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Exam 2: DHHD 5001 > Anti-Caries and Remineralizing Agents (Amaechi 8) > Flashcards

Anti-Caries and Remineralizing Agents (Amaechi 8) Flashcards

1
Q

In pure hydroxyapatite the fluoride ions may exchange

with the hydroxyl ions to form _______.

A

fluorapatite (FA)

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2
Q

F forms strong hydrogen bonds with adjacent OH groups. The F-HO bond is _______ and more ______.

A

smaller and more stable

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3
Q

During tooth formation F may substitute for ______ groups

A

carbonate

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4
Q

Improvement in the crystallinity of the apatite by:

  • increased _____ of the lattice structure
  • reduction in the number of _____ and ______ within the crystals
A
  • stability

- imperfections and dislocations

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5
Q

Larger crystal presenting smaller surface area/volume ratio, hence less _______.

A

reactivity

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6
Q

The net effects of fluoride are:

  • low ______ solubility
  • decreased rate of _______
  • less susceptible to _____
A
  • Acid
  • Demineralization
  • Caries
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7
Q

Cycles of de- and re- mineralisation result to a mineral of ________

A

better quality

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8
Q

A remineralized surface is more ______ to subsequent acid attack than the original apatite.

A

resistant

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9
Q

When the plaque pH returns to neutrality, ______ of dissolved calcium phosphate occurs.

A

redeposition

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10
Q

Fluoride in solution during de- and remineralization can react with the outer surfaces of dissolving HA crystals thereby forming a shell (of CaF2 nature) that has solubility properties of ______.

A

fluorapatite

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11
Q

At neutral pH, ____ ppm F inhibits acid production in dental plaque. ____ ppm gives greater effect. ____ ppm reduces bacterial growth. Higher concentrations (_____) become batericidal.

A
  • 1-2
  • 10
  • 100
  • > 1000
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12
Q

At acidic pH:

Reducing pH from 7 to pH 5 increases sensitivity of plaque bacteria to F. At pH 5, ____ ppm is bacericidial.

A

6-8

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13
Q

Fluoride can _____ demineralization, reduce _____ level, and ______ remineralization, which can be a _____ of the lesion or _____ of progression.

A
  • Retard
  • Bacterial
  • Enhance
  • Reversal
  • Arrest
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14
Q
  • Specifically a toothpaste ingredient
  • Not used professionally
  • Delivers 1000-1200 ppm F
  • Water soluble
  • Available OTC only
A

Sodium Monofluorophosphate

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15
Q
  • One active ion
  • Caries reduction
  • Attraction to calcium
  • Small ion - Limited ability to occlude tubules
  • Water soluble
  • Professionally available in .2%, 1.1%, 2.0%, 5.0%
  • Delivery - Rinses, gels, foams, dentifrices, varnishes
A

Sodium Fluoride

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16
Q
  • Caries, Hypersensitivity, Inflammation
  • Professionally available - .4%, .63%, 1.64%
  • Delivery - Gels and rinses (dentifrices)
A

Stannous Fluoride

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17
Q
  • Unique
  • 2 active ions
  • Attraction to both calcium and phosphate
  • Water insoluble (after uptake)
  • May cause surface discoloration
A

Stannous Fluoride

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18
Q
  • Antimicrobial (Bacteriocidal & Bacteriostatic)
  • Interferes with the development of plaque nutrients
  • Alters the electromagnetic charge of the cell wall
  • Penetrates the bacterial cell wall, thus interrupting the formation of plaque
A

Stannous Fluoride

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19
Q

-Hypersensitivity
-Ability to block the orifice of the dentinal tubules so that the registration of pain cannot be transmitted
-The Sn ion is large enough to occlude the dentinal tubules. Because it is water insoluble it will not be washed away like
the F ion

A

Stannous Fluoride

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20
Q
  • Prevents lamination
  • Sn2+ is a crystal growth inhibitor. It adsorbs to active growth and dissolution sites on enamel crystals, thereby limiting not only their remineralization but also further dissolution
A

Stannous Fluoride

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21
Q

Other forms of Fluoride

A
  • Amine fluoride
  • Titanium(IV) Fluoride
  • Silver fluoride
  • Zinc fluoride
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22
Q

Systemic Method of Fluoride

A
  • Fluoride ingested (fluids, prescription tablets, etc.) during the developmental stages of the tooth
  • Very important from birth to 8 years (critical ages are 12-30 months)
  • Can cause fluorosis if ingested in too much quantity
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23
Q

Topical Method of Fluoride

A
  • Effects the teeth already in the mouth
  • Delivered via rinses, dentifrices, gels, etc.
  • Does not cause fluorosis
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24
Q

Patient Applications of Fluoride

A
  • Toothpaste
  • Mouthrinse
  • Gels
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25
Q

