Lecture 4 Flashcards
CARIES IMBALANCE SCALE
- ) PROTECTIVE FACTORS FOR REMINERALIZATION - SALIVA COMPOSITION AND FLOW (I.E. FLUORIDE, CALCIUM, PHOSPHATE, ANTIBACTERIAL AGENTS)
* HYPERTENSION AND DIABETES CAN CAUSE DECREASED SALIVARY FLOW (XEROSTOMIA) - ) PATHOLOGICAL FACTORS OF DEMINERALIZATION - CARIOGENIC BACTERIA REDUCED SALIVARY FLOW, FERMENTABLE CARBOHYDRATES
- ) DISEASE INDICATORS OF DEMINERALIZATION -(WHITE SPOTS, RESTORATIONS < 3YR OLD, ENAMEL, LESIONS, CAVITIES/DENTIN)
PROCESS OF CARIES FORMATION
- ) SUCROSE ATTACK - BIOFILM CAN FORM/PROLIFERATE
- ) ACIDIC ENVIRONMENT FORMED BY CARIOGENIC BACTERIA BREAKING DOWN SUCROSE YIELDS HYDROGEN IONS AS A BYPRODUCT (PHOSPHATE IONS IN SALIVA CAN NEUTRALIZE ACIDIC ENVIRONMENT IF PROFICIENT ENOUGH)
- ) SUBSURFACE LESIONS CAUSE HAP DISINTIGRATION AND YIELD DENTAL CARIES FORMATION
- ) RECIPROCATION BY INTRAORAL MINERALS (FLUORIDE) ON THE SURFACE OF ENAMEL => FLUORAPETITE - REQUIRES A pH OF 4.5 TO DEMINERALIZE
2 WAYS OF CARIOGENIC TREATMENT
INVASIVE RESTORATION) AMALGAM OR COMPOSITE
NON-INVASIVE RESTORATION) ONLY PERFORM WHEN IN INITIAL STATE OF DECAY
NON-INVASIVE RESTORATION
FLUORIDE INHIBITS DEMINERALIZATION BECAUSE IT IS MORE RESISTANT TO CHANGES IN ENVIRONMENTAL ACIDITY - F REPLACE OH- OF HAP)
FLUORIDE ATTRACTS CA IONS AND FILLS CARIOGENIC GAP W/ REMINERALIZATION
BENEFITS
DOWNFALLS OF NON-INVASIVE RESTORATION
DOWNFALLS:
FLUORIDE ONLY WORKS ON ENAMEL SURFACE AND SALIVARY FLOW HAS TO BE GOOD TO ALLOW DIFFUSION OF CA AND PHOSPHATE IONS
BENEFITS OF NON-INVASIVE RESTORATION
BACTERIAL INHIBITION IN HIGHLY ACIDIC ENVIRONMENTS ALLOWS HYDROGEN AND FLUORIDE IONS TO COMBINE AND HF DIFFUSES INTO BACTERIAL CELL AND INTERFERES W/ HYDROGEN ION PRODUCING ENZYMATIC PROCESSES OF BACTERIA
ENAMEL REMINERALIZATION SYSTEMS
CRYSTALLINE CALCIUM PHOSPHATE
STABILIZED AMORPHOUS CALCIUM PHOSPHATE FORMULA
UNSTABILIZED AMORPHOUS CALCIUM PHOSPHATE SOLUTION
CRYSTALLINE CALCIUM PHOSPHATE
NEEDS TO BE DISSOLVED IN SALIVA W/ AN ACIDIC ENVIRONMENT PRESENT (CAUSES DISSOCIATION OF TWO IONS FROM EACH OTHER - @ NORMAL pH IONS DO NOT DISSOCIATE)
IONS DIFFUSE TO ENAMEL SURFACE LESION
EX. PREVIDENT, CLINPRO-5000
BIOACTIVE GLASS (TYPE OF CRYSTALLINE CALCIUM PHOSPHATE ENAMEL REMINERALIZATION SYSTEM)
IONS ARE PROTECTED W/IN A GLASS BEAD UNTIL CALCIUM PHOSPHATE INSIDE IS ABLE TO SAFELY INTERACT W/ LESION)
IONS ARE RELEASED WHEN THEY INTERACT WITH WATER
THIS ALLOWS THE IONS TO HAVE A HIGH BIOAVAILABILITY AT THE SITE OF LESION
WORKS WELL ON SUBGINGINVAL ENAMEL SURFACE LESIONS
IONS W/IN GLASS BEADS ARE ASSOCIATED W/ TWO DIFFERENT SALTS (EX. CACL2) AND WHEN SALTS INTERACT W/ SALIVA IONS ARE RELEASED AND THEY INTERACT W/ EACH OTHER => AMORPHOUS CALCIUM PHOSPHATE (ACP)
**SENSISHIELD/SENSODYNE
UNSTABLIZED AMORPHOUS CALCIUM PHOSPHATE FORMULA
CALCIUM AND PHOSPHATE DELIVERED SEPARATELY INTRAORALLY
ACP CAN TRANSFORM POORLY AND YIELD POORLY SOLUBLE PHASES IN THE MOUTH ACTUALLY PROMOTING DENTAL CALCULUS FORMATION AND F SEQUESTRATION (DECREASES REMINERALIZATION CAPABILITIES)
**ENAMELON, ENAMEL PRO
DENTIN REMINERALIZATION (2 METHODS)
CLASSICAL ION-BASED CRYSTALLIZATION
NON-CLASSICAL PARTICLE-BASED CRYSTALLIZATION
CLASSICAL ION-BASED CRYSTALLIZATION
OVERLAY OF CRYSTALLINE CALCIUM PHOSPHATE IONS ON EXISTING APATITE SEED CRYSTALLITES
DOES NOT WORK W/ COMPLETELY DEMINERALIZED DENTIN OR W/ EXTRA-FIBRILLARY REMINERALIZATION (CAPO4 IONS ARE TOO BIG)
NON-CLASSICAL PARTICLE-BASED CRYSTALLIZATION
USES ACP STABILIZED BY BIOMIMETIC ANALOGS OF NON-COLLAGENOUS PROTEINS
DOES NOT REQUIRE SEED CRYSTALLITES AND IS CAPABLE OF INTRAFIBRILLARY MINERALIZATION OF COLLAGEN
*FLUID BASED - INTRAFIBRILLARY ACCESS
DENTAL CARIES
DESTRUCTION/DEMINERALIZATION OF THE TOOTH’S CALCIFIED TISSUES BY ACID GENERATED IN ORAL “PLAQUE BIOFILMS”. THIS PROCESS USUALLY BEGINS W/ DEMINERALIZATION OF ENAMEL AND PROCEEDS TO THE UNDERLYING DENTIN AND FINALLY THE PULP.
FLUORIDE
- ) INHIBITS DEMINERALIZATION
- ) ENHANCES REMINERALIZATION
- ) MAY INHIBIT ESSENTIAL BACTERIAL ACTIVITY
