Exam I Review Flashcards
What does the Outer Oblique Portion (OOP) limit?
Limits normal rotational opening movements
What does the Inner Horizontal Portion(IHP) limit?
Limits posterior movement of condyle & disc
Centric Relation is:
a) Condylar postion…
b) Establishes the position of the what?
c) Articulation is on the what?
d) It is described as …
e) A position of the mandible where…
a) CONDYLAR position, & DOES NOT need any tooth contact to be obtained.
b) Establishes position of condyle in a SUPERIOR and ANTERIOR location w/ disc properly interposed between condyle & TEMPORAL bone.
c) Articulation on the THIN portion of the articular disc
d) Described as MOST STABLE position of the condyle
e) A position of mandible where the MUSCULATURE display MINIMAL TONUS
Maximum Intercuspation Clinical Conditions:
- ________ determines the occlusal position
- If central relation & maximum intercuspation do not coincide the patients will have a ___________
- Most patients have some degree of a slide from centric relation into ___________________ (it is approximately ___________ in length)
- Maximum Intercuspation is simultaneous contact of all teeth & is the ________ of the slide
- All occlusal forces should be concentrated ____________________________
- _____________ position is DYNAMIC in nature and will CHANGE throughout a patient’s life
- Teeth
- “Slide”
- Maximum intercuspation
- 1-2 mm
- “endpoint”
- Down the long axis of posterior teeth
- Maximum intercuspation
What is considered as the NORMAL functions/actions of the TEMPORALIS?
1) ELEVATE (closing) mandible in a superior direction to eventually contact maxillary teeth
2) RETRACTS or RETRUDES mandible
(Helps seat the condyles into mandibular fossa)
3) Positions mandible to obtain centric relation (CR)
* It is not normally involved w/ producing LATERAL movement of the mandible.
What is considered as parafunctional functions/actions of the TEMPORALIS?
1) Clenching of the teeth to occur when the muscle is overused
Regarding the Medial Pole of Condyle & Medial Pterygoid Muscle (3)
1) Relationship of the medial pole of condyle & medial pterygoid on one side establishes the MID-MOST POSITION of the MANDIBLE at CENTRIC RELATION.
2) Normal curve of occlusion is possible because the interaction of the medial pole of the condyle w/ the steep medial wall of the fossa PREVENTS mandibular POSTERIOR teeth from moving straight HORIZONTALLY toward the MIDLINE
3) As a result ideal patents, mandibular lateral translation (or direct lateral movement of mandible toward midline) is impossible from fully seated positions of condyle in fossa.
(Not mentioned in review)
What are the actions of the Superior Head of the LATERAL PTERYGOID MUSCLE?
1) Maintains a sustainable & consistent psotion of the articular disc (normal function)
2) It is PROGRESSIVELY active during “CLOSING” movement of mandible (normal function)
3) It FREQUENTLY displays SPASM as a result of some types of OCCLUSAL DYSFUNCTION
-spasm will result in articular disc being pulled anteriorly out of glenoid fossa
(Parafunctional activity)
4) Muscle works in concert w/ ACTION & INACTIVITY of the inferior head of the lateral pterygoid
5) Muscle of mastication is DEEP in PLACEMENT & is mostly covered by the medial pterygoid, clinician CAN palpate SOME portion of muscle
What are the actions of the MYLOHYOID MUSCLE?
1) Will SLIGHTLY DEPRESS the mandible
(open, doesn’t close)
2) ELEVATE the HYOID, the FLOOR of the ORAL CAVITY and the TONGUE
3) Very important during SPEAKING & SWALLOWING
Which actions occur during LATE MANDIBULAR OPENING MOVEMENT?
1) INFERIOR HEAD of the Lateral Pterygoid is at MAXIMUM POINT of contracture
- TM ligament, stylomandibular ligament, sphenomandibular ligament & capsular ligament “prevents” any further anterior movement of condyle.
