Caries Flashcards
definition of caries
decay and crumbling of tooth structure
caries is a —
disease
most common chronic disease of childhood
caries
cavity
empty space or hole
caries is a — disease
multifactorial
requirements for caries (4)
host
food source
bacteria
time
oral environment factors affecting caries (8)
fluoride dental sealants antibacterial agents saliva sugars calcium and phosphate ions plaque pH and species of microbes chewing gum
personal factors affecting caries (8)
patient education patient bevaiors oral health literacy socioeconomic status income dental insurance knowledge attitude
is it possible to impact personal factors?
very challenging or impossible
main component of enamel
fluoride
fluoride ions replace hydroxyl groups, creating
fluorapetite
Fluorapatite is — resistant to demineralization than hydroxyapatite
more
more resistant to acid
where is fluoride effective at reducing caries? (2)
crown (enamel) root surfaces (cementum)
systemic fluoride
found in water supply
used for drinking, cooking
topical fluoride (2)
toothpastes (OTC and prescription)
fluoride treatments in dental office (foam, varnish, silver diamine fluoride)
dental sealants
thin coating of resin painted on the chewing surfaces of molars (occasionally premolars)
high concentration of — in pits and fissures
strep mutants
dental sealants help to prevent
occlusal caries
saliva properties (3)
physical
chemical
antibacterial
physical saliva properties (3)
• Cleanses oral cavity
• Humans produce ~0.5-1 liter saliva per day
• Chewing gum increases saliva production
(• Xylitol ingredient also cariostatic)
chemical saliva properties (3)
- Sodium bicarbonate and phosphate ions neutralize environment
- Calcium and phosphate ions help remineralize
- Proteins raise salivary pH, help remineralize enanel
antibacterial saliva properties (6)
• — clear bacteria
• — break down food particles that stick to teeth
• — lyse cell walls of bacteria
• — deprive bacteria of iron
• — forms free radical compounds in bacterial cells, leading to self destruction
• — block bacteria from adhering to tooth surface
Mucins Amylases Lysozomes Lactoferrin Peroxidase Immunoglobulins
bacterias favorite food
fermentable carbohydrates
preferred sugar
sucrose
— is more important than — when determining caries risk
frequency
quantity
lower pH= more — environment
acidic
enamel demineralizes at
5.5
dentin and cementum are softer than enamel so they each demineralize at
6.5
Streptococcus ◦ especially --- (but not exclusively) ◦ Gram --- cocci ◦ Prefer pH ~--- ◦ Most prevalent in (2)
Strep mutans
positive
5.5
pits and fissures
Lactobacillus
◦ Gram — rods
◦ Prefer very — pH
positive
low
biofilm
an aggregation of microorganisms adhering to each other in a matrix
dental biofilm is
dental plaque stuck to tooth
biofilm alone is not
cariogenic
biofilm must contain
caries causing microbes
- streptococcus and lactobacillus
- specific plaque hypothesis theory
Caries occurs when Demineralization — Remineralization over time
>
Enamel demineralizes at pH
5.5
Normal oral cavity pH ~
6.7-7.3
Enamel components (3)
◦ 90% hydroxyapatite
◦ 8% water
◦ 2% organic material
Dentin components (3)
◦ 50% hydroxyapatite
◦ 30% organic material
◦ 20% water
Fermentable carbohydrates
• Food source for caries-causing (cariogenic) bacteria
Acidic food, drink
• Baseline environment lowers pH
Dry mouth (2)
- Lack buffers, rinse
* Age, medications contribute
Poor oral hygiene
• Bacteria able to thrive
MORE FREQUENT SUGAR = — CARIES LIKELIHOOD
INCREASED
Saliva (3)
- Neutralizes pH
- Rinses oral cavity
- Ions to remineralize
Good oral hygiene
• Destroys bacteria’s habitat, they can’t stick to tooth
Lack of cariogenic —
microbes
Reduced sugar consumption
• Bacteria starve
Why are sugary or acidic drinks so bad?
NO CHEWING.
Chewing increases saliva production. Sipping on a latte does not.
Drink your sugary drinks with
a meal
Certainly avoid Gatorade/powerade during workouts if possible
◦ Why?
◦ Salivary flow already decreased during strenuous activity.
What’s fluoride’s role in all of this? (3)
- When oral cavity pH drops below 5.5, hydroxyapatite dissolves
- Fluoride ions enter to form fluorapatite
- Enamel is now resistant to demineralization pH ~4.5
Pellicle
◦ Thin membrane on surface
Biofilm (2)
◦ Community of microorganisms held together by extracellular matrix
◦ Complex structure
Dental plaque forms itself into a Biofilm
◦ Can be comprised of (2)
◦ NOT — debris
◦ Food debris can be removed by —, dental plaque can not
microorganisms or pathogenic organisms
food
rinsing
What is the primary tool used to diagnose caries?
eyes
how to diagnose interproximal caries
Radiographs
Sharp — > sharp explorer
◦ “a stick” is not helpful
eyes
Explorer is helpful for (2) senses
tactile and acoustic
Soft, leathery feel when explorer is gently dragged across tooth=
carious
Firm, chalkboard feel and nails on chalkboard=
sound enamel
Caries progression
◦Be familiar with progression to aid with diagnosis (2)
◦Slow to progress through enamel
◦Faster once it reaches dentin
Caries is a disease
◦Must be managed —
◦Treat the person (4)
comprehensively
◦Oral hygiene instruction
◦Dietary counselling
◦Fluoride therapy
◦Surgical treatment
Oral hygiene instruction (3)
◦Plaque free surfaces do not decay
◦Home care
◦Regular dental visits
Dietary counselling
◦This is part of our job
◦Stress on — — and frequency
◦Start with small — changes
fermentable carbohydrates
habit
Fluoride therapy (4)
In office ◦ Fluoride Varnish ◦ Silver diamine fluoride At home ◦ Fluoride toothpaste ◦ May prescribe Prevident 5000 or similar Fluoride trays Education ◦ Can’t force this on patients, but you can educate them
— must also be managed
Xerostomia
evaluate the patients medications, some may cause
dry mouth
recommend aids to assist such as (3)
fluoride
xylitol chewing gum
biotine (patient comfort)
recommend habit changes to assist
recommend water instead of sugary drinks
surgical caries management once the caries has progressed pas the ability to
remineralized
drill and fill
surgical caries management is a very important part of management but
not the whole picture
