Clinical Correlation: Mechanisms of Caries & Prevention Flashcards
what is caries?
infectious disease
multifactorial (not just one thing)
-biofilm, bacteria, time, diet, habits, education, socioeconomic factors
manage caries disease ___
holistically
disease of early childhood caries (ECC)
the presence of one or more Decayed, Missing, or Filled tooth surfaces in any primary tooth in a child under the age of six
DMFT=decayed, missing, filled teeth
early childhood caries consequences
-higher risk of new carious legions
-hospitalizations and emergency room visits
-high treatment costs
-loss of school days, diminished ability to learn
-diminished oral health-related quality of life
ECC is ___ times more common than asthma
5
children @ or below the poverty level are ____
> 50% more likely to have ECC
how is bacteria transmitted from caregiver to child?
transmitted vertically through salivary contact; affected by the frequency and exposure
high levels of ___ is a result of untreated caries
Strep mutans
horizontal transmission of bacteria
also occurs b/w other members of a family or children in daycare
what happens to infants whose mothers have high levels of Step mutans?
they are at greater risk of acquiring the organism earlier than children whose mothers have low levels
AAPD policy statements
-limit sugar
-implementing oral hygiene very early
-professionally applied fluoride varnish
-getting a dentist w/in 6 months of first tooth eruption
-work w/ medical providers to make sure there is access to oral healthcare
-educating legislators and policymakers
dental caries
“decay and crumbling of tooth”
how do caries form?
-bacteria in dental plaque “eat” carbohydrates from our diet
-bacteria secrete acids
-acids lower pH
-enamel demineralizes at pH of 5.5 or below
-results in carious lesion
enamel demineralizes at what pH?
5.5
dentin demineralizes at what pH?
6.5
pit & fissure caries
?
smooth surface caries
on the smooth surface of the tooth
new caries lesion
attacking a previously INTACT surface
recurrent caries lesion
occurs around margins of restoration
residual caries lesion
caries left behind before filling is placed
active caries
matte & mushy
arrested (inactive) caries
shiny & firm
incipient/initial lesion
hasn/t broken into dentin layer
caries classification system
INITIAL caries
MODERATE caries
ADVANCED caries
initial caries
lesion has started but not progressed into the dentin
moderate caries
lesion has extended into dentin
*drill and fill
advanced caries
deeper lesions- getting close to the pulp
*probably root canal or extraction
caries is a(n) ______ disease
-infectious
-manageable
-preventable
primary microbes in caries
-Strep mutans
-Lactobacillus
-Actinomyces
requirements for caries
-susceptible host
-bacteria
-food source
-time
what is better for plaque pH?
-eating 3 meals a day
-snacking all day
eating 3 meals a day
demineralization and remineralization is ____
a constant battle
carious lesion form when…
demineralization is greater than remineralization over time
process of demineralization
-bacteria consume carbs from your diet
-acid is the waste product
-acid results in demineralized enamel
things that contribute to remineralization
-saliva
-good hygeine
-decrease fermentable carb consumption
-fluoride
functions of saliva
-raises pH to non-demineralizing levels
-flushes away floating microbes
-antibacterial properties
-calcium & phosphate ions that can re-enter the tooth for remineralization
good oral hygiene
removes bacterial habitat
diet
“starves” bacteria
fluoride
hydroxide ion is replaced by fluoride ion –> makes enamel more resistant to acid
enamel
-outer layer
-most highly mineralized tissue in the body
-96% calcium hydroxyapatite crystals
-4% organic materials and water
-there is no secondary or post-natal production of enamel
amelogenesis
enamel formation
-ends at tooth eruption
dentin
-45% hydroxyapatite crytals
-33% organic material
-22% water
-can be produced postnatally (secondary or tertiary dentin)
dentin enamel junction (DEJ)
-where the dentin and enamel meet
-weak spot
*probably should add more but that’s all she said
amelogenesis cycle
-cyclical
-dentin forms first
steps of amelogenesis
- pre-secretory stage
- secretory stage
- transition stage
- maturation stage- RA
- maturation stage- SA
- post-maturation stage
pre-secretory stage of amelogenesis
growing the enamel out from the dentin
secretory stage of amelogenesis
enamel matrix proteins (EMPs) constantly secreted near dentin–> create aprismatic enamel near dentin (very hard to bond to)
ameloblasts form…
individual enamel rods via their Tome’s processes
aprismatic enamel is closest to
dentin
progress of carries
-attachment
-colonization
-biofilm development
pellicle formation
streptococci first
filamentous follow (actinomyces)
strep mutans participate in…
formation of biofilms on tooth surfaces
PEP group translocation
distinct method used by bacteria for sugar uptake which uses phosphoenolpyruvate as an energy and phosphate source
what process makes lactic acid?
glycolysis
*anaerobic
how does the carie expand deeper into dentin?
region becomes more acidic –> promotes greater colonization
factors determining dental caries sensitivity
-differences in the gram-positive composition of supragingival microbial biofilms
-dietary carbohydrate ingestion (sucrose content & freq. of ingestion)
-saliva access to teeth surfaces & its flow rate
-fluoride in the drinking water & toothpastes
-antibodies to Strep mucans in blood & oral cavity
how does saliva resist caries?
rinses & neutralizes w/ bicarbonate ion
what stimulates saliva secretion?
primarily parasympathetics but some sympathetics
sympathetic stimulation of saliva
more viscous saliva, slower secretion rate
production of bicarbonate ion from CO2 is catalyzed by…
carbonic anhydrase enzyme
*present in saliva and salivary glands
what is the most abundant enzyme in human saliva?
amylase
how does amylase PROMOTE caries formation?
aids in breakdown of carbohydrates
how does amylase PROTECT AGAINST caries formation?
aids in clearing carbohydrates from tooth surfaces –> bacteria has less time to digest maltose
fluoride can rarely cause…
fluorosis (mottled teeth)
fluoride may become ineffective below a pH of what?
4.5
3 mechanisms used by fluoride to protect against caries
- inhibition of demineralization
- enhancement of remineralization
- inhibition of bacterial enolase activity inhibiting lactase production from ingested carbohydrates
biofilms are resistant to…
destruction