2) CONDYLE has moved as FAR to the ANTERIOR as it CAN MOVE
- Now located @ inferior border of slope of articular eminence
3) Articular disc has ROTATED POSTERIORLY OVER the POSTERIOR PORTION of the HEAD of the CONDYLE
- Superior head of lateral pterygoid is maximum contracture, attempting to hold articular disc over the head of condyle.
4) SUPERIOR RETRODISCAL TISSUE are in MAXIMUM TAUTNESS (not inferior) & CAN’T further hold articular disc in position over the head of the condyle w/out either stretching or tearing.
- Posterior portion of collateral ligament is LACKING in tautness
- Anterior portion is TAUT
What is the directional length of the Anterior, Middle, & Posterior TEMPORALIS force vector?
-SUPERIOR
What is the directional length of the MASSETER force vector?
-SUPERIOR
What is the directional length of the MEDIAL PTERYGOID MUSCLE** force vector?
**SUPERIOR & SLIGHTLY MEDIAL (MEDIOTRUSIVE) ***
What is the directional length of the INFERIOR HEAD of the LATERAL PTERYGOID muscle force vector:
-ANTERIOR & MEDIAL (slightly mediotrusive)
Like all articulated joints in the human body the temporomandibular joint is innervated by what?
- The SAME nerve that provides motor & sensory innervation to muscles that control it.
- Primarily the TRIGEMINAL NERVE (V)
MOST of the innervation to the TMJ is by the what?
- The AURICULOTEMPORAL NERVE (75%)
- Additional innervation (SENSORY) is supplied by the DEEP TEMPORAL & MESSETERIC NERVE branching of TRIGEMINAL-3 (V3)
Primary vascularization of the TMJ is with the ?
SUPERFICIAL TEMORAL BRANCH of the external carotid ARTERY
The condyle receives vascular supply throughout what?
Its MARROW SPACES from INFERIOR ALVEOLAR ARTERY & FEEDER VESSELS from other branches that perforate head from various angles
Why does the maxillary arch form DOMINATE the mandibular arch?
1) Maxillary arch is LARGER** than mandible from the distal of a 3rd molar on one side thru middle of each tooth to the 3rd molar on the other side
2) Maxillary arch is **WIDER* or larger in measurements from R/L sides
3) Esthetics are embedded MORE in the maxillary arch than in mandibular b/c smile line is extremely evident w/ maxillary ant. teeth
Intra-arch Alignment of Teeth:
- Teeth primarily contact their ___________?
- Most teeth contact ___________________?
- Which 2 teeth only have ONE antagonist in the opposing arch?
- Namesake in the opposing arch
- One additional tooth in the opposing arch
- The maxillary third molars and mandibular central incisors
Regarding Plane of Occlusion:
- The ideal plane is?
- A flat plane allows what?
- The proper plane of occlusion will permit what?
- A curved plane permits what?
- How are teeth positioned in the arch?
- The IDEAL plane is NOT FLAT
- A FLAT plane allows for TOO MANY contacts on most POSTERIOR TEETH on BOTH sides of the mouth
- The PROPER PLANE of occlusion will PERMIT SIMULTANEOUS FUNCTIONAL contacts to occur in controlled areas of arch
- A CURVED plane permits MAXIMUM USE of TOOTH CONTACTS during FUNCTION
- The teeth are “strategically positioned” in the ARCHES at VARIED & COORDINATED degrees of inclination
What is forces exerted on the first premolars are approximately what ?
50% LESS than those exerted on the 3rd molars
Occlusal contacts should occur between what?
- Should IDEALLY occur between a CUSP TIP and the DEPTH of a FOSSA, or between a CUSP TIP & a FLAT SURFACE, which is considered MORE STABLE.
- Contacts SHOULD NOT occur on CUSPAL INCLINES, because these are LESS STABLE
Regarding Classification of Occlusion what is the Ideal CLASS I ?
1) Ideal 1ST MOLAR relationship
2) Ideal CANINE relationship
Regarding Classification of Occlusion what is the Malocclusion of CLASS I ?
1) Ideal 1ST MOLAR relationship
2) NON-IDEAL canine relationship
3) Rotated or OVER-INCLINED teeth
Regarding Classification of Occlusion what is the Malocclusion of CLASS II (aka distal occlusion)?
