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Patient Care III > Caries Prevention/Caries Risk Assessment (Final Review) > Flashcards

Caries Prevention/Caries Risk Assessment (Final Review) Flashcards

1
Q

Biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization & remineralization of dental hard tissues:

A

Dental caries

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2
Q

What pushes towards remineralization and away from demineralization?

A
  1. regular dental care
  2. Fluoride
  3. Xylitol products
  4. Adequate saliva flow
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3
Q

CAMBRA:

A

CAries Management By Risk Assessment

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4
Q

Caries disease indicators include: (4)

A
  1. low socioeconomic status
  2. development problems
  3. current caries
  4. restorations placed in previous 3 years
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5
Q

Caries risk factors: (8)

A
  1. Mutans streptococci
  2. Lactobacilli
  3. Plaque
  4. exposed roots
  5. insufficient saliva flow
  6. frequent snacks
  7. deep pits & fissures
  8. orthodontic appliances
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6
Q

Caries protective factors (4)

A
  1. systemic and/or topical fluoride
  2. CHX use
  3. Xylitol
  4. Calcium & phosphate paste
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7
Q

Systemic fluoride is only beneficial to:

A

individuals whose teeth are developing

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8
Q

Describe the overall caries risk for the following scenario:

-No dental lesions
-No visible plaque
-Optimal fluoride
-Regular dental

A

Low risk

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9
Q

Describe the overall caries risk for the following scenario:

-dental lesions in the past 12 months
-visible plaque
-suboptimal fluoride
-irregular dental care

A

Moderate risk

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10
Q

Describe the overall caries risk for the following scenario:

-one or more lesions
-Visible plaque
-suboptimal fluoride
-irregular dental care
-high bacterial challenge
-impaired saliva
-medications
-frequent snacking

A

High risk

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11
Q

Describe the overall caries risk for the following scenario:

-patients with special needs
-severe hyposalivation

A

Extreme

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12
Q

What does axium classify as diseases indicators?

A

Active decay, initial decay, white spot lesions or treatment within 3 years

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13
Q

Active caries automatically places a patient at:

A

high risk

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14
Q

What does axium classify as risk factors?

How many risk factors places a patient at high risk?

A

-visible/heavy plaque
-frequent snacking
-exposed roots
-deep pits/fissures
-ortho appliances

two

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15
Q

What are modifying factors to caries?

A
  1. fluoride exposure
  2. biofilm
  3. saliva flow rate & composition
  4. oral hygeine
  5. diet
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16
Q

When trying to modify caries through saliva flow rate & composition, what might you recommend to the patient?

A
  1. consider saliva substitutes like biotene
  2. sugar free gum
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17
Q

How does dairy impact caries?

A

Studies have shown cheese consumption increases remineralization & decreases demineralization (mechanism of action is ionizable calcium & phosphate); also increases saliva & buffers

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18
Q

Studies have shown consumption of this increases remineralization & decreases demineralization; also increase saliva & buffers

A

dairy

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19
Q

What is the mechanism of dairy on caries?

A

Mechanism of action is ionizable calcium & phosphate

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20
Q

Describe the effects of nuts on dental caries:

A

Almonds, Brazil nuts, & cashews are especially beneficial because they help fight tooth decay-causing baccteria

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21
Q

What are some foods that should be avoided as they increase your risk for caries?

A
  1. breads
  2. pastas
  3. sweets
  4. alcohol
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22
Q

List three dietary components that may negatively affect dental caries:

A
  1. fermentable carbs
  2. frequent snacking/sugared drinks
  3. pH of drinks
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23
Q

What bacteria is responsible for most dental caries?

A

Streptococcus mutans

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24
Q

Fluoride is a _____ to caries prevention, not a _____

A

SUPPLEMENT; solution on its own

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25
Q

Ingested fluoride agents that become incorporated into forming tooth structures:

A

Systemic fluoride application

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26
Q

Give examples of systemic fluoride application:

A
  1. water
  2. supplements
  3. food/beverages
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27
Q

Fluoride that strengthens teeth already in the mouth making them more resistant to caries:

A

Topical fluoride application

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28
Q

Give examples of topical fluoride application:

A
  1. water
  2. homecare products
  3. In-office products
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29
Q

Systemic fluoride is ____ and incorporated into ____ during development of tooth structures

A

ingested; enamel

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30
Q

Topical fluoride promotes _____ and prevents ______ after eruption

A

remineralization; demineralization

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31
Q

What is the mechanism of action of topical fluoride?

