Dentistry -- Dental Caries

Question 1

Correlation of poor oral health to 3 diseases

Answer 1

Higher incidence of:

• Diabetes
• CVD
• Pneumonia

Question 2

What kind of disease do oral diseases share risk factors with?

Answer 2

Chronic diseases and conditions such as:

• Heart disease
• Cancer
• Stroke
• Diabetes
• Obesity

Question 3

Prevalence of caries disease in Canada

Answer 3

• Canadian children and adolescents = ~60%
• Adults = 96%

Question 4

The most common chronic disease of childhood

Answer 4

Dental caries (five times more prevalent than asthma)

Question 5

Which groups of people have the highest rate of dental caries?

Answer 5

Children from disadvantaged communities and ethnic minorities

Question 6

The single greatest risk factor of caries

Answer 6

Poverty

Question 7

Define dental caries

Answer 7

A multifactorial, ubiquitous, life-long disease process, which is initiated into the tooth biofilm and leads to the formation of localized chemical dissolution of the tooth surface – caries lesion

Question 8

Consequence of not producing enough saliva (xerostomia)

Answer 8

Increased risk for dental caries

Question 9

What kinds of people most commonly experience xerostomia (dry mouth)

Answer 9

People who take mulitple medications (i.e. elderly, radiotherapy patients for oral cancer)

Question 10

Effect of topical fluoride

Answer 10

Like a topical medication on the skin, applied to the teeth, it will slow down and stop the caries process

Question 11

What part of one’s diet puts them at risk for dental caries

Answer 11

Refined carbohydrates

Question 12

3 characteristics of dental plaque (tooth biofilm)

Answer 12

• A community of microorganisms with a collective physiology that is organized as a structure
• Forms by the growth of resident oral micro-flora
• Always metabolically active

Question 13

How do bacteria form dental caries?

Answer 13

Bacteria metabolise fermentable sugars and produce acid into the dental plaque and the bacteria bury themselves a “hole” in your tooth for protection

Question 14

Bacteria type mostly responsible for dental caries

Answer 14

Streptococcus mutans

Question 15

pH that leads to tooth decay

Answer 15

pH ~5 and lower

Question 16

Explain the state of acidity in the mouth

Answer 16

There are pH flutuations in dental plaque over time with a mineral loss and gain in enamel over time as well, so the formation of a caries lesion depends on if there is a net loss and net over-acidity in the mouth

Question 17

3 Pathological factors in the caries disease process

Answer 17

• Acid producing bacteria
• Fermentable carbohydrates
• Insufficient saliva flow

Question 18

2 protective factors in the caries disease process

Answer 18

• Fluoride
• Saliva flow and buffering capacity

Question 19

Describe the general caries disease process

Answer 19

NOTE: Dental caries ARE NOT the “cavity” in the tooth

Question 20

2 components of diagnosing caries disease and their sub-components

Answer 20

Question 21

3 components of planning the treatment for dental caries

Answer 21

• Caries risk reduction
• Active lesions treatment
• Review (recall) and monitoring

Question 22

What is the problem with the caries lesion cavitating through the enamel to the dentin?

Answer 22

Direct connection with blood and nerve in the pulp and faster progression of decay

Question 23

4 stages of caries lesions

Answer 23

Question 24

4 clinical indicators of carious lesions

Answer 24

• Lesion colour
• Lesion location/presence of dental plaque
• Lesion shape
• Tooth surface integrity

Question 25

3 different colors of caries lesions

Answer 25

* White opaque * Yellow/brownish * Dark brown/black

Question 26

Define a white spot lesion

Answer 26

The initial caries lesion characterized by mineral loss at the tooth surface and modification of enamel translucency

Question 27

Describe the appearance of white spot lesions

Answer 27

* Loss of luster * Matte * Porous * Often seen on anterior teeth of kids and adolescents, covered in plaque

Question 28

What does it mean when a white spot lesion is farther from the gingival line?

Answer 28

* Arrested lesion = no longer active * Occurred during tooth emergence

Question 29

Why are some caries lesions yellow or brownish?

Answer 29

* Color due to dietary pigments (enamel lesion) * Dentin lesion is naturally darker since dentin is darker than enamel (bottom pic)

Question 30

Why are some caries lesions dark brown/black

Answer 30

Lesions that are likely arrested (less worrisome, no need for treatment; like a scar)

Question 31

Define extrinsic staining

Answer 31

Stains throughout the mouth, but not necessarily on plaque stagnation surfaces (not caries)

Question 32

7 plaque stagnation areas

Answer 32

* Along gingiva * Under contact point * Occlusal/buccal/lingual pits or fissures * Roots (mostly in elderly people) * Associated with partial dentures * Along restorations (if not flush to tooth) * Cavitated carious lesions

Question 33

4 characteristics of active caries lesions

Answer 33

* On plaque stagnation areas * Rough/soft (i.e.dentin) on gentle probing * Loss of lustre * Color = whitish/yellowish

Question 34

5 characteristics of arrested caries lesions

Answer 34

* No dental plaque * Located on some distance from gingiva * Tecture = smooth/hard * Lucter = shiny * Color = brown/dark brown/ whitish

Question 35

Define early childhood caries

Answer 35

The presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a child under the age of six

Question 36

How common are early childhood caries?

Answer 36

* Most prevalent pediatric infectious disease * The most common chronic disease of children

Question 37

Prevalence of ECC in aboriginal children in Canada

Answer 37

66% to 98% have severe forms of ECC

Question 38

3 biological risk factors for ECC

Answer 38

* Transmission of infectious bacteria from moth/caregiver to child * Diet (exposure to fermentable carbohydrates) * Susceptible tooth (newly erupted teeth, low level of fluoride, hypoplasia)

Question 39

6 influences for the development of ECC

Answer 39

* Poverty (single greatest risk factor) * Household crowding * Family size * Health behaviors * Health parenting practices * Parent's oral health status

Question 40

2 risky health parenting practices for the development of ECC

Answer 40

* Proonged use of the bottle or taining cups with sugar-containing drinks * High frequency of sugary snacks per day

Question 41

5 policies on the prevention of ECC

Answer 41

* Improving the oral health of parents in order to decrease the transmission of cariogenic bacteria to the child * Minimizing saliva-sharing activites (i.e. sharing utensils) to decrease transmission * Implementing oral hygiene measures no later then the time of eruption of the first primary tooth * Tooth brushing should be performed for children by a parent twice daily, using a soft toothbrush of age-appropriate size * Visiting a dentist no later than 12 months of age

Question 42

How to apply toothpaste for a cihld under 2 years

Answer 42

Smear

Question 43

How to apply toothpaste for a child over 2 years old

Answer 43

Pea-sized

Question 44

4 diet-specific policies on the prevention of ECC

Answer 44

* Avoid high freq. consumption of liquids and/or solid food containing sugar. In particular, sugar-containing beverages in a baby bottle or no-spill training cup should be avoided (i.e. juices, soft drinks, milk) * Infants should not be put to sleep with a bottle filled with milk or liquids containing sugar * On demand breast-feeding should be avoided after the first primary tooth begins to erupt and other dietary carbohydrates are introduced * Parents should be encourages to have infants drink from a cup as they approach their first birthday and cut the use of a bottle

Question 45

6 risky states of your patients that you should be aware of

Answer 45

* Detection of caries lesions * Readily visible plaque * Patient is eating between-meal snacks (including juices and soft drinks) * Patient is not using fluoride toothpaste twice a day * Patient is not likely to visit the dentist * Patient is pregnant (more for parenting advice)