Prevention Flashcards
The critical regulator in the caries process?
Saliva
What disease process is 5x more common than asthma? What is an important regulator?
Caries, saliva
The key to dental caries was discovered by who and when? What was the hypothesis?
WD Miller “Miller time!”, ‘Non-specific plaque theory’ : acid production by bacteria considered for tooth break down. 1890
Clarke in 1924
Discovered strep mutans, could not prove it caused caries
Keyes to S. mutans?
1960- demonstrated S. mutans was the responsible bacteria for caries in humans. Along w/ Strep sobrinus
Cariogenic properties of strep mutans?
Ability to produce acid (primarily lactic acid), aciduricity- ability to withstand acidic environment, adherence to teeth (sticky glucans)
MS is necessary and sufficient to cause caries. T/F
F. MS is necessary but not solely sufficient for dental caries
MS acquisition and transmission: how does classic data regarding acquisition differ from new data?
1) Old: Colonization after eruption of teeth vs new:colonization may occur at birth, tongue fissures as a niche. 2)Older: MS is a poor biofilm competitor, if S. sanguis colonizes first there is less S. mutans. 3)Old: Vertical transmission, >70% New: horizontal and vertical 4) New: Early MS acquisition assoc w/Bohn’s nodules and high maternal levels
Factors associated with MS acquisition
Sweetened fluids taken to bed, frequent sugar exposure, snacking, sharing foods w/adults, maternal MS levels (Wan et al 2003)
Factors associated with non-colonization of MS
Multiple courses of antibiotics and frequent toothbrushing
Prevention of Transmission–study by? effects of interventions?
(Soderling 2000) 1. Xylitol gum 2. CHX varnish 3. FV –xylitol lowest numbers of infants colonized by MS at ages 2,3, and 6
Lactobacilli and relationship to caries?
Found in large #s of children, considered opportunistic, not initatiors, good indicator of CHO intake, # increases after DEJ is invaded
Children w/S-ECC have more or less microbial diversity?
Less diversity, w/a higher frequency of C albicans
Hopewood House Diet study- describe? Results?
Diets devoid of sugar and white flour, extremely low dental caries (1947)
Vipeholm Vive - Describe?
- Sugar consumption at meals = slight increase 2. Sugar between meals: marked increase 3. Sugar in sticky candies: greatest caries activity 4. Increased caries risk from increased frequencey of ingestion; decreases with less frequency 5. Caries activity differs among individuals.
Glucan- describe? Importance?
Adhesion properties make it difficult to disrupt the biofilm, inhibits diffusion properties of biofilm, reduces buffering capacity of saliva, inhibits transport.
Fructan- describe?
Lesser role than glucan, intracellular can be used by MSas energy source.
Fructose, sucrose, glucose, raw starch, soluble starch, refined starch, and their relative pH changing abilities?
Soluble starch and refined starch can be broken down by salivary amylase into sugars. Least acidogenic: raw starch. Frucose/glucose equally effective as sucrose.
At what pH, begins demineralization? What is the curve called?
Stephan Curve, below 5.5 pH begins demineralization.
What food factors have a protective effect?
Fat content is protective, flavonoids in apples/cranberries-antibacterial, masticatory stimulus, cheese prevents enamel demineralization
Sohn’s beverage study results?
High carbonated bevereages saw the greatest number of caries- Sohn 2006
The relationship between sugar intake and caries is very strong. T/F?
The relationship between sugar consumption is strong in 2/30 papers, vs weak in 18/30. Relationship is much weaker now with modern F- exposure.
What factors in the host’s saliva effect caries formation?
Mineral content, pH, Flow rate, buffering capacity, antimicrobial composents (lysozyme, lactoferrin, peroxidase, IgG/M, etc), proteins.
Caries factors: 3 main factors?
Host factors, dietary intake of refined CHO, oral flora principally MS
What % of the US has access to F- water (1970-80s)
70%
Describe the ethnic/SES destribution of caries
80% of caries is in 20-25% of the population. Disproportionately more caries found in lower SES groups
Primary tooth considerations and progression for caries
More rapid caries progression (less mineral), thinner enamel/dentin, relatively larger pulp, flat contacts, caries sequence (lower molars, upper molars, anteriors); 2nd molars more susceptible than first
Role of Milk, breast milk and formula in caries susceptible
milk is not cariogenic/cause pH drop, may aid in mineralization, promote growth of cariogenic bacteria. Formula - reduces pH significantly, Ad lib/prolonged breast feeding, longer than 1 year is a risk factor does not cause pH drop but could be a growth medium for bacteria (worst for children who are eating solids, greater than 1 year),
Fluoride mechanisms of action in order of importance:
- Topical - most important inhibits demineralizaiton, promotes remineralization 2. Antibacterial (somewhat), disrupts enzyme systems (enolase), reduce acidogenesis, extracellular polysaccharide 3. Systemic (not important/no fx) improves enamel crystallinity, reduces acid solubility, recirculates through saliva
F supplementation:
Birth <6 mo
6mo <3years
years <6 yo
6-16 years
Outcomes of F toothpaste
1g of toothpaste has 1mg of F- in it
Effect was increased with :
higher baseline caries rate, higher F concentration, higher frequency of use, supervised brushing.