A

Inhibits glycolysis in bacteria, thereby inhibiting the ability of bacteria to metabolize carbs and produce acid

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32
Q

What is water fluoridation?

A

An increase in the natural fluoride level in a communitys water supply to a level optimal for dental health

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33
Q

Considered one of the most cost-effective preventive dental program by public health:

A

Water fluoridation

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34
Q

Benefits of water fluoridation include:

A

1) a 30-39% decrease in caries in primary dentition

2) a 35% decrease in children/adolescent permanent dentition

3) approximately 2-30% decrease in coronal caries & 20-40% decrease in root caries in adult population

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35
Q

Optimal levels of water fluoridation means:

A

minimal caries with minimal fluorosis

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36
Q

What level of water fluoridation is considered optimal?

A

0.6-1.2 ppm

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37
Q

.7 ppm decreases caries with less than _____% of the population with fluorosis

A

10%

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38
Q

Changes in the appearance of enamel caused by too much SYSTEMIC fluoride:

A

Fluorosis

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39
Q

Fluorosis is a change in the appearance of enamel caused by too much:

A

systemic fluoride

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40
Q

How does topical fluoride work?

A

Fluoride is deposited in enamel during enamel maturation phase resulting in a concentration of fluoride in the enamel

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41
Q

The highest concentration of fluoride taken into the enamel by topical fluoride occurs on the _____ portion and ______ as you move toward the dentin

A

outermost; decreases

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42
Q

With topical fluoride application, ____ are substituted into the _____ and form a stable, more compact bond, making the tooth resistant to ____

A

Fluoride ions, hydroxyapatite crystal; demineralization

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43
Q

Can topical fluoride application cause fluorosis?

A

no

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44
Q

What influences enamels reaction to fluoride?

A
  1. concentration of fluoride
  2. pH of fluoride
  3. length of exposure
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45
Q

Acidic fluoride typically forms:

A

calcium fluoride

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46
Q

Higher concentrations of fluoride form:

A

calcium fluoride

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47
Q

In-office fluorides are ______ ppm so they typically form _____

A

greater than 9000 ppm; calcium fluoride

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48
Q

Neutral fluorides are ______ ppm and form ____

A

less than 100 ppm; fluorapatite

49
Q

What type of fluoride do you typically by at the store (OTC)?

A

Neutral fluoride

50
Q

List the benefits of topical fluoride: (3)

A
  1. remineralization
  2. interference with bacterial metabolism
  3. prevention
51
Q

List the three discussed types of topical fluoride application:

A

1) 2% neutral sodium fluoride (9000 ppm)

2) 1.23% acidulated phosphate fluoride (APF) (12,300 ppm)

3) 5.0% NaF (22,600 ppm)

52
Q

This type of in-office fluoride is available as foam or gel application (rarely used in practice today) & is 9000 ppm:

A

2% neutral sodium fluoride

53
Q

This type of in-office fluoride is available as foam or gel application (rarely used in practice today) & is 12,300 ppm:

A

1.23% acidulated phosphate fluoride (APF)

54
Q

This type of in-office fluoride is available as as a varnish application & is commonly used in dental practices today with a ppm of 22,600:

A

5.0% NaF

55
Q

After every application of topical fluoride there is an increase in the amount of:

A

permanently bound fluoride in the outermost layer of enamel

56
Q

After every application of topical fluoride there is an increase in the amount of permanently bound fluoride in the outermost layer of enamel & this causes:

A

a decrease in caries susceptibility (initiation & progression)

57
Q

Most desired form of fluoride for enamel in caries prevention:

A

Fluorohydroxyapatite

58
Q

Desired source of fluoride for remineralization of enamel:

A

Calcium fluoride

59
Q

What type of fluoride is desired for caries prevention?

A

fluorohydroxyapatite

60
Q

What type of fluoride is used for enamel remineralization?