1) Distally positioned FIRST MOLAR and CANINE relationships
2) EXCESSIVE ANTERIOR horizontal overlap
Regarding Classification of Occlusion what is the Malocclusion of CLASS III ?
1) MESIALLY positioned 1ST MOLAR relationship & CANINE relationship
2) NEGATIVE horizontal overlap
When a patient is in STATIC or STATIONARY the occlusal contact should occur between what?
Cusp tip & the DEPTH of an OPPOSING FOSSA called the CUSP-FOSSA OCCLUSION
In Maxillary Posterior Teeth, what are the Maxillary Cusp Name:::: Fossa or Marginal Ridge Locations?
- Lingual 1st molar ?
- Lingual 2nd molar ?
- ML 1st molar* ?
- DL 1st molar ?
- ML 2nd molar ?
- DL of 2nd molar ?
1) LINGUAL cusp of the Maxillary 1ST PREmolar = DISTAL marginal ridge or DISTAL fossa of the Mandibular 1st premolar
2) LINGUAL cusp of the Maxillary 2ND PREmolar= DISTAL marginal ridge or DISTAL fossa of Mandibular 2nd premolar
3) *MESIOLINGUAL (ML) of the Maxillary 1ST MOLAR= CENTRAL FOSSA of Mandibular 1st molar
4) DISTOLINGUAL(DL) cusp of the Maxillary 1ST MOLAR = DISTAL marginal reign or distal fossa of the Mandibular 1st molar
5) MESIOLINGUAL(ML) cusp of the Maxillary 2ND MOLAR= CENTRAL fossa of the mandibular 2nd molar
6) DISTOLINGUAL(DL) cusp of the Maxillary 2ND MOLAR= DISTAL marginal ridge or distal fossa of the Mandibular 2nd molar
What is BRUXISM?
- EXTENSIVE & PERSISTENT maximum intercuspation occlusal contacts on inclines can lead to mobility, excessive wear, fractures & other S/S of occlusal disease
- Displayed as EXCESSIVE WEAR on the OCCLUSAL SURFACE & INCISAL ridges of MANY teeth
Regarding Lateral Movements what is the left side called?
-The LEFT or OPPOSITE SIDE is termed the “NON-WORKING SIDE”
When Maxillary Cusps are positioned over Mandibular Teeth and PARALLEL to the LINGUAL groove and travels TOWARD the TONGUE what is this pathway called?
WORKING
- When Maxillary Cusps are positioned over Mandibular Teeth, The NON-FUNCTIONAL pathway is the area that what?
- The functional pathway is all the what?
- The AREA that the mandible CANNOT normally MOVE INTO
- Non-functional area is LARGER than the functional area
-Functional pathway is ALL the potential area that the mandible can move into!
When looking at a non-working movement of a MF (mediotrusive) permanent MANDIBULAR 1ST MOLAR where is it going to travel?
Across MESIAL marginal ridge of the permanent MAXILLARY 1ST MOLAR diagonal through the LINGUAL embrasure between the maxillary 2nd premolar and maxillary 1st molar
What type of mandibular movement is indicated in a moving occlusion diagram that displays a large bold arrow emanating from the CENTRAL fossa of a permanent maxillary 1ST MOLAR traveling out of the FACIAL groove?
Side: Working (AKA Lateralotrusive)
Cusp: DF cusp of mandibular 1st molar #30
What type of mandibular movement is indicated in a moving occlusion diagram that displays a large bold arrow emanating from the DISTAL FOSSA of a permanent maxillary 1ST MOLAR traveling diagonally and posteriorly over the DISTOLINGUAL (DL) cusp toward the lingual?
Movement: This is NON-FUNCTIONAL
-Because mandible can’t move towards the throat.
(Cusp: D cusp of mandibular 1st molar #19)
Regarding Border Movements on a Sagittal Plane which ones exhibit tooth contact?
Can it occur on centric relation (CR)?
