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Operative 2 > Cariology > Flashcards

Cariology Flashcards

1
Q

Cariology
Definition:

A

The study of caries and cariogenesis

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2
Q

CARIES definition:

A

decay, in bone or teeth

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3
Q

CARIES definition: decay, in bone or teeth
* — disease
* Leads to (2)

A

BACTERIAL
demineralization of inorganic components
destruction of organic components

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4
Q

Dental Caries
* — disease (3)

A
  • INFECTIOUS disease
  • MANAGEABLE disease
  • PREVENTABLE disease
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5
Q

Caries Requirements
(4)

A
  • Susceptible host
  • Bacteria
  • Food Source
  • Time
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6
Q

Etiology of Caries
* Specific plaque hypothesis
(5)

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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7
Q

Control the pathogens=

A

control the disease

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8
Q

Previous Theory- outdated

A
  • Nonspecific Plaque Hypothesis
    ◦Says ALL plaque is detrimental
    ◦More plaque= more decay
  • THIS IS NOT THE CASE
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9
Q

Biofilm definition:

A

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

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10
Q

Accumulation of biofilm on teeth is HIGHLY ORGANIZED
(2)

A
  • Few microorganisms are able to adhere to oral surfaces
  • Streptococci prominent group
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11
Q

Normal saliva biofilm made up mostly of

A

Strep sanguis and Strep mitis
* Non-pathogenic

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12
Q

Strep Mutans
(2)

A
  • Primary bacteria in Caries
  • Begin caries formation
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13
Q

Strep Mutans
* Primary bacteria in Caries
* Begin caries formation
* Followed by

A

Lactobacillus
* Responsible for progression of caries

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14
Q

Caries does have a genetic component

A
  • Bretz WA 2005 Twins Study
    Found genetics play a significant role in caries
    Up to 40%
  • Specific information is unknown
  • Genes involved unknown
  • Gene-gene and gene-environmental factor interaction role unknown
  • Many factors: predisposition to sweet foods, bacteria in the body, enamel makeup, saliva
    makeup
  • ?Grand Rounds project
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15
Q

Caries does have a genetic component
* THIS DOESN’T MEAN YOUR PATIENT IS OFF THE HOOK IF THEY HAVE CARIES. It means

A

they must be MORE DILIGENT to prevent future caries.
* Dentist has a responsibility to help them overcome the genetic component.

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16
Q

PROGRESSION of caries:
pulp/dentin reaction
(6)

A
  1. Tubular sclerosis
    * dentinal tubular obturation(opening gets smaller)
  2. Tertiary dentin formation
    * formed in response to stimuli (caries)
    * reactionary or reparative
  3. Inflammatory reaction when encroaching on pulp
    * within 1.0mm of pulp
  4. Pulp infection and exposure
  5. Pulp necrosis
  6. Periapical lesion
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17
Q

DEMINERALIZATION:
(4)

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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18
Q

REMINERALIZATION:
(4)

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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19
Q

A CARIOUS LESION occurs when:

A

Demineralization is greater than Remineralization over time

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20
Q

Carious Lesion Progression
* Enamel (pH below 5.5)
(4)

A
  • calcium, phosphate ions leave enamel
  • =demineralization
  • =white spot lesion
  • ->cavitation
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21
Q

Carious Lesion Progression
* Dentin demineralizes at —
(3)

A

~6.2 pH
* Lose minerals below surface (just like in enamel)
* In addition, proteolytic activity to remove the organic portions (remaining collagenous matrix)
* Remineralization may not be possible

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22
Q

What about Fluorapatite?
* pH for demineralization?

A
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23
Q

Remineralization requires:
(4)

A
  • Saliva
  • Plaque removal
  • Diet modification
  • Fluoride
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24
Q

Remineralization: Saliva
(4)

A
  • Buffers
  • Cleanses
  • Antibacterial
  • Calcium and Phosphate Ions
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25
Q

Remineralization: Saliva
* Buffers
(4)

A

◦Raises pH to non-demineralizing levels
◦> 5.5 enamel
◦>6.2 dentin
◦Bicarbonate ion

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26
Q

Remineralization: Saliva
* Cleanses
(2)

A

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

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27
Q

Remineralization: Saliva
* Antibacterial
(2)

A

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

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28
Q

Remineralization: Plaque Removal
(4)

