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Patient Care III > Caries Risk Assessment (also for operative) > Flashcards

Caries Risk Assessment (also for operative) Flashcards

1
Q

What is the definition of cariology?

A

The study of caries and cariogenesis

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2
Q

What is the definition of caries?

A

decay, in bone or teeth

  • BACTERIAL disease
  • Leads to demineralization of inorganic components
  • Leads to destruction of organic components
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3
Q

What type of disease is dental caries?

A
  • INFECTIOUS disease
  • MANAGEABLE disease
  • PREVENTABLE disease
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4
Q

What are the requirements for caries?

A
  • Susceptible host
  • Bacteria
  • Food Source
  • Time
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5
Q

What is the specific plaque hypothesis?

A

◦Biofilm is responsible for the disease
◦Plaque is pathogenic when disease is present
◦Specific Microbes are the cause
◦Strep Mutans
◦Lactobacillus and Actinomyces V. (acid producers, can live in acid)

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6
Q

Control the pathogens=

A

control the disease

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7
Q

What is the definition for biofilm?

A

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

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8
Q

Accumulation of biofilm on teeth is ________ ORGANIZED

A

HIGHLY

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9
Q

Few microorganisms are able to adhere to oral surfaces, what is the prominent group?

A

Streptococci

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10
Q

Normal saliva biofilm made up mostly of…

A

Strep sanguis and Strep mitis (non-pathogenic)

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11
Q

What begins caries formation?

A

Strep Mutans
Lactobacillus follows

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12
Q

What lives in pits and fissures?

A

◦Simple streptococcal bacteria

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13
Q

What lives on the root surfaces?

A

◦Complex bacterial community
◦Mostly filamentous and spiral bacteria

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14
Q

What is an additional complication of root surfaces?

A

anatomy of root may render hygiene practices ineffective –> unable to reach concavities with floss

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15
Q

Can you have different bacterial communities on the SAME tooth?

A

Yes- bacterial communities may differ from one another in different areas on the same tooth

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16
Q

Caries does have a ___________ component

A

genetic

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17
Q

Dentist has a responsibility to help the patient overcome the _________ component of caries

A

genetic

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18
Q

Caries formation is a constant battle between…

A

DEMINERALIZATION and REMINERALIZATION

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19
Q

What causes demineralization?

A

-Bacteria living in plaque feed off “leftovers”
-Bacterial waste product is ACID
-Acid demineralizes enamel
-Phosphates and Calcium are lost

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20
Q

What causes 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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21
Q

A CARIOUS LESION occurs when:

A

Demineralization is greater than Remineralization over time

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22
Q

What does hydroxyapatite demineralizes at pH at?

A

below 5.5

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23
Q

What leaves the enamel when it gets demineralized?

A

calcium, phosphate ions

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24
Q

What does a carious lesion progression look like?

A
  • =demineralization
  • =white spot lesion
  • ->cavitation
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25
Q

What does fluorapatite (enamel with fluoride) demineralize at?

A

Demineralizes at pH below ~4.5

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26
Q

What does dentin demineralize at?

A

Dentin demineralizes at ~6.2 pH

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27
Q

__________ activity removes the organic portions of dentin (remaining collagenous matrix)

A

Proteolytic

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28
Q

If the carious lesion progresses to dentin, what might not be possible?

A

remineralization

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29
Q

What are remineralization besties?

A
  • Saliva
  • Plaque removal
  • Diet modification
  • Fluoride
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30
Q

What are the functions of saliva?

A
  • Buffers
  • Cleanses
  • Antibacterial
  • Calcium and Phosphate Ions
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31
Q

What acts as a buffer in saliva?

A

Bicarbonate ion HCO3−

◦Raises pH to non-demineralizing levels

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32
Q

How many liters of saliva is produced to flush away organisms a day?

A

1-1.5L/day

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33
Q

What are the antibiotic salivary proteins?

A

lysozome, lactoperoxidase, lactoferrin, agglutinin

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34
Q

What aids in plaque removal?

A
  • Removes bacteria’s habitat
  • Plaque must ADHERE to cause damage
  • Home care
  • Professional dental visits
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35
Q

What does diet modification do for caries?

A

◦Preferred food source: fermentable carbohydrates
◦Strep Mutans loves sugar

36
Q

___________ OF CONSUMPTION IS MOST IMPORTANT FACTOR

A

FREQUENCY

◦More important than amount of sugar consumed

37
Q

What is the new cultural norm for diet?

A

increased consumption of sugary and acidic beverage –> no chewing = saliva doesnt know to come to the party

38
Q

What does fluoride do?

A
  • Replaces Hydroxyl groups in hydroxyapatite
  • Increases rate of Remineralization
  • Inhibits bacterial activity
  • Fluoride should be on the surface of the tooth for these mechanisms to work
39
Q

_______ surfaces respond best to remineralization

A

Smooth

◦Root surfaces are second, followed by proximal surfaces

40
Q

What can we offer to improve the remineralization process?

A
  • Fluoride (varnish, rinse, or toothpaste)
  • Dietary changes: reduce sugar frequency (ESPECIALLY DRINKS)
  • Oral hygiene instructions
41
Q

What is the role of strep mutans in caries pathogenesis?

A

initiates lesion
◦Produces lactic acid
◦Survives in low pH
◦Able to store and use intracellular glycogen
◦Produces glucans or dextrans

42
Q

What do glucans and dextrans do for carious lesions?

A

-allow S. mutans to stick to tooth
-forms barrier so remineralization can’t occur

43
Q

What is the role of lactobacilli in caries pathogenesis?

