Chapter 9 Flashcards
How do we get caries?
Teeth demineralize during acid attack.
–Every eating event is an opportunity for bacteria to use sugar to make acid.
Teeth will remineralize
in between acid attacks.
Calcium and phosphorous in saliva replace
Lost minerals
Available fluoride in the oral cavity will reduce .
The affect of acid on teeth
Normal oral pH is between
6.8-7.0
Critical pH is
5.5
What happens at critical pH
This is the point teeth will start to demineralize
- bacteria will metabolize to create acid
- good can also have pH of 5.5
1st during demineralization Acid moves through
Dentinal tubules
The acid produced by bacteria during demineralization process can cause
Increased solubility of tooth structure (calcium hydroxyapatite)
Calcium (during demin)
Leaches from tooth structure
Demineralize area first appears as
White spot
After food clears from mouth
pH starts to return to basic 7.0 and starts remineralization process
During remineralization the minerals in saliva
take the same path as the acid to through tubules to replace those that are lost —calcium and phosphorus
during remineralization fluoride will
incorporate into the crystalline surfaces tht have been partially dissolved
hydroxyapatite converts into
fluorapatite which fortifies tooth structure against future acid attack
when demineralization time is greater than remineralization time
cavities develop
when remineraliation time is greater than demineralization time
you remain caries free
enamel is
porus
how long does it take for cavitation to progress through enamel for high rick person
19-22 months
high caries risk person includes:
high carb diet
poor quality saliva
poor oral hygiene
unavailable fluoride
how long does it take for cavitation to progress through enamel for low risk person
5 years
person for low caries risk includes
Sucrose consumption in diet limited to 5% to 10% of daily calorie intake
Diet rich in whole unprocessed foods and foods that keep pH around 7
Ample saliva
Daily plaque removal
Use of fluoridated toothpaste
6 factors that play a role in caries development
- Carbohydrates in the diet
- Presence of specific bacteria
- Susceptible tooth structure/host resistance
- Absence of fluoride
- Salivary gland hypofunction
- Poor oral hygiene habits
Most of what we know about the relationship of carbohydrates and dental caries is a result of
the Vipeholm study
Vipeholm study
- 1945 to 1953
- 436 adult residents at a mental institution in Vipeholm, Sweden
- Study conducted to determine if form and frequency of eating sugar had an effect on dental caries
During Vipeholm study the subjects were divided into
3 Groups:
- ) Basal diet with 300 g of additional sugar in solution during meals (sweet beverage)
- ) Basal diet with 50 g of additional sugar with bread during meals
- )Basal diet with in-between snacks of toffee and candy consisting of a small amount of sugar
Results of Vipeholm Study: First highest caries rate found in which group?
Group that had in between meal candy
Results of Vipeholm Study: Second highest caries rate found in which group?
Group who ate sweet spread on bread
Primary factor in caries ctivity
Frequency of sugar intake
what can increase incidence of caries
Form of foods:
-Retentive foods that stay in the oral cavity longer than liquids increased the rate of caries
Sugar
Exerts caries-promoting effect locally on tooth surfaces.
What has the potential to cause caries
All foods and beverages that contain sugar
Ultra processed food that does not taste sweet may contain
High Fructose corn syrup (HFCS) to improve shelf life
Plaque bacteria will feed on
carbohydrates and produce acid that demineralizes enamel.
Bacteria produce acid for as long as
The carbohydrate remains in the mouth
When is there an opportunity to for bacteria to make acid
Every time you eat or take a sip of a drink
Eating behaviors that are detrimental to teeth
Sipping and Grazing
Goal is to keep oral pH
as close to 7.0 for as long as possible throughout the day
Research by Stephan and Miller in 1943 demonstrated that oral pH drops
within 3 minutes of rinsing with sucrose.
Categories of foods that play a role in caries
Cariogenic
Acidic
Cariostatic
Fermentable carbohydrates
- ) Monosaccharide
- ) Disaccharide
- ) Sweeteners used in manufacturing—juice, honey, HFCS, glucose, and refined starch
Average sugar consumption
¼ pound each day which is Equivalent to four cans of soda.
Ultra-processed foods contain
about 20% sucrose which accounts for 57% of daily calories
Cariostatic foods
- ) Do not contribute to initiation of enamel demineralization
- ) May prevent dental caries
- ) Maintain a more basic oral pH—animal protein, fats, and calcium-rich foods
Polyphenols (Plant molecules) inhibit
acid production—cranberries, cocoa, tea, and coffee
Cariostatic cheeses
Aged cheddar Swiss Blue cheese Monterey Jack Mozzarella Brie Gouda
Cariostatic foods
Cheese Nuts Protein Sugar-free gum Candy and gum with xylitol
Foods containing acid have a
low pH value that will erode enamel:
Foods containing acid will usually have one of these on the label
citric, phosphoric, malic, tartaric, lactic, ascorbic, and carbonic acids on food label ingredient panels.
