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da tooth > WEEK 5-10 QUIZ 2 > Flashcards

WEEK 5-10 QUIZ 2 Flashcards

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1
Q

how do dental caries occur

A

disturbance in homeostasis of oral microflora

acidogenic bacteria metabolise fermentable carbohydrates = lactic acids

lactic acids = reduction in pH in oral cavity and plaque

when pH < 5.5 [critical pH] hydroxyapatite mineral is lost from tooth

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2
Q

what are caries detection methods used in practice? describe each one

A

Radiographic imaging - bitewings, and OPGS reveal approximal caries

**Visual assessment **
Wet and dry visual assessment
white spot lesions [first stage carious breakdown of enamel]
Smooth surface active lesion = matte, chalky, feels rough
Enamel discolouration

Tactile sensation
Carious lesions - soft walls/ floors, sticky feeling

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3
Q

difference between smooth surface, approximal surface and pit/fissue caries

smooth surface

A

smooth surface caries
- Active lesion = matte, chalky, feels rough
- Arrested lesion = hard and shiny, may be brown in colour
- White colour = ^ porosity of enamel → may be brown due to exogenous stains
- Cavitated carious lesion = Visual breakdown of tooth surface + soft walls or floors

**approximal surface [type of smooth surface caries] **
- Difficult to see clinically due to nature of location
- Bitewings essential in dx of proximal caries
- Cavitated lesions likely to be active
- Gingival health is mandatory to dx aproximal root caries

pit/fissue caries
- active non-cavitated lesion = often white, with a matte surface
- INACTIVE non-cavitated lesion = brown
- main cause of cavitated occlusal lesions = usually because patient cannot
clean plaque out of the cavity

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4
Q

how are approximal caries diagnosed

A
  • Bitewings essential in dx of proximal caries
  • Cavitated lesions likely to be active
  • Gingival health is mandatory to dx aproximal root caries
  • Thoroughly dry teeth
  • Pinkish-grey area shining through marginal ridge
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5
Q

list and describe each stage in ICDAS II coronal coding system

A
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6
Q

list and describe each stage in ICDAS II restorative and sealant history coding system

A
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7
Q

describe appearance of non cavitated caries lesion

A

white spot lesions
* usually located where dental plaque accumulates
* all plaque must be removed and tooth dried –> no cavitations after visual/ tactile exam
* demin may extend to dentine but ename has not yet cavitated

smooth surface caries
Active lesion = matte, chalky, feels rough

Arrested lesion = hard and shiny, may be brown in colour

White colour = ^ porosity of enamel → may be brown due to exogenous stains

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8
Q

list 3 major salivary glands

A

Parotid gland + duct
Sublingual gland
Submandibular gland and duct

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9
Q

list and describe two types of saliva - how do we clinically assess them

A

**Unstimulated / resting saliva
**- at rest = unstimulated
- 60% comes from submandibular glands, 5% sublingual glands 5%, parotid glands 20% and minor glands 15%
- flow rate 0.03mL/min
- appears clear, watery, small amt of bubbles
- clinical assessment
= visual assessment of lower lip and pooling in floor of mouth, viscosity, pH testing [Healthy resting saliva = pH 6.7 - 7.4]

Stimulated saliva
- produced as result of some mechanical, gustatory, olfactory or pharmacological stimulus
- contributes to BULK of overall daily salivary production
- results from combined production from both major+minot glands [1.3mL/min]
- clinical assessment
= Secretion of saliva = stim by chewing
Volume of saliva collected over period of time
pH of stimulated saliva is tested [should be higher than resting saliva]

The total flow rate [both saliva types] = 500 - 1500mL / day

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10
Q

describe important roles of saliva

A

helps taste sensation
- acts as solvent for ions which are distributed –> taste pores
- gustin [salivary protein] also necessary for growth/maturation of taste buds

keeps mucous membranes lubricated - prevents drying

role in dehydration - hyposalivation triggers water intake

Bicarbonate buffering system in saliva –> Prevent colonisation of potentially pathogenic microorganisms –> buffers and cleans acids produced by acidogenic microorganisms thus preventing demin

modulates remineralisation
reservoir for ions [calcium, phosphate, fluoride]

oral cleansing
Eliminates excess carbohydrates - limiting bioavailability of sugars to biofilm microorganisms

