Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ABPD 2021 > Prevention/Anticipatory Guidance > Flashcards

Prevention/Anticipatory Guidance Flashcards

1
Q

Definition of anticipatory guidance

A

To provide developmentally relevant information about a child’s health to help prepare parents for milestones in the future

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Definition of dental caries

A

Chemical dissolution of tooth surface caused by metabolic events in the biofilm covering the affected area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Contributing factors to caries

A 
Oral hygiene
Diet
Microbiology
Fluoride
Genetics (immune, enamel, saliva)
Environmental factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Keyes Triad

A

Host and teeth
Microflora
Substrate (diet)

Very simplistic approach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Koch’s Postulates

A

Describes requirements for a microorganisms to be considered in an etiologic agent for disease

Found in all cases of disease
Organism should be grown on artificial media for several subcultures
Pure subculture should produce disease in susceptible animal

Not able to be done in caries
-many confounders (behavior, education, SES, genetics, etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Specific Plaque Hypothesis

A

Only certain species of bacteria are involved in caries process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Nonspecific Plaque Hypothesis

A

All plaque/bacteria are pathogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ecological Plaque Hypothesis

A

Shifts in pH of biofilm cause a shift toward cariogenic bacteria (S mutans) in the balance of resident oral flora, resulting in dsease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Extended Caries Ecological Hypothesis

A

Dental plaque as a dynamic microbial ecosystem in which non-mutans bacteria are key players for maintaining dynamic stability

Low pH environments can stimulate non-mutans bacteria to be more acidogenic

Variety of bacteria that are acid-producing, not just S mutans

Given the right environment, even the good bacteria can cause demineralization and destruction of tooth surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Composition of enamel

A

95% hydroxyapatite

  1. 5% water
  2. 5% organic matrix

Calcium phosphate crystals make up 99% of dry weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Active vs inactive carious lesion

A

Active lesions: white, opaque, rough

Inactive lesions: smooth, hard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

White Spot Lesion

A

Intact surface zone: 20-50um
Body of lesion - pore volume > 5%
Dark zone - pore volume 2-5%
Translucent zone - advancing front of lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dentin reaction to caries

A

Vital tissue that reacts to external insults

Most common reaction to caries progression is tubular sclerosis and occlusion of dentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pulp-dentin reactions

A

Histologically early signs of tubular sclerosis can be seen before the enamel lesion reaches the DEJ

Dentin demineralization does not extend laterally beyond contact area with enamel lesion

Reactionary dentin may form before dentin is invaded by bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Biofilm

A

Necessary but not sufficient to cause disease

Microbial biofilm on teeth is prerequisite of caries lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Primary route of transmission of caries

A

Saliva

Vertical transmission from mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Early colonizers of bacteria

A

S. Mitis
S. Salivarius
S. Oralis

Prior to tooth eruption, these bacteria are transient, usually on gingival tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Acquired pellicle formation

A

Acellular, proteinaceous film that forms on teeth within minutes after cleaning

Composed of salivary glycoproteins, phosphoproteins, lipids and components from gingival crevicular fluid

1 micron thick

Critical role in bacterial colonization

Facilitates remineralization by maintaining calcium and phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Microbial succession

A

Early bacteria create environment either favorable to others or unfavorable to themselves

Gradual replacement with other species who are better suited to modified environment

Microbial hemostasis is a state of equilibrium between microflora and local environment

Disruption can result in disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Characteristics of cariogenic bacteria

A

Rapid transport and conversion of sugars to acid

Ability to maintain metabolism under extreme conditions like low pH

Production of extracellular polysaccharides such as glucans that shift to acidic

Acid producing cocci and rods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SECC bacteria

A

More anaerobic cultures found

S sanguinis generates alkali from arginine and decreases cariogenicity of acidogenic bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Window of Infectivity

A

Between 19-31 months of age

Window appears to close after all primary teeth erupt

Once stable plaque or biofilm covers tooth surface, MS is less likely to be established

