Plaque related diseases - caries Flashcards

1
Q

what is dental caries?

A

a disease of the mineralised tissues caused by action of microorganisms on fermentable carbohydrates
1st - demineralisation of the mineralised portion
2nd - disintegration of organic material

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2
Q

what factors contribute to caries?

A

plaque - smutans and lactobacilli
carbohydrates
time
susceptible tooth

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3
Q

when do you treat caries operatively?

A

visible cavitation

caries close to EDJ

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4
Q

what is NDIP 2003?

A

national dental inspection programme

p1/7 children have a basic inspection annually and detailed inspection biannually

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5
Q

at what age do bitewings start?

A

start at 5 years

lateral obliques if no co operation

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6
Q

what are rampant caries?

A

caries involving several teeth and occur rapidly

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7
Q

how does caries progress?

A

episodically

enamel has a dynamic surface - constant remineralisation and demineralisation

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8
Q

what happens when caries reaches dentine?

A

pulp dentine complex reacts to initiate protection of tooth vitality
- bacterial toxins through tubules = inflammatory reaction in the pulp
= reactionary dentine and sclerosis, reduced permeability of tubules and the pulp retreats

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9
Q

what is the aim of a restoration?

A

remove the bacterial infection before carious exposure

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10
Q

what does pain indicate?

A

a pulpal inflammation

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11
Q

what does reversible pulpitis require?

A

remove infection and restore

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12
Q

what does irriversible pulpitis require?

A

leads to pulpal necrosis - xla,rct

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13
Q

what happens when toxins go through the root apex?

A

perriradicular periodontitis = abscess, swelling/sinus

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14
Q

what is cellulitis?

A

soft tissue swelling

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15
Q

what is ludwigs angina?

A

progresison from severe cellulitis
fom swelling and elevated tongue - difficulty swallowing, eating and breathing
risk of death by asphyxiation

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16
Q

what is primary root surafce caries?

A

below cej, no enamel involvement/restorations

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17
Q

what is secodary root surface caries?>

A

adjacent to restoration

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18
Q

what are root surface caries influenced by?

A
saliva
fluoride
oh
diet
chx
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19
Q

what are NME’s

A

caries epidemic cause

sucrose, glucose, fructose

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20
Q

what are milk sugars?

intrinsic sugars?

A

lactose

in fruit and veg

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21
Q

what does pre eruptive F cause?

A

wider fissures
more rounded cusps
thinner enamel and denitne

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22
Q

what is post eruptive F effects?

A

if f present = fluoroapatite = remineralises
fluoroapatite less soluble than HA

increases enamel mineralisation
increases resistance of enamel to demineralisation
reduced acidity of plaque

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23
Q

what is the conc of F in water?

A

1ppmF /1mg F per litre

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24
Q

what is duraphat?

A

5% sodium fluoride

22600ppmF

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25
Q

what is combined fluoride therapy?

A

gives best results

1 systemic and 1 topical

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26
Q

what is fluorosis?

A

enamel hypoplasia
white chalky spots/brown staining and pitting of teeth
increased f affects the enamel matrix formation and impairs ameloblastic function
bilateral symmetrical distribution

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27
Q

what is the tx of fluorosis?

A

microabrasion
bleaching
resin restoration
veneers

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28
Q

what is toothbrush abrasion?

A

abnromal loss of tooth structure bc non masticatory physical action - repetitive mechanical habit

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29
Q

what is chlorhexidine?

A

0.2% chlorhexidine gluconate
antiseptic/antimicrobial action
bacteriocidal and bacteriostatic
= adsorbed onto teeth and mucosal surfaces and releases bacteriostatic concentrations over a period of time

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30
Q

how much saliva is secreted daily and what is its function?

A

0.5-0.6 litres/day
protective, digestive, enamel stabilisation
buffers and neutralises acids

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31
Q

what is xerostomia?

A
reduced salivary production
meds - diuretics, antihistamines, antidepressants
radiation
s.gland surgery
systemic disease - sjogrens syndrome
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32
Q

how does xerostomia look in the mouth?

