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DMD2 > CPP - ACP > Flashcards

CPP - ACP Flashcards

1
Q

What are the 4 stages of the approach to minimal intervention dentistry?

A

Caries disease: All about biofilms, forms on all tooth surfaces. A thin biofilm is protective our task is to help restore or maintain homeostasis. Caries is a lifestyle disease.

Remineralization aka use of (CPP-ACP/Fluoride they are so highly negative that they attach to hydroxyappatite crystals and form crystals that are 6 times larger than hydroxyappatite making them more resistant to caries)

Minimal invasive dentistry

Oral hygiene

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2
Q

What is the caries balance between?

A

Pathological factors

Protective factors (saliva, calcium, and phoshate)

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3
Q

Where does calcium and phosphate come from in the saliva?

A

Calcium and phosphate come from the major salivary glands

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4
Q

How does pH affect biofilm in teeth?

A

Low pH is heavily causative of biofilm formation.

Coke has phosphoric acid (ETCH), citric acid (removes calcium away from remineralization, caffeine (dries the mouth)

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5
Q

How can biofilm be reduced?

A

Brushing twice a day thins biofilm and delivers fluoride and modifies diet and behaviour.

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6
Q

What kind of factors relating to sugar exposure affect the level of dental caries?

A

Frequency and duration of exposure are correlated with dental caries.

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7
Q

What kind of sugar consumption is most problematic?

A

Snacking is more detrimental to teeth than normal meals

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8
Q

Are strep mutans and lactobacilli the causative factors of plaque production?

A

Not just streptococcus mutans and lactobacilli are acid producing plaque

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9
Q

How can cavities be treated non-invasively?

A

Cleaning the plaque and adding topical fluoride will harden lesions. This prevents the need for restoration.

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10
Q

What is required for fluoride to remineralize dental tissue?

A

10 calcium 6 phosphate and 2 Fluoride

This means that this could be a factor for the inability of fluoride to always remineralize teeth.

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11
Q

What are white-spot lesions a good measure of?

A

White-spot lesions are a good measure of active caries disease

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12
Q

What causes white spot lesions besides caries?

A

Fluorosis

Hypomineralisation / hypomaturation

Hypoplasia

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13
Q

What is a white spot lesion?

A

Area with less calcium and phosphate and is water filled (subsurface lesion)

It is porous and covered in lipid-protein. To get things into it the lipid-protein should be removed)

High fluoride will seal the surface without reversing the white spot lesion.

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14
Q

Why can’t calcium phosphate be used to replace missing calcium and phosphate?

A

Amorphous calcium and phosphate preceipitate out fo water. Statherin is used by saliva to deliver the calcium and phosphate to the teeth.

A supersaturated solution is also needed to allow remin to take place.

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15
Q

What food types allow calcium phosphate to bind to tooth structure?

A

Milk and cheese have anticariogenic properties (casein is anticariogenic)

CPP is equivalent to milk products.

This is a different action to fluoride

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16
Q

What does CPP do?

A

CPP binds strongly to dental plaque and is able to slow or prevent diffusion of calcium ions from enamel during episodes of acid challenge

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17
Q

How does CPP-ACP work?

A

CPP-ACP breaks down plaque at <4.5 pH. Creates a concentration gradient by supersaturationn of calcium phophate and fluoride

CPP binds to the apatite crystal faces in the surface of the lesion and keeps the diffusion pathways open to allow ions to penetrate more deeply.

CPP-ACP prevents plaque development in-situ.

They allow remineralisation of the body of the lesion.

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18
Q

What are the indications for use of CPP-ACP?

A

Reversal of white spot lesions

CPP helps reduce hypersensitivity to prevent tooth erosion and helps lubricate mouth in dry mouth patients.

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19
Q

How does CPP work with fluoride?

A

Synergy of effect of CPP and fluoride.

Don’t use on patients with a tooth allergy.

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20
Q

How much remineralization is needed for white spot lesions?

A

Only 60% remineralization is needed to remove white scar

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21
Q

How should TM plus be applied?

A

Wet mouth then apply pea size drop on fingers and place on teeth directly.

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22
Q

Where is TM plus used?

A

Orthodontic cases with bad oral hygiene resulting in white spot lesions.

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23
Q

What are the difficulties with use of CPP-ACP?

A

Lack of compliance - Fluoride remains the mainstay of chemical anti-caries medication

Complexity of instructions - won’t or can’t comply

Elderly patients don’t like to chew any gum

Inadequate research papers on remineralization of dentine caries.

24
Q

How does fluoride affect the association between sugar intake and caries?

A

It reduced but did not eliminate the association between amount of sugar intake and dental caries.

Fluorides mainly prevent demineralization and high concentrations have a toxic effect on dental plaque and provide a modest level of chemical plaque control for limited period after application.

25
Q

What does fluoride do?

A

It can reduce dissolution of tooth (demineralisation by bacteria)

It can reduce bacterial metabolism in high concentrations (Glycolysis, and other)

It is highly negatively charged - touches enamel surface and it immediately chemically incorporates and forms fluoroapatite

Fluoroapatite is a larger crystal so 6x more resistant to demineralization

26
Q

How do active caries look different to arrested caries?

A

Active caries are soft and cavitated they look yellow

Active caries can also be cavitated and leathery

When arrested the cavities start to have a darker colour or a brown colour

27
Q

Is fluoride effective as a population-wide measure?

