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operative dentistry > Cariology pp2 > Flashcards

Cariology pp2 Flashcards

1
Q

Dental caries is an _______ microbiological disease of the teeth that results in ______ dissolution and destruction of the ______ tissues.

A

Infectious
Dissolution
Calcified

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2
Q

What are 3 pathologic factors that “tip the scale” towards caries in The Caries Balance?

A
  1. Acid producing bacteria
  2. Sub-normal saliva flow/function
  3. Frequent eating/drinking of fermentable carbs
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3
Q

What are 3 pathologic factors that “tip the scale” towards NO caries in The Caries Balance?

A
  1. Saliva flow and components
  2. Fluoride - remineralization
  3. Antibacterials - CHX, xylitol
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4
Q

What does caries risk assessment evaluate?

A

A patient’s oral environment and helps determine the balance whether it is re-mineralizing or de-mineralizing

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5
Q

What are 4 clinical observation disease indicators measured in a caries risk assessment? (These tell us nothing about the cause of the disease only indicate presence of disease)

A
  1. Visible cavities present
  2. Caries restored in last 3 years
  3. Interproximal caries lesions/radiolucencies
  4. White spots on enamel surfaces
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6
Q

Name 9 main risk factors for caries risk

A
  1. MS and LB medium or high - by culture
  2. Visible heavy plaque
  3. Frequent (>3x) between meal snacks with sugar
  4. Deep pits and fissures
  5. Recreational drug use
  6. Inadequate saliva flow (< 0.5ml/min)
  7. Saliva reducing factors
  8. Exposed tooth roots
  9. Ortho brackets
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7
Q

3 reasons a patient could have reduced saliva flow

A
  1. Medication
  2. Radiation to head/neck
  3. Systemic Disease (e.g. Sjogrens)
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8
Q

Protective Factors

  1. Lives/work/school in a ______ community
  2. Fluoride toothpaste as least __-__ times daily
  3. ______ mouthrinse daily
  4. ____ppm F toothpaste daily
  5. Fluoride ____ in last 6 months
  6. Office topical Fluoride in last __ months
  7. ____ prescribed/used one week each of last 6 months
  8. _____ gum 4x daily last 6 months
  9. __ paste during last 6 months
  10. Adequate saliva flow - >___ml/min simulated
A
  1. Fluoridated
  2. 1-2
  3. Fluoride
  4. 5000
  5. Varnish
  6. 6
  7. CHX
  8. Xylitol
  9. MI
  10. 1 ml/min
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9
Q

6 Intake diagnostic data procedures

A
  1. Clinical exam
  2. Dental radiographs
  3. Bacterial Test
  4. Medical Hx
  5. Environmental intake - Dietary, Fl, Hygiene
  6. Saliva function test
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10
Q

When determining a risk level (Low, medium, high, and extreme), what are the 3 groups that you take into consideration?

A
  1. Disease indicators
  2. Risk factors
  3. Protective factors
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11
Q

Example pt - no disease indicators, one or more risk factors, and needs to increase protective factors. What risk level would you assign?

A

Medium

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12
Q

What risk factor will automatically put a patient in the extreme risk level?

A

Low saliva flow

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13
Q

Caries Management: The Medical Model emphasizes to not just fill the hole in the tooth. How is this done in 3 steps?

A
  1. Suppress the bacteria
  2. Control other factors that contribute to the disease process
  3. Change oral environment favoring remineralization
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14
Q

What risk levels would you suggest use CHX Antimicrobials?

A

High and Extreme risk -10ml/1 min @ bedtime 1 week each month

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15
Q

What risk levels would you suggest use xylitol gum/mints?

A

Moderate, high, and extreme risk patients

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16
Q

How often do low and moderate risk level patients need BWXrays?

A

Every 18-24 months (Periodic exams every 12 months)

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17
Q

Are sealants recommended for all risk levels?

A

All but low risk level

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18
Q

How often should you see an extreme risk level patient for periodic exams?