Little info concerning primary dentition
Fluoride Rinse: concentration? Indication? Efficacy? Associated with?
!. .05% NaF; 220 ppm = 1mg/5mL
Indications: orthodontics, radiation therapy, prosthetics
Effect: preventive fraction 26%, w/an inconclusive benefit for those exposed to other F sources. Healthy kids probably won’t benefit, but high risk/special needs/appliance kids may benefit
Long term use assocaited with reduced salivary levels of MS
Self-Applied Gel/Paste: Indications? Efffectiveness?
ie Prevident (APF 1.1% or NaF 1.1%) 5000, or .4% SnF (1000ppm)
Indicated: rampant caries, orthodontics, radiation therapy
Effective demonstrated w/NaF, APF (20-80% reduction)
Professionally applied FV
Amount of F content in gels, foams, andvarnish,
Gels: NaF 2% (9000ppm)
APF 1.23% (12,300ppm)
Foam: APF 1.23%
Varnish 2.26%F = (22600ppm)
FV effectiveness study
RCT: FV 1x/yr or 2xyr 2-3 times less likely to have new caries than from counseling along
Prophy paste w/F in it : effectiveness?
Caries reduction ~0%, will remove F-rich enamel, should replace w/topical F treatment if you complete a rubber cup prophy
Professionally applied topical F ADA guidelines by age
Under age 6 low caries risk likely no benefit, mod caries risk FV every 6 months, high risk FV every 3-6 months.
Over 6 years: low caries risk no benfit, moderate FV or gel every 6 months, high risk FV/gel every 6 months
Acute Fluoride Toxicity: mechanisms of toxicity? Toxic doses?
Mechanisms: corrosive action on stomach lining, affinity for calcium>tetany, enzyme inhibition
Toxic doses: “certainly lethal dose” 32-64mg F/kg
Letal pediatric dose: 15mg F/kg
Probably toxic dose: 5-8mgF/kg
Treatment of F ingestion and possible F toxicity
<8mg F/kg: give milk; observe >6hrs refer if symptoms develop
>8mgF/kg: induce vomiting, followed by milk and refer immediately
Unknown if asymptomatic give milk and observe, if symptomatic same as >8mg
Xylitol : looks like/structure? Properties?
5 carbon sugar alcohol
Looks, tastes, and same relative sweet as sucrose w/40% fewer calories.
Reduces acid production of plaque, plaque mass, plaque adherence, numbers of MS, accumulates in MS intracellularly and inhibits its growth
Xylitol best fx dosage?
Best effects seen at ~6.88g/day ~50cents per day (milgrom 2006)
Xylitol recommended usage
chew 20-30 minutes 2-3x/day especially following meals. ~6.88g no more than 10/day
Chlorhexidine: properties, effects on bacteria
A bis-biguanide w/bactericidal activity against gram positive and negative bacteria
- Positively charged: binds to enamel pellicle, hydroxyapatite, mucous membranes, and enzyme systems
Reduces plaque and salivary MS, but these reboundafter you stop using
Chlorhexidine: caries inhibiting effects?
Disadvantages?
Overall has a caries inhibiting effects of about 46% however not very effective for long term use to prevent caries due to rebound.
Disadvantages: staining teeth, taste, recolonization of MS
Chlorhexidine recommended regimine?
1-2 tsp 1 minute per day for one week, repeat 1 week per month or 1 week per 3 months
Benefits of CPP-ACP (mi paste, mi paste plus)? What has it shown in studies to do?
- Stabilizes Ca and Phosphate ions in the biofilm
- as these stabilize, it binds F to the tooth surface
- Demonstrated anticargionicity (rats), more effective than F mouthrinse in remineralizing white spots post ortho, increases CA and P levels in plaque
What is the ration present in MI paste plus?
5:3:1 5Ca:3Phosphate:1F-
Rationale for pit and fissure sealants?
Occlusal surface comprise 12.5% of total tooth surface area, however 50-80% of the decay is found there
F has been effective in reducing pit and fissure caries. T/F
False- less decline of pit and fissure caries and relative increase in occlusal caries in recent years. F not as effective here.
Effectiveness of sealants? Relative risk reduction? Evidence related to which teeth?
Relative caries risk reduction of 33% which is dependent on retention.
Cochrane Review: after 4.5 yrs sealed molars of kids 5-10 had 50% caries reduction. Caries reductions ranged from 86% at 12 months to 57% at 48-54 months.
- Incomplete evidence for permanent 2nd molars, premolars, primary molars, and glass ionomer cements
Fluoride varnish provides better protection than sealants. T/F
False: sealants provide better protection (Hiiri 2006)
Anticipatory Guidance 6-12 months of age Dental and oral development, F supp, non-nutritive habits, injury prevention, diet and oral hygiene
Anticipatory Guidance 12-24 months of age Dental and oral development, F supp, non-nutritive habits, injury prevention, diet and oral hygiene
Anticipatory Guidance 24-36 months of age Dental and oral development, F supp, non-nutritive habits, injury prevention, diet and oral hygiene
Mg of F ion per mL in Fluoride Varnish? Percent F?
