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)
2
Q
F forms strong hydrogen bonds with adjacent OH groups. The F-HO bond is _______ and more ______.
A
smaller and more stable
3
Q
During tooth formation F may substitute for ______ groups
A
carbonate
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
5
Q
Larger crystal presenting smaller surface area/volume ratio, hence less _______.
A
reactivity
6
Q
The net effects of fluoride are:
- low ______ solubility
- decreased rate of _______
- less susceptible to _____
A
- Acid
- Demineralization
- Caries
7
Q
Cycles of de- and re- mineralisation result to a mineral of ________
A
better quality
8
Q
A remineralized surface is more ______ to subsequent acid attack than the original apatite.
A
resistant
9
Q
When the plaque pH returns to neutrality, ______ of dissolved calcium phosphate occurs.
A
redeposition
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
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
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
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
14
Q
- Specifically a toothpaste ingredient
- Not used professionally
- Delivers 1000-1200 ppm F
- Water soluble
- Available OTC only
A
Sodium Monofluorophosphate
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
16
Q
- Caries, Hypersensitivity, Inflammation
- Professionally available - .4%, .63%, 1.64%
- Delivery - Gels and rinses (dentifrices)
A
Stannous Fluoride
17
Q
- Unique
- 2 active ions
- Attraction to both calcium and phosphate
- Water insoluble (after uptake)
- May cause surface discoloration
A
Stannous Fluoride
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
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
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
21
Q
Other forms of Fluoride
A
- Amine fluoride
- Titanium(IV) Fluoride
- Silver fluoride
- Zinc fluoride
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
23
Q
Topical Method of Fluoride
A
- Effects the teeth already in the mouth
- Delivered via rinses, dentifrices, gels, etc.
- Does not cause fluorosis
24
Q
Patient Applications of Fluoride
A
- Toothpaste
- Mouthrinse
- Gels
25
Professional Applications of Fluoride
- Fluoride varnishes
- Acidulated Phosphate fluoride (APF) - gel/foam/mouthrinse
- Neutral Sodium Fluoride foam
26
Two stage process at high fluoride concentration
- release of Ca from enamel
- reaction with fluoride
- Formation of CaF2 material
27
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 _______
- 22,600
- Cavity liner and hypersensitivity
- caries preventive
28
5% NaF Varnish
- Long lasting resin which holds fluoride against teeth for ______
- One treatment lasts up to ______
- 24-48 hours
| - 3 months
29
Advantages of 5% Sodium Fluoride Varnish
- caries reduction ~ 40%
- easy to apply
- prolonged fluoride uptake
- small amount ingested
30
Disadvantages of 5% Sodium Fluoride Varnish
- taste
| - yellow layer
31
Fluoride varnish applied 2 to 4 times a year does prevent caries in children and adolescents by up to ___%.
40
32
Uses of fluoride varnish
- Tooth sensitivity
- Remineralization
- High-risk patients
- Young children at risk
33
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
- phosphoric acid
| - 3.0 - 4.0
34
Acidulated Phosphate Fluoride (APF) Limits enamel dissolution by _______ and _______ CaF2 globules.
- common ion effect
| - Stabilizes
35
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...
Low pH may prolong mineral ions’ access to the lesion body by preventing surface-blocking and arrest
36
Advantages of 1.23% Acidulated Phosphate Fluoride
- caries reduction ~28%
- Acceptable taste
- Stable gel or foam for tray application
37
Disadvantages of 1.23% Acidulated Phosphate Fluoride
- Possible excessive ingestion causing gastrointestinal upset
- Intolerance to trays
- Porcelain & veneer etching
38
1.23% Acidulated Phosphate Fluoride Protocol
4 minute application
39
Acidic topical fluoride solutions such as APF solutions and other acidified fluoride preparations degrade ______, ______, and ______, and should be avoided in these cases
- glass-ionomer materials
- porcelain crowns
- veneers
40
Advantages of 2% neutral Sodium Fluoride
- caries reductions~29%
- acceptable taste
- stable gel or foam
41
Indications for NaF
- Sensitivity
| - Caries Control
42
Indications for Varnish
- Sensitivity
| - Caries Control (off label)
43
Indications for SnF2
- Inflammation
- Sensitivity
- Caries Control
- Antimicrobial
44
Indications for APF
Caries Control
45
Fluoride induces the precipitation of calcium & phosphate thereby enhancing the rate of ______.
remineralization
46
Fluoride in solution surrounding apatite crystals fluoride inhibits _______.
