Cariology 1

Question 1

What is the acidogenic (chemo-parasitic) theory? (unspecific black hypothesis)

Answer 1

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.

Question 2

What are the limitations to the acidogenic theory?

Answer 2

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

Question 3

What is the specific plaque hypothesis?

Answer 3

Removing cariogenic bacteria from the teeth could prevent formation of dental caries.

Question 4

What were the limitations of the specific plaque hypothesis?

Answer 4

Kanamycin resulted in overall reduction of caries at some surfaces caries rate increased

Cariogenic bacteria where not eliminated after treatment

Question 5

What is the updated non-specific plaque hypothesis?

Answer 5

Specific pathogens from the SPH were indigenous bacteria and sometimes common bacteria in health.

Question 6

What is the ecological plaque hypothesis?

Answer 6

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.

Question 7

What is the Keye’s triad?

Answer 7

Dental plaque

Diet

Teeth

These 3 factors interact to create dental caries.

Question 8

What is different about the modified keyes’ triad? How is this shifting with time?

Answer 8

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.

Question 9

What is the caries balance?

Answer 9

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

Question 10

What is the definition of dental caries?

Answer 10

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

Question 11

Why should dental caries be treated?

Answer 11

Untreated caries can progress into more severe local and systemic disease

Question 12

What pH dissolves enamel?

Answer 12

Below 5.5 pH enamel starts to dissolve and this was discovered in 1940. Hydroxyapatite crystals dissolve. Creating a neutral environment

Question 13

Why should people wait 30 minutes after a meal before brushing?

Answer 13

pH drops after eating so it is better to wait for it to neutralize before brushing instead of spreading the acid on the teeth

Question 14

What happens to caries when they are filled?

Answer 14

The caries would arrest automatically

Question 15

What are the theories that we have for understanding dental caries?

Answer 15

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)

Question 16

Acronym to remember the aetiology of dental caries.

Answer 16

FACTSS

Frequency

Amount (of sugars)

Contact time

Sugars

Simple or cooked starches

Question 17

What are arrested caries and what do they look like?

Answer 17

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.

Question 18

How long do fillings last usually?

Answer 18

Within a decade the filling will start to degrade

Question 19

What are the classifications of dental caries?

Answer 19

Location (tooth/surface/sub/supragingival)

Status (arrested/demineralized/uncavitated/cavitated)

Extent (Into enamel, dentine, pulp)

Stage (Primary / Secondary

Age (Early childhood, adult, elderly)

Question 20

How common are caries in children?

Answer 20

Very common; in childhood to remove all primary teeth at 5

Question 21

What are the types of non-carious surface loss of teeth?

Answer 21

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

Question 22

What common developmental defects affect the teeth?

Answer 22

Fluorosis

Molar incisor hypomineralisation

Amelogenesis imperfecta

Dentinogenesis imperfecta

Question 23

What commonly correlates with caries?

Answer 23

Caries are usually plaque induced and associated with gingivitis

Question 24

What classification is used for monitoring caries progression?

Answer 24

ICDAS classification

0 - 6 classification system based on severity.

Question 25

What is the difference between infected and affected dentine?

Answer 25

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.

Question 26

What do the different ICDAS and what do they mean?

Answer 26

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