Case 1 Flashcards
1
Q
Clinical Crown
A
the portion of the tooth we
see above the gumline, exposed to the oral
cavity.
2
Q
Anatomical Crown
A
-the portion of the tooth
from the CEJ to the Cusps
3
Q
periodontal ligaments.
A
The tooth is attached to the underlying
alveolar bone with fibers known as the
periodontal ligaments
4
Q
Enamel
A
Hard calcified tissue covering the dentin
in the crown of tooth. Because it contains no
living cells, tooth enamel cannot repair damage
from decay or from wear. Only a dentist can
correct these conditions.
5
Q
Anatomical Crown
A
The visible part of your
tooth. It is normally covered by enamel.
6
Q
Gums (also called gingiva)
A
Soft tissues that
cover and protect the roots of your teeth and
cover teeth that have not yet erupted.
7
Q
• Pulp Chamber:
A
The space occupied by the pulp—
the soft tissue at the center of your teeth
containing nerves, blood vessels and connective
tissue.
8
Q
Neck
A
The area where the crown joins the root.
9
Q
Dentin
A
That part of the tooth that is beneath enamel
and cementum. It contains microscopic dentinal
tubules (small hollow tubes or canals). When dentin
loses its protective covering (enamel), the tubules
allow heat and cold or acidic or sticky foods to
stimulate the nerves and cells inside the tooth, causing
sensitivity.
10
Q
Jawbone (Alveolar Bone).
A
The part of the jaw that surrounds the roots of the teeth.
alveolar bone supports the teeth and is covered by gingival tissue.
11
Q
• Root Canal.
A
The portion of the pulp cavity inside the root of a tooth; the chamber within the root of the
tooth that contains the pulp.
12
Q
Cementum
A
Hard connective tissue covering the tooth
root, giving attachment to the periodontal ligament.
13
Q
• Periodontal Ligament.
A
A system of collagen
containing connective tissue fibers that connect the
root of a tooth to its socket.
14
Q
every tooth has 4 components
A
Enamel
• Dentin
• Cementum
• Pulp
15
Q
enamel is made by
A
Created by cells known as Ameloblasts
Because it contains no living cells, tooth enamel cannot repair itself from damage due to decay or wear.
Only a dentist can correct these conditions of damage or wear to the enamel.
Weakened enamel, however, can be strengthen with Fluoride
16
Q
Dentin is made by
A
Lies beneath the enamel and cementum in the tooth, created by cells known as Odontoblasts
The enamel and dentin meet at an area known as the “DEJ” or Dentino-enamel junction.
17
Q
Cementum is made by
A
Covers the root of the tooth • Secreted by Cementoblasts • If the cementum becomes exposed to the oral cavity through gingival recession, this surface can become very sensitive to temperature changes in the mouth (hot and cold). • The enamel and cementum meet at an area known as the CEJ or cementoenamel junction.
18
Q
pulp again
A
Pulp is the soft tissue at the center of the tooth
containing blood vessels, nerve tissue and
connective tissue.
• Pulp is lined by odontoblasts (cells that produce
dentin)
• Is divided into two areas:
• Pulp Chamber [in the crown of the tooth]
• Pulpal Canal(s) [in the root(s) of the tooth]
• If the pulpal area becomes exposed to decay,
a bacterial infection can occur and may
require root canal therapy in order to save
the tooth.
19
Q
Periodontium
A
The attachment of the tooth to the surrounding structures (bone) is accomplished through the cementum of the tooth, periodontal ligaments and the alveolar bone. Tissues of the Periodontium: 1) Gingiva 2) Cementum 3) Periodontal Ligament (PDL) 4) Alveolar Bone
20
Q
Alveolar Bone:
A
The portion
of the bone that surrounds
the root(s) of the teeth.
21
Q
Periodontal Ligaments:
A
The collagenous connective
tissue fibers that connect
the tooth to its socket
22
Q
Intraoral Radiographs and Their Indications
A
Dental Radiographs can help the dentist evaluate and definitively
diagnose caries, oral diseases and many conditions .
