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PATIENT CARE III EXAM 2 > caries risk assessment > Flashcards

caries risk assessment Flashcards

1
Q

study of caries and cariogenesis

A

cariology

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2
Q

decay in bone or teeth

A

caries

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3
Q

steps that cause caries

A
  1. bacterial disease
  2. leads to demineralization of inorganic components
  3. leads to destruction of organic components
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4
Q

3 dental caries

A

infectious disease
manageable disease
preventable disease

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5
Q

4 caries requirements

A

susceptible host
bacteria
food source
time

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6
Q

etiology of caries.
specific plaque hypothesis

  1. ____= responsible for the disease
  2. ___= pathogenic when disease is present
  3. ___=are the cause
  4. Strep Mutans
  5. Lactobacillus and Actinomyces V. =_____ and can live in acid
A
  1. biofilm
  2. plaque
  3. specific microbes
  4. strep mutans
  5. acid producers
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7
Q

control the pathogens=

A

control the disease

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8
Q

Community of bacteria, bacterial by-products, extracellular matrix, and water

A

biofilm

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9
Q

accumulation of biofilm on teeth is

A

highly organized

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10
Q

what bacteria is prominent group for biofilm

A

streptococci

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11
Q

normal saliva biofilm made up of mostly

A

strep sanguis and strep mitis
(non-pathogenic)

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12
Q

primary bacteria in caries

A

strep mutans

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13
Q

strep mutans begin caries formation

followed by:
which are responsible for progression of caries

A

lactobacillus

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14
Q

different habitats= different

A

bacteria

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15
Q

pit and fissures bacteria

A

simple streptococcal bacteria

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16
Q

root surface has complex bacterial community

A

mostly filamentous and spiral bacteria

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17
Q

bacterial communities may different from one another in different areas on

A

on the tooth

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18
Q

Bretz WA 2005 Twins Study
Found genetics play a significant role in caries
Up to

A

40%

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19
Q

Genes involved is ______

A

unknown

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20
Q

do Caries have a genetic component?

A

yes
-doesnt mean patient is off hook if they have caries. means they must be more diligent to prevent future caries

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21
Q

Caries formation is:

constant battle between

A

dynamic

demineralization and remineralization

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22
Q

what happens in demineralization

A

-Bacteria living in plaque feed off “leftovers” (sugars,
fermentable carbohydrates)

-Bacterial waste product is ACID (lactic)!!!!!!

-Acid demineralizes enamel

-Phosphates and Calcium are lost

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23
Q

what happens during remineralization

A

-Saliva rinses away sugars

-Saliva buffers acids

-Minerals in saliva (calcium, phosphate) re-enter
tooth

-Presence of fluoride facilitates process

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24
Q

Demineralization is greater than Remineralization over
time

A

carious lesion occurs

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25
Q

in enamel, hydroxyapatite demineralizes at pH below:

A

5.5

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26
Q

calcium, phosphate ions leave enamel

A

=demineralization

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27
Q

what about fluorapatite?

A

demineralizes at pH below 4.5

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28
Q

enamel carious lesion progression:

A
  • hydroxyapatite demineralizes at pH below ~5.5
  • calcium, phosphate ions leave enamel
  • =demineralization
  • =white spot lesion
  • ->cavitation
  • What about Fluorapatite?
  • Demineralizes at pH below ~4.5
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29
Q

Dentin demineralizes at ~

A

6.2 pH

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30
Q

Remineralization may not be possible in

A

dentin

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31
Q

Remineralization besties:

A

saliva
plaque removal
diet modification
fluoride

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32
Q

buffers
cleanses
antibacterial
calcium and phosphate ions

A

saliva

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33
Q

saliva buffers by

A

◦Raises pH to non-demineralizing levels
◦Bicarbonate ion HCO3
−

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34
Q

saliva cleanses by

A

◦Flushes away free-floating organisms
◦1-1.5L/day

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35
Q

saliva is an antibacterial by

A

Salivary proteins: lysozome, lactoperoxidase, lactoferrin, agglutinin
◦Shown NOT to have huge impact on caries