2nd window of infectivity at 6 years when 1st molars erupt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Transmission of caries

A

Vertical: parent to child (most often from mother)
Horizontal: spouses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Factors affecting acquisition of MS

A

Erupted teeth
Presence of hypoplasia
Diet high in fermentable carbohydrates
Antibiotic intake (?) - conflicting results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Stephan Curve

A

Curve that shows the pH drop after sucrose intake

Shows time below 5.5 pH where demin is occurring

Takes up to 30 minutes to buffer back to neutral

Why frequency is important

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Critical pH

A

Varies depending on total calcium and phosphate concentration in saliva

Average 5.5 for hydroxyapatite
Average 4.5 for fluorapatite

Low concentrations of calcium and phosphate can increase the critical pH as high as 7 in some people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Remineralization

A

Saliva acts as source for calcium and phosphate that helps in maintaining supersaturation with respect to tooth minerals

When saliva is stimulated, rapid rise in pH occurs, calcium phosphate and glycoprotein called salivary precipitin is formed - complex readily incorporated into dental plaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Fluorapatite

A

Fluorapatite has higher pH for dissolution

Displacement of hydroxide with fluoride removes a weakness of hydroxyapatite to lactic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Overview of Fluoride

A

Fluorine = most electronegative element
Fluoride is widespread in nature (water, milk, vegetables)

NaF= sodium fluoride
SnF2 = stannous fluodie 
Na2PFO3 = sodium monofluorophosphate (MFP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Does fluoride cross the placenta?

A

Most does not cross

No evidence that prenatal fluoride supplements taken by women during pregnancy are effective in preventing dental caries in offspring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Fluorosis and infant formula

A

Clinicians should consider potential fluoride exposure to infants when fluoridated water is used to reconstitute infant formula

1ppm = 1mg/L

Ex: if baby drinks 2.5oz/lb/day, 10lb baby drinks 25oz or 3 cups per day
-if powdered reconstituted with fluoridated water, 0.64-1.07ppm = 0.72mg F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Mechanism of Fluoride

A

Frequent exposure to topical fluoride is more effective in caries prevention than fluoride that is incorporated into enamel through systemic exposure during tooth development

Main mechanism = enhance remineralization and inhibit demineralization (topical)

Systemic effect (increase crystallinity of enamel) is minor

Antimicrobial effect is minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Fluoride in toothpaste

A

Sodium fluoride dentifrice offers greater cariostatic activity than MFP

Increased fluoride concentration leads to increased cariostatic activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Fluorosis

A

Permanent, intrinsic stain caused by excessive fluoride during tooth development

Usually white, but can be brown/orange

Severe cases damage tooth enamel

Directly related to total fluoride ingested during tooth development

Permanent maxillary molars most susceptible during first 3 years of life

Can affect both dentitions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Community water fluoridation

A

0.7ppm

Used to be 0.7-1.2ppm but changed in 2015

Goal is to maintain anti-caries effect but minimize risk of fluorosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Amount of fluoride in regular toothpaste

A

1000ppm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Fluoride mouthrinse

A

Provides moderate dose (226mg/L) fluoride topically on daily basis for those using it

Effective and available OTC

Not for young children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Professionally applied fluoride gels

A

High dose (12,400pmp) of fluoride 1-2 times per year

Contraindicated in younger children due to ingestion control concerns

Frequent use is impractical and expensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Professionally applied fluoride varnish

A

High dose (22,500ppm) of fluoride several times per year

Effective under providers’ control and locally retained for several hours

Small amount used, less ingestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Dietary fluoride supplements

A

Provides moderate dose (0.25-1mg per tab) on daily basis

Designed to take place of fluoridated water

Indicated if child not living in fluoridated community

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Halo effect

A

People in non-fluoridated areas receive fluoride from foods and beverages processed in fluoridated areas

Very difficult to perform research comparing effects of water fluoridation and non-fluoridation

