Caries Symposium Flashcards
What factors must be present for development of caries?
- tooth
- substrate/sugar
- acid
- time
What carbohydrate/sugar is the worst for development of caries?
sucrose
What are the 7 elements of caries risk?
- clinical evidence
- dietary habits
- social history
- fluoride use
- plaque control
- saliva
- medical history
What is a pts caries risk if they wear fixed orthodontics?
Immediately high risk
How many sugar intakes per day make someone high caries risk?
> 3 sugar intakes a day
What is SIMD?
Scottish Index of Multiple Deprivation
- looks at the extent to which an area is deprived across seven domains
What are the 7 domains of SIMD?
- income
- employment
- education
- health
- access to services
- crime
- housing
What social history answers can give an indication of a patients being high caries risk?
- SIMD category
- education
- unemployment
- work stressors
- single parent families
- violence
- inequalities & poor access to healthcare
- dependents
How does fluoride lower a patients caries risk?
- incorporation into enamel crystal to form fluorapetite (more caries resistant than hydroxyapetite)
- its bacteriocidal
- interferes with adhesion force of bacteria reducing ability to stick to tooth
How can saliva give us an indication of a patients caries risk?
- amount (oral dryness may cause caries)
- buffering capacity
- pH
- viscosity (too thick is bad as cannot flow well)
What are the 8 elements of caries prevention?
- radiographs
- toothbrushing
- strength of fluoride in toothpaste
- fluoride varnish
- fluoride supplementation
- diet advice
- fissure sealants
- sugar free medication
Why do white spot lesions occur?
Loss of mineralisation of enamel
- loss of inter-rod regions
- thickness of crystallites reduced
On SEM, how does an active white spot lesion appear?
ROUGH (vs inactive which appears smooth)
Why is sealing root caries difficult?
No enamel to bond onto
When giving advice to new mothers, what should be discussed regarding diet & nutrition?
- use a feeding cup with a free flow spout
- NO SUGARY DRINKS in bottle (especially at night)
- sweet drinks/snacks at meal times only & diluted/through straw
- sugar free medication if possible
Give some examples of “safe snacks” that you could advise for your pts?
- milk/water
- fruit (natural sugar so be careful)
- crackers
- cheese
- bread sticks
In relation to mercury in amalgam, what legislation is relevant to us?
The Minimata Treaty
- global environmental treaty aimed at reducing release of mercury into the environment
What are the clinical steps when performing traditional prep for a preformed metal crown?
- give LA
- caries removal
- clear contacts at mesial & distal
- occlusal surface reduction
- size crown & cement on with GIC
What are some minor complications of GA?
- pain
- headache
- nausea
- vomiting
- sore throat
- sore nose/nose bleed
- drowsiness
What medical conditions make GA higher risk?
- Sickle cell disease
- Down’s syndrome
- bleeding disorders
- cardiac conditions
- renal disease
- diabetes
- liver disease
What type of consent is required for GA?
WRITTEN
What determines cavity design?
- the extent of disease
- the properties of dental material being used
- the type of disease (eg caries, perio, toothwear)
Where on teeth are caries located?
- pits & fissues
- interproximal
- smooth surfaces
If a patient has a white spot lesion that doesnt appear to be cavitated, should we intervene?
NO
- focus on remineralisation FIRST
What are the steps of cavity design & preparation?
- identify and remove carious enamel
- remove enamel to the maximum extent of the caries at the ACJ & smooth margins
- progressively remove peripheral caries in dentine from ACJ then deeper
- remove deep caries over pulp
Before you etch a cavity, what should you do?
- remove any unsupported enamel
- smooth sharp cavosurface margins & line angles
What is the cavo surface margin angle?
The angle at which the outside of the tooth meets the inside of the cavity
What is configuration factor?
The ratio of bonded to unbonded surfaces
- important for composite restorations
- should be low when restoring with composite
What is the concentration of daily fluoride mouthwash?
0.05% (227ppmF)
What is the concentration of weekly fluoride mouthwash?
0.2% (909ppmF)
How does fluoride varnish work?
Colophony resin hardens in contact with saliva to maintain contact of fluoride with the tooth
- mobilisation of calcium ions into enamel
- precipitation of calcium fluoride
Which patients cannot use tooth mousse?
Pt with milk allergy
What risks are associated with fluoride use?
- enamel fluorosis
- acute toxicity via ingestion (rare)
- chronic toxicity (fluorosis)
How much fluoride do young children need to swallow to risk fluorosis?
0.1mg f/kg
What can be done to maximise caries benefit but reduce fluorosis risk in young children?
- keep toothpaste out of reach of small children
- brush 2x per day
- supervise brushing
- use recommended amount (pea/smear)
- discourage swallowing
What are the stages of caries progression?
- adhesion
- survival & growth
- biofilm formation
- complex plaque
- acid formation
- caries
State Koch’s Postulates germ theory of disease?
- microbe must be present in every case of the disease
- microbe must be isolated from the diseased host & grown in pure culture
- disease must be reproduced when a pure culture is introduced into a susceptible host
- microbe must be recovered from an experimentally infect host
What type of microbe is Steptococcus Mutans?
gram-positive coccus
Give examples of virulence factors of caries inducing microbes:
- adhesions
- binding proteins
- sugar modifying enzyme
- polysaccharides
- acid tolerance & adaption
Give examples of sugar modifying enzymes found in caries inducing microbes:
- fructanase
- dextranase
What is the pH of lactic acid?
3.5 (demin starts at pH 5.5)
