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Health Promo Exam 1 > Caries & caries prevention > Flashcards

Caries & caries prevention Flashcards

1
Q

Where does decay begin?

A

Decay begins inside the tooth and breaks out onto surface.

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2
Q

What are 4 components of biofilm?

A

S. mutans, S. sobrinus, Lactobacilli, and other pathogens

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3
Q

Describe plaque biofilm formation at 12 hours? 24 hrs? 10 days?

A

12 hrs: soft, still removable by fingernails
24 hrs: begins to harden
10 days: considered Tartar or Calculus

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4
Q

What is enamel pellicle? What’s good about it? What’s bad?

A

Enamel pellicle is a layer laid down by bacteria almost immediately after cleaning. It is good because it seals out acids. Bad because it doesn’t allow remineralization and provides a surface that bacteria, especially S. mutans can attach to more easily.

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5
Q

How do S. mutans attach to the pellicle?

A

Using extracellular polysaccharides (Glucans)

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6
Q

What are the two main ingredients in enamel?

A

Ca & P

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7
Q

Can cementum and dentin be remineralized?

A

No

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8
Q

Enamel is the most highly mineralized structure in the human body. What is it composed of? (Non-chemical comp)

A

Tightly packed carbonated hydroxyapatite crystals. Arranged in rod (cross section) or crystal form.

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9
Q

What structure of enamel allows for fluid diffusion?

A

The intercrystalline spaces between rods of the carbonated hydroxyapatite crystals allows for fluid diffusion. The intercrystalline space is filled with water and organic material.

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10
Q

How do demineralization zones spread to the enamel?

A

They follow the rods through the enamel and spread at the DEJ

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11
Q

What teeth fall into high susceptibility (2), intermediate susceptibilty (3), and low susceptibilty (3) zones for carious lesions?

A

High susceptibility: Mandibular & maxillary molars
Interm Susceptibilty: Maxillary & mandibular premolars; maxillary incisors
Low Susceptibilty: Maxillary canines, mandibular incisors, and mandibular canines

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12
Q

What are the three main salivary glands in the mouth? What is the duct associated with each?

A
  1. Parotid gland w/ Stenson’s Duct
  2. Submandibular gland w/ Wharton’s duct
  3. Sublingual gland w/ Bartholin’s duct
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13
Q

What are the three non-antimicrobial, beneficial functions of saliva in the mouth?

A
  1. Lubrication and flushing of food particles in the mouth
  2. Dilution and chemical buffering of acid
  3. Provide calcium and phosphate for buffering
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14
Q

What are the three antimicrobial functions of saliva in the mouth?

A
  1. Mucin causes bacterial aggregation
  2. Lactoferrins inhibit S. mutans adherence and deprive bacteria of iron
  3. Peroxidase inhibits ability to use glucose
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15
Q

What is the property of many medications that causes xerostomia?

A

Anticholinergic properties, block the neurotransmitter acetylcholine, causing, among other things, severe dry mouth.

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16
Q

What are three categories of medicine that commonly cause xerostomia? What is an additional aspect of many medications that increases caries risk?

A
  1. Anti-anxiety & anti-psychotic medication
  2. Anti-hypertensive agents (cholesterol lowering drugs)
  3. Allergy and asthma medication, especially inhaled glucocorticosteroids.
    Additionally, many medications include sugar to make them taste better.
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17
Q

3 recommendations for people with dry mouth?

A
  1. Artificial saliva
  2. Increase water
  3. Xylitol or sugarless gum
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18
Q

Why is radiation, treatment for oral cancer, so detrimental to oral health?

A

It kills salivary glands and stops production of saliva = severe dry mouth

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19
Q

For how long after eating does the pH in the mouth remain acidic?

A

20 minutes

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20
Q

What important characteristic relating to food intake and acidity does the Stephan curve show?

A

The Stephan curve shows that increasing the amount of food or the concentration of sugars in the food does not significantly decrease pH or make the length or time that your mouth is acidic longer. Therefore it’s not necessarily how much you eat but how OFTEN you eat that determines the amount of time your mouth is at a pH below 5.5.

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21
Q

Where is the best place to go for evidence based info on dentistry

A

CDC website

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22
Q

How does flouride enhance remineralization?

A

Fluoride attracts first Calcium and then Phosphate ions, speeding up remineralization. Fluoride also EXCLUDES carbonate to allow more fluorapatite crystal growth (fluorapatite crystals are better than hydroxyapatite crystals).