42
Q

Fluoride toxicity

A

Toxic effects at 5mg/kg body weight

Lethal dose: 15mg/kg

43
Q

Fluoride in toothpaste (g)

A

1gm: full brush size amount of toothpaste
0. 25mg: pea size
0. 125mg: smear (less than 3 years)

44
Q

Fluoride supplements for 0-6 month old

A

None

45
Q

Fluoride supplements for 6months - 3 year old

A

If water fluoride is <0.3ppm, 0.25mg

If water fluoride is >0.3ppm, none

46
Q

Fluoride supplements for 3-6 year olds

A

If water fluoride is <0.3ppm, 0.5mg

If water fluoride is 0.3-0.6ppm, 0.25mg

If water fluoride is >0.6ppm, none

47
Q

Fluoride supplements for 6+ year old

A

If water fluoride is <0.3ppm, 1mg

If water fluoride is 0.3-0.6ppm, give 0.5mg

If water fluoride is >0.6ppm, none

48
Q

Indications for fluoride supplements

A

Only for those at very high risk for dental caries with deficient water fluoridation

Must determine all sources of fluoride

49
Q

Sodium fluoride calculations

A

Fluoride toothpaste at 0.243% fluoride = 0.1215% fluoride ion

0.1215% fluoride ion = 1215ppm

?

50
Q

Caries risk assessment - risk indicators

A

Factors that have been associated with risk of caries - modifiable

Poor oral hygiene
Inadequate fluoride exposure
Frequency of between meal carbohydrate snacks
Inadequate saliva (drug use)
Recreational drug use
Radiation therapy
51
Q

Caries risk assessment - risk factors

A

Part of causal chain or expose host to causal chain

Genetic component to caries, susceptibility and resistance
Demographic factors

52
Q

Factors that predict future caries

A

Demineralized or cavitated lesions

Stained occlusal pits or fissures

53
Q

Indicies for caries

A

DMFS index does not establish if lesion is active or not

Development of technology to detect and quantify early caries lesions and directly assess caries lesion status may prove to be best way to identify patients that require intensive prevention intervention

54
Q

Caries Management

A 
Relies on assessment of risk
Classification of lesions
Intervention
Documentation of intervention provided
Measurement of outcomes of care
55
Q

Caries risk assessment tools

A

AAPD
ADA
CAMBRA

56
Q

Disease indicators

A

WSL
Cavities
Restorations

57
Q

Protective factors for caries

A

Exposure to topical fluorides
Xylitol
MI paste
Antimicrobial rinse

58
Q

Fluoride varnish

A

Concentrated topical fluoride (NaF 5%)
Sets in contact with saliva
Well-tolerated by infants and children
Minimal risk for ingestion
Should be high priority for children with developmental disabilities
Apply 2-3 times per year depending on caries risk

59
Q

MI paste

A

No significant difference between enamel lesions in subjects versus controls after 12 months with using fluoride toothpaste, MIP paste and MI varnish quarterly

Better than no fluoride, but not better than fluoride (could be alternative for fluoride resistant parents)

60
Q

Xylitol

A

Requires frequent high doses to be effective

May reduce mother-child transmission of MS

61
Q

Silver Diamine Fluoride

A

24.4-28.8% w/v silver + 5-5.9% fluoride (44,800ppm)

Ammonia and silver fluoride combine to form a diamine silver ion complex

pH of 10

Silver = antimicrobial and inhibits enzymes that break down dentin organic matrix

Fluoride = remineralization of lesion

62
Q

FDA and SDF

A

FDA approval for SDF for dentin sensitivity

Used off label for caries arrest

63
Q

SDF side effects

A

Metallic taste
Black staining
Transient gingival irritation
Stains clothes, skin, floor, etc.