A

It is but it has a limited effect. It prevents demineralization rather than achieving remineralization due to absence of calcium and phosphate ions in saliva.

28
Q

How is fluorapatite different to hydroxyappatite?

A

Fluorapatite is the most stable and least soluble form of calcium phosphate and is 6x more acid resistant due to larger crystal size

29
Q

What are white spot lesions a good measure of?

A

Active caries disease

30
Q

What is the cause of white spot lesions?

A

Presence of clinically detectable, localized areas of enamel demineralization, observed as white spot lesions of different opacity is a sign that caries process has begun. Dental caries results in the dissolution of apatite crystals and the loss of calcium, phosphate and other ions which eventually leads to demineralization of the tooth

31
Q

What are some alternate causes of white spot lesions?

A

Fluorosis

Hypomineralization / hypomaturation

Hypoplasia (Trauma, fever, illness, medications)

32
Q

How should white spot lesions be treated ideally?

A

They should be detected early and treated non-invasively.

33
Q

What is a white spot lesion?

A

A water-filled sub-surface lesion with an intact surface missing calcium and phosphate.

It is porous and covered in lipid-protein

34
Q

What protocols should be followed with white spot lesions?

A

Initially avoid high fluoride toothpaste but then it becomes essential.

35
Q

How does fluoride remineralize?

A

Predominantly at the surface of the lesion.

36
Q

Why not use ACP (amorphous) calcium and phosphate in a WSL?

A

Ca++ and PO4 must be stable in a supersaturated solution without preceipitation. In saliva this is done by statherin.

37
Q

What is the clinical reason for calcium phosphate remineralization to not be successful?

A

Low solubility of calcium phosphate

Solid calcium phosphates not easily applied nor effectively localized at the tooth surface

Solid calcium phosphates require acid for solubility to produce remineralizing ions

Soluble calcium phosphates can only be used at low concentrations and they do not effectively localize at tooth surface

38
Q

Where does CPP come from?

A

Phosphopeptides are derived from CPP which is casein phosphopeptide.

39
Q

How does CPP work differently in acidic conditions?

A

CPP are able to release calcium and phosphate ions under acidic conditions and thereby maintain a state of supersaturation with tooth enamel reducing demineralization and enhancing remineralization

40
Q

What does CPP-ACP recaldent do?

A

It is a revolutionary remineralization treatment which delivers calcium and phosphate into plaque/biofilm.

It is a salivary biomimetic providing bioavailable calcium fluoride and phosphate ions to promote remineralization.

Has a different action to highly charged fluoride ions.

41
Q

What is required for maximal effect of recaldent (CPP-ACP)

A

A biofilm is needed to maximize effect.

42
Q

How does CPP work?

A

CPP binds strongly to dental plaque, are able to slow or prevent diffusion of calcium ions from enamel during times of acid challenge and serves as a source of calcium for subsequent remineralization.

CPP-ACP binds 2x as strong as mutans streptococci this provides an increase in model plaque fluid free calcium.

CPP-ACP binds to model plaque providing a large calcium ion reservoir and slows diffusion of free calcium.

43
Q

What pH does CPP-ACP break down in the plaque?

A

At or <4.5 pH

44
Q

How does calcium affect biofilm?

A

It lowers the critical pH to <5.5

It reduces strep mutans

45
Q

How does CPP-ACP affect the biofilm it is in?

A

It raises the biofilm pH by breaking down into ammonia

46
Q

How does CPP work?

A

CPP binds to the apatite crystal faces in the surface of the lesion and keep diffusion pathways open to allow ions to penetrate more deeply.

This results in remineralization throughout the body of the lesion rather than just in the surface layer. This pattern improves aesthetics of the lesion and the strength of the lesion.

Deposits acid-resistant mineral that improves the resistance of the area to future acid challenges.

47
Q

How does CPP-ACP increase remineralization?

A

The plaque becomes supersaturated with free calcium and phosphate ions on the tooth surface resulting in net movement of ions towards the tooth surface.

48
Q

What are the indications for CPP-ACP use?

A

Reversal of white spot lesions

CPP-ACP helps reduce hypersensitivity, also helps to prevent tooth erosion and helps lubricate oral cavity in dry mouth patients.

49
Q

Who shouldn’t use tooth mousse?

A

Do not use on patients with a milk protein allergy and/or hydroxybenzoate allergy.

50
Q

How can patients use CPP-ACP at home?

A

Recaldent gum chewing.

51
Q

How should tooth mousse be applied clinically?

A

In high risk patients that have minimal salivary flow and acid challenge they should use it 2x a day.

Other patients should use a pea-sized amount of TM plus daily

52
Q

What is the role of water with CPP-ACP?

A

Need saliva-water or no remineralization.

Rinse the mouth with water before applying GC tooth mousse for hyposalivation / xerostomic patients

53
Q

How is CPP-ACP used in other ways for dentistry?

A

IT can be added to a glass ionomer for superior protection and remineralization.

54
Q

What is fuji VII EP designed for?

A

Protection of erupting molars (increasing rates of enamel hypomineralization)

Protection of exposed root surfaces

Caries stabilization and indirect pulp capping for active lesions

Long term treatment of cervical hypersensitivity

55
Q

What is the difference between tooth mousse and tooth mousse plus?

A

Tooth mousse has no fluoride whereas tooth mousse plus has fluoride.

56
Q

When should fluoride not be used for tooth mousse?

A

Avoid fluoride until >6 years old

DMD2 (89 decks)

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