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Cariology 2 > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Why is caries a complex problem?

A

Because attitudes, ability, and the environment all have a role

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2
Q

Caries is defined as:

A

localized destruction of a dental hard tissue by acidic by-products from bacterial fermentation of dietary carbs

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3
Q

T/F The Disease process can be arrested at ANY point

A

True

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4
Q

Define the Ecological Plaque Hypothesis

A

Biofilm changes over time due to periodic drops in pH and metabolism of dietary sugars

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5
Q

Actinonmyces Bacteria is related to what caries

A

Root Caries

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6
Q

Are large or small chain sugars more cariogenic?

A

Small Chain

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7
Q

Demineralization occurs below what pH?

A

5.5

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8
Q

What two minerals are required for remineralization?

A

Calcium and Phosphate

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9
Q

What are three main factors that play a role in caries?

A

Enamel
Systemic Issues
Environment (diet, habits)

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10
Q

Define a white spot lesion

A

Changes in enamel associated with plaque accumulation

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11
Q

What does a white spot lesion look like 1 week in?

A

Dissolution of outer surface, NOT VISIBLE

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12
Q

what does a white spot lesion look like 2 weeks in

A

whitish, opaque, subsurface lesion

VISIBLE WITH Drying

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13
Q

what does a white spot lesion look like 3-4 weeks in

A 
Chalky
Rough Surface
Opaque
Marked dissolution/loss of minerals
VISIBLE WITHOUT DRYING
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14
Q

How does a white spot lesion look after 1 week of it being plaque free

A

IT CHANGES

reduced chalkiness

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15
Q

how does a white spot lesion look after 2-3 weeks plaque free

A

Hard and Shiny

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16
Q

What are the 3 steps in caries diagnosis?

A
  1. Early Detection
  2. Assessment of the severity
  3. Assessment of the activity
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17
Q

What does a typical active enamel carious lesion appear as?

A

Chalky and Rough

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18
Q

What does a typical active lesion of root/dentin look like

A

Soft
Leathery
Discolored

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19
Q

What do Inactive lesions look like

A

Smooth

Hard surface

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20
Q

What does the ICDAS score allow clinicians to do?

A

Categorize the visual characteristics of the occlusal surface of teeth

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21
Q

What does an ICDAS score of 0 indicate?

A

Sound Enamel
No caries
No change after drying for 5 seconds
Includes defects like enamel hypoplasia, fluorosis, tooth wear, stains

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22
Q

What does an ICDAS score of 1 indicate?

A 
First  visual change in enamel
Smooth surface
lesion visible only after 5 seconds of drying
*Contained in Pits/Fissures*
White/brown opacity
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23
Q

What does an ICDAS score of 2 indicate?

A

Distance visual change in enamel
Seen both wet/dry
Pit and Fissure lesion extended beyond pits and fissures
NO CAVITATION

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24
Q

What does an ICDAS score of 3 indicate?

A

Cavitated lesion
local enamel breakdown with no visible dentin
loss of tooth structure at entrance
Extended beyond pit and fissure

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25
Q

What does an ICDAS score of 4 indicate?

A

Can see shadow of discolored dentin through enamel

“Hidden Caries” and undermined enamel

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26
Q

What does an ICDAS score of 5 indicate?

A

Distinct cavitation with visible dentin

Lesion extends into middle 1/3 of dentin

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27
Q

What does an ICDAS score of 6 indicate?

A

Gross Caries with Visible Dentin

Involves 1/2 of tooth and possible pulp penetration

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28
Q

Active/Incipient Caries in Axium

A

No restoration needed except for esthetics

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29
Q

Moderate caries in axium

A

Most often need restoration

Caries in outer half of dentin

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30
Q

Severe Caries in axium

A

ICDAS of 4 5 or 6

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31
Q

4 Major types of oral bacteria

A

S. Mutans
Lactobacillus
Bifidobacteria
Actinomyces (Root Surface)

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32
Q

Explain the “Iceberg”

