CAMBRA Featherstone 2010 Flashcards
Pjetursson found what were the two most common complications for FPD’s over a five year time frame?
- Abutment tooth devitalization
- Caries
Goodacre Review included how many studies and evaluated FPD complications over how long? What was incidence % of complications?
15 studies, 8 years average.
27% incidence of complications - Caries on abutment teeth (then post and core)
Explain the dynamic, chronic process of caries
Caries result from release of acids formed in biofilms that cover susceptible tooth surfaces.
The acidogenic biofilm bacteria ferment available carbs, generating acids that can diffuse into enamel/dentin and dissolve the carbonated hydroxyapatite tooth mineral.
Three primary mechanisms of fluoride in managing caries
- Inhibiting demineralization
- Enhance remineralization
- At high concentrations inhibit metabolism of bacteria
What factors potentiate caries in the pros patient? (7)
- Acidogenic bacteria
- Reduced salivary function by vol or content
- Existing restorations harboring plaque
- Frequent ingestion of fermentable carbs reducing pH
- Decreased skills/compliance with oral hygiene
- Root exposure
- Wearing an FPD or RPD
What factors protect against caries?
- Saliva
- Salivary flow rate
- Antibacterials (from saliva and extrinsic)
- Other factors that raise pH and the potential for reminerlization
What are the 9 risk factors for caries based on history (Table 1)?
- Existing/recent history of caries
- No dental visit in past 6 months
- Limited lifetime exposure to water fluoridation
- Brushes once a day or less
- Saliva reducing factors (med’s, radiation, systemic factors)
- Frequent (>3 times daily) snacking between meals
- Health behavior risk indicators (smoking, eating disorders)
- Low socioeconomic status and/or impaired cognitive ability
- Low educational level
10 risk factors for caries based on clinical exam and/or diagnostic testing (Table 2)
- High Strep mutant and Lactobacillus counts
- Inadequate saliva flow (<0.07 ml/min stimulated)
- Large number of fillings
- Visible heavy plaque
- Recession with exposed roots
- Defective restorations with open margins
- FPD’s
- RPD’s
- Deep pit and fissures
- Noncavitated lesions
9 protective factors based on history, clinical exam, and/or diagnostic testing (Table 3)
- Involving the patient in discussion of disease control
- Brushing twice daily with fluoride toothpaste
- Fluoride varnish use 3 times a year
- Daily fluoride in drinking water
- Chlorhexidine rinse daily 1 week each month
- Xylitol gum/lozenges twice daily for 15 min’s
- Amorphous calcium phosphate twice a day following use of fluoridated toothpaste
- Stimulation of salivary flow
- Buffering products and salivary substitutes
Toothpaste containing fluoride reduces incidence of caries by what %?
20-35% depending on dose and frequency. Standard levels in toothpaste (1000 to 1100 ppm) is effective.
Chlorhexidine mechanism of action?
It is most effective in conjunction with? What is the issue with the combination?
Rec dosage?
Strong base with cationic properties. The cationic molecules bind to the negatively charged bacteria cell walls (disrupting the osmotic balance) and weaken the bacteria over time.
Most effective with fluoride, but F- and chlorhexidine ion is +. Should be used 1 hour apart to not compete.
10 ml of .12% rinse for 1 minute at night at least 1 hour after brushing with fluoridated toothpaste
Xylitol - MoA? (4)
Xylitol-containing gum resulted in caries reduction of what %?
Instructions and dosage?
MoA: Increase salivary flow, raise pH, decrease colony counts of S. mutant, decrease adherence of S.mutans to tooth structure, and enhance remineralization of subsurface enamel lesions.
Caries reduction of 58%.
Chew gum twice daily for 15 minutes. Total dose 7 to 10g/day.