A

follows and leads to progression of caries
◦High acid producer
◦Found in advanced dentinal caries

44
Q

Dietary ________ is the most important factor in producing cariogenic plaque

A

sucrose

45
Q

◦Strep mutans doubles in only _____ hours in sucrose

A

1.32 (compared to 20 hours in saliva)

46
Q

______ frequency exposure is more damaging that lower frequency, high volume

A

High

47
Q

What are the layers of bacterial invasion?

A
  • bacterial front: closest to oral environment
  • discoloration front
  • softening layer: closest to pulp
48
Q

Infected dentin must be ________

A

removed
*bacteria present

49
Q

Affected dentin may…

A

remain to prevent pulp exposure
*no bacteria present

50
Q

What role does acid play in caries pathogenesis?

A
  • acid destroys tissues
  • acid output in caries active plaque is twice that of caries inactive plaque
51
Q

REDUCE CARBOHYDRATE CONSUMPTION= REDUCE ______ PRODUCTION

A

ACID

52
Q

Cavitation occurs when:

A

Tooth surface becomes anaerobic and acidic

53
Q

Decay expands rapidly in more organic part of tooth:

A

DEJ and dentin

54
Q

What happens when the tooth is cavitated?

A

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

55
Q

Where does caries pathogenesis begin?

A

white spots

56
Q

What is the first clinically detectable stage of caries?

A

white spot lesions

57
Q

T/F Surface level of enamel is still intact with white spot lesions

A

True

58
Q

You must treat the ______, not only the symptoms

A

DISEASE

59
Q

What do you need to caries diagnosis?

A
  • Clinical visualization
  • Tactile
  • Radiographs
60
Q

__________ radiographs for interproximal lesions

A

BITEWING

61
Q

Avoid using explorer on __________ surfaces

A

smooth
- Could cavitate an area that could have remineralized

62
Q

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

A

3

63
Q

Fluoride ____ rate of caries progression

A

SLOWS

64
Q

On average it takes ____ months for caries to progress from outer surface of enamel to DEJ

A

43

65
Q

Pit and Fissure Caries account for ___% of caries

A

85%

66
Q

What do active caries look like?

A

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

67
Q

What do arrested caries look like?

A

◦ White or brown spot
◦ SHINY surface

68
Q

What do you rely on primarily to diagnose caries?

A

radiographs

69
Q

NO radiolucencies present means ____% chance of no caries

A

98

70
Q

Radiolucency present means _____% chance of no caries

A

40-70%
*radiolucency does not always mean that cavitation is present

71
Q

What are the non-surgical treatments for inital carious lesions?

A

◦Fluoride varnish
◦Oral hygiene instructions
◦Dietary counseling
◦Resin infiltration

72
Q

What are the treatment options for moderate carious lesions?

A

◦Restore with amalgam or composite
◦Supplement with nonsurgical treatment (education, fluoride, etc.)

73
Q

What are the treatment options for advanced carious lesions?

A

◦May be treated with restoration (surgical)
◦Increased patient education is necessary because:
—Will likely require additional treatment
—endo, fixed, OS

74
Q

How do you treat recurrent caries?

A

◦Remove old restoration and restore with amalgam or composite
◦Supplement with non-surgical treatment

75
Q

This is not caries! This is…

A

cervical burnout

76
Q

What is the traditional surgical model of caries management?

A

◦A condition or a cavity
◦Detection of cavity
◦No susceptibility assessment and modification
◦Restoration of function and/or relief of pain
◦Does not stop disease progression
◦Results in repaired but unhealthy mouth
◦Frequent recurrence and often replacement, eventually lose teeth
outdated

77
Q

What is the medical model for managing caries?

A

◦We’re treating an infectious disease
-Diagnosis of a disease
- Risk assessment and modification
- Disease control and prevention of the disease and absence of disease occurrence
- Stop disease progression
◦Results in a managed and healthy mouth
◦Prevention of recurrence and minimal replacement, save teeth for life

78
Q

What is the single best risk predictor for dental caries?

A

current caries

79
Q

What are other significant risk factors for caries besides current caries?

A

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

80
Q

What is the CAMBRA?

A

Caries Management By Risk Assessment

81
Q

What is the overview of CAMBRA?

A
  • Any conditions in high risk= HIGH RISK
  • A useful tool to help manage the disease of caries
  • UMKC has its own system based on CAMBRA
82
Q

What are additional risk factors not listed in the UMKC CAMBRA form?

A
  • Are saliva-reducing factors present (medications/radiation/systemic)?
  • Is Salivary Flow Adequate?
  • History of Eating Disorder?
    –Provide details
  • Special health care needs (developmental, physical, medical, or mental disabilities that prevent or limit performance of adequate oral health care by themselves or caregivers)
  • MS and LB culture done?
    –Provide results
83
Q

What is the caries managment for 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
84
Q

What is the caries managment for medium 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

AND

  • Add interventions based on patient need. For example,
    ◦OTC Fluoride rinse (ACT or Fluorigard); must rinse for 1 minute!
    ◦F varnish @ 6 months
85
Q

What is the caries managment for high 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
  • Add interventions based on patient need. For example,
    –OTC Fluoride rinse (ACT or Fluorigard); must rinse for 1 minute!
    –F varnish @ 6 months
  • Surgical treatment of caries
  • Professional Fluoride varnish at recall appointments/ 3 month intervals
  • Prescribe Fluoride toothpaste
  • Nutrition Counseling
  • Xylitol chewing gum - 2 pieces for 30 minutes 3-5 times per day
86
Q

What are the ways to manage caries non-surgically?

A

◦Education
◦Oral hygiene instructions
◦Nutrition counseling
◦Remineralization
◦Fluoride

87
Q

Is patient education treatment?

A

YES

Patient Care III (25 decks)

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