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
2
Q
What pushes towards remineralization and away from demineralization?
A
- regular dental care
- Fluoride
- Xylitol products
- Adequate saliva flow
3
Q
CAMBRA:
A
CAries Management By Risk Assessment
4
Q
Caries disease indicators include: (4)
A
- low socioeconomic status
- development problems
- current caries
- restorations placed in previous 3 years
5
Q
Caries risk factors: (8)
A
- Mutans streptococci
- Lactobacilli
- Plaque
- exposed roots
- insufficient saliva flow
- frequent snacks
- deep pits & fissures
- orthodontic appliances
6
Q
Caries protective factors (4)
A
- systemic and/or topical fluoride
- CHX use
- Xylitol
- Calcium & phosphate paste
7
Q
Systemic fluoride is only beneficial to:
A
individuals whose teeth are developing
8
Q
Describe the overall caries risk for the following scenario:
-No dental lesions
-No visible plaque
-Optimal fluoride
-Regular dental
A
Low risk
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
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
11
Q
Describe the overall caries risk for the following scenario:
-patients with special needs
-severe hyposalivation
A
Extreme
12
Q
What does axium classify as diseases indicators?
A
Active decay, initial decay, white spot lesions or treatment within 3 years
13
Q
Active caries automatically places a patient at:
A
high risk
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
15
Q
What are modifying factors to caries?
A
- fluoride exposure
- biofilm
- saliva flow rate & composition
- oral hygeine
- diet
16
Q
When trying to modify caries through saliva flow rate & composition, what might you recommend to the patient?
A
- consider saliva substitutes like biotene
- sugar free gum
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
18
Q
Studies have shown consumption of this increases remineralization & decreases demineralization; also increase saliva & buffers
A
dairy
19
Q
What is the mechanism of dairy on caries?
A
Mechanism of action is ionizable calcium & phosphate
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
21
Q
What are some foods that should be avoided as they increase your risk for caries?
A
- breads
- pastas
- sweets
- alcohol
22
Q
List three dietary components that may negatively affect dental caries:
A
- fermentable carbs
- frequent snacking/sugared drinks
- pH of drinks
23
Q
What bacteria is responsible for most dental caries?
A
Streptococcus mutans
24
Q
Fluoride is a _____ to caries prevention, not a _____
A
SUPPLEMENT; solution on its own
25
Ingested fluoride agents that become incorporated into forming tooth structures:
Systemic fluoride application
26
Give examples of systemic fluoride application:
1. water
2. supplements
3. food/beverages
27
Fluoride that strengthens teeth already in the mouth making them more resistant to caries:
Topical fluoride application
28
Give examples of topical fluoride application:
1. water
2. homecare products
3. In-office products
29
Systemic fluoride is ____ and incorporated into ____ during development of tooth structures
ingested; enamel
30
Topical fluoride promotes _____ and prevents ______ after eruption
remineralization; demineralization
31
What is the mechanism of action of topical fluoride?
Inhibits glycolysis in bacteria, thereby inhibiting the ability of bacteria to metabolize carbs and produce acid
32
What is water fluoridation?
An increase in the natural fluoride level in a communitys water supply to a level optimal for dental health
33
Considered one of the most cost-effective preventive dental program by public health:
Water fluoridation
34
Benefits of water fluoridation include:
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
35
Optimal levels of water fluoridation means:
minimal caries with minimal fluorosis
36
What level of water fluoridation is considered optimal?
0.6-1.2 ppm
37
.7 ppm decreases caries with less than _____% of the population with fluorosis
10%
38
Changes in the appearance of enamel caused by too much SYSTEMIC fluoride:
Fluorosis
39
Fluorosis is a change in the appearance of enamel caused by too much:
systemic fluoride
40
How does topical fluoride work?