A

calcium fluoride

61
Q

The benefits of topical fluoride treatment are directly related to:

A

The amount of topical fluoride treatments provided

62
Q

T/F: the type of topical fluoride system used does not affect the benefit

A

True

63
Q

T/F: Fluoride does NOT benefit sound enamel

A

True

64
Q

T/F: Greater uptake into enamel occurs with higher concentrations of fluoride

A

True

65
Q

When should topical fluoride be used in office?

A
  1. high caries risk individuals
  2. sensitive teeth
  3. exposed root surfaces
  4. around margins of older restorations
  5. overdentures (with natural teeth)
  6. Xerostomia
  7. newly erupted teetg
66
Q

PTD:

A

Probable toxic dose

67
Q

The probable toxic dose of fluoride is:

A

base on body weight

68
Q

What is the PTD of fluoride considered?

A

5 mg/kg of body weight

69
Q

If a patient is showing signs of fluoride overdose and has received less than 5mg/kg:

A

office use of available calcium, aluminum or magnesium products

70
Q

If a patient is showing signs of fluoride overdose and has received more than 5 mg/kg (but less than 15 mg/kg):

A

office use of available calcium, aluminum or magnesium products + hospital observation

71
Q

If a patient is showing signs of fluoride overdose and has received more than 15 mg/kg:

A

Emergency response

72
Q

Concentrated fluoride salts can cause _____ when in contact with oral mucosa

A

chemical burn

73
Q

List three outcomes of fluoride toxicity?

A
  1. inhibits enzyme systems
  2. binds calcium
  3. cardiotoxic due to hyperkalemia
74
Q

Signs & symptoms of too much fluoride include: (5)

A
  1. nausea
  2. vomiting
  3. diarrhea
  4. abdominal cramping
  5. increased salivation/dehydration
75
Q

Fluoride varnish is composed of:

A

5% NaF (Sodium fluoride)

76
Q

List the pros of sodium fluoride varnish (5%):

A
  1. proven efficacious in decreasing caries, especially in early childhood
  2. easy to apply following an oral exam & prophylaxis
  3. easy to follow post-op instructions
77
Q

List the cons of sodium fluoride varnish (5%):

A
  1. leaves a thin-visible film on teeth that some patients don’t like
  2. possible allergies linked to specific brands
78
Q

How often should fluoride varnish application occur?

A

every 3-6 months (dependent upon caries risk)

79
Q

With water fluoridation and use of fluoridated toothpastes in the U.S., approximately 75% of the public is considered low-risk for dental caries.

Therefore, the use of any professionally applied fluoride should be limited to those individuals and communities deemed to be at:

A

moderate to high risk for developing dental caries

80
Q

SDF:

A

Silver Diamine Fluoride

81
Q

Antimicrobial properties of silver with the benefits of high dose fluoride:

A

SDF

82
Q

SDF results in a precipitate that:

A

occludes dentinal tubules & reduced hypersensitivity

83
Q

_____% SDF was found to be the most superior at arresting caries compared to lower concentraitons

A

38%

84
Q

T/F: SDF is superior at arresting dental caries & preventing new caries compared to fluoride varnish alone

A

True

85
Q

T/F: Multiple applications of SDF found to be equally successful at arresting dental caries as one-time placement of SDF

A

False- multiple applications of SDF found to be more successful

86
Q
  1. SDF gained clearance from the FDA in ______
  2. approved for use to treat _____ in adults
  3. SDF awarded title of:
A
  1. 2014
  2. dentin hypersensitivity
  3. breakthrough therapy
87
Q

Mechanisms of action of SDF:

Fluoride and silver are made soluble in water by the addition of:

A

ammonia

88
Q

Mechanisms of action of SDF:

The ____ are a broad-spectrum antimicrobial that has high biocompatibility & low toxicity in humans

A

Silver ions

89
Q

Mechanisms of action of SDF:

The silver ions act as tiny silver bullets that damage & degrade _____, disrupt _____ and ___ & disrupt _____ eventually leading to cell death

A

bacterial cell walls; bacterial DNA synthesis & replication; intracellular metabolic activity