When incorporated into the apatite crystal it makes the apatite structure more resistant to ________.
- demineralization
| - demineralization
47
Fluoride decreases the rate of metabolism of _______ (less acid is produced)
oral bacteria
48
Fluoride is important but ______ is important too.
Calcium
49
The goal is to ______ through better formulations and the addition of calcium
enhance remineralization
50
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.
added benefits
51
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
- Calcium – phosphate
- free phosphates
- coexist
52
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
- fluoride
| - Calcium
53
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
Casein Phosphopeptide
54
In CPP - ACP, _________ is:
| -Free & available to be incorporated into the tooth structure
Amorphous Calcium Phosphate
55
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)
- remineralization
- demineralization
- Neutralizing
56
- Protects against acid challenges
- Antibacterial efficacy
- Occludes dentinal tubules
Functions of Stannous
57
- Increases fluoride release and uptake
- Works with stannous fluoride to increase fluoride uptake and reduce enamel solubility.
- Helps to occlude tubules
Functions of Amorphous Calcium Phosphate
58
Which sources of fluoride are anti-caries?
- Stannous F
- Sodium F
- Sodium MFP
59
Which sources of fluoride are anti-gingivitis?
-Stannous F
60
Which sources of fluoride offer sensitivity relief?
- Stannous F
| - Sodium F (modest)
61
Nano-Hydroxyapatite dentifrices demonstrated the same remineralizing capacity as fluoridated dentifrices. Dentifrice with 10% nHAP inhibited ______ of a sound tooth surface.
demineralization
62
Toothpaste with arginine functions by producing ______ by deamination with the enzyme _______.
- Ammonia
| - Arginine Deaminase System (ADS)
63
_______ induces increase in crystallite size and improvement in crystallinity of apatite
Theobromine
64
_______ forms 3 layers and releases 6 types of ions.
Surface Pre-reacted Glass-ionomer (PRG)
65
Actions of CHLORHEXIDINE GLUCONATE
- Reduces level cariogenic bacteria in oral cavity
| - Prevents development of plaque
66
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
- Positive
| - electrolyte
67
Uses of Chlorhexidine
- Reduces S. mutans in high and moderate risk patients
| - Reduces S. mutans in mothers/caregivers
68
Chlorhexidine application
30 sec rinse, last before bed for one week every month (highly compliant high risk patients)
69
Chlorhexidine Drawbacks
- Unpleasant taste
- Teeth discoloration with prolonged use
- Recolonization occurs within 3 months
70
There is not yet any long-term clinical evidence for caries prevention with ________, so these rinses should not be recommended for caries prevention
chlorhexidine-containing rinses
71
Xylitol is not readily______ by bacteria to produce acid for demineralization
metabolized
72
Xylitol has been reported to promote remineralization of arrest early caries lesions, possibly through _______.
Salivary stimulation
73
POVIDONE IODINE forms and uses
- Solution and swabs (10% PI = 1 ppm free iodine)
| - Prevent early childhood caries in high risk infants
74
Triclosan Functions and Clinical efficacy
- provides antibacterial effects by disruption of bacterial cell wall.
- Provides anti-inflammatory effects by interlukin-1-b inhibition.
- Control of gingivitis and plaque
75
Anti-calculus agents & clinical efficacy
- 3.3% pyrophosphate
- Zinc chloride/citrate
- Reduce supra-gingival calculus formation (lingual to lower incisors) by 30-50%.
76
Probiotics tested for therapy of caries prevention
- Lactobacillus rhamnosus GG
- L. fermentum
- L. reuteri
- Bifidobacteria
77
Probiotics mechanism of action
- Bacteriocin activity (eg. Nisin)
- H2O2 production
- ↓ Biofilm/Plaque
- ↓ Glucosyltransferases
- ↓ Exopolysaccharides
- Bacterial co-aggregation