1) E-T-E= Edge to Edge
2) MP= Maximum Protrusion Point
3) CR= Centric Relation
4) MI= Maximum Intercuspation
When viewing a panographic tracing of mandibular border movements of HORIZONTAL view at level of central incisors, which of the following positions will be the MOST ANTERIOR?
MAXIMUM PROTRUSION (MP)
When viewing a panographic tracing of mandibular border movements at the condylar level, on the LEFT side the long sloping arc that travels MEDIOTRUSIVELY and ANTERIORLY is called the what?
NON-WORKING condylar pathway
What is the Mandibular Lateral Translation?
- Also known as Bennett Movement & Immediate Sideshift
- First part of the lateral movement depicted when the MEDIAL POLE of NON-WORKING condyle starts to travel down the slope of the articular eminence & against the MEDIAL WALL of the FOSSA.
- Movement is exhibited as a measurement of the distance between the MEDIAL POLE of the NON-WORKING condyle & MEDIAL WALL of the GLENOID FOSSA.
If Condylar Guidance was the only vertical Determinant of Occlusion the cusp angles would need to be what?
Cusp angles would need “LESS” (inclination) THAN the angle of the articular eminence in order to avoid collision in eccentric movements.
If a patient has a loose TM Ligament on the WORKING-SIDE and a lot of distance between the medial pole of condyle & medial wall of the fossa on the non-working side what is going to occur?
CUSP heights on the NON-WORKING side MUST be SHORTER
What is Anterior Guidance?
- Anterior Guidance is a FUNCTION of the relationship between the maxillary & mandibular “ANTERIOR” teeth
- Anterior Guidance consists of the VERTICAL and HORIZONTAL overlaps as measured at the ANTERIOR TEETH
When observing Anterior Guidance for a patient if the horizontal overlap remains unchanged in the event of vertical overlap INCREASES, what happens to the anterior guidance angle?
(What can occur in Vertical Overlap Changes? )
The Anterior guidance angle also INCREASES
In a patient that exhibits both Anterior(ACF) and Posterior(PCF) controlling factors with 45 degrees each (SAME), What will be the angle of the mandibular 1ST pre-molars as they move away from the horizontal reference plane when mandible is open?
- Also 45 degrees as it moves away from the horizontal reference plane.
- This is a coordinated movement of mandible at 4 units horizontally and 4 units vertically at both PCF and ACF
Regarding Horizontal Reference Plane (HRP):
As the plane of occlusion becomes MORE NEARLY PARALLEL to the angle of articular eminence, what happens to the posterior cusps?
Posterior cusps will need to be SHORTER in order to avoid collisions with each other
The less parallel the horizontal reference plane (HRP) is to the Condylar Guidance Angle what happens to the cusps?
The “STEEPER” the cusps can be
What is the timing of Mandibular Lateral Translation (Fixed)?
- Cusps on WORKING-SIDE must be SHORTER if the immediate side shift has a noticeable measurement with the tracing.
- Mandibular lateral translation cusp on the NON-WORKING side must be MORE shorter if you have a noticeable measurement to the immediate side shift.
Horizontal Determinants influence the ________and the ______________ of ridges and ____________ on the occlusal surfaces.
- Direction
- Location
- Grooves
- During eccentric movements, cusps pass between __________ and over ___________
- As a result, the horizontal determinants also influence what?
- RIDGES
- GROOVES
-They influence the PLACEMENT of CUSPS
When examining mandibular movement on the non-working side of the Midsagittal plane, the closer the angle between the laterotrusive & mediotrusive pathways will exhibit what?
A tooth that is CLOSER to the MIDLINE
sharper [smaller] angle = closer to the midline
What is the effect of Posterolateral Translation of the Working Condyle?
The more posterolateral the movement of the WORKING condyle, the LARGER IS THE ANGLE formed by the mediotrusive & laterotrusive pathways
When altering the Vertical Determinant of Occlusal Morphology by making the
“PLANE of OCCLUSION”(known as the Factor) MORE PARALLEL the plane to condylar guidance(known as the condition) what is the effect??