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36
Q

plaque must ____to cause damage

A

adhere

37
Q

plaque removal:

A
  • Removes bacteria’s habitat
  • Plaque must ADHERE to cause damage
  • Destroy its home, it can’t hurt you
  • Home care
  • Professional dental visits
38
Q

diet modification

A
  1. starve bacteria
    ◦Preferred food source: fermentable carbohydrates
    ◦Strep Mutans loves sugar
  2. FREQUENCY OF CONSUMPTION IS MOST IMPORTANT FACTOR
    -more important that amount of sugar consumed!
    -aim to REDUCE frequency
39
Q

Reduce sugary or acidic beverages
* Sugary beverages= food for bacteria
* Acidic beverages= lower pH of oral environment

A

lower pH of oral environment

40
Q

fluoride replaces ______ in hydropxyapatite.

this:
1. strengthens ________
2. forms ______
3. renders____

A

hydroxyl groups

  1. strengths crystalline structure
  2. forms fluorapatite
  3. renders enamel more resistant to demineralization
41
Q

___increases the rate of remineralization by:

A

fluoride
1. attracts Ca ions
2. Ca ions attract phosphate ions

42
Q

these surfaces respond best to remineralization:
____

these are second, followed by

A

smooth surfaces

root surfaces second
proximal surface third

43
Q

in remineralization these lesions have best results

A

early lesions

44
Q

_____fluoride being used more for remineralization

A

silver diamine fluoride

45
Q

the body is ideally remineralizing naturally, so we can offer suggestions to improve:
1
2
3

A
  1. fluoride- varnish, rinse, toothpaste
  2. dietary changes: reduce sugar frequency (ESPECIALLY DRINKS)
  3. oral hygiene instructions
46
Q

this bacteria initiates the lesion:
produces:
survives in:
able to store and use:
produces_____which allows it to stick to tooth and form barrier so remineralization cant occur

A

strep mutans
produces latic acid
survives in low pH
able to store and use intracellular glycogen

produces glucans or dextrans

47
Q

this bacteria follows strep mutan and leads to progression of caries

A

lactobacilli

48
Q

this bacteria is a high acid producer and found in advanced dentinal caries

A

lactobacilli

49
Q

dietary ___is the most important factor in producing cariogenic plaque, and leads to growth of highly acidogenic bacteria

A

dietary sucrose

50
Q

strep mutans doubles in only ___hours in sucrose
and ___ in saliva

A

1.32 hours

20 hours in saliva

51
Q

this is more damaging than lower frequency, high volume

A

high frequency

52
Q

layers of bacterial invasions:

A
  1. bacterial front- closest to oral environment
  2. discoloration front
  3. softening layer- closest to pulp
53
Q

infected vs. affected dentin

A

infected must be removed since bacteria present
affected may remain to PREVENT PULP EXPOSURE and no bacteria present

54
Q

this production plays an important part in caries and destroys tissues.

A

acid

55
Q

acid output in caries active plaque is ____that of caries inactive plaque

A

twice

56
Q

diets high in sucrose= ____caries rate

A

high

57
Q

reducing carbohydrate consumption= reduced

A

acid production

58
Q

cavitation occurs when

A

tooth surface becomes anaerobic and acidic

59
Q

Once tooth is cavitated

A

Bacterial (lactobacilli) that adhere poorly are now able to more easily adhere to more
retentive deep area of cavity

60
Q

Decay expands rapidly in more _____ part of tooth

A

organic
DEJ and Dentin

61
Q

where does caries all begins
this is first clinically detectable stage of caries where surface level of enamel is still intact

A

white spots

62
Q

initial lesion depth at ____week=20-100um
visible energy change at ___weeks=400-500um

A

1 week
2 weeks

63
Q

radiographs clinical visualization

A

BITEWING radiographs for interproximal lesions
not Pas- angulation misleading

63
Q

restoring teeth with active caries is like putting a new roof on a burning house. you MUST ______, not only the symptoms