A
  • Removes bacteria’s habitat
  • Plaque must ADHERE to cause damage
  • Home care
  • Professional dental visits
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29
Q

Remineralization: Diet Modification
* Starve bacteria
(2)

A

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

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30
Q

Remineralization: Diet Modification
* FREQUENCY OF — IS MOST IMPORTANT FACTOR
(2)

A

CONSUMPTION
◦More important than amount of sugar consumed
◦Aim to REDUCE frequency

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31
Q

Remineralization: Fluoride
(4)

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
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32
Q
  • Replaces Hydroxyl groups in hydroxyapatite
    (3)
A

◦Renders enamel more resistant to DEmineralization
◦Strengthens crystalline structure
◦Forms fluorapatite

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33
Q
  • Increases rate of Remineralization
    (2)
A

◦Attracts Ca ions
◦Ca ions attract phosphate ions

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34
Q

Different habitats= different bacteria
(4)

A
  • Pits and fissures
  • Root surface
  • Facial, lingual smooth surfaces and interproximal surfaces
  • Bacterial communities may differ from one another in different areas on the same tooth
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35
Q
  • Pits and fissures
    (1)
A

◦Simple streptococcal bacteria

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36
Q
  • Root surface
    (4)
A

◦Complex bacterial community
◦Mostly filamentous and spiral bacteria
◦Additional complication-anatomy of root may render hygiene practices ineffective
◦Unable to reach concavities with floss

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37
Q

CARIES PATHOGENESIS
* Bacteria
◦Strep mutans initiates lesion

A

◦Produces lactic acid
◦Survives in low pH
◦Able to store and use intracellular glycogen
◦Produces glucans or dextrans
◦Allows it to stick to tooth
◦Forms barrier so remineralization can’t occur

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38
Q

◦— follows and leads to progression of caries
(2)

A

Lactobacilli
◦High acid producer
◦Found in advanced dentinal caries

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39
Q

Dietary — is the most important factor in producing cariogenic plaque
(3)

A

sucrose

◦Leads to growth of highly acidogenic bacteria
◦Strep mutans doubles in only 1.32 hours in sucrose
◦Doubles in 20 hours in saliva

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40
Q

— frequency exposure is more damaging that — frequency, — volume

A

High
lower
high

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41
Q

CARIES PATHOGENESIS
* Layers of bacterial invasion
(3)

A

◦Bacterial front-closest to oral environment
◦Discoloration front
◦Softening layer-closest to pulp

42
Q
  • INFECTED vs. AFFECTED DENTIN
    (4)
A

◦Infected must be removed
◦Bacteria present
◦Affected may remain TO PREVENT PULP EXPOSURE
◦No bacteria present

43
Q
  • Acid production plays important part
    (3)
A

◦Acid destroys tissues
◦Acid output in caries active plaque is twice that of caries inactive plaque
Diets high in sucrose= high caries rate

44
Q
  • REDUCE CARBOHYDRATE CONSUMPTION=
A

REDUCE ACID
PRODUCTION

45
Q
  • Cavitation occurs when:
A

◦Tooth surface becomes anaerobic and acidic

46
Q
  • Once tooth is cavitated
A

◦Bacterial (lactobacilli) that adhere poorly are now able to more easily adhere to more
retentive (SURFACE AREA) of cavity

47
Q
  • Decay expands rapidly in more organic part of tooth
A

◦DEJ and dentin

48
Q

CARIES PATHOGENESIS
* Where it all begins: white spots
(5)

A

◦First clinically detectable stage of caries
◦Surface level of enamel is still intact
◦Initial lesion depth at ~1 week= 20-100μm
◦Visible energy change ~2 weeks
* Lesion depth= 400-500μm

49
Q

CARIES DIAGNOSIS
(3)

A

Clinical visualization
Tactile
Radiographs

50
Q
  • Clinical visualization
    (2)
A

◦Good light
◦Air dry

51
Q
  • Tactile
    (3)
A

◦Gently feeling occlusal surface for soft areas may be appropriate
◦Avoid using explorer on smooth surfaces
◦Could cavitate an area that could have remineralized

52
Q
  • Radiographs
    (4)
A

◦BITEWING radiographs
◦For interproximal lesions
* NOT Pas
* Angulation misleading

53
Q

Classify caries three ways:

A

site
activity
severity

54
Q
  • Site
    (5)
A

◦Pit and fissure
◦Interproximal
◦Free smooth surface
◦Root surface
◦Cusp tip

55
Q
  • Activity
    (2)
A

◦Active
◦Arrested

56
Q
  • Severity
    ◦Enamel:
    ◦Dentin:
    ◦Rampant Caries
A

◦Initial, Cavitated, E1-E2
◦Non-cavitated, Cavitated, D1-D2-D3

57
Q
  • Poor oral hygiene and diet can produce white spot lesion in
A

3 weeks

58
Q
  • Fluoride slows rate of progression in
A

pit and fissure
◦After fluoride was introduced in 1950’s, progression of caries from enamel to dentin slowed from ~ 1 year, to
~2-4 years

59
Q
  • Fluoride slows rate of progression on
A

smooth surfaces
◦Smooth surface progression is already slower than fissure

60
Q

ON AVERAGE it takes — for caries to progress from outer surface of enamel to DEJ

A

43 months

61
Q

Pit and Fissure Caries
◦—% of caries

A

85

62
Q

ACTIVE
(4)

A

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

63
Q

ARRESTED
(3)

A

◦White or brown spot
◦SHINY surface
DO NOT NEED TO TREAT SURGICALLY

64
Q

CARIES DIAGNOSIS
* Interproximal caries
◦Rely primarily on radiographs to diagnose
(3)
◦Clinical exam may show
(2)

A

◦NO radiolucencies present= 98% chance of no caries
◦Radiolucency does not always mean that cavitation is present
◦Radiolucency present= 40-70% chance of no caries

◦Opaque and discolored
◦Cavitated

65
Q

CARIES DIAGNOSIS
* Radiographs
◦By level of cavitation
◦Outside->inside
(2)

A

◦E1, E2
◦D1, D2, D3

66
Q

CARIES DIAGNOSIS
* Initial Carious lesions
◦Non-surgical treatment
(4)

A

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

67
Q

CARIES DIAGNOSIS
* Moderate Carious Lesions
(4)

A

◦Restore with amalgam or composite
◦= surgical treatment
◦Supplement with nonsurgical treatment
◦education, fluoride, etc.

68
Q

CARIES DIAGNOSIS
* Advanced Carious Lesions
(4)

A

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

69
Q

CARIES DIAGNOSIS
* Recurrent Caries
(2)

A

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

70
Q

Traditional surgical model
(8)

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

71
Q

How we are currently managing caries:
* Medical Model
(7)

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

72
Q

CARIES MANAGEMENT-Risk Assessment
* Low Risk
(2)

A

no disease indicators, <2 risk factors, has
protective factors

73
Q

CARIES MANAGEMENT-Risk Assessment
* Moderate Risk
(2)

A

no disease indicators, > 2 risk factors (but no
caries)

74
Q

CARIES MANAGEMENT-Risk Assessment
* High Risk
(2)

A

Cavitated lesions/disease indicators OR >3 risk
factors

75
Q
  • What is the single best risk predictor for dental caries?
  • Other significant factors:
    (7)
A

A: Current caries

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

76
Q

CARIES MANAGEMENT-Low Risk Patients
(3)

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
77
Q

CARIES MANAGEMENT-Medium Risk Patients
* All of the previous AND:
(3)

A
  • Add interventions based on patient need. For example,
    ◦OTC Fluoride rinse (ACT or Fluorigard); must rinse for 1 minute!
    ◦F varnish @ 6 months
78
Q

CARIES MANAGEMENT-High Risk Patients
* All of the previous AND:

A

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

79
Q

CARIES MANAGEMENT
* Newer player:
* Resin Infiltration (Icon®)

A

Use etch to “chemically drill”
◦15% hydrochloric acid gel
◦etch for 2 minutes
◦up to three times
Infiltrate with Icon® resin
Indicated for Smooth surface lesions
◦very good for small white spot lesions after ortho treatment

80
Q

CARIES MANAGEMENT
* Develop YOUR philosophy
◦WHEN to restore

A

◦Not every stick needs to be restored
◦May be stain, may be narrow fissure
◦Is treatment worse than the problem?
◦Use common sense and ethical standars
◦YOU ARE NOT A SALESPERSON, YOU ARE A HEALTH CARE PROVIDER

81
Q

CARIES MANAGEMENT
* Is there cavitation?
(2)
* Is dentin involved?
(2)
* Is enamel involved?
(2)

A

◦No= don’t need to drill
◦Manage non-surgically

◦Usually needs restoration
◦Unless worn dentin

◦May be able to do enameloplasty and seal
◦Or manage non-surgically if it has not extended into dentin

82
Q

CARIES MANAGEMENT
*Manage surgically◦YOU KNOW HOW TO DO THIS STUFF!
(3)

A

◦THIS IS THE BULK OF WHAT YOU’VE BEEN LEARNING IN OPERATIVE
◦No further slides on this matter!