No major adverse effects or systemic illness

64
Q

Indications for SDF

A 
High caries risk
Behavioral/medical management issues
Dentin hypersensitivity
Caries stabilization 
Xerostomia from cancer/medications
Difficult to treat caries lesions 
Patients with dental phobia
Patients with limited access to restorative services
Physical or cognitive disability 
Very young/very old
65
Q

Contraindications for SDF

A

Silver allergy
Ulcerative gingivitis/stomatitis
Abscessed tooth needing extraction
Irreversible pulpitis

66
Q

Advantages of silver solutions

A 
Controls pain by arresting caries 
Affordable
Procedure is fast 
Minimal support in staff or equipment required 
Non-invasive and safe
67
Q

Maternal Nutrition

A

Linear enamel hypoplasia in primary incisors is more common in malnourished children

Caused by disruption during appositional stage of enamel formation in neonatal period

Most common in middle third of maxillary central incisor and incisal third of lateral incisor

68
Q

Enamel Hypoplasia

A

Quantitative defect of enamel formation

Caused by variety of stresses during tooth development

Neonatal line is present in almost all children either clinically or subclinically

69
Q

Enamel hypoplasia in primary incisors

A 
Correlated with poor prenatal care in first trimester 
Premature labor or birth 
Greater pre-pregnancy weight of mother 
Postnatal measles infection
Maternal smoking
70
Q

Enamel hypoplasia in permanent teeth

A

Localized (trauma, intubation, irradiation)

Postnatal (otitis media, other conditions)

71
Q

Vitamin D

A

Essential for proper bone and tooth formation
Regulates serotonin synthesis in brain
400 IU/day recommended in all infants from birth to 12 months
Beyond 12 months, 600 IU/day recommended

72
Q

Calcium

A

Works with Vitamin D for mineralization of bones and teeth
Needed for nerve and muscle activity
Intake of 500mg/day during childhood and adolescence

Deficiency: most common in children with restricted diets

73
Q

Food security

A

Access by all people at all times to enough food for an active and healthy life

Food insecurity is limited or uncertain access to adequate food for a healthy life

74
Q

Undernutrition

A

Insufficient ingestion of essential nutrients

Failure to thrive in infants

Marasmus: severe wasting
Kwashiorkor: adequate calories but inadequate protein

75
Q

Zinc

A

Important for immune function

Severe deficiency in US is uncommon but can lead to stunted growth, altered immune response, xerostomia, poor appetite

Zinc and iron supplementation should be staggered - interfere with each other’s absorption

76
Q

Overnutrition

A

Result = obesity and/or diabetes type II

BMI: overweight is 85-95%, obese > 95%

77
Q

Sugar consumption

A

WHO recommendation that no more than 10% of adult’s calories (ideally less than 5%) come from added or natural sugars

Children and adolescents in US obtain 16% of total caloric intake from added sugars alone

78
Q

Vipeholm Study

A

Institutionalized adults

Compared types of sugar consumption - sucrose, bread, chocolate, caramel, sticky toffee

Stickiness, clearance time, and frequency increase caries risk

79
Q

Turku Sugar Study

A

Compared fructose, sucrose, xylitol

Xylitol was acceptable for human consumption and showed dramatic reduction in caries incidence after 2 years

80
Q

Feeding Infants

A 
No bottles in bed
No sweetener on pacifier
Introduce cup by 6 months 
Avoid cariogenic foods/beverages between meals
No sweetened beverages 
Avoid introducing juice
81
Q

Feeding Toddlers

A 
Avoid excessive juice 
Discontinue bottle by 12 months 
Avoid unrestricted use of sippy cup
Avoid cariogenic snacks between meals
Avoid candy, soda, etc.
82
Q

AAP Juice Recommendations

A

0-1: no juice
1-3 years: limit to <4oz/day with snack or meal
3-6 years: <6oz/day with snack or meal
7-12 years: limit to 8oz daily

