Caries 2 Flashcards
1
Q
Caries caused by: (3)
A
- interaction between tooth surface
- biofilm
- sugar
2
Q
Where are caries located?
A
dental hard tissues
3
Q
How do caries begin?
A
deminerilzation of enamel
4
Q
Keyes presented caries as…?
A
in the form of overlapping circles
5
Q
Define dental plaque
A
deposit of diverse bacterial communities immersed in an ECM of polysaccharides
6
Q
What is the natural source of primary infection for primary teeth?
A
the mother is a vertical and exogenous transmission
7
Q
How many stages of dental plaque formation are there?
A
3
8
Q
How long does it take for the 1st stage of dental plaque formation?
A
minutes
9
Q
How long does it take for the 2nd stage of dental plaque formation?
A
after 24 hours
10
Q
How long does it take for the 3rd stage of dental plaque formation?
A
7-14 days
11
Q
1st stage of dental plaque formation visibility?
A
not visibile
12
Q
What happens during the 1st stage of dental plaque formation ? (2)
A
• Glycoproteins and proteins from the saliva are absorbed to the
tooth surface.
• An acquired pellicle is formed on a smooth polished surface.
13
Q
What is an acquired pellicle? (3)
A
Appears in 1st stage of plaque formation
- amorphous (unstructured), acellular and organic.
- formed on a smooth polished surface
14
Q
1st stage of dental plaque formation: visibility?
A
not visible
15
Q
1st stage of dental plaque formation: time?
A
formed within minutes
16
Q
1st stage of dental plaque formation: contents? (3)
A
saliva
bacterial products
gingival fluid
17
Q
2nd stage of dental plaque formation: 1st Bacteria?
A
coccus gram+: streptococcus
18
Q
2nd stage of dental plaque formation: What occurs? (3)
A
• Bacteria adhere to the receptors of the film acquired by adhesives,
fimbrias and electrostatic forces.
• The first microorganisms are the coconuts gram+: streptococcus.
• Congregations
19
Q
2nd stage of dental plaque formation: How do bacteria adhere? (3)
A
• to the receptors of the film acquired by adhesives,
fimbrias and electrostatic forces.
20
Q
Who are the last dental plaque colonizers? what stage? (2)
A
- anaerobic bacteria
- 3rd stage
21
Q
3rd stage of dental plaque formation: What occurs? (3)
A
- Last colonizers appear: anaerobic bacterias.
- Flora of the plaque varies in its composition according to the tooth surface and its nutrients.
- Balance of flora ”Bacterial Homeostasis”
22
Q
How does the rupture of bacterial homeostasis occur? (3 steps)
A
- increase intake of carbs
- displacement of non cariogenic bacteria
- increase of cariogenic bacteria
23
Q
What are the non cariogenic bacterias? (3)
A
Oralis
Sanguis
Mitis
24
Q
What are the acids associated with noncariogenic bacterias? (3)
A
- acetic
- propionic
- butiric
25
What are teh cariogenic bacterias? (2)
- steptococcus mutans
| - lactobacilus
26
_______ is harder to neutralize by saliva (2)
lactic acid
27
Streptococcus mutans properties? (2)
- very virulent
| - aciduric bacteria
28
Streptococcus mutans transport and metabolization?
Rapid transport and metabolization of sugars
29
Streptococcus mutans produces...? how? (4)
1. Glucan production:
-Water insoluble extracellular
polysaccharides that create persistent adhesion to the
tooth
2. intracellular polysaccharids: can transform into energy and produce acid in the absence of substrate
30
Lactobacilus first colonizes...?
mucosal surfaces ex. tongue
31
What role does lactobacilis play in different types of lesions? (2)
- small amount in initial lesions
| - most important in advanced lesions
32
Lactobacilus properties? (2)
Aciduric and acidogenic bacteria
33
What are the short chain carbs? (3)
- glucose
- fructose
- sucrose
34
Which short chain carb is the most cariogenic? why? (2)
Sucrose
| - the ONLY substrate that enables S.mutans to produce glucans
35
Why do bacterias need substrate? (3)
- to produce energy and dextran
| - acid = collateral product of their metabolism
36
What happens after the intake of carbs? when? (3)
- 3-5mins after intake
- pH drops from 7 to 5.5
- demineralization of enamel
37
When does the pH recuperate after ingestion of carbs?