90
Q

Mechanisms of action of SDF:

When SDF kills bacteria, these killed bacteria further act as a carrier of _____ & can kill living bacteria nearby in a process known as the “_____”

A

silver ions; “zombie effect”

91
Q

Once SDF is applied a ______ precipates out of the clear solution onto the carious lesion

A

physical barrier

92
Q

Once the SDF has formed physical barrier that precipitates out onto the carious lesion, two products form:

A
  1. silver phosphate
  2. calcium fluoride
93
Q

Once the SDF has formed physical barrier that precipitates out onto the carious lesion, two products form:

  1. silver phosphate
  2. calcium fluoride

Describe the role of each:

A
  1. The silver phosphate- acts as a reservoir of phosphate ions
  2. The calcium fluoride- is a pH regulated calcium supply available during cariogenic challenge
94
Q

Product of SDF-action that is a reservoir of phosphate ions:

A

silver phosphate

95
Q

Product of SDF-action that is a pH regulated fluoride supply available during cariogenic challenge:

A

calcium fluoride

96
Q

What are the two products that SDF forms on carious lesions?

A
  1. silver phosphate
  2. calcium fluoride
97
Q

Why does the carious lesion treated SDF turn black?

A

The black color occurs when free silver ions are reduced by environmental oxygen

98
Q

What is a major non-medical side effect of SDF?

A

Carious lesion turning black

99
Q

What does it mean if a carious lesion treated with SDF turns black?

A

The decay has been arrested

100
Q

5% SDF solution contains ____ppm fluoride

A

44,800 ppm

101
Q

T/F: 5% SDF solution contains almost twice as much fluoride as 5% NaF varnish

A

true

102
Q

In 5% SDF solution, SDF reacts with calcium and & phosphate ions to produce ____, which are less susceptible to solubility & crucial to tooth remineralization

A

fluorohydroxyapatite crystals

103
Q

T/F: one application of SDF is sufficient for ultimate results

A

False- may need to place SDF a few times for effectiveness in treating the area

104
Q

When is SDF indicated?

A
  1. dentin hypersensitivity
  2. uncooperative patients
  3. root surface caries on elderly patients with existing restorations
  4. patients without access to care
  5. difficult to treat lesions
105
Q

T/F: SDF has an unpleasant metallic taste

A

True

106
Q

What are two contraindications to use of SDF?

A
  1. Silver allergy
  2. pulpal involvement
107
Q

At home fluoride products include: (3)

A
  1. toothpaste
  2. mouth rinse
  3. MI paste plus
108
Q

The average concentration of fluoride in OTC toothpaste is:

A

0.22% NaF (1000 ppm)

109
Q

_____ is the most effective dentirifice system or caries prevention

A

Sodium fluoride (NaF)

110
Q

What risks come with OTC fluoride toothpaste?

A

Risk of fluorosis & toxicity if ingested (hence pea-sized amount for small children)

111
Q

Give three examples of fluoride rinses:

A
  1. ACT kids
  2. Listerine fluoride defense
  3. ACT anti-cavity
112
Q

What does OTC fluoride mouth rinse do?

A
  1. remineralizes tooth structure
  2. strengthens enamel to prevent caries
  3. kills bad breath
113
Q

For mouth rinses that are labeled 0.02% NaF this contains _____ ppm

For mouth rinses that are labeled 0.05% NaF this contains _____ ppm

A

100 ppm

225 ppm

114
Q

Uses RECALDENT (a milk-derived protein) that releases calcium & phosphate to the surface of teeth to relieve tooth sensitivity (NOT TO PREVENT DECAY):

A

MI paste

115
Q

What is the goal of MI paste plus?

What does it NOT do?

A

relieve tooth sensitivity; it does NOT prevent decay

116
Q

MI paste PLUS has 0.20% NaF (900 ppm) and can be used for:

A

BOTH caries prevention & tooth sensitivity

117
Q

What is the fluoride concentration of Prevident toothpaste?

A

1.1% NaF (5000 ppm)

118
Q

What is the fluoride concentration of Prevident mouth rinse?

A

0.2% NaF (900 ppm)

119
Q
A

Patient Care III (19 decks)

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