A

dry glossy atrophic mucosa
fungal bacterial infections common
angular chelitis

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33
Q

what is the tx of a disabled pt with caries?

A

superbrush
modified handle
sponges with chx and chx gel

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34
Q

what is moisture control used to eliminate?

A

saliva
gcf
bleeding
pus etc

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35
Q

what is a PRR?

A

min pit and fissure caries

restores caries and seals rest of fissure pattern

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36
Q

what problems does NCTSL cause?

A
sensitivity 
cupping lesion
pulp exposure
loss of vitality
proud restorations
reduced height of crowns
aesthetic problems
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37
Q

what is erosion?

A

chemical dissolution of hard tissues not including bacteria

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38
Q

what is attrition?

A

loss of structure bc mechanical action of mastication

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39
Q

what is abrasion?

A

friction

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40
Q

what is abfraction?

A

tensile/compressive forces during tooth flexure = loss of tooth surface

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41
Q

why might a restoration fracture?

A

secondary caries
heavy filling
weak tensile tooth structure

42
Q

what does staining around a composite suggest?

A

secondary caries

43
Q

how to diagnose an approximal lesion?

A

floss and probe

ortho seprators, transilluminate, radiographs

44
Q

what is an electronic resistance measurer?

A

sound tooth - insulates
carious tooth - current passage allowed
vanguard similar

45
Q

what is transillumination?

A

digital imaging fibre optic
transillumination
approx lesions

46
Q

what dyes are used for caries detection?

A

carious detection agents

stains demineralised not infected

47
Q

what is laser fluoresnce/diagnodent?

A

early caries diagnosis
caries alters fluoresence
low reading = sound tooth

48
Q

what is air abrasion?

A

aluminium oxide particles

49
Q

what does the stephan curve show?

A

rapid drop in plaque pH by speed microbes metabolising sugars
slow rise - acid diffusing out of plaque by action on saliva
15-40mins recovery time

50
Q

what governs the shape of the stephan curve?

A

saliva

dilutes/clears metabolites and buffers

51
Q

what is the action of xylitol?

A

raises intra oral pH bc salivary flow increases/buffers
inhibits adhesion, growth and metabolism of microorganisms
- suppresses S mutans
- remineralises
- synergistic with F

52
Q

what is the tristan da cuhna study?

A

before 1940 - low sugar diet

after 1940 - sugar introduced and caries increases

53
Q

what is the hopewood house study?

A

dental exams between 1947-1962
lactoveg diet with little or no sugar
no oh/f
low caries rates

54
Q

what is the vipeholm study?

A

sweden 1945-1953 study on mentally handicapped pts
high sugar levels associated with small caries increase if taken 4x daily with meals and no sugar in between
sugar between meals = increased caries

55
Q

what does cheese after sugar do?

A

prevents depression of plaque pH because increased salivary flow

56
Q

what does excessive fruit consumption cause?

A

caries and erosion

57
Q

bacteria on the surface of teeth is affected by what antibodies?

A

secretory - from saliva

serum - from GCF

58
Q

a caries vaccination is being developed against what bacteria?

A

s mutans

59
Q

how does fluoride make apatite crystals less soluble?

A

becomes fluoroapatite which is less sol

displaces carbon and magnesium and improves crystalline structure and reduces solubility

60
Q

how does fluoride affect remineralisation?

A

reduces the less soluble carbonate
acid attack = f released which favours remineralisation
f accumulates in early lesions and reduces solubility

61
Q

how does fluoride affect morphology?

A

wider fissures
more rounded cusps
thinner enamel and dentine

62
Q

how does fluoride affect plaque?

A

enzyme inhibitor/affects metabolism by -
binding to plaque in high concs
inhibits metabolic pathway and acids are not formed

63
Q

at what ppm is water fluoridated?
how much of the UK has it?
how effective is caries reduction?

A

1ppmF
15%
20-40% caries reduction

64
Q

what is in fluoride tabs, how effective are they?