SHORTER the POSTERIOR CUSPS must be
Oral hygiene and caries:
- Is there evidence that removal by brushing or flossing decreases caries explain.
- Daily oral hygiene helps control what?
There is no evidence that removal of plaque by brushing (with a non-F toothpaste) or flossing decreases the incidence of caries
Daily oral hygiene does help to control gingival disease and is necessary for the application of fluoride toothpaste
What is the # 1 Factor w/ caries?
- Salivary [ ] of S Mutans
- Establishment of a care is risk profile
Why is there no evidence?
1) Plaque indices designed for studies of periodontal disease not caries
2) Plaque indices don’t measure microbes
3) Plaque removal is important
Effective plaque removal
What is the best way to remove plaque?
1) Brushing
- The winner by a landslide
- No significant difference between manual and “motorized” toothbrushes*
2) Flossing
- Introduce floss only when brushing is mastered
- We don’t know the best frequency
- Probably every few days to once a week
What is Caries diagnosis?
1) Detection
2) Observe and describe patient and oral tissues
3) Select appropriate form of intervention
4) Prerequisites for detection
5) Treatment (Clean teeth)
What are the prerequisites for Detection?
1) Clean Teeth
2) Dry teeth
3) Sharp eyes & magnification
4) Lighting
Describe dry teeth?
1) When dried, air replaces water in enamel
The refractive index of air is farther away from enamel than water, making lesions easier to see
2) White-spot lesions VISIBLE WHEN DRIED have penetrated about ½ of the enamel
3) White/brown lesions VISIBLE WHEN WET have penetrated through the enamel
Sharp eyes and magnification:
What is the visual acuity of dentists?
- Visual acuity of dentists > 45 years
- 60% of dentists failed close vision test at 24cm
- 40% failed at 33cm
Why Early diagnosis?
1) Changes in management of disease requires change in how we diagnose
- Detection of cavitated lesions is no longer an appropriate diagnosis of dental caries
2) If detected before cavitation, caries is reversible
- We need systems that allow us to diagnose before cavitation
What is the Problems in diagnosis?
- Instruments currently available for the diagnosis of carious lesions do not detect lesions early and quantitatively
- We can not detect caries until it is 1/3-1/2 way through enamel
What is Conventional diagnosis?
1) One generation ago, caries diagnosis was relatively simple
- Semi-annual visits
- Check all surfaces for signs of cavitation
- Immediate restoration
- Irreversible damage to tooth not
What is the Conventional Diagnostic Tools?
1) Visual inspection
- Transillumination
2) Probing w/ a sharp explorer
3) Radiographs
What occurs when Probing with a sharp explorer?
-Passing the explorer into pits
Noting whether or not there is any softening or if instrument catches or enters at any point
- Black, 1924
- Not entirely accurate
- Can result in false positive or false negative
What is the Blunt Statement #1 for sharp explorers?
- Teaching the use of the explorer may be potentially damaging
- 1984, Dr. Kidd, United Medical & Dental Schools, London
What can probing with a sharp explorer do?
1) Cause damage to newly erupted teeth
2) Cause cavitation at superficial lesion
3) Transmit bacteria to uninfected fissures
Note: 60% of fissures that were probed had tissue loss
How does the explorer accelerate caries?
1) Lab study found- sound & demineralized fissures
- All demineralized fissures became activated
- Created microscopic “entrances” for bacteria
- increased rate of lesion growth
What percent of probed fissures transmitted bacteria?
78% had S. mutans
When probing, all surfaces of a tooth are CLEANED of debris & plaque, the teeth are DRIED using air syringe & EXAMINED visually. If there are suspicious areas THEN an explorer is used with what pressure to check for the surface texture?
Enough light pressure to blanch a finger nail
What is the concern with x-rays?
- Caries prevalence has declined
- Awareness of the consequences of ionizing radiation has increased
- Radiographs are an invasive procedure that should be used with caution
- In populations with a low prevalence of caries, the routine use of ionizing radiation as a means of diagnosing caries in becoming less desirable as the potential benefit is being outweighed by the potential risk of its use (Stookey, 1999)
Accuracy of Radiographs?