83
Q

CARIES MANAGEMENT
* Manage non-surgically

A

◦Education
◦Oral hygiene instructions
AND
◦Nutrition counseling
◦Remineralization
◦Fluoride
◦Varnish, prescription toothpaste, OTC rinses

84
Q

CARIES MANAGEMENT
*PATIENT EDUCATION IS —

A

TREATMENT
* Insurance codes
D1310 nutritional counseling
D1320 tobacco counseling

85
Q

CARIES MANAGEMENT
*Conservative
(3)

A

◦Sealant
◦Enameloplasty and seal
◦Preventative Resin Restoration

86
Q

Sealant procedure side-track
(6)

A
  • Pumice tooth
  • May or may not enameloplasty
  • Etch
    ◦Rinse and dry
  • Place sealant
    ◦Light cure
  • Check for voids, check occlusion
    ◦Adjust if necessary
  • Suction is OFF (or it would
    suction the sealant material)
87
Q

What is PRR side-track

A
  • PRR= Preventative Resin Restoration
  • One tiny step beyond a sealant
    May even PRR small area (pit) and seal the remaining occlusal surface
  • The carious lesion has STARTED but not progressed into dentin
    or so we think…
88
Q

REMINERALIZATION
* — surfaces respond best to remineralization
(3)

A

Smooth

◦Root surfaces are second, followed by proximal surfaces
◦Early lesions have best results
◦Silver diamine fluoride being used more

89
Q
  • The body is ideally doing this naturally, we can offer suggestions to improve:
    (3)
A

Fluoride- varnish, rinse, or toothpaste
Reduced sugar (ESPECIALLY DRINKS)
Oral hygiene instructions

90
Q

REMINERALIZATION
* Types of fluoride
(5)

A

◦0.05% NaFmouthrinse
◦8% Stannous Fluoride
◦1.23% acidulated fluoride
◦5% fluoride varnish
* ◦1.1% NaF toothpaste

91
Q

◦8% Stannous Fluoride

A

◦stains

92
Q

◦1.23% acidulated fluoride

A

◦Used in trays

93
Q

◦5% fluoride varnish

A

◦Painted on teeth at dental office

94
Q

REMINERALIZATION
* Indications for self-applied fluoride:
(6)

A

*High caries risk
*Rampant enamel or root caries
*Xerostomia
*Exposure to radiation therapy
*Root surface sensitivity
*Orthodontic bands or bonded appliances

95
Q

EMINERALIZATION
* Self Applied Fluoride methods:

A

Custom tray
Tooth brushing
◦Regular toothpaste
◦Prescription toothpaste
◦Spit only, do not rinse after brushing
Rinses
◦Contraindicated for children under 6 years of age
Fluoride gels
◦Use after normal tooth brushing and flossing
◦Brush for 1 minute with gel

96
Q

REMINERALIZATION
* Silver diamine fluoride
* Contraindications:
(3)

A

Patient desires esthetic treatment in the area
Silver Allergy
Ulcerative gingivitis, stomatitis

97
Q

REMINERALIZATION
* SDF Application:
(3)

A

Isolate tooth well, apply petroleum jelly to lips/face of child
Apply SDF liquid to dry tooth for one minute
◦Gently rinse and remove isolation

98
Q
  • SDF WILL CAUSE
A

AREAS TO TURN BROWN
◦They will be hard
◦SDF will also stain fabric, etc. (i.e.your patient’s favorite
shirt)

99
Q

REMINERALIZATION
* Xylitol Gum
(4)

A

Non-cariogenic
Antibacterial
Enhances remineralization
Patient must chew 3-5 times/day

100
Q

IN CONCLUSION
Dental Caries
* Still a high prevalence
* Most common chronic —
* By age 17, —% of people have had a carious lesion
* Fewer than —% of adults are caries-free
* Elderly patients experience substantially more — caries
* —% of the population bears 75% of the caries burden

A

disease of childhood
89
5
root
10-20

Operative 2 (12 decks)

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