Final Flashcards
Salivary flow is controlled by what system
ANS
Within the ANS what is the main controller of saliva production
PSNS
Pressure in the mouth __ salivary nuclei in the medulla and __ saliva secretion
stimulates
increases (Vasodilation)
T/F: sight, smell, taste, and sound can stimulate saliva production
True
T/F: There is a decrease in salivary production during sleep
True
Sympathetic division stimulates __ secretion, decreasing __ , this produces __ saliva
mucus
serous (vasoconstriction)
viscous
Saliva is a filtrate of __
Blood
Transport in the acinar cells, end with __
isotonic solution
Transport in the ductal cells, end with __
hypotonic solution (b/c Na+ and Cl- reabsorption greater than K+ and HCO3- secretion)
Water has impermeability in __ so it cannot follow Na+ and Cl-
Ductal cells
The final saliva product by ductal cells is __
hypotonic
Tonicity and ion concentrations depend on __
Rate of salivary flow (ion channels have a maximum rate of transport ( I Love Lucy video))
What gland opens via stensons duct
Parotid gland
This gland opens via whartons duct
submandibular gland
What gland opens via excretory ducts
sublingual gland
This gland produces serous, watery secretion only - dominant in stimulated saliva
Parotid Gland
This gland produces mixed, serous and mucous - dominant in unstimulated saliva
Submandibular gland
This gland has predominantly mucous secretions
sublingual gland
These cells secrete serous fluid for mastication
serous cells
These cells secrete mucus rich secretion for protection
mucous cells
Normal mean for unstimulated saliva
0.5 mL/min (abnormal = less than 0.2)
70% submandibular gland
Normal mean for stimulated saliva
1.5 mL/min (abnormal = less than 0.5)
90% parotid gland
What is resting flow rate of saliva, and what shows hypo salivation
30-60s
Greater than 60s
What is the stimulated saliva flow and what would make it hypo salivation
Greater than 5 mL
lower than 5 mL
This is the major buffer in stimulated saliva
Carbonic acid/ bicarbonate buffer
Bicarbonate acts mainly to __ produced by bacteria
neutralize acids
The concentration of the bicarbonate ion depends largely on the __
Salivary flow rate
A high bicarbonate concentration linked to a high flow rate in __ would keep saliva pH above __ so that the risk of erosion of tooth structure is low
stimulated saliva
6.3
Below the critical pH of __ calcium phosphate salts dissolve from the enamel and leads to cavities
5.5
Major buffer of unstimulated saliva
Phosphate buffer
What is the maximum buffering capacity of the phosphate buffer
pH 6-8
Perform more than one function
Multifunctional
Mucin proteins are involved in antimicrobial activity , maintenance of tooth integrity, and lubrication / protection. This means they are __
Multifunctional
Perform both a good and a bad function, dependent of location or site of action
Amphifunctional
In solution amylases facilitate clearance of viridian streptococci but when absorbed on tooth surface they promote adherence of bacteria. This means they are __
amphifunctional
critical pH of enamel
5.5
Critical pH of dentin
6.5
Every time you eat or drink you experience a drop in __
The more time you spend above pH 5.5 =
The more time you spend below pH 5.5 =
pH
more remineralization = low caries risk
more demineralization = high caries risk
The acquired enamel pellicle is a __
selective protein rich film covering enamel surface
The acquired enamel pellicle forms __
immediately after the tooth is cleaned
What protects the enamel against acid dissolution (prevents continuous deposition of calcium and phosphate)
Acquired Enamel Pellicle
What is the base attachment for oral bacteria adherence
Acquired enamel pellicle
Early biofilm formation: The first bacteria to attach to the pellicle glycoproteins are __ from the __ family (30 min to an hour)
gram positive aerobic cocci
Mutans Streptococci
Early biofilm formation: The bacteria are able to replicate in the__ environment of the oral cavity and form micro-colonies within __ after attachments (12 to 24 hours)
oxygen rich
minutes
Early biofilm formation: These bacteria produce an enzyme known as __ (12-24 hours)
gluccosyltransferase
Early biofilm formation: Glucosyltransferase converts sucrose into a sticky extracellular polysaccharide called __ (12-24 hours)
Glucan
This creates a sticky environment that allows other early colonizing bacteria to attach to the initial colonies and protect them from acidic environments (12-24 hours)
Glucan
As the plaque begins to develop and expand __ (1-3 days)