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23
Q

How does fluoride decrease demineralization?

A

Fluoride, in water phase, fills intercrystalline spaces making it more difficult for acids to enter spaces and dissolve teeth.
Fluorapatite (FAP) in enamel crystal lattice is more resistant to demineralization that hydroxyapatite, therefore, demineralization is inhibited.

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24
Q

How does fluoride inhibit bacterial metabolism?

A

Fluoride is converted to hydrogen fluoride ions (HF) in the presence of acid. HF is incorporated into cells w/in plaque biofilms. There HF reduce acid by inhibiting enolase, a key enzyme in carbohydrate metabolism, therefore reducing acid production.

  • Reduces mucopolysaccharides
  • Inhibits glycolysis
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25
Q

Give 2 ways systemic fluoride prevents caries beyond remineralization, bacterial inhibition, etc…

A
  1. Affects developing tooth enamel via the bloodstream by increasing fluorapatite crystals in developing teeth
  2. Excreted in saliva for topical effects
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26
Q

What are the two flourides used in toothpaste (dentifrice)? Which is used more often? What company uses the lesser common fluoride? What is an additional benefit provided by the lesser common fluoride?

A
  1. 0.2% Sodium Fl 1000 ppm- most common

2. 0.454% Stannous Fl ppm- Crest Pro Health, also provides antibacterial benefits

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27
Q

What is the age to which children should be supervised while brushing and flossing?

A

Approximately 8 yrs old. until they can write cursive.

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28
Q

Cochrane systematic review pooled 24 studies on fluoride toothpaste and water fluoridation. What were the findings of the study?

A
  1. Found caries reduction of 24% with consistent brushing with fluoridated toothpaste. Especially true for:
    • People with higher baseline caries levels
    • The higher the fluoride concentration in the toothpaste
    • Higher frequency of use
    • Parental or teacher supervision of brushing
  2. Interestingly found that water fluoridation did not have a significant influence on the presence of caries
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29
Q

In a study presented in class assessing effectiveness of fluoride home rinses for children found what?

A

A 26% reduction in prevalence of decayed, missing, or filled teeth.

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30
Q

What is the recommended times of use? Ppm? Percentage of fluoride? Type of fluoride? Of each of the following fluoride home rinses:
ACT, Listerine anticavity rinse (purple), Phosfluor, and DentiCare/NAF rinse?

A

ACT/Fluorogard: 1/day, 250ppm, 0.05%, sodium Fl
Listerine(purple): 2/day, 250ppm, 0.025%, sodium
PhoFluor: 1/day, 250ppm, 0.044%, acidulated phosphate fluoride (acid creates small cavitations for easier infiltration by fluoride into enamel).
Denticare/NAF rinse: Weekly, 1000ppm, 0.2%, sodium Fl

31
Q

The two main daily use, topical at home fluoride gels are 5000 ppm, 1.1% sodium Fl and 1000 ppm 0.4% Stannous Fl. What are the main advantages and problems (if any) for each?

A
  • The 1.1% Sodium Fluorides (Control Rx, Prevident 5000, Fluoridex) are effective for caries control & are good with esthetic restorations & dry mouth. May not be as effective with periodontal cleaning.
  • The 0.4% Stannous Fl (Gel Kam, Gel Tin, Stan Gel, Flo Gel) is very effective for root sensitivity and caries control. However, STAINS due to tin ion & can pit restorations due to acidic formulation.
32
Q

In pooled studies, what effectiveness has been found for caries reduction? Avg max? Average of all gels and groups studied?

A

In some studies 28% caries reduction was found.

When ALL gels and groups studied were pooled a 19% reduction in caries was found.

33
Q

Clinical procedure for applying professional topical fluoride treatments?

A

1) Dry teeth, use salive ejector
2) Varnish: Paint directly on teeth, back to front
Gel: Apply in tray for 4 minutes
3) Varnish: Avoid toothbrushing until bed
Gel: DO NOT EAT, DRINK, or SMOKE for 30 MINUTES after application
4) Stay with patient and ensure removal of excess fluoride

34
Q

What are the adavantages to fluoride varnishes?

What type of fluoride at what ppm and percentage?

A

5.0% sodium fluoride varnish @ 20,600 ppm.
Easiest to apply. Accepted for root sensitivity.
Shows a PF 14% GREATER than other topical fluoride treatments
46% greater than no fluoride treatments in adult teeth & 33% greater in baby teeth

35
Q

What is the type of fluoride used in traditional fluoride gels? What percent and ppm?
How often applied?
Percent carries improvement?

