Cariology Final Study Guide Flashcards
Hard tissues of the tooth
Dentin, enamel, cementum (DEC)
Soft tissues of the tooth
Pulp
Where are occlusal/pit and fissure caries?
On the biting surface of posterior teeth
Where are smooth surface caries located?
On the facial and lingual sides of teeth
Where are cervical caries located?
At the neck of the teeth where the enamel and cementum connect
Where are proximal caries located?
At the articulations between teeth at both the mesial and distal sides
Where are root caries locate?
In the cementum
What is cementum?
Hard tissue that covers the root of the tooth
What are rampant caries?
They develop and progress quickly
What are incipient caries?
They are small and at the early stages
What are arrested caries?
Caries that have not progressed further, such as by improving oral care, use of fluoride, or they improved on their own
What are recurrent caries?
They develop under/around the filling
Xerostomic caries
These occur because there is little saliva in the mouth, which protects against caries
What three external factors can impact caries production?
Radiation (damage to salivary glands), Medications (xerostomia can be a side effect), and systemic conditions (i.e. diabetes)
What age group do we classify Early Childhood Caries (ECC) under?
71 months or younger (under 6 years)
Caries is the most common chronic disease amongst children. How much more likely is it compared to asthma and hay fever?
5 and 7, respectively
Which theory of caries is most accepted? Who proposed it?
Acidogenic (chemo-parasitic) by W.D. Miller
What three factors must be present to produce caries?
Plaque (bacteria/biofilm)
Host (tooth structure and saliva)
Diet (carbs/sugar substrates
Describe the caries process
- Bacteria ferments carbohydrates
- Organic acids are produced and act on the hard tissues (enamel, dentin & cementum) 🡪 Minerals of the hard tissues are destroyed (demineralization)
- Demineralized tooth + proteolytic enzymes 🡪 cavitation/cavity/decay/caries
What ions come out of the tooth when acid acts on the tooth surface?
Calcium and phosphate
What is the critical pH? What is the normal mouth pH?
5.5; 6.7 to 7.4
What are the four most cariogenic bacteria in the mouth?
- Streptococcus mutans
- Streptococcus sobrinus
- Lactobacillus acidophilus
- Actinomyces viscosus
Which of the four oral bacteria are most common on the cementum, forming root caries?
Actinomyces viscosus
Streptococcus mutans is most associated with caries in what location?
Enamel caries/coronal caries
What does “extension for prevention refer to?
Extend caries to prevent more-no longer taught
What age group used to be most affected by caries? What group is most affected today?
used to be peds, today is it adults and geriatric patients (longer tooth retention-so longer exposure to cariogenic bacteria and reduced salivation with age)
What SES status used to have more caries? Which is highest today?
Used to be higher SES in 1960s (could afford sweets and treats), today it is lower SES (use of more sugary products, living in food deserts)
When was the first water system fluoridated in the US?
1945, in Grand Rapids Michigan
What year was the pit and fissure sealant approved by the ADA?
1977
WHat’s the difference between primary and secondary prevention?
Primary is to prevent or reverse early stages, and second is to terminate disease that is formed
Why is tertiary prevention so invasive?
You have to replace lost tissues and rehabilitate to restore function?
What decade was fluoride products created?
1950’s
What is a drawback to silver diamine fluoride?
Causes areas with caries to turn black
What is the ppm of fluoride in SDF? How much is in fluoride varnish? how much silver does SDF have?
44,600 ppm; 22, 000 ppm; 38%
When was SDF approved by the FDA?
2015
What does DMFT stand for? WHat does DMFS?
Decayed, missing due to caries, filled teeth; decayed, missing due to caries, filled tooth surfaces
What does the decay (D or d) score only include?
Only untreated caries
What the two teeth that are most susceptible to caries?
Lower first and second molars, respectively
Why are the 1st and second molars so susceptible?
- More pits and fissures (less protection by fluoride)
- They are the first permanent teeth and have been exposed to cariogenic factors for a longer period of time
- Further away from the salivary glands (which open between the upper 1st and 2nd molar and behind the incisors
Which two teeth are least susceptible to caries exposure?
lower lateral incisor and lower canine (with the lower canine being the least susceptible)
What are the lateral incisor and lower canine least susceptible to caries?
- They are close to the salivary glands (can wash them, essentially)
- Submandibular and sublingual salivary ducts open behind the lower anterior teeth
- They have more smooth surfaces and few pits, which allows for protection from fluoride
What are the caries suspectible sites (in no order)?
- pits and fissures
- Proximal surfaces
- Cervical margins
- Exposed root surfaces
- Margins around fillings (ridge)
- Surfaces close to partial dentures/bridges
What are the two age groups that the CAMBRA protocol addresses?
0-5, 6+
What is the medical model of treatment?
- prevention
- Minimally invasive techniques
- Restore teeth to proper functions
What is the composition of enamel?
96% mineral (hydroxyapatitie is the main component), 3% water , 1% organic
What is the composition of the crystals in enamel?
