CAMBRA baby! Flashcards
Dental caries is an ______ microbiological disease of the teeth that results in localized dissolution and destruction
of the calcified tissues.
infectious
What are the two categories of factors that have our caries balance?
1.Pathological 2.Protective
BOOM: WHAT ARE THE 4 indicators of HIGH caries risk in CAMBRA?
1.Visible Cavities Present 2.Caries restored in last 3 years 3.Interproximal Caries lesions/radiolucencies 4.White Spots on enamel surfaces
LETS GET IT!!!! What are the 9 indicators for MODERATE caries risk in CAMBRA?
- MS and LB medium/high by culture 2.visible heavy plaque 3.frequent snacks (>3x/day) 4.Deep P&F 5.Drugs 6. Bad Saliva Flow (meds, radiation, Sjogrens) 7.Exposed roots 8.Ortho Appliances
ASSIGN A RISK LEVEL!!! Disease Factors: None Risk Factors: None Protective Factors: one or more
low risk
ASSIGN A RISK LEVEL!!! Disease Factors: None Risk Factors: One or more Protective Factors: need to increase
medium risk
ASSIGN A RISK LEVEL!!! Disease Factors: one or more Risk Factors: blank Protective Factors: need to increase
high risk
ASSIGN A RISK LEVEL!!! Disease Factors: one or more Risk Factors:low saliva flow Protective Factors: need to increase
extreme risk
What are the 4 ways we can INCREASE PROTECTIVE FACTORS??
1.Topical Fluoride 2.Saliva Stimulation/Supplement 3.Antibacterial Tx 4.minimally invasive restorative dentistry
Hey heres a concept that works!!! ______ the tooth and _____ the bacterial infection!
restore…treat
CAMBRA DAWG!!! Antimicrobials: Low Risk
Not indicated
CAMBRA DAWG!!! Antimicrobials: Moderate Risk
Not indicated
CAMBRA DAWG!!! Antimicrobials: High Risk
CHX-10mL rinse for 1 min daily at bedtime for 1 wk/month
CAMBRA DAWG!!! Antimicrobials: Extreme Risk
CHX-10mL rinse for 1 min daily at bedtime for 1 wk/month
CAMBRA DAWG!!! Bacterial Test/Saliva Flow: Low Risk
basline reference
CAMBRA DAWG!!! Bacterial Test/Saliva Flow: Moderate Risk
baseline/suspision
CAMBRA DAWG!!! Bacterial Test/Saliva Flow: High Risk
tests at EVERY periodic oral exam
CAMBRA DAWG!!! Bacterial Test/Saliva Flow: Extreme Risk
tests at EVERY periodic oral exam
CAMBRA DAWG!!! Fluoride…Low Risk
otc fluoride toothpase 2x day
CAMBRA DAWG!!! Fluoride…Moderate Risk
otc fluoride- toothpaste, mouth wash
CAMBRA DAWG!!! Fluoride…High Risk
varnish at all visits, Rx toothpaste 2x day
CAMBRA DAWG!!! Fluoride…Extreme Risk
varnish, Rx toothpaste, AND gel in trays daily
CAMBRA DAWG!!! Freq of RGraphs—Low Risk
BW’s 18-24 mo
CAMBRA DAWG!!! Freq of RGraphs—Moderate Risk
BW 18-24 mo
CAMBRA DAWG!!! Freq of RGraphs—High Risk
BW 6-12 mo, until no caveated lesions
CAMBRA DAWG!!! Freq of RGraphs—Extreme Risk
BW every 6 mo until no caveated lesions
CAMBRA DAWG!!! Freq of POEs (Periodic Oral Exams) Low Risk
1/yr!