A

1.23% acidulated phosphate fluoride (12,300 ppm)
Apply every 6 months
PF 26% DMFS

36
Q

What are two problems associated w/ traditional 4 minute gels?

A
  1. Fluoride gels will cause pitting and staining in esthetic restorations due to acidic formulations (speeds fluoride penetration).
  2. Difficult with patients with dry mouth or mucositis
37
Q

What is the major advantage of neutral formulation 2.0% sodium fluoride (9,040 ppm)? How often should it be applied? Efficacy?

A

It is safe for all patients.

Should be applied twice per week. Studies haven’t been completed to prove effectiveness.

38
Q

For each scenario tell whether that is good supporting evidence for it’s efficacy or whether studies have proven inconclusive…

1) Community water fluoridation for all ages?
2) School water fluoridation in non-fluoridated areas?
3) Fluoride supplements for pregnant women?
4) Fluoride supplements for children 6 mos-16 yrs?

A

1 & 4 have good evidence to support

2 & 3 have lack of evidence or mixed evidence

39
Q

What are the guidelines for Fl supplementation for ages 0-6 months?

A

NO supplementation

40
Q

What are the guidelines for Fl supplementation for ages 6 mo-3 yrs?

A

0.25 mg when Fl less than 0.3 ppm

41
Q

What are the guidelines for Fl supplementation for ages 3-6 yrs?

A
  1. 5 mg when Fl less than 0.3 ppm

0. 25 mg when Fl 0.3-0.6 ppm

42
Q

What are the guidelines for Fl supplementation for ages 6-16 yrs?

A

1 mg when Fl less than 0.3 ppm

0.5 mg when Fl 0.3-0.6 ppm

43
Q

What is fluorosis? Appearence?

A

Fluorosis is a condition caused by too much fluoride. Appears as white chalky or yellow look

44
Q

What is the range of fluoride that is considered a certainly lethal dose (CLD), which has the potential for causing death?

A

5-10 gram sodium Fl OR

32-64 mg F/kg

45
Q

What is considered a safely tolerated dose?

A

1/4 CLD
1.25-2.5 gram NaF OR
8-16 mg F/kg

46
Q

What fluoride overdose care should be given at an overdose less than 5.0 mg/kg?

A

Give oral calcium (milk or lime juice)

47
Q

What fluoride overdose care should be given at an overdose more than 5.0 mg/kg?

A

Empty stomach by inducing vomiting, give oral calcium, hospitalize.

48
Q

What fluoride overdose care should be given at an overdose more than 15.0 mg/kg?

A

Emergency. Hospitalize immediately, induce vomiting, give calcium IV, cardiac monitoring.

49
Q

Why should you give someone who has overdosed on fluoride calcium?

A

Calcium binds to fluoride (Just like on teeth) and becomes easily excretable.

50
Q

Give two benefits to fluoridated water?

Give two main areas arguments against generally focus on?

A

Benefits:

  1. Available to all regardless of socioeconomic status
  2. Ease of compliance. All you need to do is drink the water or eat ambient F products (pasta & sauce, juice, frozen foods).

Against:

1) Health issues
2) Freedom of choice

51
Q

Recent public health studies of benefits to water fluoridation have found what percent caries reduction?

A

25-30%

52
Q

What percentage of US population has access to fluoridated water today?

A

61-69%

53
Q

What is the #1 preventive strategy against occlusal decay (the most common type of decay)? What percent caries reduction?

A

Dental sealents. Provide 70% caries reduction overall and 100% reduction while retained, however, ~25% lost after 5 yrs and ~50% lost after 10 yrs.

54
Q

Approximately, what percentage of kids 6-9 yrs and kids 13-15 yrs have dental sealents? Is this number increasing or decreasing?

A

6-9 = About 1/3 (32%)
13-15 = About 1/2 (50.5%)
The numbers are increasing as they were only 25% and 19.4% in 1999.

55
Q

Should sealants be applied to incipient caries? Frank or Cavitated caries?

A

Incipient caries yes. Shouldn’t even have to remove the carious lesion before sealant if the there is no cavitation w/in the dentin yet (CONTROVERSIAL).
Should not put sealants on frank caries. must clean and fill first.