A

D4 - lesion into pulp
D3 - Lesions into Dentin
D2 Lesion limited to Enamel
D1 - Lesions with intact surface
E2 - lesions only detectable with diagnostic aid
E1 - Subclinical lesions in dynamic state of progress/regression

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33
Q

T/F you should debride before doing your findings in clinic

A

True

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34
Q

What are general color characteristics for caries detection

A

White/Yellow/Brown

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35
Q

What are surface characteristics for caries detection

A

Dull/Chalky/Rough/Cavitated

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36
Q

What is the texture for caries detection

A

Sticky/Soft

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37
Q

If the surface is still intact how should we classify a lesion

A

Incipient

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38
Q

What percentage of caries are detected WITHOUT the use of radiographs

A

30%

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39
Q

Define Sensitivity

A

Measures the number of actual positives that are correctly identified

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40
Q

Define Specificity

A

Measures the number of negatives where are correctly identified

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41
Q

What does a diagnosis of 0 on a radiograph indicate?

A

Sound Enamel on bitewings

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42
Q

What does a diagnosis of 1 on a radiograph indicate?

A

Radiolucency confined to enamel

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43
Q

What does a diagnosis of 2 on a radiograph indicate?

A

Radiolucency up to the DEJ

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44
Q

What does a diagnosis of 3 on a radiograph indicate?

A

Radiolucency in meal and outer 1/2 of dentin

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45
Q

What does a diagnosis of 4 on a radiograph indicate?

A

Radiolucency in enamel and inner half of dentin

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46
Q

What does a DIAGNOdent measure

A

measures the degree of bacterial activity

Can yield false positives

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47
Q

What has the ADA approved DIAGNOdent use to detect?

A

Pit and fissure caries
smooth surface caries
recurrent caries around amalgam restorations

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48
Q

What is the ECM best used to detect?

A

Root Caries

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49
Q

What is the “Gold Standard” of caries detection

A

QLF
Blue light wavelength that is shined through tooth and absorbed reflected at green wavelength
Direct relationship between fluorescence and mineral content

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50
Q

What is the only surface QLF is not able to image?

A

Interproximal surface

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51
Q

When you combine QLF with visual examination how specific and sensitive is it?

A
  1. 9% specific

49. 9% sensitive

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52
Q

What are the 4 main things QLF is able to do?

A

Detect early caries
Assess lesion activity
follow development of the lesion
Assess remineralization treatement

53
Q

What numbers are used to interpret DiagnoDENT results

A

0-10 - healthy
11-20 - E1 enamel caries
21-30 - E2 enamel caries
30+ dentin caries

54
Q

What percentage of the adult population suffers from dental caries

A

Estimated 91%

55
Q

Dental caries is a ____, and _____ mediated disease

A

Biofilm, pH

56
Q

Remineralization can only occur in the presence which two ions?

A

Calcium

Phosphate

57
Q

The low pH is generated from what?

A

Sugar metabolism not availability

58
Q

What is CAMBRA

A

Caries management by risk assessment through:

Disease indicators
Risk factors
Protective factors

59
Q

What are Pathologic Factors in CAMBRA (BAD)

A

Bad Bacteria
Absence of Saliva
Diet

60
Q

What are protective factors in CAMBRA (SAFE)

A

Saliva/Sealants
Antibacterials
Fluoride
Effective Diet

61
Q

What categories of meds could lead to a higher caries risk?

A 
Tylenol
Blood pressure meds
antidepressants
psychoactive drugs
muscle relaxants
alcohol mouth rinses
asthma inhalers
62
Q

What are 4 disease indicators

A

Visible Cavities or radiographic penetration of dentin
Inter proximal lesions not into dentin
White spots on smooth surfaces
Restorations within the last three years

63
Q

What are the 3 steps inCAMBRA

A
  1. Identify Risk
  2. Categorize Risk
  3. Establish clinical protocols based on individual risk
64
Q

What is the low caries risk

A

No disease indicators
few risk factors
outweighed by protective factors

65
Q

What is moderate risk?

A

no disease indicators

Multiple risk factors

66
Q

What is high risk?