A

Every 3-6 months to re-eval for caries and apply fluoride varnish

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19
Q

How often is the bacterial test and saliva flow test done on a high risk level patient?

A

Every POE (periodic oral exam - which should be every 6-12 months)

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20
Q

2 types of streptococci involved in dental decay - Properties = aciduric, acidogenic, produces acetic/latic acids

A
  1. MS

2. S. sobrinus

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21
Q

What is the proposed window of time that shows the infectivity of acquisition of MS in infants?

A

19-31 months

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22
Q

How does xylitol interfere with transmission of S. mutans?

A

Blocks adherence

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23
Q

Patients with Frank Cavities - ___ or more frank cavities indicates high risk for future new carious lesions. ______ to high levels of mutans streptococci and _______. Patients have a high bacterial challenge that most likely can not be completely overcome by _____ alone. Placing restorations does not reduce ____ ____ in the rest of the mouth.

A 
1
Moderate
lactobacilli
Fluoride
Bacterial loading
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24
Q

Favorably altering the caries balance by intervention with CHX and F rinses successfully reduced caries risk status. Reducing caries risk status by chemical therapy markedly reduced the level of new caries. What does this confirm?

A

The “Caries Balance” concept

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25
Q

Enamel is made up of what mostly?

Dentin has more_____, ____, and ____ than enamel?

A

Carbonated hydroxyapatite

Protein, Lipid, and Water

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26
Q

What contains phosphoproteins and carboxlic acid amino acid residues?

A

Enamelins

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27
Q

What protein is mostly eliminated from mature enamel?

A

Amelogenins

28
Q

In enamel, _____ surrounds every individual hydroxyapatite crystal

A

Protein

29
Q

In mature enamel, what are the %s of protein and lipids by weight and volume?

A

Weight - 1%

Volume - 3% protein +lipid 50:50

30
Q

Enamel rods are ____ to surface of tooth

A

Perpendicular

31
Q

4 functions of saliva

A
  1. Antibacterial
  2. Clearance - clears carbs from plaque
  3. Lubrication
  4. Mineral exchange - buffering/re-mineralization
32
Q

Normal simulated flow rate is what?

A

about 1 or more ml/min *

33
Q

Stimulated flow rate of less than what, is a high risk factor for dental caries?

A

Less than 0.7ml/min

34
Q

Inorganic components of saliva

A
  1. Calcium - remin/prevent demin
  2. Phosphate - buffer helps remin/prevent demin
  3. Potassium
  4. Sodium
  5. Chloride
  6. Bicarb - buffers, pH 6.8-7.3
35
Q

T/F saliva is high in phospholipids

A

TRUE*

36
Q

What 2 things do PRPs (Proline-Rich Proteins) do? Found in parotid and submandibular saliva

A
  1. Pellicle formation

2. Inhibits spontaneous precipitation of Ca by binding to it.

37
Q

What is the name of the protein that is involved with pellicle formation and inhibits primary precipitation of Ca and PO$

A

Statherins

38
Q

What protein is involved with pellicle formation, is antibacterial, and antifungal?

A

Histatins - parotid and submandibular saliva

39
Q

What protein is involved with pellicle formation and has cystein protease inhibitory activity but found in the submandibular/sublingual saliva

A

Cystatins

40
Q

What are the 6 main antibacterial salivary proteins?

A
  1. Lysozyme
  2. Lactoferrin- binds Fe
  3. Salivary peroxidase
  4. sIgA - inhibits attachment of S. mutans to tooth surface
  5. Amylase
  6. Mucins
41
Q

What are 7 other components of saliva?

A
  1. Hormones
  2. Steroids
  3. Antibodies
  4. Growth Factors
  5. Cytokines and chemokines
  6. Nucleic Acid
  7. Drugs
42
Q

The salivary pellicle is a thin film on the surface of the enamel. It begins immediately and forms within hours with multiple layers. What is it comprised of?