83
Q

Grapefruit juice

A

Should be avoided by any child taking medication metabolized by CYP3A4

Decreases P450 enzymes

Leads to increase levels of drugs and side effects

Ex: cyclosporine, tacrolimus, others

84
Q

Adolescent Oral Health

A 
Unique needs
High caries rate
Traumatic injury and periodontal disease
Poor nutrition
Esthetic desire/awareness
Complex ortho/restorative needs 
Dental phobia
Risky behaviors
Pregnancy
Eating disorders
Unique social/psychological needs
85
Q

Oral findings of anemia

A

Angular cheilitis
Atrophic glossitis

Iron, B12 or folate deficiency can result in anemia

86
Q

Leukemia oral findings

A

May present with paleness of oral mucosa, gingival bleeding, oral petechiae, painless gingival hyperplasia

Be concerned about spontaneous gingival bleeding in absence of plaque, caries, calculus or trauma

Oral manifestations can be presenting clinical signs, especially in AML

87
Q

Langerhan’s Cell Histiocytosis oral findings

A

Alveolar bone invasion by histiocytes commonly occurs in the mandible
Can result in pain, loose teeth, fractures
X-ray appearance of teeth “floating in space” due to radiolucent areas in bone
Precocious eruption or exfoliation of primary teeth
Can also cause gingivitis and oral ulcers

88
Q

Inflammatory Bowel Disease oral findings

A

8-10% of cases of Crohn’s have oral manifestations that may precede GI involvement

Aphthous ulcers and angular cheilitis found in Crohn’s disease and ulcerative colitis (IBD ulcers are painful)

Cobblestoning or mucosal modularity of buccal mucosa and gingiva indicative of Crohn’s

89
Q

Diabetes oral findings

A

Poorly controlled diabetes increases periodontal attachment loss

Xerostomia = increased caries risk

Increased risk for candidiasis

90
Q

Bulimia Oral findings

A

Enamel erosion, especially lingual surfaces of maxillary incisors
Increased risk for caries and gingivitis

Patients should rinse mouth with water with baking soda or fluoride mouth rinse (don’t brush for 30-60min)

Counsel to avoid acidic drinks

Need to be referred for medical/psychological evaluation

91
Q

AAPD Policy on Tobacco Use

A

90% of smokers started by age 18
6.7% of middle school students and 23% of high school students used tobacco products in 2012

Decrease in cigarettes, smokeless tobacco
Increase in cigarillos, E cigarettes

92
Q

5 As of tobacco cessation

A 
Ask (ask if they are smoking)
Advise (tell them to stop)
Assess (see if they are ready)
Assist (help them)
Arrange (follow up)
93
Q

Pharmacological tobacco cessation strategies

A

Nicotine replacement therapies - best if used along with behavioral treatment

Bupropion and Varenicline tartrate prescription drugs

94
Q

E-Cigarettes

A

5mL vial contains 100mg of nicotine

Lethal dose of nicotine is 10mg for children, 30-60mg for adults

Most e-cigs have a battery, heating element, and a place to hold liquid

95
Q

Ingredients of E-cigarettes

A

Nicotine
Ultrafine particles
Formaldehyde
Other carcinogens

96
Q

Concerns of e-cigs with children?

A

Gateway drug for cigarettes

Youth use is associated with appealing flavors

97
Q

Substance Use Disorder

A

A maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to repeated use of substance

98
Q

Signs of Substance Use Disorder

A

Changes in behavior
Emotional or mental changes
Physical changes

99
Q

Dental findings of substance abuse

A 
Excessive tooth decay
Malnourished appearance
Unreliability in keeping appointments
Excessive tooth wear from grinding/clenching 
Xerostomia
Hypersensitive teeth
100
Q

Most common drug used by teens

A

Alcohol

101
Q

Adolescents and confidentiality

A

Each state varies to what age an adolescent can make their own decisions and when parents can or should be told

Can call the pediatrician and ask their advice

102
Q

When to transition care for adult patients

A

Have a clear policy and give patients information with enough time to find a general dentist for care

Consider a different timeframe for patients with SHCN

ABPD 2021 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions