Dental Pathology Flashcards
What are caries?
transmissible bacterial infection
What are the two groups of bacteria responsible for caries?
mutans streptococci (MS) and lactobacilli (LB)
Explain the structure of mutans streptococci (MS)?
major pathogenic (disease-producing) bacteria
found in high numbers in dental plaque
What does the presence of lactobacilli (LB) mean?
patient has a high sugar intake
What is plaque?
oral biofilm is a colorless, soft, sticky coating made up of communities of microorganisms that sticks to structures of the oral cavity
If you were to look at biofilm under a microscope. what would you see?
colonies of bacteria embedded in an adhesive substance called the pellicle
What is the adhesive substance that plaque is in called?
pellicle
What is the most highly mineralized tissue in the body, stronger than bone?
enamel
What is enamel?
microscopic crystals of hydroxyapatite arranged in layer/rods known as prisms.
What tooth’s enamel has more water, primary or permanent teeth?
primary has slightly more water
What are the three factors allowing caries?
a susceptible tooth
a diet rich in fermentable carbs
specific bacteria
How does bacteria cause cavities?
- bacteria feed on fermentable carbs
- they produce acid as a by-product of their metabolism
- acid an penetrate the hard substance of the tooth and demineralize
How long after eating or drinking can bacteria produce acids?
5 minutes
Where do pit-and-fissure caries occur?
occur primarily on occlusal surfaces, on buccal and lingual grooves of posterior teeth, and on lingual pits of the maxillary incisors
Where do smooth surface caries occur?
on enamel surfaces, including mesial, distal, facial, and lingual surfaces
Where do root surface caries occur?
on any surface of the exposed root
Where do secondary/recurrent caries occur?
on the tooth that surrounds a restoration
When do carious lesions occur?
When more minerals are lost than deposited
When does demineralization occur?
when calcium and phosphate dissolve from hydroxyapatite crystals in the enamel
When does remineralization occur?
when calcium and phosphate are redeposited in previously demineralized areas
What is the first stage of carious lesions?
incipient caries or lesions, occurs when caries begins to demineralize the enamel
What is the second stage of carious lesions?
the overt or frank lesion, is characterized by cavitation
What is rampant caries?
development of cavitation, with multiple lesions throughout the mouth
Why are dental restorations usually replaced?
recurrent caries under the existing restoration
What is more susceptible to caries; enamel or cementum? Why?
Cementum, it has less mineral content and is more soluble
What is Early Childhood Caries (ECC)?
an infectious disease that can happen in any family
What are the risk factors for ECC?
lower socioeconomic status
limited access to dental care
lack of water fluoridation
special needs
What is the rate of untreated dental disease in low-income children than high-income families?
almost 5 times higher
What is another term for ECC?
baby bottle tooth decay (BBTD)
How is ECC transmitted?
bacteria from caregiver’s mouth are passed down to child
What type of protective measures does saliva provide for the teeth?
Physical
Chemical
Antibacterial
What is the physical protection of saliva?
depending on the water content, if enough saliva is present, it provides a cleansing effect
What is the chemical protection of saliva?
saliva contains calcium, phosphate, and fluoride, to be used for remineralization
What is the antibacterial protection of saliva?
immunoglobulins that work against bacteria
When an explorer tip is pressed on suspected caries it will “stick”, what are the limitations?
new research shows limitations on the occlusal surface
What are radiographs good at for caries diagnosis?
useful for detection of interproximal caries
What are the cons of radiograph for caries diagnosis?
- early caries on occlusal are not visible
- easy misdiagnosis because the caries are often 2x deeper and wider than it appears
What color teeth indicates caries?
darkly stained grooves
gray shadowing underneath enamel
What is an indicator dye?
special dye for use during operations that is placed inside a preparation, if the color changes, it indicates decay
What can caries detection devices use to check for decay?
- bacterial by products and sound signals
- differentiated tooth structure
- software to analyze density
What is a caries laser detector?
a recently developed device that is used to diagnose caries and bacterial activity underneath the enamel surface
What does the caries laser detector not detect?
interproximal caries
subgingival caries
secondary caries
What is CAMBRA?