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11
Q

what can affect saliva quality

A

dehydration

salivary gland pathology - infections, salivary stones

medical conditions // lifestyle

medications
- antidepressants
- antihistamines
- BP medications
- pain meds

side effects of recreational drugs
- methamphetamine / cocaine

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12
Q

explain how fluoride prevents demineralisation

A

enamel = hydroxyapatite [HA] crystals

HA + fluoride = fluoroapatite [FAP] - incorporated into crystal by iso-ionic exchange
- harder than HA + more resistant to dissolution by acid ions
- less soluble than HA
- critical pH for FAP = 4.5, whereas HA =5.5
- can form in presence of fluoride when pH between 4.5-5.5

Incorporating in hydroxyapatite crystal - reducing acid solubility [demineralisation]
Promoting remin on incipient caries lesions [white spot lesions]
Inhibition of bacterial metabolism

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13
Q

how does fluroide have antimicrobial effect

A

Can affect bacterial metabolism via
- Actions on bacterial enzymes
- Enhance membrane permeability impacting bacterial cell homeostasis
- Bactericidal in high concentration

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14
Q

benefits of water fluoridation

A

Cost effective way to decrease caries risk
Aids in remin of lesions and prevents cavity formation
Saves community time and money
Reduces discomfort and pain caused by caries
Provides benefit to all people - esp low SES communities who have less access to other forms of fluoride treatments

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15
Q

recommended fluoride conc for
* 5 yo pt
* 29 yo pt

A
  • Adults 1000-1500 ppm F
  • Children 250; 400; 500 ppm F
  • children <5 = 0.4-0.5 mg F/g
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16
Q

steps in class I cavity prep and composite resotration

A

Tooth selection
RD isolation
Clean surface [pumice/water]
Caries removal
Apply lining if required - if into dentine [cure 30 sec]
Etch - wait 30 sec, wash/dry 10-20 sec
Bond - light cure 10 sec
Restore - light cure 40 sec
Cure in increments if resto material = deeper then 2mm

f/s - light cure 20 sec
Remove RD
Check occlusion

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17
Q

what are the indications and rationale for PPR

A

rationale: minimal interventional approach, avoids removal of sound tooth tissue

indications: small cases of small carious lesions confined to enamel or just involving the dentine eg pits on occlusal surface, remove caries, restore lost tooth structure and seal remaining fissue system –> maintains MID principles

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18
Q

two guidelines that apply in establishing outline form for all class I preps - why are these important and what is the outcome of not following these

A
  1. Active carious lesion should be removed
    - w/ spoon excavator, SS hp
    - prevent secondary caries
  2. Margins should be placed on sound tooth structure [enamel should be supported by dentine]
    - Sound cavity prep is important for restoration success and longevity
    - Unsupported enamel will likely result in a failed restoration - further damage to tooth and patient
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19
Q

compare gingivitis to periodontitis

A

gingivitis
- reversible tissue damage - tissue health will resolve when contributing factors removed
- does not always progress to periodontitis
- clinical signs - swelling, redness, bleeding, pseudopockets
- can EITHER be classified as
- 1. dental biofilm induced [poor OH = plaque accumulation]
-2. non dental biofilm induced [eg pregnancy, medication, trauma]

periodontitis
- bacterial infection of all parts of periodontium [gingiva, PDL, bone, cementum
- IREEVERSIBLE tissue damage
- histological changes – apical migration of junctional epithelium, CT destruction, root cemetum exposed to plque biofilm
- clinical signs - gingival margin = swollen/ fibrotic, bleeding upon probing, suppuration [pus], recession, mobility

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20
Q

define fluorisis

A

Molting of teeth from excessive ingestion of fluoride during teeth development eg diet, supplements, toothpastes, topical application

Looks like fine, pearly white mottling, flecking or lines on tooth surface

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21
Q

describe a healthy periodontium

A

Pink, firm, no bleeding
JE coronal to CEJ
Supragingival fibers intact
Alveolar bone intact
PDL intact

22
Q

what are the two types of bone loss - how do they occur

A
  1. horizontal bone loss
    - more common = results in even reduction in bone height
    - inflmmation spreads from gingival CT –> bone = detachment and destruction of PDL = even reduction of alverolar crest
  2. vertical bone loss
    - less common = uneven bone height reduction = creates trenches [bony defects]
    - trench described by # walls
    - inflammation spreads from gingival CT –> PDL = destruction of PDL
23
Q

what indicates an active disease site

A

Continued progression of disease over time
Presence of bleeding = clinical indicator of inflammation and activity, but not necessary indicator of activity