Professional Applications of Fluoride

A
  • Fluoride varnishes
  • Acidulated Phosphate fluoride (APF) - gel/foam/mouthrinse
  • Neutral Sodium Fluoride foam
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26
Q

Two stage process at high fluoride concentration

A
  • release of Ca from enamel
  • reaction with fluoride
  • Formation of CaF2 material
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27
Q

5% NaF Varnish
-_____ ppm F
-Approved in the US in 1994 (Europe 1960’s)
US label claims ____ and _____, but “off-label” use - Fluoride treatment as a _______

A
  • 22,600
  • Cavity liner and hypersensitivity
  • caries preventive
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28
Q

5% NaF Varnish

  • Long lasting resin which holds fluoride against teeth for ______
  • One treatment lasts up to ______
A
  • 24-48 hours

- 3 months

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29
Q

Advantages of 5% Sodium Fluoride Varnish

A
  • caries reduction ~ 40%
  • easy to apply
  • prolonged fluoride uptake
  • small amount ingested
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30
Q

Disadvantages of 5% Sodium Fluoride Varnish

A
  • taste

- yellow layer

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31
Q

Fluoride varnish applied 2 to 4 times a year does prevent caries in children and adolescents by up to ___%.

A

40

32
Q

Uses of fluoride varnish

A
  • Tooth sensitivity
  • Remineralization
  • High-risk patients
  • Young children at risk
33
Q

Acidulated Phosphate Fluoride

  • Sodium fluoride with ______
  • Prevention of caries
  • Provides greater fluoride uptake (surface phenomenon)
  • ______ pH
  • Water soluble
  • 1 active ion
  • Professionally available - .0444%, .31%, 1.23%
  • Delivery - Gels, foams, rinses, dentifrices
A
  • phosphoric acid

- 3.0 - 4.0

34
Q

Acidulated Phosphate Fluoride (APF) Limits enamel dissolution by _______ and _______ CaF2 globules.

A
  • common ion effect

- Stabilizes

35
Q

The rate of formation of FA is relatively slow at resting oral pH values, reducing the pH from 7.0 to ≈ 5.0 increases the rate considerably because…

A

Low pH may prolong mineral ions’ access to the lesion body by preventing surface-blocking and arrest

36
Q

Advantages of 1.23% Acidulated Phosphate Fluoride

A
  • caries reduction ~28%
  • Acceptable taste
  • Stable gel or foam for tray application
37
Q

Disadvantages of 1.23% Acidulated Phosphate Fluoride

A
  • Possible excessive ingestion causing gastrointestinal upset
  • Intolerance to trays
  • Porcelain & veneer etching
38
Q

1.23% Acidulated Phosphate Fluoride Protocol

A

4 minute application

39
Q

Acidic topical fluoride solutions such as APF solutions and other acidified fluoride preparations degrade ______, ______, and ______, and should be avoided in these cases

A
  • glass-ionomer materials
  • porcelain crowns
  • veneers
40
Q

Advantages of 2% neutral Sodium Fluoride

A
  • caries reductions~29%
  • acceptable taste
  • stable gel or foam
41
Q

Indications for NaF

A
  • Sensitivity

- Caries Control

42
Q

Indications for Varnish

A
  • Sensitivity

- Caries Control (off label)

43
Q

Indications for SnF2

A
  • Inflammation
  • Sensitivity
  • Caries Control
  • Antimicrobial
44
Q

Indications for APF

A

Caries Control

45
Q

Fluoride induces the precipitation of calcium & phosphate thereby enhancing the rate of ______.

A

remineralization

46
Q

Fluoride in solution surrounding apatite crystals fluoride inhibits _______.
When incorporated into the apatite crystal it makes the apatite structure more resistant to ________.

A
  • demineralization

- demineralization

47
Q

Fluoride decreases the rate of metabolism of _______ (less acid is produced)

A

oral bacteria

48
Q

Fluoride is important but ______ is important too.

A

Calcium

49
Q

The goal is to ______ through better formulations and the addition of calcium

A

enhance remineralization

50
Q

Challenge is to add calcium and formulate a better product that truly provides _______. Not just the same benefits. Should not reduce fluoride’s proven benefits.

