The Host & Saliva Flashcards
4 Factors that determine caries risk:
- Bacteria (“the Agent”)
- Host Factors (“the host”)
- Oral Cavity Environment (“The Environment”)
- Time
What caries factors factors do we have less control over
Disease indicators
Explain what entails being genetically pre-disposed
They become pre-disposed because their salivary flow is not adequate, or their tooth morphology includes deep pits and fissures. Maybe they don’t
have enough phagocytic cells to fight off the bacterial infection, or their immune system doesn’t run efficiently enough to keep the infection under control.
The ___ enamel allows for water and ion movement because it is more organic than the enamel rods are.
interrod
If you are more genetically predisposed to having a little more organic material in your enamel, you might be more susceptible to caries
yes no?
___ ____ during formation, demineralization, and remineralization is also important. If you don’t have the correct ions needed to form (or re-form) enamel, the result is a weaker structure
yes
Ion exchange
the mineral matrix of enamel and dentin are made up of hydroxyapatite. However, in teeth, it is an imperfect ________structure due to the addition of carbonate to the hydroxyl group – which is where it gets its name: hydroxyapatite.
hydroxyapatite
A perfect ____mineral results in a very translucent, crystal structure – some of which are considered to be gemstones.
apatite
2 of the main components in hydroxyapatite are ___ and ____!!!
Calcium
Phosphate
Calcium is a large, necessary component of hydroxyapatite, but when there is a deficiency of calcium the body will replace it with ___ and ___. This makes a weaker structure
Magnesium Mg2+
Na Sodium
In the presence of fluoride, however, the structure is strengthened. The F- replaces the ___group and makes it less soluble in an acidic environment
On the flip side, if there is not enough (or NO) fluoride exposure, then ____ may substitute for phosphate and the hydroxyl group of hydroxyapatite.
hydroxyl
carbonate
Just as a general “rule-of-thumb,” dentin is ___ deficient.
the peritubular dentin that lines the dentinal tubules is highly mineralized
calcium
ssp
sub species within that genus
Corynebacterium
is normal or not normal oral flora
normal
One of the benefits of these particular bacteria is their ability to take the metabolic waste by- products of more cariogenic bacteria and consume it, and then producing a less acidic waste product. In effect, they help to neutralize a more acidic environment.
Veillonella & Strep. Sanguinis
Saliva has antimicrobial activity of enzymes and ____ that are present
immunoglobulins
____, in particular, plays a role in reducing the bacterial infection due to its ability to effect and damage bacterial cell walls. It is also worth noting that you can find ___ in tears and human breast milk as well.
Lysozyme
____ particularly alpha-____, plays a significant role not only in carbohydrate digestion but in bacterial clearance and metabolism.
Amylase,
___ is primarily secreted by the von Ebner’s glands and serves as an antimicrobial agent against a variety of pathogens. It helps to regulate the oral flora balance – especially when new bacteria are introduced and unestablished.
Histatin
high amount of Ca2+ and ____- in saliva, the caries rate is decreased. And when there are low amounts of these minerals, the caries rate is increased.
PO43
Lymphocytes:
The small cells (T & ___ cells) create and release the Salivary Antibodies mentioned in the next slide and the
NK cells provide additional ___ of pathogenic cells
B
phagocytosis
Salivary Antibodies: Secretory IgA aids in the agglutination of bacterial cells and marking them for phagocytosis through the _______.
opsonization
The older a person is, the more susceptible they are to ______, the more medications that they may take, the weaker the immune system is overall.
co-morbidities
4 Natural Defense Mechanisms
- Anatomical Barriers
- Normal Oral Flora
- Saliva
- Immune System
Host Factor Importance:
An individual’s ____and physical
factors may increase their susceptibility, which
greatly increases the severity of the disease
___ tooth can be susceptible if the other criteria for caries is met
biochemical
ANY
Enamel Structure: Hydroxyapatite
- ___ enamel allows for water & ionic movement
- May be more or less soluble depending on ion substitution and exchange
- Contains _____CO^2^3
Interrod
3% carbonate
Exchange of Ions in Enamel: -\_\_\_ and \_\_ may substitute for Ca2+ -F- may substitute for \_\_\_\_\_ -\_\_\_\_\_\_ may substitute for both PO 4^3-and OH-
Mg2+ and Na+
OH- (hydroxyl group)
Carbonate
Dentin is
- _____ rich 5%
- ____ deficient
- Peritubular dentin is __-mineralized
Carbonate-rich
Calcium
Peritublar dentin
Dentin
____ + _____ + ______ = Greater Susceptibility to Dissolution
- Small Crystal
- Deficient Structure (Reduced Ca++)
- Higher Carbonate Content
Why do caries progress so fast once it reaches dentin?