- Interpretation between dentists varies when viewing same radiographs
- Multiple diagnostic tools should be used to avoid missed diagnosis
- Quality is important
- Horizontal over lap can result in false or exaggerated radiolucency
-Contrast can effect appearance of radiolucency
ADA Guidelines
Note: Occlusal decay is MORE inaccurate b/c it can not be seen in x-rays
What are the Newer Diagnostic Technologies?
1) Digital imaging fiber optics trans-illumination (DIFOTI)
2) Lager Fluorescence (LF)
3) Quantitative light fluorescence (QLF)
4) Infra Red Light Imaging
What is Digital imaging fiber optic trans-illumination (DIFOTI)?
1) Superior sensitivity compared to x-rays
- Occlusal caries (3 times as sensitive)
- Approximal caries (twice as sensitive)
- Other smooth surface caries (10 times)
2) DIFOTI can detect incipient or recurring caries before they are visible on x-rays
- -Non ionizing radiation
- Decary scatters & absorbs more light than healthy tissue
- -Can indicate early decay before x-rays.
What is Laser fluorescence (LF)?
- DIAGNODent
- A laser diode provides pulsed light directed onto tooth.
- When the light meets a change in tooth substance, it stimulates fluorescent light of a different wavelength
- Translated through the hand piece into an acoustic signal
- Wavelength is then evaluated by an appropriate electronic system in the control unit
- More sensitive but LESS specific in diagnosing dentinal caries
- Identifies more true caries
- Identifies more false positives
***Should not be relied on as a clinician’s primary diagnostic method
What is Quantitative light –induced fluorescence (QLF)?
- Tooth is illuminated with blue-green light
- Fluorescence of enamel is observed
- Demineralized areas appear dark
- Inspektor Pro
What are the QLF measures?
-Fluorescence loss
-Lesion area
-Lesion depth
-Detects enamel lesion 5-8 mm in depth
-Quantitative light –induced fluorescence (QLF)
-Tooth is illuminated with blue-green light
Fluorescence of enamel is observed
-Demineralized areas appear dark
Inspektor Pro
-Radiographs detect at about 500 mm
Infra red light imaging?
- Can visualize bacteria, caries, and cracks
- Not yet commercially available
What is the preferred Treatment?
- Select appropriate form of intervention
- Remineralization past theory
- Fluoride is incorporated into the enamel mineral during formation to make the enamel more resistant to acid attack.
- “Fluoride makes the tooth stronger”
- Systemic action (little effect)
- Remineralization current theory
- Topical application more effective than systemic action
Cariostatic mechanism of fluoride?
- Fluoride enhances remineralization
- Fluoride concentrates in dental plaque
- Fluoride is released from plaque when pH is lowered
- Fluoride is taken up more readily by demineralized enamel than by sound enamel
- Plaque fluoride inhibits bacterial glycolysis
- Primary cariostatic effect is” TOPICAL”
- “FREQUENT” exposure to “LOW CONCENTRATIONS”
- Exposure about every 4 hours
- Water fluoridation and toothpaste
- Fluoride prevents smooth surface caries
- Fluoride arrests enamel and dentine caries
What are the Fluoride Delivery Vechicles?
1) Community water fluoridation
2) Self applied fluorides
- Toothpaste, OTC mouth rinse, Rx fluoride
- Weekly school rinse programs
3) Professional applied fluorides
- Gels, foams, varnish
Community water fluoridation advantages/disadvantages?
-Reduces caries by 15-20 percent
Advantage of fluoridation:
-Does not require individual effort
Disadvantage of fluoridation:
Children DO NOT DRINK WATER
Requires cooperative water operator
Self applied fluorides
-The main reason for the decline in caries
-Brush at least 2 times per day with fluoridated toothpaste
-Dry brushing does not prevent caries
-Prevents about 24% of caries
Dose
-Age 1-2 slight smear
-Age 3-5 half of pea size
-Age 6> pea size
Supplements for Self-Applied Fluorides?