• ADA guidelines advise that the dentist must conduct a clinical examination
with oral and medical histories to determine the type of imaging and frequency
to formulate the proper diagnosis and evaluation.
23
Q
Types of X-ray radiographs
A
Bitewing x-ray Periapical x-ray Occlusal x-ray Panoramic x-ray Cephalometric radiograph Cone Beam x-ray (CBCT)
24
Q
Bitewing (BWs) Radiographs: Indications
A
Also called interproximal radiographs
• Visualize contact points between distal
surface of canine and posterior teeth for
detection of caries.
• Visualize alveolar bone level between canine
and posterior teeth for detection of
periodontal bone loss.
25
Bitewing Radiographs: Detection of Dental Caries (Decay)
Demineralization - makes tooth softer due to caries passing through the enamel
towards or into the dentin
• X-rays can pass through softened areas of tooth hitting the sensor, making these
areas look dark
• Radiolucency: a dark area on a radiograph representing loss of hard tissue, known
as dental caries or destructive lesions in the jaws, or normal soft tissue (pulp space)
• Radiopacity: light or white areas on a radiograph representing normal hard tissue,
increased hardness, or restorative materials
• Radiographs can’t predictably visualize pathological loss of hard tissue until
its affected at least 30% of hard tissue.
• X-rays are limited in detecting small carious (decayed) lesions
• Caries is always deeper than it appears on radiographs
```
Dental caries is always radiolucent
• Enamel, dentin, bone, and most restorations
are radiopaque
• Radiopacity is a relative term (like a
gradient)
• Bitewing (BW) radiograph is the best
diagnostic image for detecting caries in the
posterior teeth
```
26
Periapical Radiographs
```
PA radiographs help in visualizing crowns, contact
points, roots, apices (tip of the root) and area around
the apices into alveolar bone
Peri- = around, apical = apices
Indications:
• Periapical pathology
(infection or disease)
• Lesions in alveolar process
• Lesions in body of jaws
• Proximal caries in anterior teeth
```
27
Dental Caries on Periapical Radiographs
Radiographs cannot distinguish active from arrested caries
• Deeper aspect remains radiolucent (or darkened area)
• Radiographic examination and interpretation must be supplemented or
confirmed by visual intraoral examination
• Keep in mind caries is deeper than it appears on radiographs: can’t see
the leading edge of lesion because there must be at least 30%
destruction of hard tissue to see a radiolucency to begin with
28
Radiographic Interpretation
Pulp horns extend more coronally than the radiograph
indicates for the same reason – fine extent of pulp horns
are not 30% of tooth
• Often underestimate depth of caries and extent of pulp
horns
• Visual examination of teeth may not discover caries if
surface is intact due to remineralization (not cavitated)
• Radiographs may be only way to detect caries if
surfaces are intact
• Proximal surfaces:
Ø Radiolucent triangle with base at enamel surface
Ø Originate just apical to contact point of the teeth
Ø Location important; permits distinction from
cervical burnout
29
Radiographic Interpretation and dental caries
Caries (Latin for “decay” or “rot”)
• Multifactorial disease involving the tooth, oral
microflora, and diet over time in a susceptible host.
• Causes demineralization of tooth
• Initial lesion: subsurface loss of minerals at outer
surface of enamel
• Appears as a chalky white spot, if active
• Appears as brown or opaque spot, if arrested
• Caries can progress and/or remineralize: it’s a
dynamic process
• Caries can approximate or extend into pulp, causing
pulpitis (infection)
30
dental caries in general
Dental Caries remains the most prevalent chronic disease in
both children and adults, even though it is largely
preventable.
• Caries is the breakdown of tooth enamel. It is the result of
bacteria breaking down foods that produce acids which
destroy tooth enamel.
• Cavities may appear in many different colors including
chalky white, yellow, brown or even black.
• Symptoms when present, may include sensitivity, pain and
difficulty eating.