30-60 mins
38
What is more important than the quantity of substrate for plaque formation? (2)
form and frequency
39
What form of substrate enables a bigger retention to the teeth? Ease of removal? (2)
Sticky forms
| difficult by saliva and tooth brush
40
What are the host factors that cause plaque formation? (2)
1. Tooth
| 2. Saliva
41
What tooth factors contribute to plaque formation? (3)
- arrangement of teeth
- constitution of enamel/hypoplasia
- post eruptive stage of tooth
42
How does arrangement of teeth contribute to plaque formation? (3)
- crowding
- posterior teeth > anterior
- upper > lower
43
Why are upper teeth more susceptible to plaque formation?
lower teeth have tongue protection
44
When is the tooth more susceptible to plaque formation? (2)
- posteruptive age of tooth
| - more susceptible after eruption
45
What saliva factors reduce dental plaque formation? (2)
- Mechanical cleaning and rinsing of food
- Buffer effect
- antibacterial properties
- components inhibiting demineralization & favor remineralization
46
What buffer affects of saliva reduce plaque formation? how? (4)
Neutralize and decrease pH
- phosphate ions
- bicarbonate
- urea
47
What antibacterial properties of saliva reduce plaque formation? (6)
- lactoferritin
- lysozyme
- peroxide
- immunoglobulins
- IgA
- IgG
48
Why does IgA reduce plaque formation?
inhibits adhesion of bac to enamel
49
Preventative measures for plaque? (2)
- brushing
| - topical fluoride
50
the longer the exposure to ______ the greater risk of carries
acid attack
51
What causes acid formation after plaque has been established?
the metabolization of carbs by bacterias
52
What causes demineralization of the enamel after acid formation?
reduction of pH
53
What causes caries after the demineralization of enamel?
Disbalance (of bacteria?)
54
What are Silverston's carie;s zones? (4)
1. initial lesion/white spot
2. Body of lesion
3. Dark area
4. Translucent zone/front of internal advance
55
Silverstone's 1st caries zone? (3)
- intitally white spot
- differential diagnosis with structure/color alterations
- mineral loss of 5-10%
56
How do you differentiate the manifestation of caries in Silverstone's zone 1? (6)
1. Dry the area with an air syringe:
- Colour matte or chalk: Caries.
- Glossy area: Enamel defect.
2. When the probe is passed:
- Rough or rough zone: Caries.
- The probe slips: enamel defect.
57
Silverstone's 2nd caries zone? (3)
- body of lesion
- located below previous zone
- main area of demineralization (~60% loss)
58
Silverstone's 3rd caries zone? (3)
-Dark zone
¤ For its aspect to the optical microscope of polarized light.
¤ It represents an intermediate mineral loss between zone 1 and 2
59
Silverstone's 4th caries zone? (3)
- Translucent/advance front
- deepest zone
- 5-10% material loss
60
How many dentin caries zones are there? Where to they start?
5
| -start closest to pulp and move towards outer surface
61
Dentin Caries zone 1? (4)
- Zone of fatty Degeneration of Tome's Fibers
- next to pulp
- cause: degeneration of odontoblastic process
- occurs before sclerotic dentin is formed & makes tubules impermeable
62
Dentin Caries zone 1 cause?
degeneration of odontoblastic process
63
Dentin Caries zone 1 occurs before...?
sclerotic dentin is formed & makes tubules impermeable
64
Dentin Caries zone 2? (2)
- Zone of dentinal sclerosis
| - deposition of Ca salts in tubules
65
Dentin Caries zone 3?
-Zone of decalcification of dentin
66
Dentin Caries zone 4?
Zone of bacterial invasion
67
Dentin Caries zone 5?
Zone of decomposed dentine due to acids and enzymes
68
Is the dentin-pulp complex able to respond to a caries attack? when? (2)
yes
| before the enamel breaks
69
What are the defence mechanisms for the dentin-pulp complex?
1. tubular sclerosis
| 2. reparative dentin formation
70
What is tubular sclerosis?
Deposit of mineral in the light of dentin tubules
71
What is reparative dentin formation? (2)
- Creation of an irregular dentine layer at the interface between dentine and pulp
- AKA tertiary dentine
72
Primary dentin?
formed during development of the tooth
73
Secondary dentin?
formed during the whole life
74
How does pulp necrosis form? (3)
1. failure of defence mechanisms
2. inflammation of pulp tissue (Acute pulpitis)
3. Necrosis
75
How are carries classified? (6)
- progression speed
- caries location
- lesion type (etiology)
- # of surfaces affected
- lesion type (previous treatments)
- cavity design
76
How are carries classified by progression speed? (2)
- acute
| - chronic
77
How are carries classified by lesion location? (2)
- smooth surfaces
| - pits and fissures
78
How long do acute carries take to form? properties? (4)
- 2-3 months (rampant)
- White-yellowish color
- soft
- humid
79
How long do chronic caries take to form?properties? (3)
- 2-3 years
- Dark brown color
- hard
80
Most common lesion location? why? (2)
Pits and fissues
| -plaque poorly removed b/x of anatomy
81
Where do lesions begin to form in pits and fissures?
fissure walls
82
Progression of lesions in pits and fissures? (2)
- Begin in fissure walls
- increase in size and coalesce at the base
- spreads rapidly when reaches the amelodentinary junction
83
If 1mm of the enamel in a pit and fissure is affected then how much dentin is affected?