Erosive foods will
soften enamel surface
-As the surface continues to soften and erode, the dentin gets closer to the surface.
How does a tooth look where it has eroded
Darker
examples of acidic food
soda, citrus fruits, yogurt, and grapes.
Liquids clear the oral cavity faster than what
solid or sticky food
Regular and diet sodas are very acidic and
Most have citric and phosphoric acid as flavor enhancers.
pH levels range from 2.3 to 2.6.
Is diet soda better for your teeth than regular soda
NO
Drinking acidic soda lowers pH to
below 5.5
Are starchy foods cariogenic or cariostatic
Cariogenic
starches have retentive factors such as:
bread, rice, and vending snacks.
Starch is reduced to fructose and maltose
by salivary enzymes
Starches combined with sugar
the combination is more detrimental than either by itself (EX: bread spread with jelly)
if you alternate a bite of cariogenic food with a bite of cariostatic food it will
keeps the oral pH higher.
Eating crunchy foods with a meal assures
adequate saliva to clear the oral cavity quickly.
Drinking sugary beverages with meals will
clear with other food. Drinking between meals provides a separate acid attack.
Bacteria that play a role in dental caries must me
Acidogenic
Aciduric
Acidogenic
ability to produce acid
Aciduric
ability to tolerate and thrive in an acidic environment
Acids produced
Lactic
Formic
Propionic
Acetic
Which acid is most abundant
Lactic
How many bacteria are in the mouth
over 500
Bacteria cultivated at site of caries
- ) Streptococcus mutans
- ) Streptococcus sobrinus
- ) Actinomyces
- ) Lactobacillus—predominant in dentinal and root caries
- ) Candida albicans—ECC
Shallow grooves are less susceptible to
dental caries
Straight teeth are less or more susceptible
Less susceptible
-Affected by pre-eruptive nutrition
Fluoride is absorbed by
the mucosal tissue
Professional application of fluoride will arrest
developing caries.
Salivary fluoride levels will be elevated
up to 3 hours after brushing with fluoridated toothpaste.
Fluoride accumulates in
plaque fluid and is held against enamel.
True or false?
Daily use of fluoridated toothpaste and mouthwash adds to the reservoir of the mineral available in the oral cavity.
TRUE
After fluoride what is the #1 protector of teeth
Saliva
Saliva is saturated with
calcium, phosphate, sodium bicarbonate, and proteins.
what is pH of Sodium bicarbonate
7.0
eating what increases salivary production?
Crunchy foods
Clears food from oral cavity and dilutes acid
Saliva
which is more effective at rinsing teeth: Viscous or more fluid saliva
More fluid saliva
More chewing means that
saliva increases :
Saliva flow is stimulated by
Chewing
If a person has a lot of saliva
food will clear faster so pH returns to basic faster.
Chemical factors in saliva
Sodium bicarbonate, phosphates, protein, and urea in saliva buffer acid.
More saliva means more buffering chemicals available and that will
Protect teeth
Calcium and phosphorus in the diet can
saturate saliva and assist with remineralization.
Mucins in saliva
Trap bacteria and are swallowed with saliva.
Proteins in saliva can
Kill bacteria
Does Motivation to remove bacterial plaque play a role in keeping teeth caries free?
Yes, a major role
Eating carbohydrates will make plaque sticky which can
cause more plaque to accumulate
Scrupulous home care will
eliminate bacterial plaque from the caries equation.
Early Childhood Caries (ECC)
- Affects mainly maxillary anterior teeth.
- Mandibular anterior teeth are protected by tongue and saliva.
- Sucking on bottle stops during sleep and fluid pools around teeth.
ECC can be prevented by
- ) Wean off bottle at an early age
2. ) Put child to bed with bottle of water or pacifier
Sugar substitutes
Synthetic sweeteners
Sugar alcohols
(Both are noncarogenic)
Which sweeteners are noncaloric
ONLY synthetic
Aspartame
(Equal or NutraSweet)
180 times sweeter than sucrose
Used by 100 million people worldwide
Saccharine
(Sweet ‘N Low or Sugar Twin)
300 times sweeter than sucrose
Acesulfame K
(Sweet One)
Sucralose
(Splenda)
Made by chlorinating sucrose
Sugar alcohols
Sorbitol Xylitol Maltitol Mannitol Lactitol Isomalt Erythritol
Xylitol
- Most desirable of all sugar substitutes
- Not metabolized by bacterial plaque
- Reduces salivary Streptococcus mutans in the oral cavity
- Has capability to remineralize incipient decay
Include what with each meal for ample saliva and to help clear the oral cavity
One crunchy food
