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Cariology > Unit 1 > Flashcards

Unit 1 Flashcards

1
Q

What is a Dental Carie?

A

Multifactoral, transmissible, infectious oral disease. Caused by biofilm(flora) + fermentable carbohydrates.

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2
Q

What 3 things are needed for caries pathogenesis (traditional)

A

1) Tooth Structure
2) Bacteria
3) Carbohydrates

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3
Q

Primary modifying factor for caries (8)

A

1) Tooth anatomy
2) Saliva
3) biofilm pH
4) Use of fluoride
5) Diet
6) oral hygiene
7) Immune system
8) Genetic factors

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4
Q

Secondary modifying factors for caries (7)

A

1) socioeconomic
2) Education
3) Lifestyle
4) Environment
5) Age
6) Ethnic
7) Occupation

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5
Q

Caries on what 2 surfaces would indicate rampant caries throughout the mouth

A

Occlusal

Interproximal smooth surface

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6
Q

How does bacteria demineralize tooth structure?

A

Metabolize carbohydrates–> produce organic acid by products–>lower biofilm pH–>calcium and phosphate leave tooth

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7
Q

How does remineralization occur?

A

1) When pH in biofilm returns to neutral,
2) concentration of calcium and phosphate is supersaturated (relative to tooth)

–> Then mineral can be added back

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8
Q

Pathological Factors

A

Acid producing bacteria
Subnormal saliva flow/function
Frequent eating/drinking fermentable carbs
Poor hygiene

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9
Q

Protective Factors

A

Saliva flow components
Remineralization (F, Ca, Phosphate)
Antibacterial (fluroide, chlorhexidine, xylitol)
Good oral hygiene

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10
Q

Ecological Plaque Hypothesis

A

PH effects both dominance and how the flora acts

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11
Q

3 Critical pH levels

A

Enamel 5.5
Dentin 6.2
Hydroxyfluroapitite 4.5

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12
Q

Carie therapeutic treatment

A

Biofilm control
Elevating biofilm pH
Enhancing remineralization

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13
Q

Caries lesion

A

Tooth demineralization as a result of the caries process

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14
Q

Smooth surface caries

A

A caries lesion on a smooth tooth surface

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15
Q

Pit and fissure caries

A

Lesion on a pit or fissure

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16
Q

Enamel caries

A

A lesion in enamel typically indicative that the lesion has not penetrated dentin

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17
Q

Coronal caries

A

A lesion in any surface of the anatomical tooth crown

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18
Q

Root caries

A

Lesion on root surface

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19
Q

Primary caries

A

A caries lesion not adjacent to an existing restoration or crown

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20
Q

Secondary caries

A

A caries lesion adjacent to an existing restoration crown or sealant

CARS caries adjacent to restoration or sealant

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21
Q

Residual caries

A

Refers to various tissue that was not completely excavated prior to restoration. Difficult to differentiate from secondary caries

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22
Q

Cavitation caries lesion

A

A caries lesion that results in the breaking of the integrity of the tooth or cavitation

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23
Q

Noncavitated caries lesion

A

A caries lesion that has not been cavitated. In enamel referred to as white spots. Blunt prope must be able to enter but usually sharp explorer finds roughness

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24
Q

Active caries lesion

A

A caries lesion that is considered to be biologically active at time of examination

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25
Q

Rampant Caries

A

Presence of extensive and multiple cavitated and active caries lesions in the same person. Meth mouth radiation therapy caries baby bottle caries

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26
Q

Dental Plaque

A

Soft film accumulating on the surface of teeth–>biofilm

Composed of bacteria, by products, ECM, Water

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27
Q

No pathogenic bacterial plaque

A

Pellicle composed of salivary proteins and free cells. Protects, reduces friction, remineralization

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28
Q

Mucosa flora

A

S. mitis
S sanguis
S salviarius

Aerobic
PH 7
Oxidative reduction is positive

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29
Q

Tongue Flora

A

S salviarisu
S mutans
S sanguis

Aerobic
PH 7
Oxidation reduction positive

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30
Q

Teeth Flora (non carious)

A

S Sanguis

Ph 5.5
Aerobic
Oxidative reduction negative

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31
Q

Gingival Crevice Flora

A

Fusobacterium
Spirochatea
Actnomyces
Veillonella

Anaerobic
Variable pH
Very Negative Oxidation reduction

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32
Q

Enamel Caries

A

S mutans

An aerobic
PH less than 5.5
Negative

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33
Q

Dentin Caries

A

S mutans
Lactobacillus

PH less than 5.5
An aerobic
Oxidation negative

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34
Q

Root Caries flora

A

Actinomyces

Anaerobic
PH less than 5.5
Oxidation reduction

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35
Q

Caries originating on root are alarming (4)

A

Rapid progression
A symptomatic
Closer to pulp
Difficult to restore

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36
Q

Saliva Enzymes

A

Amylase
Lactoperoxidase
Lysozyme
Lipases

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37
Q

Non Enzyme Proteins Of Saliva

A

Lactoferrin
Secretory immunoglobulin
Glycoproteins

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38
Q

When enamel caries penetrates to the DEJ….

