes active ____ decay

Systemic Fluoride

  • Affects developing tooth enamel via ____
  • Increases ____ crystals in developing tooth
  • Excreted in ____ for topical effect for all teeth
A

surface
subsurface
subsurface

bloodstream
fluorapatite
saliva

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11
Q 
Fluoride Toothpaste (Dentifrice)
0.243% Sodium Fl 1100 ppm 0.454% Stannous Fl 1100 ppm (Crest Pro Health)
  • Abrasivity of paste varies, with silica, mica and ca carbonate
  • Whitening pastes = more ____
  • SDS is ____ surfactant as a foaming detergent
  • Sweeteners include ____ and ____, also serves as a humectant and antimicrobial
A

abrasive
anionic
saccharin
xylitol

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12
Q

Fluoride Home Rinses

____ ppm

  1. 05% Sodium (ACT, Fluorogard)
  2. 025% Sodium (Listerine AntiCavity Rinse (purple) 0.044% Acidulated phosphate (PhosFluor)

____ ppm
0.2% Sodium (DentiCare, NAF rinse)

A

Daily 250

Weekly 1000

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13
Q

Fluoride Home Rinses

“This review suggests that the regular and supervised use of fluoride mouthrinse by children
…result on average in 26% fewer ____, missing, or filled permanent tooth surfaces…
We found no evidence that this relative effect was dependent on ____ level or exposure to other fluoride sources, fluoride concentration and ____frequency.”

A

decayed
baseline caries
mouthrinsing

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14
Q

Topical At Home Fluoride
Gels

Daily 5000 ppm
Effective for ____ Control with neutral formulation
Good with ____ restorations & ____

Daily 1000 ppm
Effective in ____ sensitivity & caries control
Stains due to ____ ion & can pit ____ due to acidic formulation

A

caries
esthetic
dry mouth

root
tin
restorations

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15
Q

Topical Fluoride At Home Gels

Twenty Five Studies Pooled Together, with the Pooled PF of Caries Reduction was 28%

Effectiveness Varied Based on Type of ____ and Specific Group Studied, with Average Caries Reduction PF 19%

A

Gel

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16
Q

Other Remineralizing Agents
n Provide Additional ____ for Remineralizatoin, especially with Reduced Saliva

n ____ (CP/ACP) (Trident Xtra Care, MI Paste)

n ____ (ACP) (Enamel Care, Enamelon Toothpaste with stannous fluoride)

n Conflicting conclusions in two systematic reviews

A

calcium/phosphate
casein phosphopeptides/amrophous calcium phosphate
amorphous calcium phosphate

17
Q

Professional Topical Fluoride Treatments

5.0% Sodium Fluoride Varnish 20,600 ppm

PF in DFS = 46%
PF 14% greater than other TFT
- \_\_\_\_ to apply, even in infants
- accepted for \_\_\_\_sensitivity
- off label use due to lack of USA FDA approval for caries prevention, only \_\_\_\_
A

easiest
root
densitization

18
Q

Professional Topical Fluoride Treatments

1.23% Acidulated Phosphate Fluoride 12,300 PPM

  • traditional foam or gel product, easily applied at six month intervals for ____ minutes, not minute gel
  • PF 26% DMFS
  • acidic formulation speeds fluoride penetration, but will pit or ____ esthetics
  • difficult with patients with ____ or ____
A

four
stain
dry mouth
mucositis

19
Q

Professional Topical Fluoride Treatments

  1. 0% Sodium Fluoride, 9,040 PPM
    - neutral formulation safe for all patients easily applied for ____ minutes, not 1 minute
  • Research Protocol application in ____ week intervals, so research
    is regarding caries limited prevention with 2% sodium fluoride
A

four

4

20
Q

Clinical Procedure

____ Teeth, Use Saliva Ejector

Paint Directly on Teeth, Lingual ____ first, Maxillary ____ Teeth Last

With Varnish, Avoid ____ until Bed Time

if gel is chosen, apply in tray for ____ minutes

____ with patient

ensure ____ of excess fluoride

With Gel, Patient should not eat drink OR SMOKE FOR ____ MINUTES AFTER

A 
dry
molars
labial
toothbrush
4
stay
removal
30
21
Q

Silver Diamine Fluoride (SDF)