Fluoride is deposited in enamel during enamel maturation phase resulting in a concentration of fluoride in the enamel
41
The highest concentration of fluoride taken into the enamel by topical fluoride occurs on the _____ portion and ______ as you move toward the dentin
outermost; decreases
42
With topical fluoride application, ____ are substituted into the _____ and form a stable, more compact bond, making the tooth resistant to ____
Fluoride ions, hydroxyapatite crystal; demineralization
43
Can topical fluoride application cause fluorosis?
no
44
What influences enamels reaction to fluoride?
1. concentration of fluoride
2. pH of fluoride
3. length of exposure
45
Acidic fluoride typically forms:
calcium fluoride
46
Higher concentrations of fluoride form:
calcium fluoride
47
In-office fluorides are ______ ppm so they typically form _____
greater than 9000 ppm; calcium fluoride
48
Neutral fluorides are ______ ppm and form ____
less than 100 ppm; fluorapatite
49
What type of fluoride do you typically by at the store (OTC)?
Neutral fluoride
50
List the benefits of topical fluoride: (3)
1. remineralization
2. interference with bacterial metabolism
3. prevention
51
List the three discussed types of topical fluoride application:
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
This type of in-office fluoride is available as foam or gel application (rarely used in practice today) & is 9000 ppm:
2% neutral sodium fluoride
53
This type of in-office fluoride is available as foam or gel application (rarely used in practice today) & is 12,300 ppm:
1.23% acidulated phosphate fluoride (APF)
54
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:
5.0% NaF
55
After every application of topical fluoride there is an increase in the amount of:
permanently bound fluoride in the outermost layer of enamel
56
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 decrease in caries susceptibility (initiation & progression)
57
Most desired form of fluoride for enamel in caries prevention:
Fluorohydroxyapatite
58
Desired source of fluoride for remineralization of enamel:
Calcium fluoride
59
What type of fluoride is desired for caries prevention?
fluorohydroxyapatite
60
What type of fluoride is used for enamel remineralization?
calcium fluoride
61
The benefits of topical fluoride treatment are directly related to:
The amount of topical fluoride treatments provided
62
T/F: the type of topical fluoride system used does not affect the benefit
True
63
T/F: Fluoride does NOT benefit sound enamel
True
64
T/F: Greater uptake into enamel occurs with higher concentrations of fluoride
True
65
When should topical fluoride be used in office?
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
PTD:
Probable toxic dose
67
The probable toxic dose of fluoride is:
base on body weight
68
What is the PTD of fluoride considered?
5 mg/kg of body weight
69
If a patient is showing signs of fluoride overdose and has received less than 5mg/kg:
office use of available calcium, aluminum or magnesium products
70
If a patient is showing signs of fluoride overdose and has received more than 5 mg/kg (but less than 15 mg/kg):
office use of available calcium, aluminum or magnesium products + hospital observation
71
If a patient is showing signs of fluoride overdose and has received more than 15 mg/kg:
Emergency response
72
Concentrated fluoride salts can cause _____ when in contact with oral mucosa
chemical burn
73
List three outcomes of fluoride toxicity?
1. inhibits enzyme systems
2. binds calcium
3. cardiotoxic due to hyperkalemia
74
Signs & symptoms of too much fluoride include: (5)
1. nausea
2. vomiting
3. diarrhea
4. abdominal cramping
5. increased salivation/dehydration
75
Fluoride varnish is composed of:
5% NaF (Sodium fluoride)
76
List the pros of sodium fluoride varnish (5%):
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
List the cons of sodium fluoride varnish (5%):
1. leaves a thin-visible film on teeth that some patients don't like
2. possible allergies linked to specific brands
78
How often should fluoride varnish application occur?