A

added benefits

51
Q

When TCP is blended/milled with organic materials:

  • _______ bonds are broken
  • Calcium oxides become ‘protected’ by the organic materials (Demonstrated by an increase in ______ after milling)
  • Process allows the Innovative TCP ingredient to _____ with fluoride ions in an aqueous dentifrice base –> High fluoride availability
A
  • Calcium – phosphate
  • free phosphates
  • coexist
52
Q

As Tri-Calcium Fluoride reaches the tooth surface:

  • Organic materials (often surfactants) have an affinity for tooth surfaces
  • Carries the calcium to the tooth surface, protected from fluoride ion –> High _____ bioavailability during application
  • Saliva activates the calcium compound degrading the protective coating, releasing calcium at the tooth surface –> ______ bioavailability during application
A
  • fluoride

- Calcium

53
Q

In CPP - ACP, _________ is:

  • Derived from casein found in cow’s milk
  • Binds Ca and P
  • Keeps Ca and P in a soluble form
  • Binds to tooth surfaces, plaque and bacteria in plaque
A

Casein Phosphopeptide

54
Q

In CPP - ACP, _________ is:

-Free & available to be incorporated into the tooth structure

A

Amorphous Calcium Phosphate

55
Q

Casein Phosphopeptide-stabilized Amorphous Calcium Phosphate (CPP-ACP):

  • Provides the Ca and PO4 for lesion _______
  • Prevent the mineral elution (Inhibit the ______)
  • _______ the acid from bacteria (Neutralizing & buffering)
A
  • remineralization
  • demineralization
  • Neutralizing
56
Q
  • Protects against acid challenges
  • Antibacterial efficacy
  • Occludes dentinal tubules
A

Functions of Stannous

57
Q
  • Increases fluoride release and uptake
  • Works with stannous fluoride to increase fluoride uptake and reduce enamel solubility.
  • Helps to occlude tubules
A

Functions of Amorphous Calcium Phosphate

58
Q

Which sources of fluoride are anti-caries?

A
  • Stannous F
  • Sodium F
  • Sodium MFP
59
Q

Which sources of fluoride are anti-gingivitis?

A

-Stannous F

60
Q

Which sources of fluoride offer sensitivity relief?

A
  • Stannous F

- Sodium F (modest)

61
Q

Nano-Hydroxyapatite dentifrices demonstrated the same remineralizing capacity as fluoridated dentifrices. Dentifrice with 10% nHAP inhibited ______ of a sound tooth surface.

A

demineralization

62
Q

Toothpaste with arginine functions by producing ______ by deamination with the enzyme _______.

A
  • Ammonia

- Arginine Deaminase System (ADS)

63
Q

_______ induces increase in crystallite size and improvement in crystallinity of apatite

A

Theobromine

64
Q

_______ forms 3 layers and releases 6 types of ions.

A

Surface Pre-reacted Glass-ionomer (PRG)

65
Q

Actions of CHLORHEXIDINE GLUCONATE

A
  • Reduces level cariogenic bacteria in oral cavity

- Prevents development of plaque

66
Q

Chlorhexidine adheres strongly to the cell membrane of bacteria due to its high _____ charge, and acts by precipitating the protein in the cell membrane, resulting to cell being unable to maintain its ______ balance

A
  • Positive

- electrolyte

67
Q

Uses of Chlorhexidine

A
  • Reduces S. mutans in high and moderate risk patients

- Reduces S. mutans in mothers/caregivers

68
Q

Chlorhexidine application

A

30 sec rinse, last before bed for one week every month (highly compliant high risk patients)

69
Q

Chlorhexidine Drawbacks

A
  • Unpleasant taste
  • Teeth discoloration with prolonged use
  • Recolonization occurs within 3 months
70
Q

There is not yet any long-term clinical evidence for caries prevention with ________, so these rinses should not be recommended for caries prevention

A

chlorhexidine-containing rinses

71
Q

Xylitol is not readily______ by bacteria to produce acid for demineralization

A

metabolized

72
Q

Xylitol has been reported to promote remineralization of arrest early caries lesions, possibly through _______.

A

Salivary stimulation

73
Q

POVIDONE IODINE forms and uses

A
  • Solution and swabs (10% PI = 1 ppm free iodine)

- Prevent early childhood caries in high risk infants

74
Q

Triclosan Functions and Clinical efficacy

A
  • provides antibacterial effects by disruption of bacterial cell wall.
  • Provides anti-inflammatory effects by interlukin-1-b inhibition.
  • Control of gingivitis and plaque
75
Q

Anti-calculus agents & clinical efficacy

A
  • 3.3% pyrophosphate
  • Zinc chloride/citrate
  • Reduce supra-gingival calculus formation (lingual to lower incisors) by 30-50%.
76
Q

Probiotics tested for therapy of caries prevention

A
  • Lactobacillus rhamnosus GG
  • L. fermentum
  • L. reuteri
  • Bifidobacteria
77
Q

Probiotics mechanism of action

A
  • Bacteriocin activity (eg. Nisin)
  • H2O2 production
  • ↓ Biofilm/Plaque
  • ↓ Glucosyltransferases
  • ↓ Exopolysaccharides
  • Bacterial co-aggregation

Exam 2: DHHD 5001 (14 decks)

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