A

Rapid lateral expansion of the caries lesion occurs because dentin is much less resistant to acid demineralization

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39
Q

3 Distinctly different clinical sites for caries initiation

A

Pits and fissures
Smooth enamel surfaces
Root surface

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40
Q

Pits and Fissures Caries

A

Bacteria: MS usually found in carious pits and fissures

Physical Properties: narrow fissure prevents biofilm removal

Difficulty: appear smaller than the actual lesion. Inverted v appearance. Covers more surface area than smooth

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41
Q

Smooth Enamel Surface Caries

A

Less favorable

Usually under sites of contact

Board area of origin. Pointed or conical extension towards DEJ. Parallel to enamel rods

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42
Q

Root Surface Caries

A

Roots surface much rougher than enamel

Increasing prevalence because older are retaining more teeth

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43
Q

Progression of Carie Lesions

A

Caries development in healthy individuals is usually slow compared to compromised persons

18 +/- 6months from noncavitated to clinical caries

  • occlusal less time than smooth surface
  • 3 weeks with poor hygiene acidic food and sucrose
  • 3 months from onset of dry mouth
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44
Q

Hypocalcified Enamel

A

Developmental white spot
Same WET OR DRY
Do no restore!

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45
Q

White Spot Lesion (noncavitated enamel caries)

A
  • Disapears when wet
  • Do not restore
  • Noncavitated can remineralize
  • chalky white hard external surface
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46
Q

Cavitated Enamel Lesions (Active Caries)

A
  • Surface is disturbed or missing
  • Soft, chalky surface
  • Into dentin
  • Can not remiineralize must be restored
47
Q

Remineralized Enamel Lesion (Inactive Caries)

A
  • Should not be restored
  • Intact but discolored usually brown or black.
  • Supersaturation of saliva with calcium and phosphate ions Is the driving force
48
Q

Every time a tooth remineralizes…

A

It becomes a little more resistant to decay

49
Q

Normal Enamel

A

Hydrated: translucent
Desiccated: Translucent
Surface Texture: Smooth
Surface Hardness: Hard

50
Q

Hypocalcified Enamel

A

Hydrated:Translucent
Desiccated:Opaque
Surface Texture:Smooth
Surface Hardness:Hard

51
Q

Noncavitated Caries

A

Hydrated:Translucent
Desiccated:Opaque
Surface Texture:Smooth
Surface Hardness:Softened

52
Q

Active Caries

A

Hydrated: Opaque
Desiccated: Opaque
Surface Texture: cavitated
Surface Hardness: Very soft

53
Q

Inactive Caries

A

Hydrated: Opaque dark
Desiccated: opaque dark
Surface Texture: roughened
Surface Hardness: hard

54
Q

Normal Enamel (clinical significance)

A

Plaque: Normal
Enamel Structure: normal
Therapeutic Treatment: NA
Restorative: NA

55
Q

Hypocalcified Enamel (Clinical sig)

A

Plaque: Normal
Enamel Structure: abnormal not weakened
Therapeutic Treatment: NA
Restorative: Only for aesthetic

56
Q

Noncavitated Caries (clinical sig)

A

Plaque: Cariogenic
Enamel Structure: pours weakened
Therapeutic Treatment: Yes
Restorative: NA

57
Q

Active Caries (clinical sig)

A

Plaque: Cariogenic
Enamel Structure: Cavitated very weak
Therapeutic Treatment: Yes
Restorative: Yes

58
Q

Inactive Caries (clinical sig)

A

Plaque: Normal
Enamel Structure: Remineralized very strong
Therapeutic Treatment: NA
Restorative: Only for esthetic

59
Q

Dentin Composition

A

50% HA (75% wt)
25% Collagen (20% wt)
25% water (5% wt)

60
Q

Reaction to long term low level acid

A

Repair demineralize dentin by remineralization
Direct exposure of pulp tissue to micro organisms is not a prerequisite for inflammatory response
Hypermineralized areas may be seen