Caries management by risk assessment is an evidence-based strategy for preventative and reparative care for early dental caries
What is the goal of CAMBRA?
to assess the risk of caries in individual and protective factors to provide a personalized preventative plan
When there is more disease-causing agents than protective agents, caries form. How can this process be interrupted?
fluoride
antibacterial rinses
decreased fermentable carbs
increased saliva
What do Caries Risk Tests (CRTs) do? Name an example.
detect the numbers of MS and LB present in the saliva, in example, the saliva flow rate test
What is the CariScreen Caries Susceptibility test?
a simple 1-minute chairside bacterial test for assessing caries risk
What is periodontal disease?
an infectious disease process that involves inflammation of the structure of the periodontium
What is the periodontium?
made up of structures that surround, support, and are attached to the teeth
What does periodontal disease cause?
breakdown of the periodontium; resulting in loss of tissue attachment and destruction of alveolar bone
What other diseases is periodontal disease connected with? Why?
coronary artery disease
diabetes
stroke
delivery of low-birth-weight infants
periodontal infection is seen as a risk factor
What is preterm birth?
birth that follows a pregnancy that is shorter than 37 weeks
What is low-birth-weight?
less than 5.5 lb
What are the two most significant predictors of the health and survival of an infant?
preterm birth and low-birth-weight
What is the rate of risk for women with severe periodontal disease having PLBW babies?
7x the risk than little to no periodontal disease
Although biofilm is the primary factor causing periodontal disease, what else are critical factors?
type of bacteria
length of time bacteria are left
patient response to bacteria
How is calculus (tartar) formed?
calcium and phosphate salts in the saliva that form calculus (tartar)
What is calculus (tartar)?
A hard, stonelike material that attaches to the tooth surface
Describe the surface of calculus.
The surface of calculus is porous and rough and provides an excellent surface on which additional plaque can grow.
Where is supragingival calculus found? What does it look like?
found on the clinical crowns of the teeth, above the gingival margin
visible as yellowish-white deposit that may darken over time
Where is subgingival calculus found? What does it look like?
forms on the root below the gingival margin and can extend to the periodontal pockets
dark green or black
What are the symptoms of periodontal disease?
red, swollen, or tender gingiva
bleeding gingiva
loose/separating teeth
pain when chewing
pus around the teeth
What is the goal of periodontal therapy?
to get the root surfaces as clean as possible so tissues can heal
What does a dental perioscopy do?
allows the clinician to see any remaining subgingival calculus on roots
What is the magnification of a dental perioscope? What does that allow?
up to 46x, allows the viewing of initial decay or cracks on roots
Why is taking family histories important?
genetic disorders such as dentinogenesis imperfecta
Why is taking medical/dental histories important?
can provide information about medications the patient may be taking that could have an effect on the oral tissues
What is a clinical diagnosis based on?
clinical appearance; color, size, shape, and location
What are examples of conditions diagnosed based on clinical appearance?
fissured tongue
maxillary/mandibular torus palatinus
median rhomboid glossitis
What is radiographic diagnosis?
assessment of the soft and hard tissues to reveal abnormalities
What are radiographic diagnosis excellent in?
periapical pathology
internal resorption
impacted teeth
What is a microscopic diagnosis?
a biopsy being taken from a lesion and evaluated microscopically
What diagnosis method is often used to make the final diagnosis?
microscopic diagnosis
What is a laboratory diagnosis?
diagnosis made from a clinical specimen obtained from a secretion, discharge, blood, or tissue
What is a therapeutic diagnosis? Name an example.
providing a certain drug/therapy and seeing how the condition responds
angular cheilitis; caused by b-complex deficiency or a fungal infection
What is a surgical diagnosis? Name an example.
a diagnosis made on the basis of finding from a surgical procedure
surgically opening to confirm or deny an area that a radiograph deemed a condition
What is a differential diagnosis?
When two or more possible causes of a condition are identified
What does a dentist do during a differential diagnosis?