oxygen can no longer diffuse into the colonies
After a few days __ begin to colonize the plaque (1-3 days)
anaerobic gram negative cocci, rods, and filaments
After several weeks the bacteria grow together forming colonies known as __
Corncobs
The anaerobic environment causes facultative anaerobes such as __ and __ to break down sucrose through fermentation pathways
S. mutans
Lactobacilli
The facultative anaerobes produce __ as a metabolic byproduct
Lactic acid
How to read a caries risk chart
Draw a line at 5.5
Above the line = low risk more remineralization
Below the line = high risk more demineralization
Recommend ppm of fluoride in public tap water
0.7 ppm
ppm of fluoride in OTC toothpaste
1000 ppm
(0.22% SF, 0.76% SMFP, 0.4% STF)
From a radiograph, identify as E1, E2, D1 or D2 (ADA caries classification system)
E1 = enamel only
E2 = At the DEJ
D1 = into outer 1/3rd of dentin
D2 = into middle 1/3rd of dentin
D3 = into inner 1/3rd of dentin
Look at pic
Xylitol is used for __
moderate and high risk patients (caries management chart)
Naturally occurring, low calorie sugar substitute with anticariogenic properties (found in gum and sweeteners)
Xylitol
Short term consumption of xylitol is associated with decreased __ in saliva and plaque
streptococcus mutans levels
Bacteria are unable to produce what in the presence of xylitol
acid ( no decrease in plaque pH –> no demineralization)
This hardens the lining of cavities, making untreated cavities less sensitive, and increases salivary flow to optimize pH
xylitol
During tertiary prevention of periodontal disease, use this as an antimicrobial therapy agent
Chlorohexadine (0.12% peridex solution)
Chlorohexadine can also be used as an antimicrobial oral rinse for __ and __
plaque control
salivary hypofunction
Used for the treatment of fungal infections
Nystatin
(comes as rinses, lozenges, troches, pastilles, cream, ointment, powder)
If the patient has active non-cavitated caries you want to prescribe __
Prevident 5000
(2.2% sodium fluoride)
Prevident 5000 contains __ sodium fluoride which helps it to __ and __
2.2%
Prevent cavities
reduce pain from sensitive teeth
White spot lesions can have both __ and __ occurring simultaneously
demineralization
remineralization
An advancing subsurface lesion with a remineralizing surface lesion
White spot lesion ( sub surface shows greater degree of demineralization
If the outer enamel stays intact, the white spot lesion will remain stable / arrested, an arrested lesion is considered __
More resistant to demineralization
What 5 disease indicators automatically place the patient as high caries risk classification
- Visible cavitated lesions into dentin
- Active proximal enamel demineralization radiographically
- Visible active smooth surface enamel demineralization
- Restorations due to cavitation in the last 3 years
- Extractions due to extensive cavitation in the last three years
How many yeses are needed for a pt to be high, moderate and low risk when looking at risk factors
low risk = <3
moderate risk = 3-6
high risk = > 6
(opposite for protective factors)
List some risk factors
Visible plaque on more than 25% dentin
< 3 fluoride exposures per day
Deep pits and fissures
Reduced Salivary flow
Head and Neck radiation history
Restorations with open margins / overhangs
Exposed root
Ortho
Limited access to care
> 3 snacks and sugar exposures
Recreational drug use
What are the codes for low, moderate and high risk
D0601
D0602
D0603
Fluoride salt, highly reactive fluoride ion, silica abrasives are compatible, more stable than stannous
Sodium Fluoride 0.22% (1000ppm)
Not an ionic fluoride salt, covalently compound fluoridated compound that requires enzymatic activation by a salivary enzyme to release bioavailable fluoride, compatible with more abrasives
Sodium Monofluorophosphate 0.76% (1000ppm)
Tin (II) fluoride - chemical compound with formula SnF2, fluoride that is highly reactive, abrasive calcium pyrophosphate, adheres to the surface of tooth enamel and forms a protective layer, shields tooth from erosion
Stannous fluoride 0.4% (1000ppm)
Acidulated fluoride is the __
most commonly professionally applied topical fluoride (12,300ppm)
If someone is low risk for caries what caries management should you perform
OTC fluoride toothpaste
12-18 months recall frequency
BWINGS 18-24 months
Difference in radiograph frequency between moderate and high risk
Moderate = every 12 months
High = every 6 months
Recall frequency for moderate and high caries risk
Moderate = 6-12 months
High = 3-6 months
