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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
what is combined fluoride therapy?
gives best results | 1 systemic and 1 topical
26
what is fluorosis?
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
27
what is the tx of fluorosis?
microabrasion bleaching resin restoration veneers
28
what is toothbrush abrasion?
abnromal loss of tooth structure bc non masticatory physical action - repetitive mechanical habit
29
what is chlorhexidine?
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
30
how much saliva is secreted daily and what is its function?
0.5-0.6 litres/day protective, digestive, enamel stabilisation buffers and neutralises acids
31
what is xerostomia?
``` reduced salivary production meds - diuretics, antihistamines, antidepressants radiation s.gland surgery systemic disease - sjogrens syndrome ```
32
how does xerostomia look in the mouth?
dry glossy atrophic mucosa fungal bacterial infections common angular chelitis
33
what is the tx of a disabled pt with caries?
superbrush modified handle sponges with chx and chx gel
34
what is moisture control used to eliminate?
saliva gcf bleeding pus etc
35
what is a PRR?
min pit and fissure caries | restores caries and seals rest of fissure pattern
36
what problems does NCTSL cause?
``` sensitivity cupping lesion pulp exposure loss of vitality proud restorations reduced height of crowns aesthetic problems ```
37
what is erosion?
chemical dissolution of hard tissues not including bacteria
38
what is attrition?
loss of structure bc mechanical action of mastication
39
what is abrasion?
friction
40
what is abfraction?
tensile/compressive forces during tooth flexure = loss of tooth surface
41
why might a restoration fracture?
secondary caries heavy filling weak tensile tooth structure
42
what does staining around a composite suggest?
secondary caries
43
how to diagnose an approximal lesion?
floss and probe | ortho seprators, transilluminate, radiographs
44
what is an electronic resistance measurer?
sound tooth - insulates carious tooth - current passage allowed vanguard similar
45
what is transillumination?
digital imaging fibre optic transillumination approx lesions
46
what dyes are used for caries detection?
carious detection agents | stains demineralised not infected
47
what is laser fluoresnce/diagnodent?
early caries diagnosis caries alters fluoresence low reading = sound tooth
48
what is air abrasion?
aluminium oxide particles
49
what does the stephan curve show?
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
what governs the shape of the stephan curve?
saliva | dilutes/clears metabolites and buffers
51
what is the action of xylitol?
raises intra oral pH bc salivary flow increases/buffers inhibits adhesion, growth and metabolism of microorganisms - suppresses S mutans - remineralises - synergistic with F
52
what is the tristan da cuhna study?
before 1940 - low sugar diet | after 1940 - sugar introduced and caries increases
53
what is the hopewood house study?
dental exams between 1947-1962 lactoveg diet with little or no sugar no oh/f low caries rates
54
what is the vipeholm study?
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
what does cheese after sugar do?
prevents depression of plaque pH because increased salivary flow
56
what does excessive fruit consumption cause?
caries and erosion
57
bacteria on the surface of teeth is affected by what antibodies?
secretory - from saliva | serum - from GCF
58
a caries vaccination is being developed against what bacteria?
s mutans
59
how does fluoride make apatite crystals less soluble?
becomes fluoroapatite which is less sol | displaces carbon and magnesium and improves crystalline structure and reduces solubility
60
how does fluoride affect remineralisation?
reduces the less soluble carbonate acid attack = f released which favours remineralisation f accumulates in early lesions and reduces solubility
61
how does fluoride affect morphology?
wider fissures more rounded cusps thinner enamel and dentine
62
how does fluoride affect plaque?
enzyme inhibitor/affects metabolism by - binding to plaque in high concs inhibits metabolic pathway and acids are not formed
63
at what ppm is water fluoridated? how much of the UK has it? how effective is caries reduction?
1ppmF 15% 20-40% caries reduction
64
what is in fluoride tabs, how effective are they?
40-50% | NaF
65
what ppm is fluoridates salt?
250mg
66
what ppm is milk?
0.03ppm
67
a high reg intake of F at what ppm causes skeletal fluorosis?
>8ppmF
68
what is the lethal overdose of F?
5mg/kg per body weight
69
describe enamel structure?
core - tightly packed HA crystals sheath - less well packed, spaces - water and organic material - easier acid diffusion where demineralisation starts
70
what are the layers of a carious lesion?
surface zone body lesion dark zone translucent zone
71
describe the surface zone?
intact, higly mineralised F content high small porosity forms and reforms
72
describe the body of the lesion?
largest 25-50% porosity radiographically seen
73
describe the dark zone?
5-10% porosity large and mall pores demineralisation and remineralisation occurs
74
describe the translucent zone?
1st carious change 1-2% mineral loss few large pores
75
what is arrested caries?
remineralised caries | brown exogenous staining
76
why does cavitation occur?
demineralisation and bacterial invasion
77
what is the defence respone of dentine?
reactionary tertiary dentine | translucent sclerotic dentine - blocks tubules
78
what happens in dentine if there is rapid carious progression?
no sclerosis/odontoblasts die and there is poss reparative dentine
79
what are the zones of a lesion in dentine?
zone of destruction zone of bacterial penetration advancing front of dentine
80
what is the advancing front of the lesion?
zone of demineralisation | acid and no bacteria
81
what is the zone of bacterial penetration?
bacteria in tubules lateral spread lactobacilli
82
what is the zone of destruction?
proteolytic enzymes | destroys organic matrix
83
what are the 2 zones of dentine caries?
outer - infected, irriversibly demineralised dentine, proteolytic degradation of collagen matrix inner - dentine reversibly attacked, collagen not severly damaged, minimal infection
84
what is the initiation of the carious process?
suscpetible tooth and pellicle formation - colonisation in 0-4 hours, s sanguinis, s oralis s mitis
85
what is microbial succession of the enamel pellice?
strep to actinomyces in 1-14 days
86
what makes bacteria cariogenic?
acidogenic : sugars to lactic acid use extracellular and intracellular polysaccharides into acid aciduric - thrives at low pH
87
what is the specific plaque hypothesis?
300 species of bacteria - limited number involved in carious process
88
what is the non specific plaque hypothesis?
caries happens because of the all over effect of bacteria
89
what is the ecological plaque hypothesis?
environment influences action
90
what is the critical pH?
pH of 5.5 | HA dissolves below
91
what are nutritive sweetners?
sorbitol, mannitol,xylitol | bulk sweetners, slowly fermented, only slight pH drop
92
what are alternative sweetners?
saccharin, aspartme, acesulfame K | intense sweetners
93
what are tooth friendly sweets?
dont cause pH to fall below 5.7 in 30 mins of ingestion
94
what can sodium lauryl sulphate be the cause of?
apthous type ulceration
95
when can GI be used for fissure sealing?
limited co operation highly anxious partially erupted teeth - less moisture control but - wear easier, fall off more often
96
what is the critical pH of fluorapatite?
4.5
97
what did dr fredrcik mcKay discover?
1901 pts had mottled teeth colorado brown stain
98
what did dr trendley dean discover?
examined caries in 21 cities in america | F levels in water
99
what is DMFT?
decayed missing filled teeth
100
what is Def?
count of primary teeth - decayed/extracted due to caries
101
what is DMFS?
decayed missing filled tooth surfaces

1st year (8 decks)

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