A

Strongly adsorbed specific PROTEINS and LIPIDS from the saliva

43
Q

The pellicle is a protective layer on teeth, what are other functions?

A
  1. Lubrication
  2. Prevents demineralization
  3. Mineral storage needed for remineralization
44
Q

What are 4 bad salivary effects?

A
  1. Pellicle formed allows bacteria to colonize on the tooth
  2. Provides a sticky surface
  3. Provides nutrients for a bacteria
  4. Precursor to plaque formation
45
Q

_____ a population or community of bacteria living in organized structures at an interface between a solid and a liquid. Bacteria live in microcolonies encapsulated in a matrix of extracellular polymeric substances

A

Biofilm

46
Q

What is the first bacterium to stick to the dental pellicle (PRPs) and grows very rapidly?

A

S. sanguis (“low colonization threshold” pH approx. 7, aerobic)

47
Q

What enzyme does MS produce that helps enhance the adherence of bacteria to the pellicle?

A

glucosyl transferase

48
Q

Up to what % of plaque is bacteria?

A

40%

49
Q

4 reasons S. mutans is so cariogentic?

A
  1. Acidogenic
    2, Aciduric (pH resistant)
  2. Produce extracellular glucans
  3. Transport sugar
50
Q

What bacterium is associated with early demineralization, higher concentrations at white spot lesions, sucrose sensitive, and prefers anaerobic

A

Mutans streptococci

51
Q

Why are some Mutans Streptococci “heavily loaded”? (5 reasons)

A
  1. Diet
  2. Irregularities in enamel
  3. Other retention sites
  4. Heavy colonization of other family members
  5. Genetic and immunological factors
52
Q

Can MS survive without teeth?

A

Yes colonize in furrows of tongue

53
Q

Acids producing bacteria are usually less than __% of the total flora in plaque.

A

1%

54
Q

Diffusion - acids produced by bacteria in the plaque diffuse rapidly through the plaque and into the enamel or dentin, travelling amongst the _____. After demineralization the dissolved ____ and ____ each diffuse out to the plaque. Diffusion occurs from a ____ concentration to a ____ concentration

A

Crystals
Calcium and Phosphate
High
Low

55
Q

Cariogentic bacteria + fermentable carbs =

A

organic acids - which penetrate enamel and dentin, and dissolve tooth mineral

56
Q

What percent of the crystal is carbonated hydroxyapatitie?

A

20% - it is more easily dissolved by acids

57
Q

Which is most soluble in acid?
Carbonated apatitie
Hydroxyapatitie
Fluorapatitie

A

Carbonated apatite = dental mineral

58
Q

What is the critial pH for enamel?

A

5.5

59
Q

Carbonated hydroxyapatite(dental mineral)
+ organic acids(lactic, acetic, propionic, formic)
= ?

A

Demineralization - Ca/P into solution

60
Q

Can caries lesion reach dentin without cavitation?

A

Yes - remineralization is still possible

61
Q

Demineralization can be stopped by?

A

Fluoride in the solution between crystals, it inhibits mineral loss

62
Q

What type of acid is more damaging than acid produced by bacteria?

A

Citric acid and HCL due to GERD

63
Q

What does Ca/P do in the remineralization process?

A

Builds on existing crystal remnants and new mineral is less soluble - like a new fluorapatitie veneer overlying the original defective crystal

64
Q

Systemically incorporated F has a _____ effect on solubility

A

Limited - F works primarily via topical mechanisms

65
Q

What are 3 positive affects of topical F?

A
  1. Inhibits demineralization
  2. Inhibits plaque bacteria
  3. Enhances remineralization
66
Q

F in solution at __ppm or greater markedly reduced the rate of dissolution of 3% carbonated apatite in acid buffer.

A

1 ppm - above 20-50ppm no further inhibition by F occurs

67
Q

F cannot enter bacteria in its ionic form, but as the bacteria produce acid, ___ is formed which diffuses readily into the cells where it inhibits ____ activity

A

HF

Enolase

operative dentistry (3 decks)

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