A

treat the disease

64
Q

clinical visualization:

A

good light
air dry
tactile
radiographs

65
Q

tactile clinical visualization

A
  1. Gently feeling occlusal surface for soft areas may be appropriate
  2. Avoid using explorer on smooth surfaces
    -Could cavitate an area that could have remineralized
66
Q

Poor oral hygiene and diet can produce white spot lesion in how many weeks

A

3 weeks

67
Q

Fluoride slows rate of progression in

A

pit and fissure

68
Q

fluoride slows rate of progression on what surfaces

A

smooth
smooth is already slower than fissure

69
Q

on average, how many months for caries does it take to progress from outer surface of enamel to DEJ

A

43 months

70
Q

what percent of caries are pit and fissure

A

85%

71
Q

active pit and fissures

A

◦White spots
◦Matte, frosted
◦Cavitated
◦Visible dentin

72
Q

arrested pit and fissures

A
  1. white or brown spots
  2. shiny surface (do NOT need to treat surgically)
73
Q

interproximal caries

A
  1. rely primarily on radiographs to diagnose
74
Q

if there is NO radiolucencies present= ___% chance of no caries

A

98%

75
Q

does radiolucency mean that cavitation is present?
radiolucency present = __% chance of no caries

A

no
40-70%

76
Q

radiographs by level of cavitation

A

outside to inside
E1, E2
D1, D2, D3

77
Q

what carious lesions are non-surgical treatment, fluoride varnish, oral hygiene instructions, dietary counseling, resin infiltration

A

initial carious lesions

78
Q

what carious lesion can you
-restore with amalgam or composite= surgical treatment
or
-supplement with nonsurgical treatment

A

moderate carious lesions

79
Q

what carious lesion
-may be treated with restoration= surgical
-increased patient education is necessary because: will likely require additional treatment like endo, fixed, OS

A

advanced carious lesions

80
Q

what carious lesion
-remove old restoration and restore with amalgam or composite
-supplement with non-surgical

A

recurrent caries

81
Q

not caries???

A

cervical burnout??

82
Q

how we are currently managing caries:

A

MEDICAL MODEL
1. treating infectious disease
-dx of disease
2. risk assessment and modification
3. disease control and prevention of disease and absence occurrence
4. stop disease progression

results in:
managed and healthy mouth
prevention of recurrence and minimal replacement, save teeth for life

83
Q

What is the single best risk predictor for dental caries?

Other significant factors:

A

current caries

other:
*Parent and siblings with caries
*Extensive restorative work
*Orthodontic appliances
*Multiple medications
*Recession
* Nutritional habits
*Poor OH

84
Q

caries risk assessment

A

CAMBRA
caries
management
by
risk
assessment

85
Q

cambra
1. any conditions in high risk=
2. moderate and low conditions only=
3. low risk conditions only=

A
  1. high risk
  2. moderate risk
  3. low risk
86
Q

CARIES MANAGEMENT-Low Risk Patients

A
  • Toothpaste 2x day (F 1000ppm)
  • Sealants for all Molars
  • Age-related Oral Hygiene Education
    ◦Between meal snacks
    ◦Acidic or sugary drinks, like sports drinks
87
Q

CARIES MANAGEMENT-Medium Risk Patients

A

all low risk managements and
* Add interventions based on patient need. For example,
◦OTC Fluoride rinse (ACT or Fluorigard); must rinse for 1 minute!
◦F varnish @ 6 months

88
Q

CARIES MANAGEMENT-High Risk Patient

A

all low and moderate risk AND
1. Surgical treatment of caries
2. Professional Fluoride varnish at recall appointments/ 3 month intervals
3. Prescribe Fluoride toothpaste
-Dispense: Prevident5000 (1.1% NaF) Sig: Brush with small amount for 2 minutes before bedtime, expectorate excess
DO NOT RINSE
4. Nutrition Counseling
5. Xylitol chewing gum
-2 pieces for 30 minutes 3-5 times per day

PATIENT CARE III EXAM 2 (4 decks)

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