Module 1: What Are Caries

Question 1

Is the cavitation the early or late stage of the disease process?

Answer 1

Late

Question 2

How do carious lesions start?

Answer 2

Loss of surface integrity

Question 3

What part of the crown is vulnerable?

Answer 3

Any uncovered portion of the tooth

Question 4

What are the three steps of a Lesions Assessment?

Answer 4

See it: Visually on the surface
Feel it: Drag the explorer to assess surface texture
Radio it: Use it to verify the histological depth of lesion

Question 5

How do active smooth surface caries look on visual examination?

Answer 5

They look dry and feel rough

Question 6

If treated properly, can active smooth surface caries be remineralized?

Answer 6

Yes

Question 7

What do inactive smooth surface caries look like

Answer 7

Hard
Smooth
Shiny
Black to Brown to White in Color

Question 8

What are the three Stages of Caries Progression?

Answer 8

Initial
Moderate
Extensive

Question 9

Besides Initial, Moderate, and Extensive…how else are caries categorized?

Answer 9

Active or Inactive

Question 10

How do active Dentine lesions appear?

Answer 10

Soft, flaky, and/or leathery

Question 11

How do inactive Dentive lesions appear?

Answer 11

Shiny and hard on probing

Question 12

What are three ingredients that allow for caries development?

Answer 12

Tooth
Bacteria
Sugar sources

Question 13

What are the three parts of the ven diagram that allow caries to form?

Answer 13

Host factors
Bacterial factors
External factors

Question 14

What are some examples of host factors?

Answer 14

Tooth anatomy, texture, protected surfaces
Salivary quality and flow rates
Salivary pH and buffering capacity
Systemic disease

Question 15

How can a caries infection be described?

Answer 15

A multifactorial pH mediated disease

Question 16

Why might diabetic patients have a lot of carious lesions?

Answer 16

Due to a reduced salivary flow rate

Question 17

What are some Environmental/External Factors?

Answer 17

Diet:
Fermentable carbs, frequency of meals, acidity of meals

Oral hygiene and compliance
Fluoride exposure

Question 18

What do the bacteria create in order to adhere to teeth?

Answer 18

Sticky glucans

Question 19

What does the acidic byproducts from the bacteria do to weaken the enamel?

Answer 19

It removes calcium and phosphates

Question 20

What are some of the bacterial factors that must be present for carious development?

Answer 20

Mutans Streptococci
Lactobacilli
Other non-cariogenic bacteria can become cariogenic for short periods of time under certain conditions

Question 21

What is the theory that states that some typically non carious bacteria can become cariogenic if the pH of the oral environment remains acidic for an extended period of time?

Answer 21

Extended ecological plaque hypothesis

Question 22

Who came up with the ecological plaque hypothesis?

Answer 22

Marsh

Question 23

What does Marsh’s ecological plaque theory reconcile?

Answer 23

the non specific and specific bacterial hypotheses

Question 24

What is the non-specific bacterial hypotheses?

Answer 24

All bacteria is bad and should be removed

Question 25

What doe the ecological hypothesis say?

Answer 25

There are several varieties of bacteria that may be cariogenic and that the pH of the environment play a significant role in carious development

Question 26

What is the first step in the process of decay?

Answer 26

The dissolution of minerals in the enamel

Question 27

What is the imperfect mineral structure of enamel and dentin?

Answer 27

Calcium deficient carbonated hydroxyapatite

Question 28

What direction do the enamel rods run in?

Answer 28

Perpendicular to the DEJ

Question 29

What is detectable ahead of the advancement of the lesion towards the DEJ?

Answer 29

Tubular sclerosis or sclerotic/translucent dentin

Question 30

What is the most common reaction of the pulpodentinal complex to adverse insult?

Answer 30

Deposition of minerals in the dentin tubules

Question 31

Why is it called translucent dentin?

Answer 31

The dentin appears translucent due to reduced light scattering

Question 32

What happens when the carious lesion makes it to the DEJ

Answer 32

A light brown discoloration will appear in the dentin which is the first sign of dentin demineralization

Question 33

What part of the odontoblast is housed in each dentin tubule?

Answer 33

The odontoblastic process

Question 34

Are the odontoblastic processes peritubular or intertubular?

Answer 34

Peritubular

Question 35

What is more mineralized? Odontoblastic processes or intertubular dentin?

Answer 35

Odontoblast processes

Question 36

What sensations are delivered to the nerves in the pulp via the odontoblastic processes?

Answer 36

Pain Pressure Temperature

Question 37

What degrades the dentin once the bacteria has come into direct contact with it?

Answer 37

Acid and proteolytic enzymes

Question 38

What happens in the zone of destruction?

Answer 38

Dentin that has been exposed directly to bacteria will decompose

Question 39

What might happen before the dentinal invasion by the bacteria

Answer 39

Reactive/Reparative dentin may form

Question 40

How are dead tracks in dentin formed?

Answer 40

When the bacteria invades below the zone of destruction and quickly progresses through the tubules

Question 41

What is it called when a bacterial invasion causes two or more dead tracts to coalesce?

Answer 41

Liquefactive foci

Question 42

What will the decomposing/ed dead tracts make up?

Answer 42

The zone of bacterial penetration

Question 43

Besides during embryonic development, when do we see amelogenin expression?

Answer 43

During pathological conditions like carious lesions

Question 44

What might amelogenin be an important precursor for?

Answer 44

Reactionary dentin matrix formation

Question 45

When does primary dentin form?

Answer 45

before eruption

Question 46

When does secondary dentin form?

Answer 46

forms through root formation

Question 47

When does tertiary dentin form?

Answer 47

In response to stimuli from the bi-products of bacterial invasion in advance of the bacteria

Question 48

What can mimic carious lesions in children that ingested high levels of fluoride before the age of 8?

Answer 48

Fluorosis

Question 49

What do teeth look like that have mild fluorosis?

Answer 49

The teeth look like they have white flakes, frosty edges, or fine lace like white lines "Snow capped appearance on incisal edges"

Question 50

What can occur in severe cases of fluorosis?

Answer 50

Pitting and staining

Question 51

Besides fluorosis what are two other conditions that mimic the look of carious lesions?

Answer 51

Hypocalcification | Amelogenesis imperfecta

Question 52

What type of inheritance pattern has Amelogensis imperfecta been linked to?

Answer 52

X chromosome and sporadic

Question 53

What is another mimic of caries that be attributed to low birth weight, prematurity, maternal illness, smoking, drug use, liver disease or drug use

Answer 53

Hypoplasia

Question 54

What is erosion caused by?

Answer 54

Acids of non-bacterial origin

Question 55

What causes abraction lesions?

Answer 55

Microfractures in the cervical tooth structure due to destructive excursive forces

Question 56

Why can abfraction, abrasion, attrition, and erosion lesions be mistaken for arrested/inactive carious lesions?

Answer 56

Because they form hard, shiny surfaced lesions