A

Any disease indicators

Multiple risk factors

67
Q

What is extreme risk?

A

High Risk +

Severe salivary hypofunction

68
Q

What is the primary mode of fluoride?

A

topical

69
Q

What are the most important factors influencing DMF?

A

Fluoride

Fermentable Carbs

70
Q

T/F Fluoride is the most widely used agent for managing caries, supported by strong levels of evidence

A

T

71
Q

How does cheese protect against caries?

A

Protects against oral pH decrease
Increases flow rate
Increase Calcium concentration

72
Q

How does Xylitol effect caries risk

A

Non-cariogenic

Cariostatioc and anticariogenic is dose dependent

73
Q

What is the only anticaries agent recognized by the FDA?

A

Fluoride

74
Q

What is one the 10 greatest public health achievements of the 20th century

A

Community water fluoridation

75
Q

How much does water fluoridation reduce caries n children/adults

A

Children - 18-40%

Adults - 31%

76
Q

What is the Halo Effect?

A

When products made with fluoridated water are distributed to non-fluoridated communities

77
Q

What is the greatest single source of ingested fluoride in children?

A

Toothpaste

78
Q

What are some of the main cariogenic factors?

A 
Poor OH
Lots of Bacteria
Lots of sugar
tooth morphology
root exposure
xerostomia
79
Q

What are some of the main protective factors?

A 
Salivary Flow
Fluoride
Calcium and Phosphate
Education
OH
Diet Analysis
Xylitol
Sealants
80
Q

What is the primary force driving demineralization

A

Diffusion of hydrogen ions into the tooth which draws out Calcium and Phosphate

81
Q

What are the mechanisms of fluoride?

A
  1. promotes remineralization
  2. Stabilizes tooth surface
  3. Inhibits dental plaque
  4. slows demineralization
  5. Converts hydroxyapatite –> fluoroapetite
82
Q

How does fluoride effect metabolism of sugars

A

Retards it

83
Q

What is the recommendation for the amount of fluoride in water?

A

.7 mg/L

84
Q

At what level is Fluoride considered a contaminant?

A

4 mg/L

85
Q

How much does community water fluoridation reduce caries?

A

by 60%

86
Q

How much does dentifrice reduce caries in children?

A

Up to 23%

87
Q

What is a major factor leading to increased fluorosis prevalence

A

Halo Effect

88
Q

Are fluoride products good at protecting secondary caries?

A

Research currently leans towards products not being able to protect against secondary caries

89
Q

What is bioavailable fluoride?

A

The sum of ionic fluoride, precipitated fluoride and absorbed pro fluoride compounds that become available in the oral cavity after brushing

90
Q

Does Stannous fluoride or sodium fluoride have a lower bioavailability in a dentifrice?

A

Stannous Fluoride

91
Q

When does the ADA recommend fluoride varnish?

A

For caries prevention and in “At-Risk Patients”

92
Q

What is the method in which fluoride varnishes works?

A

Slows demineralization by blocking “kink” sites

93
Q

What are the 5 mechanisms that increase biofilm resistance

A
  1. Slows penetration
  2. Stress response by biofilm
  3. Altered microenvironment
  4. persistent bacteria
  5. antimicrobial depletion
94
Q

What is Prevident 5000

A

Prescription toothpaste with 5000 ppm of Fluoride

95
Q

What is Acidulated Phosphate Fluoride

A

5x fluoride concentration of normal toothpaste
pH of 5.6
DO NOT APPLY to porcelain or glass ionomer

96
Q

What is the key benefit to Fluoride Varnish

A

It does not depend on patient compliance

97
Q

What is MI paste

A

Only product that provides the correct bio-available ratio of 5Ca - 3 Phosphate - 1 Fluoride
Reduces dentinal sensitivity b occluding tubules

98
Q

What allergy is a contraindication for MI paste

A

Dairy

99
Q

What is the mechanism of action of MI paste

A

Alters the pH of the oral environment

100
Q

Which product can be considered Non-Cariogenic at Any concentration and frequency, but can only be cariostatic and anticariogenic depending on the dose, frequency and duration

A

Xylitol

101
Q

What are the negatives of Glass Ionomer Composite for Root Caries?