24
Q

what is furcation involvment and what does it indicate abt the severity of the disease

A

occurs when there is bone loss at furcation of tooth

indicates severe progression of the infection spreading from gingival CT past the PDL

25
Q

function of dental board of australia

A

Set registration standards and register dental practitioners
Develop codes and guidelines for the profession
Handle notifications, complaints
Assess overseas trained practitioners
Accreditation

26
Q

how might plaque biofilm appear clinically and what do the different presentations indicate

A

biofilm = dense, non-mineralised mass of bacterial colonies which adhere to teeth, calculus, fixed/ removable appliances

clinical presentations
- stained biofilm = extrinsic sources eg tobacco, food may stain - yellow, green

  • mature/ thick biolfilm = tooth may appear dull w/ matted, fur like surface
  • debris = materia alba or food debris can collect over biofilm
27
Q

differences in sub and supragingival calculus [other than location]

A

supragingival calculus
- above free gingiva margin
- predominantly white, can be stained by food, bev, tobacco

subgingival calculus
- below free gingiva margin - often on root
- light-dark brown, dark green or black [stained by blood]
- often gives tissue a cyanotic appearnace
- tenacious [difficult to remove]

28
Q

CPP-ACP

A

CASEIN PHOSPHO-PEPTIDE AMORPHOUS CALCIUM PHOSPHATE
- milk product = aids in remin
- eg tooth mousse, tooth mousse plus, recaldent, chewing gum
- may have fluoride added [ACFP - amorphous calcium fluoride phosphate]
- FUNCTION = buffers plaque pH + promotes ^ saturation for calcium and phosphate for remin of enamel and subsuface lesions
- treats = white spot lesions, childhood caries, root caries, reduces # bacteria which cause caries

29
Q

describe sickle scalers

A

rigid periodontal instrument - removes med-large calc depo from CROWN of tooth

triangular cross section - supragingival use

2 cutting edges/ working end
inner cutting edge = distal surfaces
outer cutting edge = mesial surfaces

working end –> lower shank = parallel to tooth // func shank = up and over

30
Q

Fluoride MOA for Remin + Demin

A

When outer enamel surface is exposed to fluoride [>50ppm], calcium fluoride [CaF2] can be formed

Can be precipitated on enamel surface and act as source of fluoride ions [may also act as barrier to denim

CaF2 released in acidic conditions and either diffuse rapidly into underlying enamel = FAP and subsequent enamel hardening ot ^ fluoride levels in saliva

FAP can form in presence of F when pH is below 5.5 but above 4.5

F = incorportated into solid HA crystal via iso ionic exchange, forming FAP which is stronger, less soluble and more resistant to acidic dissolution with a critical pH of 4.5 compared to 5.5 in HA.

  • promotes remin of white spot lesions, inhibits bacterial metabolism, arrests or slows progression of caviated coronak lesions, remins root surface lesions
31
Q

components of saliva

A
  • derived from blood as filtrate from serum
  • 99% of volume = water - acts as solvent fot other components
  • composite of secretions from minor + major salivary glands and material from gingival sulcus
32
Q

Benefits of water fluoridation [1ppm]

A

Cost effective way to decrease caries risk
Aids in remin of lesions and prevents cavity formation
Saves community time and money
Reduces discomfort and pain caused by caries
Provides benefit to all people - esp low SES communities who have less access to other forms of fluoride treatments

  • Level should remain in range 0.6-1.1mg/L (ppm)
33
Q

Etch

A

37% phosphoric acid which creates microtags for micromechanical adhesion of a resin based material
Sits for 30 sec, washed/dried 10-20 sec until matte, chalky appearance

34
Q

bond

A

Resin which allows the composite resin to adhere to tooth and stay in prep via CHEMICAL BOND

Difference between bond and composite = bond has more filler material

Distribute with triplex air - 5 sec - to create even application and evaporate solvents - cure 10 sec

35
Q

liner

A

RMGIC - Vitrebond - cure 30sec
Required if cavity prep > 2mm [into dentine]
Remove from enamel walls - only have thin layer on cavity floor - line until DEJ
function
Seals dentine tubules
Prevents thermal conduction
Prevents toxins from dental materials reaching pulp
Prevents post op sens

36
Q

No extension for prevention - GV black

A

cavity preparations should be limited to removing only the diseased or decayed tooth structure [no need to remove more unless it is necessary for retention or resistance form

