Dental Caries

Question 1

What is the current accepted school of thought for the production of pain secondary to dental caries

Answer 1

Hydrodynamic theory
- “When the tooth is subjected to insult, fluid movement through the tubules increases and the greater flow deforms the nerve endings in the pulp leading to pain response.”

• “Cold conductivity increases both the volume and flow in the tubules resulting in pain stimulus.”

Question 2

What are the most common cariogenic bacteria in coronal caries?

Answer 2

Streptococcus mutans

Lactobacilli

Question 3

What are the most common cariogenic bacteria in ROOT surface or SMOOTH surface caries?

Answer 3

Actinomyces viscus

Question 4

What are the Dental Plaque organisms?

Answer 4

Streptococcus sanguis is found earliest

Question 5

Define Incipient Caries

Answer 5

Describes caries that have not progressed farther than enamel, they are reversible or able to remineralize.

Question 6

Define Frank Caries

Answer 6

Describes caries that have progressed just into the dentinoenamel junction (DEJ)

Question 7

Name the two different types of Enamel caries

Answer 7

1) Incipient caries

2) Frank caries

Question 8

Which bacteria is mostly found in pit and fissure caries?

Answer 8

S. sanguis and other strep

Question 9

What is the most prevalent type of dental caries

Answer 9

Pit and Fissure Caries

Question 10

Describe the difference in shape as caries progress in Pit and Fissure caries versus Smooth surface caries.

Answer 10

Pit and Fissure caries: Narrow at the enamel surface and spreads wide at the DEJ (Inverted V)

Smooth surface caries: Wide at the surface and converges toward the DEJ (V shape)

Question 11

Prevention for Pit and Fissure caries?

Answer 11

Prevent with fissurotomy and sealant

Question 12

Prevention for Smooth surface caries?

Answer 12

Prevent with fluoride

Question 13

Name and describe the 4 zones of carious enamel.

Answer 13

1) Translucent zone - the deepest zone, is termed accordingly due to its absent or composition-less appearance seen under polarized light.
2) Dark zone - Represents remineralization and is termed so due to its inability to transmit polarized light
3) Body zone - the largest zone, represents a demineralizing phase
4) Surface zone - outermost zone, seems unaffected by the caries.

Question 14

Describe Infected Dentin

Answer 14

Tubules are infected with many acid-producing bacteria, and acidogenic and proteolytic activity result in degradation

Question 15

Describe Affected Dentin

Answer 15

Bacteria present, but in smaller amounts. Demineralization occurs but still can be reversed if favorable environment assumes and infected layer is removed.

Question 16

Name the five zones of carious dentin

Answer 16

1) Normal dentin - no bacteria or byproducts present in this deepest unaffected area
2) Subtransparent dentin - demineralization from acidogenesis, but no bacteria found in dentinal tubules
3) Transparent dentin - softer than normal, further demineralization - yet still no bacteria found
4) Turbid dentin - zone of bacterial invasion: bacteria present in the dentin tubules. Must remove this zone
5) Infected dentin - many bacteria found in this outermost carious zone. Must remove dentin to treat successfully.

Question 17

Which zones of carious dentin are considered affected vs. infected?

Answer 17

Affected: 2 & 3
Infected: 4 & 5

Question 18

How does cementum increase risk of caries in root surface caries vs enamel

Answer 18

Cementum surface is rougher than enamel and has greater mechanical advantage of acquiring plaque

Question 19

Define residual caries

Answer 19

Infected or cavitated tooth structure remaining after attempted removal in a completed cavity preparation
- Can be intentional such as in indirect pulp capping procedures

Question 20

Define recurrent caries

Answer 20

Also known as secondary caries, is decay that remains in a completed cavity.
- Radiolucent bases or liners can be mistaken for recurrent decay on radiographic presentation

Question 21

Define arrested caries

Answer 21

Lesions that have remineralized

- Hard
- Black or brown discoloration, a result of trapped debris and metallic ions
- Asymptomatic