CS 1 - introduction

Question 1

what factors are needed for caries to develop?

Answer 1

• tooth
• substrate
• flora
• time

Question 2

what affects the tooth susceptibility to caries

Answer 2

○ Age 
○ Fluorides
○ Nutrition
○ Morphology 
○ Trace elements
○ Carbonate level

Question 3

what affects the substrates ability to act on a tooth?

Answer 3

○ Oral clearance 
○ Oral hygiene
○ Salivary stimulants
○ Frequency of eating
○Carbohydrate (type, concentration)

Question 4

what is caries risk assessment?

Answer 4

The risk of the patient developing new / progressive disease in the future
an assessment must take place on an individual level for each patient and not at a population level

Question 5

what 2 categories can caries risk factors be divided into

Answer 5

general

local

Question 6

what is included within general caries risk factors?

Answer 6

○ Social 
	§ Where they live
	§ What means do they have
	§ What are their thoughts about OH
○General health

Question 7

what is included within local caries risk factors?

Answer 7

○ OH
○ Diet 
○ Fluoride experience 
○ Past caries Experience
	§ Restorations present
○ Orthodontic treatment
	§ Braces can create poor oral hygiene

Question 8

what are the 7 elements of caries risk?

really common exam Q

Answer 8

i) Clinical evidence
ii) Dietary habits
iii) Social history
iv) Fluoride use
v) Plaque control
vi) Saliva
vii) Medical history

Question 9

what does dmft / DMFT stand for

Answer 9

diseased missing filled teeth in primary dentition for lower case and in permanent dentition for upper case

Question 10

what role does clinical evidence play?

Answer 10

• Caries experience
○ dmft greater than / equal to 5 (primary dentition)
DMFT greater than / equal to 5 (permanent
dentition)
○ Caries in 6’s at 6 years
○ 3 years caries increment greater than / equal to
• Orthodontics
○ Fixed appliance therapy
• Prosthetics
○Fixed or removable

Question 11

what role does the diet play in caries risk?

Answer 11

• sugar intake
  ○ frequency more of a problem than amount
  ○ processed sugars more cariogenic than natural
  sugars ie sucrose worse than glucose
  ○ natural sugars still cause harm
  ○ diet diary beneficial

Question 12

how does social history affect caries risk?

Answer 12

• SIMD category
• Education
• Unemployment
• Work stressors
• Single parent families
• Violence
• Inequalities and access to healthcare
• Dependents

Question 13

how does patient’s fluoride intake affect caries risk?

Answer 13

• infrequent use of fluoride toothpaste

- no water fluoridation

Question 14

what does fluoride / F- do?

Answer 14

• Incorporation into enamel crystals to form fluorapatite which is more caries resistant (resistant to demineralisation) than HA
• Bactericidal? Resistant to streptococcal strains
• Interferes with the adhesion force of bacteria reducing their ability to stick to the surface of the teeth

Question 15

what role does oral hygiene play in caries risk?

Answer 15

• poor brushing technique
• irregular brushing
• young / old / unable left unassisted
• access to tooth paste / toothbrush
• difficulty due to changes ie mixed dentition, orthodontics, gaps
• lack of other cleaning aids like floss

Question 16

how does saliva play a role in caries risk?

Answer 16

• Amount
• Flow
• Buffering capacity
• pH
• Viscosity

Question 17

what is the ideal viscosity of saliva?

Answer 17

don’t want it too thick, should be washing

Question 18

how does medication affect caries risk?

Answer 18

• some medications cause xerostomia (dry mouth) so lack of saliva for clearance
• medications often have free sugars added to them to make them easier to take
• social convention = when someone is ill we bring them sweets
• lactoulose for children

Question 19

what are the 8 elements of caries prevention?

Answer 19

i) Radiographs
ii) Toothbrushing instruction
iii) Strength of F in toothpaste
iv) F varnish
v) F supplementation
vi) Diet advice
vii) Fissure sealants
viii) Sugar free medicine

Question 20

what is typical of a child who is a high caries risk?

Answer 20

• Social 
	○ Mother's education secondary only
	○ Poor dental attender
	○ Family unit
		§ Single parent
		§ Social class
		§ Unemployment
• Health 
	○ Poor health / chronic sick
	○ Sugar-based medications

• Caries experience
	○ Dmft > 5, DMFT >5 
	○ >/= 10 initial lesions in primary dentition at first attendance 
	○ Caries in 6's at 6 years
	○ 3 years caries increment >/= 3

• Orthodontics
○ Fixed appliance therapy

• Behavioural
○ Mother’s caries rate
○ Prolonged nursing habits
§ Giving milk overnight - try and stop this as soon as possible (14 weeks old)
§ On demand breastfeeding overnight = terrible tooth decay
○ Bottle / pacifier at bedtime
§ Put to bed with sippy cup of juice / milk = overnight caries
○ Cariogenic snacking
○ No tooth cleaning
§ tiny bit of tooth visible = start cleaning
○ Little fluoride exposure

Question 21

what is typical of an adult who is high caries risk?

Answer 21

• Level of education
• Attends only when they have a problem
• Social difficulties 
• Sweet tooth with poor OH
	○ Good OH solves this problem
• Sugar containing meds or meds affecting saliva
• Root caries
• Secondary caries