CAMBRA DAWG!!! Freq of POEs (Periodic Oral Exams) Moderate Risk
1/yr
CAMBRA DAWG!!! Freq of POEs (Periodic Oral Exams)
every 6-12 mo to re-eval and apply F- varnish
CAMBRA DAWG!!! Freq of POEs (Periodic Oral Exams)
every 3-6 mo to re-eval and apply F- varnish
CAMBRA DAWG!!! Xylitol/Baking Soda- Low Risk
none
CAMBRA DAWG!!! Xylitol/Baking Soda- Moderate Risk
2 sticks/mints 2x/daily
CAMBRA DAWG!!! Xylitol/Baking Soda- High Risk
2 sticks/mints 4x/daily
CAMBRA DAWG!!! Xylitol/Baking Soda- Extreme Risk
2 sticks/mints 4x/daily AND Baking Soda 4-6x/day
CAMBRA DAWG!!! Sealants–Low Risk
none
CAMBRA DAWG!!! Sealants–Moderate Risk
for deep P&F’s
CAMBRA DAWG!!! Sealants–High Risk
for deep P&F’s
CAMBRA DAWG!!! Sealants–Extreme Risk
for deep P&F’s
When doing Caries Risk Assesment which factor had BY FAR the highest odds of having a cavity?
Interproximal Enamel Lesions! 13.6 (vs white spots 3.3 and visible plaque 2.7)
_________ does not reduce the bacterial loading in the rest of the mouth!
Placing restorations
Reducing caries risk status by ________ markedly reduced the level of new caries.
chemical therapy
Enamel: Hexagonal crystals are closely packed, but with protein/_____/water channels between them
LIPID!
Enamel rods are _______ to the surface of the tooth.
PERPENDICULAR
What are the 4 Functions of Saliva? What is the MOST important one??
1.Antibacterial 2.Clearance 3.Lubrication 4.MINERAL EXCHANGE (most important)–buffering & re-mineralizatoin
What is the “normal” stimulated saliva flow rate? Where do we draw the line and call it LOW saliva flow?
1.0 (haha or 1.4) mL/min….draw the line at 0.7mL/min
What are the two most important inorganic compounds in saliva?
Calcium and Phosphate
IMPORTANT! the LIPIDS in our saliva are high in ________.
Phosphate (a BUFFER)
What are the pellicle forming proteins found in saliva? They inhibit spontaneous precipitation of ______ by binding to it. (making it available for Remineralization!!)
Proline-Rich-Proteins (PRP’s)…Calcium
What is the salivary protein that helps with pellicle formation and inhibits PRIMARY precipitation of Ca AND PO4?
Stat-Her-Ins
What is the AWESOME pellicle former, antibacterial, AND anti fungal protein in saliva?
His-tat-ins (histidine rich proteins)
What Pellicle forming protein in saliva ALSO inhibits periodontal distruction!
Cys-tat-ins
Antibacterial Salivary Proteins: ________ aggregation and lysis of oral micro-organisms; aggregation of bacteria
LysoZyme
Antibacterial Salivary Proteins: _______: Binds iron needed for cell wall. Effective against S. mutans
Lacto-Ferrin
Antibacterial Salivary Proteins: _________: Effective against S. mutans. WOO (hint, and cuts on skin)
Salivary Peroxidase
Antibacterial Salivary Proteins: ________ Inhibits attachment of S. mutans to tooth surface.
sIgA
Other salivary proteins: ______ DIGESTIVE
and antibacterial. Breaks down starch.
Amylase
Other salivary proteins: _________: lubrication, bacterial aggregation, pellicle
Mucins
THE SALIVARY PELLICLE: Thin film on the surface of the enamel, Comprised of strongly adsorbed specific _______ and _____ from the saliva, Begins immediately. Forms within _____. Matures in days. Multiple layers.
proteins….lipids….HOURS
The Pellicle is also a protective layer for ________, protection from _______, and is a mineral store needed for ________..NOT ALL BAD!!
lubrication….demineralization….remineralization
THE GOOD in SALIVA: Salivary proteins contribute to the _______ to protect the outer surface

pellicle
THE GOOD in SALIVA: Salivary proteins maintain supersaturation of _________.