• Complications may include inflammation of the gum tissue
around the tooth, tooth loss and infection or abscess
formation.
31
Types of Caries
```
Smooth Surface
Cavity
• Pit and Fissure Cavity
(occlusal)
• Root Cavity
```
32
risk factors for caries
- food, history od decay, visible white spots, low socioec, special needs, premature birth, dry mouth.
33
preventative caries measures
saliva and sealants, antimicrobials, fluoride, good dietq, pit and fissue sealants
34
why do caries risk assessment
allows patient and provider to work together and determine the patients risk for caries and for treatment and homecare recs to be patient specific
35
how does fluoride prevent tooth decay
it is incorporated into developing tooth's mineralized structure, exchanges Oh in hydroxyapatite with mixed fluorohydroxyapatite which is stronger
- F makes crystals less sol and more resistant
36
caries risk factors
biological from family, protective (dental care at home) clinical findings (white spot lesions, high strep mutans, plaque)
37
attachment mech of tooth
The attachment of the tooth to the surrounding and supporting structures (bone) is accomplished through the cementum of the tooth, periodontal ligaments and the alveolar bone. The root of the tooth (cementum) is attached to the underlying bone by a series of periodontal fibers that make up the periodontal ligament and allow for minor movement of the tooth in the socket without damage to the tooth or the underlying structures.
38
gingiva structure - Alveolar mucosa
Alveolar mucosa –
The area of tissue beyond the mucogingival junction.
It seems less firmly attached and redder than the attached gingiva.
It is non-keratinized and provides a softer and more flexible area for the movement of the cheeks and lips.
39
Attached gingiva –
is adjacent to the free gingiva and is keratinized and firmly attached to the bone structure.
40
Free gingiva –
is not attached and forms a collar around the tooth.
the trough around the tooth is called the sulcus and its depth is normally 1-3 mm.
It is lined with sulcular epithelium and attached to the tooth at its base by the epithelial attachment.
41
Gingival margin –
The border region of the gingiva that touches the tooth.
42
Interdental papillae
The region of gingival tissue that fills the space between adjacent teeth. In a healthy mouth this is usually knife-edged and fills the interdental space.
43
Muco-gingival junction
The scalloped line that divides the attached gingiva from the alveolar mucosa.
44
Risk:
is the probability that an event will occur.
45
Risk Factor:
is an environmental, biological, behavioral, or social factor confirmed by temporal sequence, which directly increases the probability of a disease occurring if it is present. If this factor is absent or removed, it will reduce the probability of a disease occurring.
46
Risk Assessment:
is the qualitative or quantitative estimation of adverse effects that may result from exposure to specific hazards or the absence of biologic influences.
47
What is happening in the Oral Cavity
It is important to note other factors that increase caries risk.
tooth morphology and alignment—such as areas that are crowded, teeth that are pitted or rough, or teeth that are physically difficult to clean
restorations with faulty margins can also increase caries risk because they provide a perfect physiologic niche that can harbor cariogenic bacteria.
48
Pit-and-Fissure Sealants
Anatomical grooves, or pits and fissures on occlusal surfaces of permanent molars can trap food particles and promote the presence of bacterial biofilm, increasing the risk of developing caries lesions. Effectively penetrating and sealing these surfaces with a dental material e.g., pit-and-fissure sealants, can prevent lesions and is part of a comprehensive caries management approach.
sealants are effective in preventing and arresting pit-and-fissure occlusal caries lesions of primary and permanent molars in children and adolescents compared to the non-use of sealants or use of fluoride varnishes; and
sealants can minimize the progression of non-cavitated occlusal caries lesions (also referred to as initial lesions) that receive a sealant.
49
Nutrition
how body uses food to meet requirements for growth , development, repair and maintenance
the micro- (vitamins and minerals) and macro- (carbohydrates, protein, and fat) nutrients
affects the development, regeneration, and repair of both hard and soft oral tissues.
