CAMBRA / Preventative 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
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.
Recommended fluoride levels to reduce cavities?
What are levels for moderate to severe fluorosis?
0.7 mg/L or 0.7 ppm
Exposure to fluoride exceeding 1.5-2.0 mg/L for an extended period
How does caries indicating dye work?
What are two key ingredients?
Which one was banned?
Carious dentin has a less organized structure and contains more denatured collagen than health dentin. The dye gets absorbed into this porous, degraded dentin.
Ingredients: Acid red 52 (erythrosine)
Both as potential carcinogens with thyroid cancer.
CAMBRA 2022 - Protective factors (which improve the score) (8)
- Fluoridated water
- Fluoride toothpaste 1/day
- Fluoride toothpaste twice/day
- 5k ppm fluoride
- F varnish last 6 months
- 0.05% sodium fluoride mouth rinse daily
- 0.12% chlorhexidine gluconate mouthrinse daily 7 days monthly
- Normal salivary function
CAMBRA 2022 -Biologic or environmental risk factors Question items (3)
- Frequent snacking (>3 times/day)
- Hyposalivatory medications
- Rec drug use
CAMBRA 2022 - Biological risk factors - Clinical Exam (4-8)
- Heavy plaque
- Reduced salivary function
- Deep fits and fissures
- Exposed tooth roots
- Orthodontic appliances
CAMBRA 2022 - Disease indicators - Clinical exam (4)
- New cavities or lesions into dentin (radiographically)
- New white spot lesions on smooth surfaces
- New non-cavitated lesions in enamel (radiographically)
- New restorations within 3 years (new patient) or 1 year (patient of record)
Difference between fluoroapatite and hydroxyapatite?
Fluoroapatite has a more compact (dens) crystalline structure rendering it less susceptible to acidic attach and mechanical degradation
At what ages would a patient have fluorosis affect their:
- Mandibular anteriors
- First molars
- Second molars
What time frame would this have happened for your patient?
- Mand ant: Begins 3-4 months to 4-5 years
- First molars: Begins Birth to 7-8 years
- Second molars: Begins 2.5-3 years to 8-9 years
For my patient, the time that overlaps with everything is three years of age (due to second molar beginning calcification at 3).
Explain mechanism of tetracycline staining
When is tetracycline avoided for children and for women?
Drug can bind with calcium ions
The drug becomes incorporated primarily into the dentin.
The teeth first have a yellow hue, but then the tetracycline oxidizes upon exposure to light, causing the color to change to a yellow, gray, or brown.
Children - Under the age of 8
Pregnant women - Avoided all the time
Besides fluorosis, what are other ways that teeth become intrinsically stained?
- Amelogenesis imperfecta
- Dentinogenesis imperfecta
- Tetracycline staining
- Hyperbilirubinemia staining
- Internal resorption
- Molar Incisor Hypomineralization