88% hydroxyapatite, 12% water, proteins, lipids and organic molecules
What does fluoride replace on the hydroxyapatite molecule?
It replaces the hydroxyl group with fluoride
What is the strongest substance in the body?
Enamel
What is the resulting color when enamel decalcifies?
Hyper white
What happens to the child if the mother ingests tetracycline during gestation?
The child’s teeth will have stains
What does cloudiness imply?
“3-D depth”
What are the stages of caries? Long answer
- No caries
- White spot lesion (early signs of demion-maybe chalky)
- Breakdown of enamel (soft floor)
- Secondary/recurrent caries
- Demineralization continues
- Fractured tooth
- Arrested caries (shiny, lustrous surface, brown-stain sometimes)
- Root caries (on cementum and can extend to the enamel; the lesion is either at the CEJ or fully on the root surface)
What is a class 1 caries?
Only on one surface; on occlusal surface of teeth
What is a class 2 caries?
Extends to two surfaces-starts at occlusal surface and extends to proximal surface of posterior teeth
What is a class 3 caries?
Proximal surfaces of anterior teeth only - does not extend to incisal edge
What is a class 4 caries?
It starts in the proximal surface of the anterior teeth and extends to the incisal edge
What is a class 5 caries?
It starts at the cervical regions of the teeth
What is a class 6 cariesa?
At the incisal edges of anterior teeth and cusp tips of posterior teeth
What type of caries is most difficult to diagnose?
Dentino-Enamel Junction (DEJ)
What are the surface characteristics of active lesions for non-cavitated lesions?
“Chalky”/dull, rough on gentle probing
What are the surface characteristics of inactive lesions for non-cavitated lesions?
Glossy, smooth on probing
What is the color of active lesions on non-cavitated lesions?
whitish to light brown
What is the color of inactive lesions for non-cavitated lesions?
Whitish to brownish/black
What are the demarcation characteristics for active lesions on non-cavitated lesions?
Most often sharply demarcated which indicates plaque-retention sites
What are the demarcation characteristics for inactive lesions for non-cavitated lesions?
Well-demarcated, or with diffuse borders
What can be a result of osteosclerosis in the more advanced stages?
Immobilization
How does fluorosis develop, specifically in relation to the developmental stages of enamel?
If someone takes in 1 mg/day for 6-8 years during the developmental stages of enamel.
Who investigated stains on teeth, that eventually led to the phrase “Colorado Brown Stain”, or Fluorosis?
McKay
In what year was the Colorado Brown Stain attributed to something in the water?
1920
When did Dr. Trendley Dean conclude that fluoride prevented caries?
1930s to 1940s
Who discovered fluorosis?
Dr. Trendley Dean
When did G.V. Black write the “Manual of Operative Dentistry”?
1896
What percent of fluoride in plaque/biofilm is bound to other chemicals, and what percent is in the ionic form?
95% and 5 %
What is the recommended multiplier for fluoridation in schools?
3-4.5 times the general population
How much does it cost per person to fluoridate water?
72 cents
What percentage of the US has access to fluoridated water, by both natural and artificial means?
> 74%
When was school water fluoridation popularized?
1970s and 1980s
Why are fluoride supplements discontinued at age 16? What are they replaced with?
They are discontinued due to the enamel being fully mineralized; at this point only topical fluorides are effective
What four factors do you consider with giving fluoride supplements?
- Age
- Fluoride level in water
- Weight
- Caries risk
What is the rate of fluoride per hour to induce acute fluoride toxicity in:
- Adults
- 10 kg child
- 3-year old child
Adults: 2.5-5 g / 2-4 hours
10 kg child: 320 mg / 2-4 hours
3-year old: 435 mg / 3 hours
What do you do to treat acute fluoride toxicity? (3 steps)
- Induce vomiting
- Give milk (calcium binds to fluoride)
- Call 911
How does fluoride prevent caries by bonding to the hydroxyapatite? (4 steps)
- Improves the crystal structure
- Decreases solubility (more stable apatite)
- Inhibits bacterial growth
- Promotes remineralization of enamel
How much fluoride is in toothpaste in the US? In ppm
900 to 1200 ppm
How much fluoride is in stannous fluoride? In ppm
Who do you prescribe stannous fluoride to?
19,360 ppm; give to patients with tooth sensitivity
How much fluoride is in Acidulated phosphate fluoride?
In what kind of environment (with the corresponding pH) is the enamel best able to take up this fluoride agent?
12,300 ppm; the enamel best takes up the fluoride in an acidic environment with a pH of 3
At what pH is Sodium fluoride absorbed by enamel? What biological process does it limit in the mouth?
pH of 7; it reduces salivary flow
How much fluoride is in SDF (in ppm)? When was it approved by the FDA? Is it more effective on the anterior or posterior teeth?
44,000 ppm; approved in 2016; more effective on the anterior teeth
Who is SDF recommended for?
Severe EEC
How much fluoride is in fluoride varnish? When was it approved by the FDA in 1994? Does it slow caries progression in both deciduous and permanent teeth?