56
Q

What are the steps to applying sealants? Hint: 11 steps

A
  1. Brush teeth w/o toothpaste to clean grooves
  2. Use Isodry or cotton rolls to keep saliva away
  3. Dry teeth with air spray
  4. Etch for 30 seconds w/ gel
  5. Rinse for 15 sec using air spray & evacuation
  6. Re-isolate as needed
  7. Dry teeth until chalky (SUPER DRY)
  8. Apply sealent
  9. Light cure w/ sealant for 40 sec
  10. Wipe sealant w/ cotton roll
  11. Check retention & interproximal contact
57
Q

Describe the Bass & modified Bass method of toothbrushing.

Fones method?

A

Bass: Sulcular brushing. Angle the bristles into the gum line, gently wiggle brush against tooth, roll remaining surface.
Fones: Circular brushing

58
Q

What are 4 examples of antimicrobial products? Describe the most effective.

A
  1. 0.12% Chlorhexidine Gluconate (most effective)
    • Total microbial kill. Good for periodontal disease
    • Strong, bitter taste
    • Baby wipes/varnish
  2. Essential Oil mouth rinse (Listerine) & Essential Oil plus fluoride
  3. Triclosan (Colgate total toothpaste)
  4. Cetylpyridinium Chloride (Crest pro health rinse and colgate total rinse)
59
Q

What are the benefits of Xylitol and sugarless chewing gum? What is the dose required to have an anticaries effect?

A

-Increased Salivary volume
-Increased buffering capacity of saliva
-reduction of food retention
-Substitution of sugary or neutral gum
-Xylitol has antibacterial properties
Anticaries effect has been seen with 6-10 grams per day (2 tabs of gum or 2 mints 4X/day)

60
Q

Best ways to increase saliva?

A
  1. Saliva substitutes - liquid or gel
    • Biotene, Xero-lube, Toms of Maine
  2. Increase frequency of brushing & rinsing (?)
  3. Increase water intake
  4. Increase xylitol mints
  5. Change nutritional patterns (?)
61
Q

What are characteristics of a patient at low risk for decay? 6

A
  • No caries w/in 1 yr for children & 2 yrs for adult
  • No current dental decay
  • Good oral hygiene
  • Use of fluoride toothpaste
  • Has sealants on susceptible occlusal surfaces
  • Regular dental visits
62
Q

What are characteristics of a patient at moderate risk for decay? 5

A
  • 1-2 recent caries
  • Teeth w/o sealants, exposed roots, orthodontic care
  • Fair oral hygiene
  • Fair use of fluoride
  • Irregular dental visits
63
Q

What are characteristics of a patient at High risk for decay? 7

A
  • 2+ recent caries
  • Susceptible teeth-no sealants, large pits &fissures
  • Poor oral hygiene
  • Xerostomia
  • Bad diet. Snacking, high sugar
  • Little or no fluoride
  • Irregular dental visits
64
Q

Who is more susceptible to caries kids ages 2-5 or 6-11 yrs old?

A

6-11 are twice as likely (~25% vs ~49%)

65
Q

Who is more susceptible to caries boys or girls (2-11)?

A

In the late 80’s/early 90’s It was pretty much the same with females being barely more susceptible. In the early 2000’s boys have become 5% more likely than girls to develop caries.

66
Q

Who is more susceptible to caries white, black, or hispanic children (2-11)?

A

Hispanics (~54%) > Blacks (~42%) > Whites (~36%).

67
Q

Who is more susceptible to caries kids ages 6-11, 12-15, or 16-19 yrs old?

A

16-19 (`68%) > 12-15 (~50%) > 6-11 (~20)

68
Q

Who is more susceptible to caries white, black, or hispanic teenagers (6-19)?

A

All more similar than child aged. Hispanic (~50%)&raquo_space; Black & White (~39%)

69
Q

More susceptible male or female teenagers?

A

Females by about 5%. This is opposite of children.

70
Q

In teenagers carie prevalence is pretty similar between black and whites. Do we find a similar percentage breakdown of untreated tooth decay?

A

No, blacks are ~10% more likely to have untreated decay.

71
Q

Does the prevalence of caries in adults follow the same patterns as in children and teenagers?

A

NO. White, educated and wealthy individuals actually have a greater prevalence of caries

72
Q

Does smoking history effect the rate of tooth decay?

A

No

73
Q

Does smoking effect the rate of root carries? Endentulism?

A

Yes, ~10% difference b/t never smoked and current smokers for BOTH root carries and endentulism.

Health Promo Exam 1 (6 decks)

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