61
Q

Moderate intensity attack

A

Bacterial invasion of dentin
Can cause degeneration and death of odontoblasts; information of pulp

Cause formation of secondary odontoblasts(mesenchyme derived)

62
Q

Severa advancing caries

A

High levels of acid production
Abscesses
Death of pulp due to impaired blood supply

63
Q

Zones of Dentin Caries

A

1) weak organiz acids demineralize dentin
2) The organic material of dentin practically collagen degenerated and dissolves
3) the loss of structural integrity Is followed by invasion of bacteria

64
Q

3 Zones of dentin caries

A

Zone 1: Normal
Zone 2: Affected Dentin
Zone 3: Infected Dentin

65
Q

Zone 1: Normal Dentin

A

Deepest area is normal dentin
Has tubules with odontoblasts processes smooth and no crystals

Intertubular denint has normal cross banded collagen

66
Q

Zone 2: Affected Dentin

A

-Inner carious dentin
Zone of demineralization of interubular dental
Initial formation of fine crystals in the tubules lumen at the advancing front
Odontbalsitc procees damage evident
Painful when stimulated
Uninflected
1)Subtransparent dentin 2) transparent dentin 3) turbid dentin

67
Q

Zone 3: Infected dentin

A

“Outer carious dentin”
Layer that the clinician would encounter first when opening Lesion

Bacterial invasion and is marked by widening and distortion of dentin tubules

Non sensitive

68
Q

What is Dentistry?

A

The Evaluation, diagnosis, prevention, and or treatment of diseases disorordr and conditions of the oral cavity, maxillofacial area and or adjacent structures

69
Q

Composition of Enamel

A

90-95% HA
4-8% Water
1-2% Protein

70
Q

Enamel Vs. Dentin/pulp Development

A

Enamel is epithelial origin and the ameloblasts extinct after deposition

Dentin/pulp complex mesenchymal origin but the odontoblasts remain in the pulp

71
Q

Enamel Organization

A

Interlocking rods with he tails closer to the dentin

The rods are surrounded by organic sheath

Millions of crystallites make up rods. Each crystalline is surrounded by a film or matrix.

  • composed of calcium phosphate (Hydroxyapitate)
  • Needlike irregular shape
72
Q

Cystyallite Organization

A

The crystallites themselves are irregular in shape but they are arranged in patterns within a rod.
Body:
-long axis of crystal parrallel to rod direction
Periphery and tail:
-up to 65 degree from pirsim or rod direction

The rods will follow a way spiraling path…very rarely straight

73
Q

Properties of Enamel: Parallel to Rod Direction

A

Very Hard, brittle, stiff

74
Q

Properties of Enamel: Perpendicular to Rods

A

Low Tensile strength

75
Q

Isotropic Vs. Anisotropic

A

ISO: Same in all direction (Isotropic)

Ani: depends on direction (Enamel)

76
Q

Dentin Composition

A

50% HA
25% Collagen
25% Water

77
Q

Function of the Dentinal Tubule

A

Allow fluid movement and ion transport

  • Remineraliztion
  • Apposition of peritubular dentin
  • Pain perception
78
Q

Dentin Organization

A

Dentin is not uniformly organized
Peritubular dentin is more mineralized than intertubular

Less and smaller tubules in roots

79
Q

Dentin Structure

A

Long rope like protein (organic) adds toughness
HA crystals contained within that collagen
Crystals are smaller than in enamel

80
Q

Properties of Dentin

A

20% less hard than enamel
Higher tensile strenght and lower stiffness than enamel
Isotropic properties

-Dentin stops the propagation of most cracks in enamel

81
Q

Types of Dentin

A 
Primary Dentin
Secondary Dentin
Presenting
Reparative Detnin (tertiary)
Sclerotic Dentin
82
Q

Primary Dentin

A

Forms up to 3 years after tooth eruption

83
Q

Secondary Dentin

A

Without any obvious stimulus, dentin direction changes and deposition slows

84
Q

How is dentin different from enamel?

A 
Less mineral content
Small tubules run throughout
-more fluid and ion transport
Ability to repair or regenerate
-physical chemical response
-cellular response
85
Q

4 Functions of Dental Pulp

A

Formative or developmental
Nutritive
Sensory or protective
Defensive or reparative

86
Q

Dental Pulp:Formative

A

Production of primary and secondary odontoblasts

87
Q

Pulp: Nutritive

A

Supplies nutrients and moisture to detnin through the blood vascular supply to odontoblasts and their processes.