-Good for high-risk compliant patients
Regardless of age
Including teens, adults and elders
- Use lozenges to prolong contact
- LOZI-FLUR (www.dreirpharmaceuticals.com)
- Not appropriate for low-risk patients
Professionally applied fluorides?
1) Gels, foams, varnish:
Professional rinses not approved by ADA
2) Mechanism of action:
- Arrestment of incipient lesions
- Increased resistance to further demineralization
3) Fluoride ingestion:
-Gels and foams: up to 35 mg of F
Varnish: up to 5 mg of F
4) Do not use gels/foams in children 5 years and younger
5) Frequency of application:
At least 2 times per year
4-6 times per year for very high risk patients
What are the Indications for use for Professionally applied fluorides?
1) Patients at high risk of caries on smooth surfaces
2) Patients at high risk of caries on root surfaces
3) Special patient groups such as
- Orthodontic patients
- Patients undergoing head and neck radiation
- Patients with decreased salivary flow
4) NOT recommended for patients at low caries risk
Application specifics?
- Applying gel with floss can help with contact areas
- Do not apply fluoride varnish to teeth that are being prepared for composite restorations, it can effect bonding
- Prophy not required before professional fluoride application
- Polishing does not remove enamel fluoride
- When contact time is reduced to 1 minute, enamel fluoride uptake is significantly less
- No clinical data to support the 1 minute application of any product
Fluoride and root caries?
- Fluoride prevents root caries
- Fluoride arrests root caries
- Daily self-application of 5,000 ppm NaF gel plus fluoride toothpaste for 12 months
- arrested 91% of incipient root lesions
- arrested 57% of actual root lesions
Recommendations for high risk patients?
- Fluoride therapy alone may not be effective in arresting caries progression & remineralizing enamel.
- Use additional therapies to control the infection.
What are additional caries therapies?
- Combine with appropriate fluoride
- Goal is to alter oral environment and reduce levels of mutans streptococci
- Prior to using these therapies
- Restore existing carious lesions
- Apply pit & fissure sealants
What are Chemo-Therpaeutics?
1) Fluorides-remineralization
2) Baking Soda-pH Buffers
3) Chlorhexidine- Anti-microbials
4) Xylitol- non fermentable sugars
Benefits of Baking Soda?
1) Increases salivary pH, neutralizes salivary pH
2) Suppresses mutans streptococci
3) Improves taste in those with xerostomia related taste dysfunction
- Used as a rinse
- Dissolve 1 teaspoon in tumbler of water
- Rinse vigorously and spit
Chlorhexidine
- For those who will self medicate
- 14 day regimen suppresses mutans streptococci for 12-26 wks
- CHX vehicles
- Mouthrinse – available in US
- Varnish – clinical trials only
- Gel – clinical trials only
- Meta-analysis of CHX clinical studies average caries inhibitory effect was 46%
- Chlorhexidine and fluoride treatment complement each other
What did the CHX study show?
- Mothers participated in chlorhexidine program until children were 3 years
- At age 7 years children had lower S. mutans levels
- More were caries free (23% vs. 8%)
- DMFS was lower (5.2 vs. 8.6)
CHX varnish
- Cervitec and Prevora (Not available in US)
- 3-4 month applications reduce root caries
- More effective then CHX rinses in reducing mutans streptococci
CHX varnish product development ?
-10% CHX Varnish (Prevora)
- CHX Technologies, Toronto, Canada
- Approved in Canada and Ireland
- Clinical trials for FDA approval in process
- Moms and infants
-1% CHX Gel (no name yet) University of Iowa
How is CHX varnish applied?
- 2 stages – medication then varnish
- Painted on teeth
- Once per week for 4 weeks then every 6 months
- Bitter taste
- Burns if it touches gums
What is Xylitol?
-A five carbon sugar alcohol
As sweet as sucrose
- Prevents mutans streptococci from metabolizing other sugars
- Inhibits enamel demineralization
- Inhibits bacterial adhesion
Proposed action of xylitol?