Its like Dentin has smaller crystal size so will erode faster
Anatomical Barriers: “Ideal” Teeth
- Anatomically complete • Excellent coalescence of enamel lobes • Contact between teeth
- Fluoride exposure
- No tooth abnormalities present
- Malformation factors
- Malnutrition factors
- Illness factors
3 Anatomical Barriers:Mouth
- Mastication
- Speech
- Mucosa (Desquamation, Keratinized, Non-keratinized)
Acquired Pellicle provides
• Diffusion of small molecules (nutrition)
• Adhesive proteins (glycoproteins)
• Competition for sites - we want good bacteria on those sites
• If bacteria are not attached, they will be
washed away by saliva (except for perio “swimmers”)!
Normal Oral Flora
is predominately gram-postitive cocci and rods
and Fungi
List 4 gram posit.
and 1 fugi
Gram Positive
- Streptococcus ssp.
- Veillonella ssp.
- Actinomyces ssp.
- Corynebacterium ssp.
Fungi
- Candida Albicans
Veillonella and Strep. Sanguinis
• Provide some acid-neutralizing properties
• Inhibit some colonization of A. israelii and S.
mutans
***Major Salivary Glands
Parotid Gland:
- Provides 25% of salivary volume
- Secretes majority of NaHCO
- Produces amylase
- Serous secretions (primarily)
- Produces majority of stimulated salivary flow
- Contains statherin
Parotid Gland:
• Provides 25% of salivary volume • Secretes majority of NaHCO • Produces amylase •Serous secretions (primarily) • Produces majority of stimulated salivary flow ****• Contains statherin
Submandibular Gland
- Provides 60-65% of salivary volume
- Mixed serous & mucous secretions
- Secretes the majority of unstimulated saliva
- Contains histatin and statherin
- Controls Ca2+ & PO43- concentrations in saliva
Submandibular Gland
• Provides 60-65% of salivary volume
• Mixed serous & mucous secretions
• Secretes the majority of unstimulated saliva
**• Contains histatin and statherin
• Controls Ca2+ & PO43- concentrations in saliva
Sublingual Glands:
- Provides 10% of salivary volume
- Mucous secretions (primarily)
- Contributes a minor amount of unstimulated saliva
Palatal, lingual, labial, buccal:
- Most are mucous secreting but some are serous
- _____ glands are only serous
- Produce a significant amount of histatins
- Contribute ___
- Contribute approximately ___of total saliva
von Ebner’s
fluoride
1/10th
5 Protection Functions of Salivar
- Lubrication
- Antimicrobial activity
- Buffering
- Flushes and Rinses
***- Saturated with minerals (Ca2+, PO
4^3-, F-)
# posteruptive maturation
Salivary glands secrete several major groups of
organic molecules in addition to electrolytes:
- Lysozyme (among other protective enzymes)
- Amylase
- Mucins/agglutinins
- Histatin
- Statherin
keeps the salivary Ca2+ levels high which helps to prevent the dissolution of teeth
Statherin
antifungal function with some
antimicrobial activity; assists host with control
over resident microflora
Histatin(S)
Relationship of Ca2+ & PO 3-
4
look at slide
relationship of ca2+ and PO43-
The amount of time that is required to 4 3- present in saliva & 4 3- are inversely related to caries development! • Saliva is supersaturated compared to the tooth demineralize tooth structure has to do with the amount of Ca2+ and PO biofilm • Concentrations of Ca2+ and PO
• An infectious agent that can cause disease • Non-host, potential disease-causing cells
Pathogen
• Has a receptor that specifically identifies a unique portion of a pathogen as non- host • The portion that it is identified by the antibody is called the antigen
Antibody host cell
Area of the pathogen identified by host antibodies that labels it for destruction • ANTIbody GENerator
Antigen
Immune System monitors the body for foreign invaders and is comprised of 8 systems list them
- Complement System
- Thymus
- Hormones
- Antibodies
- WBC
- Bone Marrow
- Spleen
- Lymphatic System
PMNs are
Polymorphonuclear cells
Phagocytosis
Lymphocytes
- Langerhans Cells: antigen-presenting cells of the mucosa (and skin) - Lymphocytes • Large: ‘NK’ (natural killers) • Small: T & B cells
Salivary Antibodies
IgA
IgG
IgM
Complement
- Main immunoglobulin found in saliva
* Aids in the agglutination of bacterial cells
IgA
- Prevents microbial adhesion & metabolism
* Activates complement
IgG
• Promotes complement binding to the antigen for
opsonization
IgM
• Activates neutrophils & other phagocytic cells
to the site = inflammation!
Complement
6 Risk Factors
- Co-morbidities
- Polypharmacy
- Age
- Gender
- Periods of growth
- Wounds and burns
Xerostomia
• Results in a greatly increased risk of caries 4
These limitations are often found in the
presence of GOOD oral hygiene & dietary
habits!
• Limited buffering capability • Limited immune response • Limited ability to wash pathogens away • Limited suspension of Ca2+, PO43-, F2 for remineralization