22,600 ppm; approved by the FDA in 1994; slows caries progression in both permanent and primary teeth
For children between the ages of 2-19, which group has the highest proportion of untreated caries, and which has the highest caries experience?
6-11 with the highest proportion of untreated caries
12-19 with the highest caries experience
Race-wise, for 2-19 y/os, what is the proportion for total caries experience?
H>AA>W
Race-wise, for 2-19 y/os, what is the proportion for untreated caries?
AA>H>W
For 20-64, who has the highest total caries experience?
W>B>H
For 20-64, who has the highest caries experience?
B>H>W
For 65+, who has the highest total caries experience?
W>B>H
For 65+, who has the most untreated caries?
B>H>W
Race-wise, who has the most sealants placed?
W>H>B
Race-wise, who has the greatest rate of tooth retention?
W>H>B
Race-wise, who has the greatest rate of edentulism?
B>W>H
Before what process does primary dentin form? Where does primary dentin lay?
Forms before eruption, lies between enamel and pulp chamber
After what process does secondary dentin occur? It also occurs after this particular structure is complete.
Forms after eruption, and after root formation is complete
What is the inductive pulp function?
To form enamel
What is the formative pulp function?
Dentin formation
What does the odontoblast layer synthesize?
The matrix
What two signaling molecules appear to initiate the pre-odontoblasts to form odontoblasts in the pulp?
- Boneo morphogenetic protein
2. TGFbeta
What do fibroblasts do in the cell rich zone of pulp?
Produces and maintains collagen and ground substance
What do undifferentiated cells do in the cell rich zone of pulp?
Replace CT cells
What are the three common immune cellsin the cell rich zone of pulp?
- Macrophages
- Dendritic cells
- Lymphocytes
Dendritic cells in the cell rich zone of pulp mostly perform one function. What is it? They can also capture and present antigens to what two cell types?
They most signal, but they can capture and present antigens to T-cells and macrophages
Dentin is comprised of what type of collagen, which is produced by what cells?
Type 1 collage, secreted by odontoblasts
What are two types of collagen definitely made by fibroblasts for the pulp?
Type 1 and 3
What does the ground substance do in the pulp?
Supports cell and acts as a “medium for transport of nutrients”.
What clinically may be relevant to calcification of the pulp?
The canal system may be blocked
How many arterioles are there per root of the pulp?
1-2
In the canal of the pulp, a decrease in smooth muscle coating can lead to what happening to the lumen size?
An increase in lumen size
Where is there the most extensive branching of the arterioles of the pulp?
Subodontoblastic layer
AV anastomoses of the pulp avoid what structure, in order to shunt blood away from a site of injury?
They avoid the capillary bed
What two receptors respond by constricting when sympathetic nerves are stimulated, or a vasoconstrictor is present?
Alpha and Beta adrenergic receptors
What are the two most abundant types of nerve fibers of the pulp, and what type is present to a lesser degree?
AlphaSigma and C are most abundant, and there are some AlphaBeta fibers
Myelinated nerve fibers of the pulp ascend coronally and loser their myelin close to what layer?
The odontoblast layer
Are Alpha fibers of the pulp myelinated? What quality of pain do they record? Is it quick or long lasting-pain?
They are myelinated (fast acting, low threshold). They report sharp pain. They report quick/spontaneous pain
Are C fibers of the pulp myelinated? What qualities of pain do they report? Is this pain quick or long-lasting?
Not myelinated (slow acting, low threshold). Records slow, burning/aching/throbbing pain. Reports long-lasting pain
What is the clinical significance of varying stages of tooth maturity?
They have variable responses to stimulatory tests
For the pulp to CNS 1st Order Pathway, where does the signal go from and to ?
From V2 or V3 to the Trigeminal ganglion (cell bodies)
For the 2nd order pathway for sensation from the pulp to CNS, where does it start, and where does it end?
From the ganglion to the trigeminal nuclear complex (at the base of the medulla and upper spinal cord)
What portion of the spinal chord conducts painful stimuli?
Subnucleus caudalis
What is defined as referred pain? Mention 1st and 2nd order neurons
When several 1st order neurons converge to a single 2nd order neuron
What is gate-control theory in regards to the first order and second order neurons?
Information at the 2nd order neuronal level is a modified size of the 1st order neuron, and is modulated by higher centers of the brain
When toxic bacterial by-products pass through what structure, there is a local chronic inflammatory cell infiltration?
Dentinal tubules
In the deepest layers of carious dentin, how does the number of bacteria change?
There is less bacteria in the deeper layers of carious dentin
How does the number of dentinal tubules per unit area and their area change as you get closer to the pulp?
They increase
For pulpal pathosis, at what stage is inflammation inhibited by corticosteroids?(i.e. at what enzymatic level)
Phospholipases
For pulpal pathosis, at what stage do NSAIDs inhibit inflammation? (i.e. at what enzymatic level)
Cyclooxygenase
What type of chemical do mast cells inhibit?
Histamine
What type of intermediate chemical that produces the final chemical does plasma produce?
Kininogens->kinins