50
Diet
refers to the specific foods consumed
| - pattern of individual food intake
51
diet and nutrition
The relationship that diet and nutrition have with oral health is bidirectional
- one impacts the other
52
Factors influence the oral cavity
```
Dietary
Macro- and micro- nutrients
Vitamins
pH properties
Stage of development
Medical conditions
Socioeconomic status
and +
behaviors associated with their consumption
```
53
six essential nutrients
vitamins, minerals, fats, proteins, carbs, water
54
Carb functions
Provide a source of energy to facilitate body metabolism and control body temperature
Spares the burning of protein for energy
Combine with nitrogen to form nonessential amino acids
Needed for structural components of the body
Collagen, cartilage, bone, nervous tissue
Palatability
Carbohydrates should supply between 45% and 65% of daily calories.
55
Monosaccharides
Glucose (dextrose)
Grapes, corn syrup, honey, fruits
Majority stored in the liver and muscle as glycogen
Fructose
Fruit, honey, corn syrup, high fructose corn syrup
Galactose
Component of lactose, rarely found in nature as a monosaccharide
Dairy products
56
dissac
Sucrose
Table sugar, brown sugar, maple syrup, fruits
Maltose
Malt barley, beer, ale
Lactose
Milk, milk products (cheese, yogurt, cream)
57
Polysaccharides
Composed of more than 10 sugar units
Starch
Plant storage form of glucose
Potato, rice and wheat are major sources of starch in the human diet.
Glycogen
Animal storage form of glucose
Stored in muscle and liver until body needs energy
58
Proteins - Functions of Proteins in the Body
```
Essential to muscles, tendons, nerves, bones, and teeth
Some types
Collagen
Actin and myosin
Enzymes
Hormones
Maintain fluid balance
Maintain acid–base levels
Can provide energy to the body but more important for tissue building
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59
role of proteins in the body
structure: collagen: matrix of protein in skin, bones and teeth. Crystallin structural protein of eye lens
transport and binding: hemoglobin, ferritin
enzymes: salivary amylase, pepsin
regulation: insulin: hormone that regulates uptake and storage of glucose
calmodulin: involved in regulation of calcium mediated process
protection: IgA antibodies in saliva that neutralize foreign stufff
histatins; salivary antibac
pH regulation:
sialin is salivary pH buffering protein
protein conjugates:
- glycoproteins: salivary mucins
lipoproteins: low-density lipoproteins, chylomicrons
nucleoproteins: chromatin , nucleosomes
60
types of AA
Essential (indispensable or conditionally indispensable) amino acids
Cannot be made by the body and must be consumed in the diet
Nonessential (dispensable) amino acids
Body requires for functioning but can derive these from the diet or synthesize in the liver from other amino acids.
61
Groups at risk for protein deficiency
Children of low socioeconomic status
Chronically ill
Hospitalized patients
Elderly
D R I is 0.8g/kg body weight for healthy adults.
Even a single event of protein-energy malnutrition in the first year of life can lead to:
delayed deciduous tooth eruption
delayed loss of primary teeth
increased number of caries
62
protein deficiency in dentistry
Protein deficiency can affect the growth and development of oral tissues and structures
Protein deficiency can also increase susceptibility to general and oral infections
Protein in excess can reduce calcium retention and subsequent bone health
63
lipids
Composed of carbon, hydrogen, and oxygen
Insoluble in water; soluble in organic solvents
Widely distributed in food and the body
Some are essential in the diet.
64
Functions of Lipids
Provide calories needed to meet the body's energy needs.
Source of essential fatty acids needed for:
cell membranes, skin, cardiovascular, eye, and brain health
Phospholipids are essential:
for the structure of cell membranes
form the membrane of lipoproteins in order to make the transport of lipids in the blood possible
Give a sense of fullness by delaying emptying of food from the stomach.
Provide a sense of satiety by stimulating the release of hormones such as leptin, which communicate with the body to regulate appetite and food intake.
Cushion vital body organs.
