Midterm 1: Cariology I Pit & Fissure Caries Flashcards
What are dental caries?
Disease where ecological shift within dental biofilm environment
What is biofilm?
Aggregation of microorganisms in which cells adhere to each other forming small communities
held together by extracellular polymeric matrix
Ex. Dental plaque
What does acidogenic mean?
something that produces acid
Ex. cariogenic bacteria
What does it mean to be of higher cariogenicity?
more acid
acidogenic
In dental caries, the population shifts from a balanced population of microorganisms of ____________________ to a microbiological population of _______________.
low cariogenicity
high cariogenicity
What does the microbiological population of high cariogenicity increase production of?
organic acids
What does the microbiological population of high cariogenicity promot?
dental hard tissue net mineral loss
carious lesions
What is the disease of dental caries driven by?
frequent access to fermentable dietary carbohydrates
What does demineralization mean?
chemical process by which minerals are removed from dental hard tissues (enamel/dentin/cementum)
occurs through dissolution by acids or chelation
can be replaced with remineralization
What is a carious lesion?
The clinical manifestation of caries disease
can have a few or many
What does cariogenic mean?
the ability to cause dental caries
Ex. a cariogenic diet contains sugar
What does cavitated mean?
Denotes a loss of surface intergrity
refers to total loss of enamel and exposure of underlying dentin
inability to biologically replace loss of hard tissue
What is dental plaque?
organized community of many different microorganisms that forms itself into a biofilm
can vary from healthy to harmful microorganisms
What are monosaccharides?
Simplest forms of carbohydrates
What does noncavitated mean?
initial caries lesion development before cavitation occurs
change in color, glossiness, or surface structure
What is a pellicle?
A thin cellular membrane of salivary proteins adsobed to the enamel or cementum
What is remineralization?
The chemical process by which minerals (esp Ca) are replaced into the substances of the dental hard tissue
requires supersaturation with calcium and phosphate ions, fluoride, and adequate buffering
What 3 factors must be considered in evaluating Caries Disease?
- Personal Factors
- Oral environmental factor
- Factors that directly contribute to caries development
What is a substrate?
material metabolized by specific microorganisms in dental plaque to produce acids that lead to demineralization
What are the 4 requirements for active caries disease process to occur?
- susceptible tooth area
- acid producing bacteria from biofilm
- fermentable carbohydrates in diet
- time
What are some causes of Caries disease?
- bacteria
- diet
- saliva
- genetics
- biofilm dysfunction - prolonged exposure to low pH: 100%
What is the primary pathogen in the biofilm?
Streptococcus Mutans
What does the carbonate ion do to the carbonated hydroxyapatite?
makes the mineral more acid-soluble than pure hydroxyapatite
What is dentin primarily composed of?
small thin crystal flakes embedded in a protein matrix of cross-linked collagen fibers
What is the structure of enamel?
repeating molecular units of hydroxyapatite
Ca19(PO4)6(OH)2
What mineral is in enamel and dentin?
carbonated hydroxyapatite
a calcium phosphate with numerous impurity inclusions
What are some susceptible tooth surfaces?
- occlusal of posterior teeth
- lingual anteriors
- mesial/distal approximal surfaces
- free smooth surfaces (gumline)
Dental caries is a _________ disease that results in localized destruction of tooth tissues by acids that are produced in mouth as oral bacteria ferment ____________.
Biofilm
dietary carbohydrates
What does the odontoblast do?
secretes organic matrix
regulates mineralization
What is dentin composed of?
- tubules
- inorganic apatite crystals
- organic matrix
- water
What are some other tooth surfaces caries disease can occur on that are not considered susceptible?
- white spot lesion (smooth surface)
- root caries on exposed cementum
What is a biofilm?
An aggregate of microorganisms in
which cells adhere to each other and/or to a solid substrate exposed to
an aqueous surface
What happens if the pH in the biofilm becomes too acidic? What pH would it have to drop below for this to happen?
Demineralization of tooth enamel
pH < 5.5
Caries are not caused by an infectious agent but what?
a shift in oral microflora to caries-causing bacterial types in response to shift in pH
What are some fermentable carbohydrates?