calcium phosphate
THE GOOD in SALIVA: Salivary calcium and phosphate inhibit _______ and enhance ________.
demineralization…remineralization
THE GOOD in SALIVA: Saliva carries ______ around the mouth
fluoride
THE GOOD in SALIVA: Salivary components ______ plaque acids
buffer
THE GOOD in SALIVA: Salivary proteins have _______ properties
antibacterial
THE GOOD in SALIVA: With low saliva, caries activity grows
_________.
exponentially
What is the FIRST bacterial to colonize the teeth? How? (oxygen preferences, pH)
S. Sanguinis..aerobic, pH of 7
What is this term used to describe S.Mutans? Produce acids that can dissolve the tooth..
Acidogenic
What is this term used to describe S.Mutans? Can survive in a low pH environment.
AcidUric
S. Mutans can adhere to the tooth structure using the extracellular _______ they produce.
GLUCANS!
What is the critical point pH?
5.5
Levels of S. Mutans in a White Spot Lesion are __-___ times higher then on adjacent sound enamel.
10-100x
What is the other main bacterial family associated with Caries? The presence of this bug may indicate a _____ lesion.
Lactobacilli…deeper!
S. Mutans can survive without ______, Colonize in furrows of the ______.
teeth…tongue
By what method does acid get to the enamel and how does Ca2 & P04 leave the enamel?
diffusion!
About ___% of the hydroxyapatite crystal is CARBONATED and is therefor more easily dissolved by acids.
20%!!
In the early stages of demineralization, some of the dissolved mineral gets ______ at the surface as it exits the tooth…SO we can have a NON-cavitated lesion (with a cover on top!)
re-deposited
How can I tell the difference between demineralization and gastric acid exposure?
Gastric acid/Citric Acid exposure is MORE damaging and gets Mulitple surfaces of multiple teeth
What form of F- must we have in order to gain access to bacteria? What bacterial enzyme does it block?
HF…Enolase
If the Pt is ingesting LIQUID sugar, then multiply by…
1
If the Pt is ingesting Solid & Sicky sugar, then multiply by…
2
If the Pt is ingesting Slowly Dissolving sugar, then multiply by… What is a high DIETARY risk?
3..Total of 9 or more
In a pH test you record the pH every ______ for ___ minutes total.
minute…20
What # is low risk for AMOUNT of SMutans via a bacteria test?
< 1500
What does a HIGH bacterial test indicate for OVERALL caries risk?
> 1500 on the bacteria test indicates Moderate caries risk in CAMBRA
CHX: Use ____ml and swish in mouth for __ minute
10mL…1min
CHX: Spit out without ______, Continue daily for a total of __ days and then discontinue use Using same routine, rinse with NaF rinse for ___ weeks. See your dentist for ______ testing and re-evaluation If necessary, continue Chlorhexidine and NaF rinse regime used earlier
rinsing…7 days…3 weeks…bacterial
Drawbacks of CHX: _______ & alters ______ if used for prolonged period, the 1% gel is not available in the ___. It is _______ for cariogenic bacteria.
stains & alters taste…US…NOT specific
Is Iodine more effective in Children or adults?
Children
Rank Xylitol, F- Varnish, CHX in prego moms not to pass S. Mutans to kiddo.
Xylitol > CHX > F- Varnish
What is the THERAPUTIC dose of Xylitol/Day??
5-10mg/day
What is MI paste made of? What are the 3 methods of delivery?
Amorphous Calcium Phosphate…1 Rub on teeth 3-5x/day 2.Tray 3.prohpy paste
OK this is just fun now…..What are the 6 systemic diseases we, as the ORAL PHYSICIAN, can test for in the saliva??
1.Myocardial Infarction (c-reactive proteins released) 2.Renal disease (elevated nitrate/urea) 3.Breast Cancer (antigen) 4.Type II Diabetes (proteins) 5.Sjogren’s Syndrome (proteins) 6. DNA analysis (forensics, who the daddy)