Provide insulation and help maintain body temperature.
65
functions of lipids 2
Enhance the palatability of foods by absorbing and retaining flavors.
Aid in absorption of the fat-soluble vitamins A, D, E, and K and carotenoids.
Adipose tissue is the site of fat storage in the body where excess triglycerides are stored until they are needed for energy during fasting.
Cholesterol is used to make hormones, bile acids, vitamin D, aldosterone, and glucocorticoids.
66
lipid types
Lipids that are relevant to food and nutrition
Triglycerides
Phospholipids
Sterols
67
Food sources for dietary fats
98% of dietary fat is triglyceride.
Approximately half of fat in the American diet comes from oils, meats, and whole-dairy foods.
Meat, poultry, and eggs are high in saturated long-chain fatty acids.
Nuts, seeds, olives, and avocados are high in unsaturated fats.
High dietary fat intake is significantly associated with chronic diseases.
Obesity, cancer, cardiovascular disease
It is recommended to reduce total fat and saturated fat intake.
For children and adolescents ages 4-18 years: 25-35% of total calories.
68
implications for dent with fatty diet
Periodontal disease
Although a pathogen is required to initiate the infection that leads to destruction of connective tissue and bone, dietary factors can exacerbate the body's inflammatory response.
Omega-3 polyunsaturated fatty acids may be useful to manage
A higher intake of DHA (Docosahexaenoic acid) or EPA (Eicosapentaenoic acid) may be associated with reduced prevalence of periodontal disease in adults.
Dental caries
Fats may protect tooth surface, prevent adherence of carbohydrates, and have an anti-cariogenic effect
69
minerals
The essential minerals are a group of elements that are necessary in small amounts to maintain health and function.
Cannot be made endogenously and must be supplied by the diet
70
Macrominerals
are needed in larger amounts (100mg/day or more).
| Calcium, phosphorus, magnesium, sodium, potassium, and chloride
71
Microminerals, or trace elements
are needed in amounts no more than a few milligrams per day.
| Iron, zinc, iodine, fluoride, chromium, cobalt, manganese, molybdenum, selenium, and zinc
72
Minerals Involved in Mineralization of Hard Tissues
Calcium
Phosphorus
Magnesium
Fluoride
73
calcium
The most abundant mineral in the body
There are 1200-1400g present in adults.
99% located in the skeleton
Majority is in the structure of bones and teeth.
Functions of calcium
Bones and teeth
Bone formation and remodeling
Vascular, muscle, nerve, and hormone function
74
calcium metabolism
```
Metabolism
Absorption
Absorption enhancers
Acid pH
Vitamins C and D
Some amino acids and lactose
Regulation of calcium
Parathyroid (P T H ), calcitriol, calcitonin, serum phosphorus levels, and metabolically active vitamin D
```
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Metabolism
Excretion: in the urine, feces, and other bodily fluids
Calcium requirements and range of safety
1000mg/day for adults (Upper level (UL) of safety: 2.5 grams/day)
People at risk for deficiency
Insufficient calcium intake
Milk allergies
Lactose intolerance
Malabsorptive conditions
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75
sources of calcium
```
Sources of calcium
Foods
Highest concentrations in dairy products as well as leafy greens
Dietary supplements
Calcium carbonate and calcium citrate
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76
too little calcium
Effects of too little calcium
Rickets
Deficiency seen in infants and children
Osteomalacia
New bone matrix fails to mineralize in adults.
Osteoporosis
Compromised bone strength due to reduced mass and quality
77
too much calcium
Effects of too much calcium
Calcium excess has not been observed in healthy people.
Toxic signs are associated with:
Excess vitamin D
Disease states: parathyroid or kidney diseases
78
calcium and dent
Calcium is essential for mineralization of teeth, maxilla, and mandible.
Insufficient calcium is a major problem in females, leading to osteoporosis and related disorders.
Patients should be encouraged to consume adequate calcium.