A

It has poor wear resistance

102
Q

What is the negative of composites for Root Caries

A

Low Fluoride Release

103
Q

What is the pH that demineralization occurs in root caries?

A

Below 6.7

104
Q

T/F if you are unsure of the cause, then assume that it was due to caries

A

True

105
Q

What categorizes someone as Low Caries Risk

A

No disease indicators

Protective factors outweighs risk factors

106
Q

What categorizes as someone with Moderate Caries risk

A

No Disease indicators

Risk Factors outweigh protective factors

107
Q

What categorizes someone as High Caries Risk

A

Any disease indicator

or Multiple Risk Factors

108
Q

What categorizes someone as extreme caries risk?

A

Severe disease indicators

Severe salivary hypo function

109
Q

Prior to a saliva test a patient should not smoke, eat, drink or rush their teeth for how long?

A

1 hour

110
Q

How do you visually inspect the level of hydration

A

Lower lip labial gland watch for droplets

111
Q

If droplets don’t form in 60 seconds or less what does that say about salivary flow?

A

It is Low

112
Q

What does Sticky/Frothy saliva indicate

A

High viscosity

At Risk

113
Q

What does Frothy Bubbly Saliva Indicate?

A

Increased Viscosity

Medium Risk

114
Q

What does Water clear saliva indicate

A

Normal Viscosity

Low Risk

115
Q

What is the normal pH range in the mouth?

A

6.5-6.8

116
Q

If you have less than 3.5 saliva after 50 minutes of collecting do you have normal or low saliva quantity?

A

Very Low

117
Q

What does 0-5. 6-9, and 10-12 points indicate in Buffering Capacity

A 
0-5 = Very low
6-9 = Low
10-12 = Normal
118
Q

What lesions are responsible for the majority of restorations in children?

A

Occlusal Caries

119
Q

What lesions are ideal to remineralize because topical fluoride works well on smooth surfaces?

A

Approximal Lesions

120
Q

What lesions are the most difficult to restore? Why?

A

Root Lesions

Bonding to dentin and cementum is a challenge

121
Q

What is the treatment recommendation for an ICDAS score of 0,1 or 2

A

Sealants

122
Q

What is the tx recommendation for an ICDAS score of 3

A

Sealant or restoration

123
Q

What is the tx recommendation for an ICDAS score of 4, 5, or 6

A

Restoration

124
Q

What are examples of disease indicators

A

Cavitation into dentin
Smooth surface enamel lesions
White spots on smooth surfaces
Restoration in the last 3 years

125
Q

What is the x-ray and recall interval for Extreme Classification?

A

6 mo - X Ray

3 mo Recall

126
Q

What is the x-ray and recall interval for High Classification?

A

6-18 mo - X Ray

3-4 mo Recall

127
Q

What is the x-ray and recall interval for Moderate Classification?

A

18-24 mo - X Ray

4-6 mo recall

128
Q

What is the x-ray and recall interval for LowClassification?

A

24-36 mo - X ray

6-12 mo recall

129
Q

Of the following which would be used for Low/Moderate/High/Extreme Risk:

  • Everyone Brush 2x Daily**
    1. Tooth Paste (OTC /w Fluoride)
    2. Reduce Snacking (Nuts, cheese, celery/carrots)
    3. Xylitol (3-4x daily)
    4. Fluoride Rinse (5000 ppm)
    5. Prescription Mouth Rinse (Chlorahexadine/Peridex 10 mL for 60 seconds 1 week per month, ALSO 1 hr post brushing due to interaction with SLS)
    6. ACP/MI Paste (at least 3 minutes without rinsing)
    7. Baking Soda Rinses (after eating/drinking)
A

Low - 1 and 2
Moderate - 1, 2, 3 and 4
High - 1, 2, 3, 4, 5, and 6
Extreme - All

Cariology 2 (1 decks)

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