MIDTERM 1: cariology/products Flashcards
what is the pH of saliva, what minerals are in it
greater than 5.5, HCO3 (Ca2+., PO3-)
what is the critical dentin ph
6.2-6.8
what are the protective factors for caries ON TEST!
SAFER
saliva and sealants
Antibacterials
Fluoride,ca, po4
effective lifestyle habits
risk based reassessment
what are the risk factors for caries (ONTEST)
BAD
bad bacteria
absence of saliva
destructive lifestyle habits
what are disease indicators for caries (ONTEST)
WREC
white lesions
restorations less than 3 yrs
enamel lesions
cavities/dentin
what is the clinical presentation of ICDAS 1/ ICDAS 2?
earliest clinically detectible lesions. indicates mild demineralization. lesion limited to enamel or to shallow demineralization of cementum/dentin. mildest forms are only detectable AFTER DRYING!!!! when established and active, may be white or brown and enamel has lost its normal gloss. (icdas2)
-infected dentin is UNLIKELY.
whats the clinical presentation of ICDAS 3 and ICDAS 4
moderate
visible signs of enamel breakdown or signs dentin is moderately demineralized. established, early cavitated, shallow cavitation or microcavitation. dentin demineralization is pOssible!!
whats the clinical presentation of ICDAS 5 or 6
advanced
enamel is fully cavitated and dentin is exposed. dentin lesion is deeply/severely demineralized. spread/disseminated, late cavitated or deep cavitation.
-dentin demineralization for sure
when on icdas scale do you never do surgical intervention?
0,1, and 2
-chemical treatment only!
how do E1, E2 and D1 come up on radiograph
or ra1, ra2, ra3
-radiolucency may extend to dentinoenamel junction or outer one third of dentin.
how does d2 come up on radiograph
or rb4
radiolucency extends into middle one third of the dentin
how does d3 come up on radiograph
or rc5. radiolucency extends into the inner one third of the dentin
which radiographic groups require no surgical treatment
e0,e1,e2,d1
d1 SOMETIMES depends..
when (radiograph classification) is surgery required
d2 and d3
what are the 5 overall strategies /treatments for caries management (not surgical)
- pH neutralization (reduces growth/acid production of cariogenic bacteria- supports healthy bacteria)
- antibacterial
- fluoride (aids in remineralization, inhibits acid production of cariogenic bacteria)
- xylitol -reduces growth and acid production of cariogenic bacteria
- nano HA (Ca PO4) aids in remineralization w nano particles of hydroxyapatite
what does chlorhexidine rinse do
antibacterial but does not work against lactobacillus!!!! so more for periodontal disease!
(twice a day for 1 week per month. mau cause staining and increased calculus)
what does carifree treatment rinse do
ctx4 gel - antibacterial, pH neutralizer
what does carifree maintenance rinse do
ctx3, pH neutralizer and xerostemia
(daily to prevent dental caries infection from returning. rinse w 10 ml for 1 minute, usually twice a day. more frequently for xerostomia)
what does fluoride rinse do
ACT- remineralization
what does carifree bost spray do
ctx2, pH neutralizer, xerostemia
what does baking soda toothpase and or rinsing do
pH neutralizer and xerostemia
what do xylitol mints /gum do
xerostemia (salivary flow stimulant) and antibacterial, and pH neutralizer
what is MI paste or MI plus paste and what does it do
fluoride varnish!!! desensitizer, remineralization
what does 5000 ppm fluoride toothpaste do?
remineralization
for a low risk person ; what is the home care rec, recare interval, and radiograph interval (Pacific protocol)
oral hygiene, individualized diet modification, frequency and exposure, OTC fluroide toothpaste
recare: 12 months
radiographs: 24-36 months
for a moderate risk person ; what is the home care rec, recare interval, and radiograph interval (Pacific protocol)
Everything from low risk +
- xylitol gum/mints throughout the day
- .05% NaF rinse after meals if possible
- xylitol gum/mints throughout the day
Alternative therapy would be to use a 5000 ppm F toothpaste twice daily instead of OTC toothpaste and no mouth rinse’
recare: 4-6 months
radiographs: 18-24 months
for a highrisk person ; what is the home care rec, recare interval, and radiograph interval (Pacific protocol)
everything from low and moderate +
- 5000 ppm toothpaste instead of OTC F toothpaste morning and night
- antibacterial /pH neutralizer (CTx4 treatment rinse) before bedtime
recare: 3-4 months
radiographs: 6-18 months
for a extreme risk person ; what is the home care rec, recare interval, and radiograph interval (Pacific protocol)
everything from now, moderate and high +
- pH neutralization (boost spray) throughout the day
- Ca/PO4 supplementation (MI paste) throughout the day and right before bedtime
recare: 3 months
radiographs: 6 months until no new caries lesion
how do you use treatment rinse (carifree ctx4) , what is its pH , ingredients?
mix equal amounts of A and B (about 10 mL total) and swish for 1 minute once or twice a day
- pH 10-11 , makes biofilm inhospitable for acid loving bacteria
- ingredients: (active)- sodium hydroxide and sodium hypochlorite
- also has fluoride and 11% xylitol
alcohol free
how do u use chlorhexidine gluconate , whats its pH and ingredients, brands
-whats the treatment plan with it?
rinse w 1/2 ox (15 ml) for 1 minute twice a day for one week
- use a fluoride product for the next 3 weeks.
- repeat each month
pH 5-7
ingredients= .12% chlorhexidine gluconate, 12% alcohol or alcohol free.
brands: peridex and periogard. (paroex is alc free)
- DONT USE WITH FLUORIDE!!!!!!!
- use until caries control is completed and bacterial counts are low (all antimicrobials)
meant to be intensely used, short term, therapeutic endpoint.
-set a caries recall dpeendent upon what you have described and patient motivation. usually want another ATP measure at 1 month. repeat as frequently as you feel adequate
what should you not mix w fluoride
chlorhexidine rinse
how should antimicrobials be used
whats the chlorhexidine rinse protocol/treamtent
-use until caries control is completed and bacterial counts are low (all antimicrobials)
meant to be intensely used, short term, therapeutic endpoint.
- set a caries recall dpeendent upon what you have described and patient motivation. usually want another ATP measure at 1 month. repeat as frequently as you feel adequate
- twice a day for 1 week per month. doesnt work against lactobacillus. may cause staining, increased calculus formation.
whats the carifree ctx4 treatment
antimicrobial
2x a day till gone
what is the iodine treatment
antimicrobial, its hospital dentistry. requires long contact time.
how should carifree ctx3 be taken, whats its ingredients. does it have alcohol?
maintenance rinse-
- daily to prevent dental caries infection from returning.
- rinse with 10 ml for 1 minute (usually twice a day, for xerostemia- use more frequently, especially after snacking)
- pH 8.0
active ingredients - .05% NAF
other ingredients; 25% xylitol
-alcohol free
how is high fluoride toothpaste used
5000 ppm
1.1% Na fluoride
pea sized amount twice a day
NOT for young children.
OTC is like 1k-1200ppm, much more.
whats the ingredients in MI paste,how is it used
-paste vs ONE
active ingredient: recaldent (CPP-ACP) a complex of casein phosphopeptides (CPP) and amorphous calcium phosphate (ACP)
- DONT rx for someone with a milk protein allergy (caesin IgE)
- helps remineralization, root sensitivity, and pH neutralization. (pH 7.8)
- xerostemia/salivary gland hypofunction use. rub on cotton swab or clean finger several times a day and/or use a bleaching tray overnight.
- apply w/toothbrush is not recommended its sticky.
MI Paste plus- with fluoride
MI paste one- can brush teeth w it.
whats in fluoride varnish, how does it work and when used
white or clear usually
-5% NA fluoride= 22,600 ppm!!!!
time released fluoride for months
safe for infants and children.
should be considered after cleanings.
how does xylitol gum/mints work and what is it
-recommended dose for gum/mints
naturally occuring sugar. slowly absorbed so lower caloric intake than other sugars. doesnt require insulin for metabolism. maintains neutral oral pH.
decreases adhesion of bacteria to teeth.
bacteria cant metabolize it. -strongly anti-acidogenic bacteria and decay
dosing:
gum: each piece is 1 gram of xylitol, recommended 6-10 grams (pieces) a day
mints: each piece is .5 grams of xylitol. 12-20 pieces each day is ideal.
what is boost spray recommended for, whats it made of, pH, and how should it be used (how it works)
Rec for xerostemic patients!
- calcium hydroxide w/9 pH
- 35% xylitol, glycerine also
- 2-3 sprays as often as needed
- raises pH and prevents demineralization.
fits in pocket.
what are products that are good for xerostemia?
MI paste, xylitol gum, boost spray, baking soda toothpaste etc.
ADA caries classification: what is low caries risk
no incipient or cavitated primiary or secondary lesions in past 3 years and no risk factors
ADA classification what is moderate caries risk under and over 6 yrs old
under 6: no lesions in last 3 years but at least 1 risk factor
over 6: 1 lesion in past 3 years or at least 1 risk factor
ADA classification high caries risk under and over 6 yrs old
-under 6: any of the following- any lesion in past 3 years, multiple risk factors, low socioeconomic status, suboptimal fluoride exposure, xerostemia
over 6: any of the following: 3 or more lesions in past 3 years, multiple risk factors, suboptimal fluoride exposure, xerostomia