1/4 and 1/2 of dentin is affected
84
If 2mm of the enamel in a pit and fissure is affected then how much dentin is affected?
2/3 of affected dentin
85
Pits and fissures radiographic image shows...?
-2 truncated triangles/cones joines at the base
86
Smooth surface caries are usually found where? why?
interproximal areas b/c of bad hygiene
87
how do you diagnose smooth surface cavities?
With radiographic bite wings
88
Smooth surface caries progression compared to furrow carries?
reverse progression
89
Where do Smooth surface caries advance? Raadiographic image?
In arrowhead Triangle tip to base (?)
90
Caries on these surfaces are indicative of poor hygiene and high propensity to caries...(2)
lingual
| vestibular
91
What are the different types of carious lesions according to etiology:? (6)
- rampant
- bottle/pacifier
- hypoplasia
- medicines
- radiation
- blanket caries
92
Rampant caries surfaces?
surfaces that are not usually susceptible
93
Rampant caries age?
children and adolescents
94
Rampant caries are associated with? (3)
- exaggerated consumption of carbs
- poor oral hygiene
- reduced saliva flow
95
Define rampant caries: (3)
- acute
- rapid cavitation
- coronary destruction
96
Rampant caries usually affect which tooth?
- lower incisors
| - DD with baby bottle carries
97
When do bottle/pacifier caries appear?
first 2 years
98
Why do bottle/pacifier caries form?
- frequent and lasting exposure to carbs at night
99
Progression of bottle/pacifier caries? (3)
- white spot lesions on vestibular & gingival surfaces of the crown of the incisors
- progress affecting palatal surfaces canines, upper and lower molar
100
When do bottle / pacifier caries progress to the pulp?
few months
101
How do bottle caries lead to malnutrition?
Pain causes decreased urge to eat
102
Longterm consequence of bottle/pacifier caries?
more likely to develop caries later
103
Whos more susceptible to bottle caries?
families with low socioeconomic status
104
Bottle carries do not affect which tooth?
lower incisor
105
Define early childhood caries:
Appearance of caries on any surface before age 3
106
Define caries caused by hypoplasia (2)
- early childhood caries group
- different forms
-
107
What are the different forms of hypoplasia?
- linear (14.5x more susceptible to develop caries)
| -
108
What causes hypoplasia? (5)
* Premature newborns
* Systemic diseases in newborns
* Malnutrition
* Metabolic alterations
* Exposition to toxics: Lead
109
What drugs reduce saliva flow? (4)
Antihistaminics
Antidepressants
Anticolinergics
Anxiolytics
110
Caries caused by radiation? (3)
• It is becoming more frequent in children
• It produces a qualitative and quantitative reduction of
the saliva
• It has a fast advance
111
Blanket caries (3)
* Currently infrequent.
* Multiband orthodontic wearers.
* Cement is diluted with saliva and does not release fluoride.
112
How do you classify caries depending on surface? (3)
- simple
- compound
- complex
113
How do you classify caries depending on type of previous treatment of lesion? (3)
- incipient
- secondary
- residual
114
How do you classify caries depending on how many surfaces are affected? (3)
- simple: 1 surface
- compound: 2 surfaces
- complex: 3 or more surfaces
115
What is an inci[ient caries?
initial attack on a surface
116
What is a recurrent / secondary caries? How does it occur? (2)
- appears under exisiting restoration / in its margins
| - microfiltratioons appear and the bacteria colonize spreading the caries along the restoration walls
117
What is residual tooth decay?
tooth decay left during a restorative procedure
118
How many cavity designs are there?
6
119
What's black's classification of a Class I cavity? (2)
- begin in structural defects (pits, fissues, defective grooves)
- ex. occlusal surfaces of molar/premolars and lingual surfaces of anterior teeth (cingulum)
120
What's black's classification of a Class II cavity?
-proximal surfaces of bicuspids and molars
121
What's black's classification of a Class III cavity?
- proximal surfaces of anterior teeth
| - do NOT involve removal of incisal angle
122
What's black's classification of a Class IV cavity?
- proximal surface of anterior teeth
| - INVOLVE incisal angle
123
What's black's classification of a Class V cavity?
-gingival third of facial and lingual surfaces
124
What's the classification of a Class VI cavity?
- incisal angle of anterior teeth OR cusps of posterior teeth
- NOT part of black's classification