  • colorless liquid, pH 10
  • contains: 24.4% to 28.8% ____, 5.0% to 5.9% (weight/volume ____ (44,800 ppm).
  • caries control in children, adults, especially ____ caries in the ____
A

silver
fluoride
root
elderly

22
Q

Silver Diamine Fluoride: Mechanism of Action

  • fluoride ions in SDF mainly act by reacting with hydroxyapatite converting it to ____ which is more resistant to an acidic environment than hydroxyapatite
  • silver acts against ____ bacteria
  • the black stained layer > arrested ____ caries: hard and impermeable layer of ____
A

fluorapatite
cariogenic
dentin
silver phosphate

23
Q

Silver Diamine Fluoride

  • has been utilized internationally for decades to arrest dental caries in primary and permanent teeth
  • 2014, the US FDA cleared the use of SDF in the US as a topical agent to decrease ____
  • used ____ to arrest caries
  • available SDF product for dental use is ____
A

sensitivity
off label
advantage arrest

24
Q

Silver Diamine Fluoride versus Fluoride Varnish, or Both

Recent systematic reviews of human clinical trials have shown that SDF has greater anticariogenic effects than ____ alone and therefore maybe more effective in arresting caries than ____

A

fluoride

fluoride varnish

25
Q

Systemic Fluoride

Water Fluoridation: “adjustment of fluoride”

Initial research at 1.0 PPM

____ current recommended amount

A

0.7 PPM

26
Q

Evidence for Recommending Systemic Water Fluoridation, CDC, 2001

  • Code ____: good evidence
    • community water fluoridation for all areas
    • fluoride supplements for children age 6 mos-16 years
  • Code ____: lack of evidence or mixed evidence
    • school water fluoridation in non-fluoridated areas
    • fluoride supplements for pregnant women
A

A

C

27
Q

Total Dietary Fluoride Intake table

0-6 mo: \_\_\_\_/day
6-12 mo: \_\_\_\_/day
1-3 yr: \_\_\_\_/day
4-8 yr: \_\_\_\_/day
9+ yr: \_\_\_\_/day
A
  1. 01 mg
  2. 5 mg
  3. 7 mg
  4. 1 mg
  5. 0-4.0 mg
28
Q

Guidelines for Fl Supplementation

  • 0-6 mo: ____ supplementation
  • 6mo - 3 years: ____ when Fl less than 0.3 ppm
  • 3-6 yr: ____ when Fl less than 0.3 ppm; ____ when Fl 0.3-0.6 ppm
  • 6-16 yr: ____ when Fl less than 0.3 ppm; ____ when Fl 0.3-0.6 ppm
A 
NO
0.25 mg
0.5 mg
0.25 mg
1 mg
0.5 mg
29
Q

Fluoride Toxicity

  • Certainly lethal dose - potential for causing detah
    • ____ gram NaF or 32-64 mg F/kg
  • Safely tolerated dose - consumed without toxic symptoms
    • 1/4 CLD, or ____ mg F/kg
A

5-10

8-16

30
Q

Look at dosage range for CLD/STD!

A

YAY

31
Q

Fluoride Overdose Care

Less than 5.0 mg/kg: Give ____ (milk or lime juice)

More than 5.0 mg/kg: Empty stomach by inducing ____, give ____, ____

More than 15.0 mg/kg: ____, induce vomiting, give calcium ____, ____ monitoring

A 
oral calcium
vomiting
oral calcium
hospitalize
hospitalize
iv
cardiac
32
Q

Public Health Significance of Water Fluoridation

Proven caries reduction since 1945

50-60% caries reduction in 1950, 25-30% more recent studies

Benefits for both children and adults

Benefits regardless of ____ or ability to buy ____ or mouthrinse

A

dental visits

toothpaste

33
Q

Community Wide Benefits from a Population Perspective

Access to all despite ____ or dental visits

Easy ____ without effort

Ambient fluoride from products made with ____ (soda, juice, spaghetti sauce, frozen foods) disseminate in population

Limited to those who drink ____ water

Brita filters OK, ____ filters out Fl

A 
economics
compliance
fluoridated water
tap
reverse osmosis

BHS I (12 decks)

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