Cariology 1 Flashcards
What is the acidogenic (chemo-parasitic) theory? (unspecific black hypothesis)
Microorganisms of the human mouth cause the formation of dental caries.
Proposed 2 stages of caries formation:
Decalcification and dissolution
Showed that degradation of carbohydrates led to degradation of enamel.
What are the limitations to the acidogenic theory?
Unable to explain site specificity
Does not determine the specific bacterial aetiology
Does not explain why some populations are caries free
Cannot explain arrested caries
What is the specific plaque hypothesis?
Removing cariogenic bacteria from the teeth could prevent formation of dental caries.
What were the limitations of the specific plaque hypothesis?
Kanamycin resulted in overall reduction of caries at some surfaces caries rate increased
Cariogenic bacteria where not eliminated after treatment
What is the updated non-specific plaque hypothesis?
Specific pathogens from the SPH were indigenous bacteria and sometimes common bacteria in health.
What is the ecological plaque hypothesis?
Disease is the result of an imbalance of the total microflora due to ecological stress.
This results in enrichment of some oral pathogens or disease related micro-organisms.
What is the Keye’s triad?
Dental plaque
Diet
Teeth
These 3 factors interact to create dental caries.
What is different about the modified keyes’ triad? How is this shifting with time?
Time was added to the 3 factors. This is because time is necessary for degradation of plaque under the other factors. Frequency of being exposed to the relevant factors will increase the impact of dental caries.
After the modified keye’s triad is a multifactorial look at the aetiology of dental caries.
What is the caries balance?
A balance exists between pathological factors and protective factors
Protective factors include saliva flow, fluoride, and antibacterials
Pathological factors include acid, fermentable carbs, sub-normal saliva flow and function
What is the definition of dental caries?
Dental caries is a continuum of disease states of increasing severity and tooth destruction that ranges from sub-clinical sub-surface changes at the molecular
level to lesions with dentinal involvement, either with an intact surface or obvious cavitation
Why should dental caries be treated?
Untreated caries can progress into more severe local and systemic disease
What pH dissolves enamel?
Below 5.5 pH enamel starts to dissolve and this was discovered in 1940. Hydroxyapatite crystals dissolve. Creating a neutral environment
Why should people wait 30 minutes after a meal before brushing?
pH drops after eating so it is better to wait for it to neutralize before brushing instead of spreading the acid on the teeth
What happens to caries when they are filled?
The caries would arrest automatically
What are the theories that we have for understanding dental caries?
Traditional non-specific plaque hypothysis
Specific plaque hypothysis
Updated non-specific plaque hypothesis
Ecological plaque hypothesis
Keystone pathogen hypothesis (certain species of bacteria have a disproportionate pathogenicity)
Acronym to remember the aetiology of dental caries.
FACTSS
Frequency
Amount (of sugars)
Contact time
Sugars
Simple or cooked starches
What are arrested caries and what do they look like?
Arrested caries are caries that started and then stopped. They are usually hard and black.
Active caries are soft and can be penetrated by probing.
How long do fillings last usually?
Within a decade the filling will start to degrade
What are the classifications of dental caries?
Location (tooth/surface/sub/supragingival)
Status (arrested/demineralized/uncavitated/cavitated)
Extent (Into enamel, dentine, pulp)
Stage (Primary / Secondary
Age (Early childhood, adult, elderly)
How common are caries in children?
Very common; in childhood to remove all primary teeth at 5
What are the types of non-carious surface loss of teeth?
Attrition
Erosion (acidic mediated)
Abrasion (worn away enamel from physical force)
Trauma
Abfraction is similar to abrasion but only affects buccal surfaces. This has been challenged due to its specificity to buccal surfaces
Several things can occur simultaneously
What common developmental defects affect the teeth?
Fluorosis
Molar incisor hypomineralisation
Amelogenesis imperfecta
Dentinogenesis imperfecta
What commonly correlates with caries?
Caries are usually plaque induced and associated with gingivitis
What classification is used for monitoring caries progression?
ICDAS classification
0 - 6 classification system based on severity.
What is the difference between infected and affected dentine?
Infected dentine contains micro-organisms, Cannot be remineralized.
Affected dentine does not contain micro-organisms. It has the potential to remineralize, it is accepted to preserve affected dentin during cavity preparation leathery and partially demineralised.
What do the different ICDAS and what do they mean?
0 Clinically sound
1 Opacity with air drying (white, brown)
2 Opacity without air drying (White or brown opacity beyond fissure with no loss of surface integrity)
3 A white or brown spot lesion with localised enamel breakdown without visible dentin shadow
4 White or brown spot lesion with/without enamel breakdown and a dentine shadow
5 Distinct cavity with dentine exposure
6 Huge cavity including more than half the tooth
If in doubt always score lower