88
Q

Pulp: Sensory

A

Nerve fibers within the pulp–Pain

ONLY PAIN

89
Q

Pulp: Defensive/Reparative

A

Deposition of reparative dentin in response to stimuli

Inflammatory reaction to severe irritation…may result in death of pulp

90
Q

Cementum Composition

A

5-10% mineral content
45-50% HA by weight
50-55% organic matter and water by weight

91
Q

What Tissue has the highest fluoride content of all mineralized tissue

A

Cementum

92
Q

Cementum Structure

A

Hard, avascular dental tissue covering anatomy roots

Formed continuously throughout life: acellular and cellular

Formed by cementoblasts—>from mesenchymal cells in CT of dental follicle

93
Q

CDJ

A

Attachment of cementum to dentin

94
Q

CEJ

A

Cervical line

Cementum joins enamel

95
Q

Cementum Properties

A

Slightly softer than dentin(less minerals)
Permeable
Can undergo self repair

96
Q

Tooth Centered vs Patient Centered

A

Tooth centered is surgical intervention to eliminate cavitated lesions

Patient centered is to use a medical model to control the disease process

97
Q

Caries Risk Assessment

A

Gather data on current and recent dental history

  • interview
  • conduct test to determine status of saliva, bioload, and any other pertinent data
  • Establish a risk level for each patient that indicates their level of risk
  • Establish a caries treatment plan or protocol
98
Q

Social, Economic, and Education Status

A
  • Not directly involved in the disease
  • Affect the expression and management of the caries disease
  • Compliance and behavioral changes

Predictive at the population level but are inaccurate at the individual level

99
Q

Dietary Analysis

A
  • Sugar in the form of fermentable carbohydrates and frequency increase risk
  • Candies lozenges increase risk
  • Acidic beverages, sport drinks, juice, and soft drinks provide energy to the acidogenic and aciduric bacteria and change biofilm pH
  • Snacking frequency lower pH environment
100
Q

Salivary Anaylsis

A

Flow, rate, buffering capacity, and pH all can be measured by tests

  • Predicitve for these tests is not supported in all circumstances
  • Patients can still have caries
101
Q

A salivary test in cases of xersotomia is predictive of risk for what

A
  • Root caries in older patients with recession

- For increased caries in the general population

102
Q

Effects of saliva

A 
Inhibition of bacteria and substrates 
Diluting
Elimination
Buffer bacterial acids
Offering a reparative environment with necessary ca and phosphate
103
Q

Patients with dry mouth are at higher risk why?

A

Saliva effects are diminished and therefore the fermentable carbs, low pH food and beverages have more effect

104
Q

Dental Clinical Analysis to determine risk factors

A

Current caries
White spots
Brown Spots
Visible plaque
Exposed root surfaces
Deep Pits, grooves, fixed, removable prosthesis/orthodox
Poor restorations-with open contacts, markings, or overhangs

105
Q

Risk considerations for children under 6

A

Age specific

  • active caries in primary caregiver
  • bedtime bottle or snippy cup
  • no supervised brushing
  • severe enamel hypoplasia
106
Q

In a modern practice model

A

The restoration of a caries lesion should no longer be considered a cure dental caries. Rather, the practioner must identify patients who have active caries lesions and patients at high risk for caries and institute appropriate preventive and treatment measures

107
Q

Caries Management

A

1) Limiting pathogen growth and altering metabolism
2) Increasing the resistance of the tooth surface to demineralization
3) Incresasing biofilm pH

108
Q

Primary goal of caries prevention program

A

Redeuce the number of cariogenic bacteria and create an environment conducive to remineralization

109
Q

Factors Influencing Caries Risk

A 
General health
Diet
Oral Hygeine
Fluoride Exposure
Immunization
Function of Saliva
Antimicrobial agents
Calcium and Phospahte Compounds
Probiotics 
Sealants
Restorations
110
Q

Caries Control Restorations

A

Removing the infected tooth structure
Medicating the pulp
Restoring the defects

111
Q

Large Carious lesions with healthy pulp a and periodical tissues should

A

Be managed via partial caries excavation and indirect pulp capping

112
Q

4 Strategies for prevention of root caries

A

1) Improve salivary flow rates and increase buffering capacity
2) Reduce numbers of cariogenic bacteria (s. Mutans)
3) Reduce quantity and numbers of exposures of carbohydrates
4) Attempt to remineralizes

113
Q

How to restore root caries

A

With a fluoride-releasing material

Resin modified glass ionomer materials are preferred for definitive restorations primarily because they bone effectively to both enamel and dentin.They act as reservoirs for fluoride which can be re-released into mouth

Cariology (2 decks)

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