every 3-6 months (dependent upon caries risk)
79
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:
moderate to high risk for developing dental caries
80
SDF:
Silver Diamine Fluoride
81
Antimicrobial properties of silver with the benefits of high dose fluoride:
SDF
82
SDF results in a precipitate that:
occludes dentinal tubules & reduced hypersensitivity
83
_____% SDF was found to be the most superior at arresting caries compared to lower concentraitons
38%
84
T/F: SDF is superior at arresting dental caries & preventing new caries compared to fluoride varnish alone
True
85
T/F: Multiple applications of SDF found to be equally successful at arresting dental caries as one-time placement of SDF
False- multiple applications of SDF found to be more successful
86
1. SDF gained clearance from the FDA in ______
2. approved for use to treat _____ in adults
3. SDF awarded title of:
1. 2014
2. dentin hypersensitivity
3. breakthrough therapy
87
Mechanisms of action of SDF:
Fluoride and silver are made soluble in water by the addition of:
ammonia
88
Mechanisms of action of SDF:
The ____ are a broad-spectrum antimicrobial that has high biocompatibility & low toxicity in humans
Silver ions
89
Mechanisms of action of SDF:
The silver ions act as tiny silver bullets that damage & degrade _____, disrupt _____ and ___ & disrupt _____ eventually leading to cell death
bacterial cell walls; bacterial DNA synthesis & replication; intracellular metabolic activity
90
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 "_____"
silver ions; "zombie effect"
91
Once SDF is applied a ______ precipates out of the clear solution onto the carious lesion
physical barrier
92
Once the SDF has formed physical barrier that precipitates out onto the carious lesion, two products form:
1. silver phosphate
2. calcium fluoride
93
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:
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
Product of SDF-action that is a reservoir of phosphate ions:
silver phosphate
95
Product of SDF-action that is a pH regulated fluoride supply available during cariogenic challenge:
calcium fluoride
96
What are the two products that SDF forms on carious lesions?
1. silver phosphate
2. calcium fluoride
97
Why does the carious lesion treated SDF turn black?
The black color occurs when free silver ions are reduced by environmental oxygen
98
What is a major non-medical side effect of SDF?
Carious lesion turning black
99
What does it mean if a carious lesion treated with SDF turns black?
The decay has been arrested
100
5% SDF solution contains ____ppm fluoride
44,800 ppm
101
T/F: 5% SDF solution contains almost twice as much fluoride as 5% NaF varnish
true
102
In 5% SDF solution, SDF reacts with calcium and & phosphate ions to produce ____, which are less susceptible to solubility & crucial to tooth remineralization
fluorohydroxyapatite crystals
103
T/F: one application of SDF is sufficient for ultimate results
False- may need to place SDF a few times for effectiveness in treating the area
104
When is SDF indicated?
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
T/F: SDF has an unpleasant metallic taste
True
106
What are two contraindications to use of SDF?
1. Silver allergy
2. pulpal involvement
107
At home fluoride products include: (3)
1. toothpaste
2. mouth rinse
3. MI paste plus
108
The average concentration of fluoride in OTC toothpaste is:
0.22% NaF (1000 ppm)
109
_____ is the most effective dentirifice system or caries prevention
Sodium fluoride (NaF)
110
What risks come with OTC fluoride toothpaste?
Risk of fluorosis & toxicity if ingested (hence pea-sized amount for small children)
111
Give three examples of fluoride rinses:
1. ACT kids
2. Listerine fluoride defense
3. ACT anti-cavity
112
What does OTC fluoride mouth rinse do?
1. remineralizes tooth structure
2. strengthens enamel to prevent caries
3. kills bad breath
113
For mouth rinses that are labeled 0.02% NaF this contains _____ ppm
For mouth rinses that are labeled 0.05% NaF this contains _____ ppm
100 ppm
225 ppm
114
Uses RECALDENT (a milk-derived protein) that releases calcium & phosphate to the surface of teeth to relieve tooth sensitivity (NOT TO PREVENT DECAY):
MI paste
115
What is the goal of MI paste plus?
What does it NOT do?
relieve tooth sensitivity; it does NOT prevent decay
116
MI paste PLUS has 0.20% NaF (900 ppm) and can be used for:
BOTH caries prevention & tooth sensitivity
117
What is the fluoride concentration of Prevident toothpaste?
1.1% NaF (5000 ppm)
118
What is the fluoride concentration of Prevident mouth rinse?
0.2% NaF (900 ppm)
119