- Sugars (sucrose, glucose, fructose, lactose)
- Starches
What are two examples of cariogenic bacteria?
- stretococci mutans
- lactobacilli
What is the process called where bacteria convert glucose, fructose, and sucrose into acids?
glycolysis
A shift in plaque ecology, in which ______________ bacteria, such as S sanguinis are less able to survive. When pH neutral, S sanguinis keeps acid production low and increases remineralization.
Acid-sensitive
Increased sugar intake results in _________ acid production
more frequent
When the pH drops, there is an ecological shift from _______________ and _______________ to ____________, ______________, and ________________.
** all bacteria names
S. sanguinis
S. gordonii
S. mutans
lactobacilli
bifidobacteria
What is the solubility of enamel?
pH 5.5
What is cavitation?
collapse of enamel surface due to compromised dentin structure
no longer support enamel rods
reach dentin
may reach pulp
Where does pit/fissure formation begin?
cusp tips
What causes the formation of pits and fissures?
imperfect fusion at interfaces
Variations in ____________________ anatomy affects caries suceptibility.
pit and fissure anatomy
Depth of a pit is very near ___________.
dentin
What fills the inaccessible spaces of pits and fissures?
biofilm
What can diffuse into pits and fissures filled with biofilm?
Fermentable carbohydrates
What are the signs of an incipient occlusal lesion?
chalky enamel bordering
darkly stained plaque
Does incipient occlusal lesions require surgical treatment?
No
What part of dentin responds to the chemical threat of caries?
Vital dentin
What is the ICDAS system?
How to diagnose pit and fissure caries
International Caries Detection and Assessment System
0-6 scale
visual criteria
Describe an ICDAS 0.
sound tooth structure
no change after air drying
no hypoplasia (incomplete development)
no wear
no erosion
no histological depth
Describe an ICDAS 1.
changes in enamel after drying
colored changes
limited to pits and fissures
histological depth:
90% enamel
10% dentin
Describe an ICDAS 2.
Distinct change in enamel
seen when wet
widening of pit/fissure
50% into inner enamel
50% into outer dentin
Describe an ICDAS 3.
localized enamel breakdown
no underlying dentin shadowing
widening of fissure
77% into dentin
Describe an ICDAS 4.
underlying dark shadow in dentin
WITH or WITHOUT enamel breakdown
88% into dentin
Describe an ICDAS 5.
distinct cavitation
dentin visible
involving less than half the tooth surface
100% into dentin
Describe an ICDAS 6.
Extensive cavitation within dentin
involves more than half the tooth structure
100% reaching inner third of dentin
Secondary prevention covers ICDAS ______ to ______
1-3
Tertiary prevention covers which ICDAS classifications?
4-6
What is CAMBRA?
Caries Management by Risk Assessement
Focus on treating/preventing disease at patient level rather than surgical/restorative approach
What is CAMBRA used for?
determine patient’s caries risk
rate as: extreme/high/moderate/low risk
CAMBRA risk assessment is based on:
- disease indicators
- risk factors
- protective factors
What does fluoride do?
Rinses
Gels
Varnishes
Toothpastes
Fluoridated water
How do you form a crystal nucleus?
Take a partly dissolved crystal and remineralize with calcium, phosphate, and fluoride
What is the main characteristic of a crystal nucleus?
acid resistant
fluorapatite-like coating on crystals
What does CPP-ACP do?
aids in remineralization with nano particles of hydroxyapatite
What do sealants do?
creates a smooth occlusal surface
removes food source of bacteria
TRUE OR FALSE
Dental caries are transmissible.
TRUE
What is vertical transmission?
Passage of bacteria from mother to baby during the period after birth
What is horizontal transmission?
Transfer of bacteria between individuals of the same generation
Prolonged periods of low pH leads to what?
demineralization of teeth
ultimate damage to the tooth
Treatment strategies aim to eliminate the biofilm dysfunction, or prolonged periods of __________ (high/low) pH.
low
How does saliva help against dental caries?
hydrate
neutralize and support the pH