A dentist will determine which tests or procedures should be prescribed to rule out the incorrect cause and make a final diagnosis
What is the broad term for abnormal tissues in the oral cavity? What is it?
lesions; a wound, sore, or any other tissue damage caused by injury or disease
What does an ulcer look like?
a break in the mucosa that looks like a punched-out area, similar to a crater
What is an erosion of the soft tissue?
a shallow injury in the mucosa caused by mechanical trauma
What is an abscess?
a collection of pus in a specific area, commonly at the apex of the tooth (periapical abscess)
What is a cyst?
a fluid/semisolid filled sac, material is not always infectious
What is a blister?
commonly known as vesicles, are filled with a watery fluid
In the oral cavity, what does a blister commonly turn into?
after rupturing, they leave ulcers with ragged edges
What is a pustule?
like a blister, but containing pus
What is a hematoma?
like a blister, but contains blood
What is a plaque (NOT DENTAL PLAQUE)?
any patch or flat area that is slightly raised from the surface
What is an ecchymosis?
medical term for bruising
What is a macule?
a flat, well-defined, discolored area of the oral mucosa
What are nodules? What does it feel like?
underneath or slightly elevated, small, round, solid lesions
feels like a pea when palpated
What is a granuloma?
a nodule that contains granulation tissue
What is a tumor? What is it also known as?
any mass of tissue that grows beyond the normal size and serves no useful purpose
aka neoplasms
What is leukoplakia? What is the cause?
painless, firmly attached, white patch that occurs anywhere in the mouth
unknown cause, linked to chronic irritation or trauma
What is lichen planus?
a benign, idiopathic, chronic disease that affects the skin and oral mucosa, characterized by patchy white lesions with a pattern of circles and Wickham’s striae
What are Wickham’s striae
interconnecting lines on lichen planus
What is candidiasis?
a common, superficial infection caused by the yeast-like fungus candida albicans
What is the most common oral fungal infection?
candidiasis.
What is candidiasis caused by?
antibiotics
diabetes
xerostomia
weakened immune system
What are aphthous ulcers?
“canker sores”, common form of oral mucosal ulceration
What is a recurrent aphthous ulcer (RAU)?
a disease that causes recurring outbreaks of blister-like sores inside the mouth and on the lips
What is a Minor RAU?
90% of RAUs
recurring episodes less than six times a year and heals within 7-10 day
What is Major RAU?
10% of RAUs
more frequent outbreaks of larger, deeper ulcers that take longer to heal
What is cellulitis?
inflammation is uncontrolled within a localized tissue, commonly the soft tissue or organ
What is glossitis?
inflammation to the tongue
What is black hairy tongue? What’s the cause?
filiform papillae become elongated; caused by an oral flora imbalance after using antibiotics
What is geographic tongue?
the surface of the tongue loses areas of the filiform papillae in irregularly shaped patterns
What is pernicious anemia? Symptoms?
a condition in which the body does not absorb vitamin b12
signs of anemia, weakness, pallor, and fatigue on exertion
What is a carcinoma?
a malignant neoplasm of the epithelium (tissue lining the mouth) that tends to invade the surrounding bone and connective tissue
Where do carcinomas usually metastasize to?
cervical (neck) lymph nodes
What is an adenocarcinoma?
a malignant tumor originating from the underlying glands of the oral mucosa
What is a sarcoma?
a malignant neoplasm that comes from the supporting and connective tissues such as bone
What is an osteosarcoma?
a malignant tumor that involves bones, in the mouth it usually affects the jaw
What is leukemia?
a cancer of the blood-forming organs; rapid growth of immature leukocytes
What is the end stage for an individual with HIV?
Acquired Immunodeficiency Syndrome (AIDS)
Why do lesions appear from HIV?
immune system is compromised when T-helper cells become depleted as a result of disease
What is death by HIV caused by?
opportunistic infection
What are the characteristics of HIV (atypical) Gingivitis?
a bright red line along the border of the gingival margin
What are petechiae?
small, pinpoint bruises
What do HIV periodontitis lesions resemble?
Acute necrotizing gingivitis with rapidly progressive periodontitis
What is HIV periodontitis also known as?
AIDS virus–associated periodontitis
What is cervical lymphadenopathy?
the enlargement of the cervical nodes?
What is lymphadenopathy?
swelling of the lymph nodes
What is a lymphoma?
general term used to describe malignant disorders of the lymphoid tissue