79
Phosphorus
85% of phosphorus is located in bones and teeth.
Remaining amount is found in muscles, organs, blood, and other fluids
Functions of phosphorus
Bone and teeth development
Major buffer
Energy metabolism
Cell structure
80
phosphorus metabolism
Absorption
Nearly all phosphorus ingested is absorbed.
Presence of high levels of other cations lessens absorption.
Absorption is by both active and passive transport mechanisms.
Absorption can range from 55-70%.
Excretion
Regulated by kidneys
81
Phosphorus sources
```
Requirements and range of safety
DRI: 700mg/day
Upper range of safety: 3-4 g/day
Sources of phosphorus
Foods
Processed foods and carbonated beverages contain phosphates for non-nutrient function.
Dietary supplements
```
82
Summary and implications for dentistry of phosphorus
Deficiency associated with altered dentin and enamel mineralization, resulting in hypoplasia
Urge moderation in the use of phosphorus-containing beverages such as colas.
83
Fluoride
```
Natural element found at varying concentrations in all drinking water and soil
Present in trace amounts in the body
Deposited in calcified structures of the body (bones and teeth)
Body content depends on intake.
Requirements and range of safety
Adequate Intake (AI)
3mg/day for women
4mg/day for men
UL: 10mg/day
```
84
Functions of fluoride
Increased resistance to acid demineralization
Re-mineralization of incipient lesions
Interference in the formation and functioning of dental plaque microorganisms
Increased rate of post-eruptive maturation
Improved tooth morphology (pre-eruptive)
Stimulates bone cell (osteoblast) proliferation and increased new mineral deposition (cancellous bone)
85
Fluoride Metabolism
Absorption
Absorption occurs rapidly, directly from the stomach
Better absorbed from drinking water than from food
Deposited into bones and developing teeth, or excreted in the urine (60-70%)
Incorporated into the developing tooth's mineralized apatite structure
Excretion
By the kidneys; amount ranges from 20-50%
86
Sources of fluoride
Foods
Fluoridation: the adjustment of water to contain from 0.7 to 1.2 ppm of fluoride
The amount that confers optimum protection against dental caries
Dietary supplements
Nearly 75% of community water supplies in the U.S. are fluoridated.
Fluoride supplements may be indicated for children who do not have fluoridated water.
87
Effects of too little fluoride
Increased risk for dental caries
88
Effects of too much fluoride
Excess fluoride in developing teeth can result in fluorosis.
Appearance of irregularly distributed patches in tooth enamel
Range from chalky-white to yellow, to grey, and to brown or black
Occurs in children when fluoride concentration ingested is from 2-8mg/kg body weight
89
Summary and implications for dentistry of fluoride
A mineral that enhances tooth and bone health when provided in optimal amounts throughout the lifespan
Fluoride increases tooth resistance to dental caries, primarily through topical effects
Fluoridation of public water supplies has been endorsed as the most effective dental public health measure in existence
The dental team should:
Ensure that young children obtain appropriate amounts of fluoride.
Educate patients of all ages on the benefits of topical fluoride in caries prevention throughout life.
Educate patients as to how to avoid excess fluoride consumption.
90
Beverage-Related Issues
Increased juice intakes increase caries risk.
Increased carbonated beverage intakes create tooth decay, excess energy intake.
Decreased milk intakes lead to osteoporosis.
Decreased water intakes leads to dehydration
Recommendations are to limit consumption of sugary beverages, drink using a straw, and drink water when one's mouth is dry.
91
Nutrition Basics for Children and Teens
The primary oral health issues in adolescence and adulthood are the prevention and treatment of:
Caries
Periodontal disease
Children's dietary needs vary at different stages of development.
92
Nutrition Basics for Children and Teens 2
Energy and nutrient requirements depend on body size and composition, rates of growth, and activity patterns.
Growth rate slows after infancy into the preschool years, then increases into puberty.
It is important to follow diet and vitamin/mineral requirements.
Parental and peer environments have major impacts on food choice.