- Non-fermentability by plaque organisms
- Reduction in plaque quantity
- Selective reduction of mutans streptococci
- Induction of mutans streptococcus strains with reduced virulence
- Increased concentration of ammonia in plaque
- Accumulation of xylitol-5-phosphate in some plaque streptococci
- Participation in a futile metabolic cycle in some plaque organisms
- Reduced adhesion of plaque flora
- Reduced transmission of mutans streptococci
- Changes in quantity and quality of saliva
- Aids remineralization
Xylitol dose?
- Recommended for patients who chew gum
- Reduces decay and reverse si ncipient lesions
- Chew 3-5 times/day, 5 minutes each time
- Xylitol gum chewing should start at least 1 year before permanent teeth erupt
What are the Benefits of Xylitol?
- Teeth erupted during 2nd year 93% reduction in caries risk
- Teeth erupted after chewing stopped 88% reduction in caries risk
Difference between CHX & Xylitol Gum users?
Gum users had:
1) Increased salivary flow
2) Reduced denture debris
CHX gum users had:
1) Lower levels of oral bacteria mutans streptococci, lactobacilli, and yeast
2) 91% reduction in denture stomatitis
- 62% reduction in xylitol only group
- No reduction in control group
Xylitol users had osmotic diarrhea at what amount?
Osmotic diarrhea at:
- 100 grams/day in adults
- 45 grams/day in children
Dose for dental caries prevention:
-6-10 grams per day
What are the other benefits w/ Xylitol and other health issues?
1) Ear infections
40% reduction in incidence of ear infections in children that chewed 8.4 g of xylitol/day
2) Osteoporosis
Xylitol added to the diet of rats increased their bone mineral content and accelerated bone recalcification
What are dental Dental sealants ?
- An important dental caries prevention technology
- Should be used in combination with fluoride
- Safe & effective
- Prevent pit and fissure caries
- Arrest caries progression
What are the consideration for Sealants use?
- Morphologic characteristics
- Risk for pit and fissure caries extends into adult life
- Some patients with pit and fissure caries are candidates for sealants
- “therapeutic sealants”
The surgical management of noncavitated carious lesions should be __________________
The treatment of LAST RESORT
Why wait to restore?
- Caries progression is slow in permanent teeth
- Preserving sound tooth structure is beneficial
- Restorations compromise tooth integrity and possibly vitality through a cycle of restoration and re-restoration
Benefits of remineralization versus surgical intervention?
- Prevents loss of tooth structure
- Reduces exposure to anesthetic agents
- Reduces pain and inconvenience
- Preserves esthetics
How successful are fillings?
- 70% of fillings are replacements of existing fillings
- Replacements get bigger and lead to more replacements
Life expectancy of restorations in Sweden vs Florida?
Sweden: Median age at replacement -Amalgam; 9 years -Composite; 5 years Glass ionomer restoration ; 3 years
Florida:
Amalgam Adolescents: 9 years
Adults: 11 years
-Composite
Adolescents: 3 years
Adults: 8 years
-Glass ionomer restoration
Adolescents: 2 years
Adults: 4 years
Cycle of re-restoration?
- Re-restoration results in teeth receiving progressively larger restorations
- 70% of replaced posterior restorations increase the number of restored surfaces
When are lesions cavitated?
- Radiolucency in outer half of enamel
0. 0% of permanent teeth were cavitated
2. 0% of primary teeth were cavitated - Radiolucency in inner half of enamel
10. 5% of permanent teeth were cavitated
2. 9% of primary teeth are cavitated - Radiolucency in outer half of dentin
40. 9% of permanent teeth were cavitated
28. 4% of primary teeth were cavitated
-Radiolucency in inner half of dentin
100% of permanent teeth were cavitated
95.5% of primary teeth were cavitated
Restore active caries only when what?
1) Must determine if the caries process is
- Progressing
- Arrested
- Shifting toward remineralization
2) Early lesions must be recorded and monitored
- Filling teeth does not treat the disease of dental caries
- Filling teeth simply restores the effects of the disease
