Cariology 4 Flashcards
What is risk
the probability that an event will occur, an event occurring within a specific period of time, usually connotes the event will lead to a negative implication. Jeez
Why is it important to estimate caries risk
caries is almost universal, not everyone will get a cavity, diagnostic ability to locate small cavities is rather poor
Most important activity we engage in
determining patient risk of current oral environment in causing formation of cavities requiring restoration-dictate aggressiveness of our therapies
what dictates aggressiveness of our therapies
caries risk
There is not one set of conditions that can be determined highest risk in a single patient-just know this
–
Factors contributing to disease are dependent on
Dose-how much
Frequency-how often
Duration-how long
Factors to be immediately involved in caries process
Attack and defense mechanisms
Factors related to occurrence of cavities
educational factors
Socioeconomic factors
Past Caries experience
Attack mechanisms
Bacteria and fermentable carbs
Strep Mutans-initiators
Initiator of caries and why
Strep mutans
- acidogenic
- aciduric
- produce glycans and fructans to adhere to tooth
- some produce substance which will kill neighboring bacteria and produce dominence in the flora
Bacteria dose and predictor
high levels of S mutans increases risk-not a good predictor alone
low levels of s mutans
is a good predictor for future cavities avoidance
Older plaque….
can transport materials/nutrients better
Amount of glucose to drop pH from 7 to below 4.8
15ml
15ml of glucose pH if brush and floss after
above 5.5 so okay (above critical level)
Progressor of cavities
Lactobacillus
larger sugar consumption means what
more lactobacillus –> more acid
Sucrose
complex carb with glucose and fructose
prime sugar contributing to glucans and fructans
sucrose
Starch and caries
repeating glucose, can form glucans to help adhere
Fructose and caries
moderate cariogenecity, can form fructans
lactose and caries
low cariogenecity
Dose of fermentable carbs
sucrose drops pH fast, more sugar will not drop pH more just will take longer for saliva to remove sugar from teeth (low cariogenic plaque returns pH to normal from acidic faster )
10% sucrose in 5 min does what
pH from 7 to 4.5
Saliva defense (how?)
buffers, water in saliva will dilute acids, Ca and P stabalize enamel equilibrium
Stimulated vs non stimulated saliva
stimulated is better, from smell, taste, chewing
contains bicarb?
saliva
what will bicarb do
buffer and reduces solubility of the enamel crystal
proportion of salivary proteins in saliva on cavity rates
it has an effect
A large part of the reason why we ask what medications someone is on
they reduce salivary flow
Sleeping reduces what
salivary flow, thus sugar stays in the mouth longer
Chewing gum vs caries
increases saliva, this is good
Fluoride present will preferentially form what apatite
Flourohydroxyapatite
poison to ameloblast
Fluoride is, will produce poor enamel formation
fluoride does what to solution
super-saturates it
small doses of Fluoride often or large doses less often?
small doses often-hence water
is SES status a cause or correlation of cavities?
no-just a relationship
is gingivitis a direct indicator of cavities?
no, but likely do not brush a lot so this is bad news bears
non-surgical caries measures
antibacterial mouthwash
xylitol
flouride
amorphous calcium phosphate
more than 1 million cfu’s S. mutans?
prescribe chlorhexidine gluconate .12% QD or BID x14 days-reculture and repeat if necessary
When Rx of antibacterial mouthwash can be stopped
once 2 consecutive cultures with low (<100,000cfu)
How do you keep the patient below 1 million without the mouthwash
xylitol
appropriate dose of xylitol
5-10grams/day in 3-5 divided doses
A problem with xylitol
not absorbed well, water goes to it, cause diarhhea
high dose fluoride recommended for who? Why?
children over 10 (because enamel is finished on most teeth crowns)
How do we know how much fluoride is in a product? 1 ppm = ?
1mg Fl/liter water
Children swallow about how much fluoride from toothpaste
about 1/2
a 1% solution has _____ppm
10,000ppm
colgate total has .14% w/v fluoride, how much fluoride in ppm?
14,000ppm
fluoride varnishes have ______ppm
22,500ppm but use little
Fluoride varnish releases for how long
4-6 hours
% reduction when fluoride varnish is used 2-3x year
14% reduction of caries
Silver diamine fluoride % reduction
70-80%, arrests decay for up to 6 months
Licorice root
kills a shit ton of S. mutans,
Smart bombs
kills stuff
acts as a yardstick for sugar consumption
lactobacillus
F in mouth when teeth first erupt
very little
KSP of FHAP ___ KSP of HAP; thus which will form in solution super saturated with F
FHAP < HAP; so FHAP is formed in preference
Silver diamine F turns demineralized tooth ______ (color)
black-and arrests decay for ~6 months