A

40-50%

NaF

65
Q

what ppm is fluoridates salt?

A

250mg

66
Q

what ppm is milk?

A

0.03ppm

67
Q

a high reg intake of F at what ppm causes skeletal fluorosis?

A

> 8ppmF

68
Q

what is the lethal overdose of F?

A

5mg/kg per body weight

69
Q

describe enamel structure?

A

core - tightly packed HA crystals
sheath - less well packed, spaces - water and organic material - easier acid diffusion
where demineralisation starts

70
Q

what are the layers of a carious lesion?

A

surface zone
body lesion
dark zone
translucent zone

71
Q

describe the surface zone?

A

intact, higly mineralised
F content high
small porosity
forms and reforms

72
Q

describe the body of the lesion?

A

largest
25-50% porosity
radiographically seen

73
Q

describe the dark zone?

A

5-10% porosity
large and mall pores
demineralisation and remineralisation occurs

74
Q

describe the translucent zone?

A

1st carious change
1-2% mineral loss
few large pores

75
Q

what is arrested caries?

A

remineralised caries

brown exogenous staining

76
Q

why does cavitation occur?

A

demineralisation and bacterial invasion

77
Q

what is the defence respone of dentine?

A

reactionary tertiary dentine

translucent sclerotic dentine - blocks tubules

78
Q

what happens in dentine if there is rapid carious progression?

A

no sclerosis/odontoblasts die and there is poss reparative dentine

79
Q

what are the zones of a lesion in dentine?

A

zone of destruction
zone of bacterial penetration
advancing front of dentine

80
Q

what is the advancing front of the lesion?

A

zone of demineralisation

acid and no bacteria

81
Q

what is the zone of bacterial penetration?

A

bacteria in tubules
lateral spread
lactobacilli

82
Q

what is the zone of destruction?

A

proteolytic enzymes

destroys organic matrix

83
Q

what are the 2 zones of dentine caries?

A

outer - infected, irriversibly demineralised dentine, proteolytic degradation of collagen matrix
inner - dentine reversibly attacked, collagen not severly damaged, minimal infection

84
Q

what is the initiation of the carious process?

A

suscpetible tooth and pellicle formation - colonisation in 0-4 hours, s sanguinis, s oralis s mitis

85
Q

what is microbial succession of the enamel pellice?

A

strep to actinomyces in 1-14 days

86
Q

what makes bacteria cariogenic?

A

acidogenic : sugars to lactic acid
use extracellular and intracellular polysaccharides into acid
aciduric - thrives at low pH

87
Q

what is the specific plaque hypothesis?

A

300 species of bacteria - limited number involved in carious process

88
Q

what is the non specific plaque hypothesis?

A

caries happens because of the all over effect of bacteria

89
Q

what is the ecological plaque hypothesis?

A

environment influences action

90
Q

what is the critical pH?

A

pH of 5.5

HA dissolves below

91
Q

what are nutritive sweetners?

A

sorbitol, mannitol,xylitol

bulk sweetners, slowly fermented, only slight pH drop

92
Q

what are alternative sweetners?

A

saccharin, aspartme, acesulfame K

intense sweetners

93
Q

what are tooth friendly sweets?

A

dont cause pH to fall below 5.7 in 30 mins of ingestion

94
Q

what can sodium lauryl sulphate be the cause of?

A

apthous type ulceration

95
Q

when can GI be used for fissure sealing?

A

limited co operation
highly anxious
partially erupted teeth - less moisture control
but - wear easier, fall off more often

96
Q

what is the critical pH of fluorapatite?

A

4.5

97
Q

what did dr fredrcik mcKay discover?

A

1901
pts had mottled teeth
colorado brown stain

98
Q

what did dr trendley dean discover?

A

examined caries in 21 cities in america

F levels in water

99
Q

what is DMFT?

A

decayed missing filled teeth

100
Q

what is Def?

A

count of primary teeth - decayed/extracted due to caries

101
Q

what is DMFS?

A

decayed missing filled tooth surfaces