“No extension for prevention” = preserve as much healthy tooth structure as possible = maintain the strength and integrity of the tooth + reduces risk of complications - pulp exposure - tooth weakening

minimizes the invasiveness of dental treatment. This is in line with the concept of MID

37
Q

Define simple, compound, complex cavity design

A

Simple = one surface
Compound = two surface
Complex = three or more surface

38
Q

GV Black Classification of Caries Lesions

A

Class 1 =pit and fissure carious lesions [occ of post teeth] [lingual surface max incisors]
Class II = proximal surfaces of posterior teeth [MO, MOD, DO]
Class III = restorations on proximal surface of anterior teeth not involving incisal edge
Class IV = Class III + incisal edge
Class V = involving gingival ⅓ of all teeth [NOT INCLUDING PITS/F/S]

39
Q

Outline Form Objectives

A

Access caries
Reach sound tooth structure
Resist fracture of tooth / filling
Retain filling in tooth

40
Q

How Does Class I Cavity Prep Differ if it is for Amalgam

A

Depth of 2 - 2.5mm instead of 1-2mm
Then requires Vitrebond lining

Requires resistance and retention features
Slight undercuts required for retention of amalgam

Outline form larger than CR
More rectangular cavity prep than cup shaped for CR

41
Q

How does caries removal differ for enamel only lesions and enamel/dentine lesions for a PRR?

A

Enamel only
Remove unsupported enamel and visually/ mechanically inspect pit/fis anatomy ensuring there is no denim and no active caries penetrating dentine

Enamel/dentine
Remove unsupported enamel
Remove infected dentine w SS round bur / spoon excavator
Ensure DEJ = caries free
Apply Vitrebond liner - cure 20 sec - remove from enamel walls

42
Q

List and describe each stage in ICDAS II Coronal coding System

A

0 = sound tooth surface, no evidence of caries after 5 sec air dry
1 = first visual change in enamel → opacity or discolouration [white/brown] is visible at entrance to pit or fissure after prolonged air DRY
2 = distinct visual change in enamel visible when WET, lesion must be visible when dry
3= LOCALISED enamel breakdown [w/o dentinal involvement] - seen when WET and after prolonged DRYING
4 = underlying dark shadow from dentine
5 = Distinct cavity with visible dentine
6 = extensive [more than half of surface] distinct cavity w visible dentine

43
Q

List and describe each stage in ICDAS II Restorative and Sealant Hx Coding System

A

0 = surface not restored or sealed
1 = partial sealant
2 = full sealant
3 = tooth coloured restoration [GIC/CR]
4 = amalgam resto
5 = stainless steel crown
6 = porcelain/ gold/ PFM crown/Veneer
7 = lost of broken resto
8 = temp resto
9=
96 = tooth surface cannot be examined
97 = tooth missing from caries
98 = tooth missing for reason other than caries
99 = unerupted

44
Q

Compare active vs inactive lesions according to ICDAS II criteria

A

Active
ICDAS I - III
Enamel surface = whitish yellow opaque, loss of lustre, feels rough
Lesion is in plaque stagnant area eg p/f/s, near gingival and approximal surfaces

ICDAS IV
Probably active

ICDAS V - VI
Cavity feels soft or leathery on probing dentin

Inactive
ICDAS I - III
Enamel surface = whitish. Brownish, black
Enamel may be shiny, hard, smooth
On smooth surfaces → caries lesions typically located some distance from gingival margin

ICDAS V - VI
Cavity may be shiny and feels hard

45
Q

Define Gingival pocket

A

In gingivitis → coronal portion of JE detaches from tooth = slight increase in probing depth - pseudopockets [exacerbated by gingival swelling]
NO apical migration

46
Q

Define periodontal pocket

A

Clinical attachment loss of JE > 4mm probing depth

As disease progresses
Apical migration of JE
PDL destruction
Alveolar bone destruction

Horizontal bone loss = suprabony pocket
Vertical bone loss = Infrabony pocket

Can be spiral at twist around multiple tooth surfaces [different depths]

47
Q

Clinical signs of periodontitis

A

swollen/fibrotic gingiva, absence of knife edged interdental papilla
Bluish - purple hue of gingiva
Bleeding upon probing, suppuration
Pocket depth of 4mm or greater

48
Q

Histological process associated with periodontitis

A

Apical migration of junctional epithelium
Destruction of gingival connective tissue [collagen]
Destruction of PDL and alveolar bone
Root cementum exposed to plaque biofilm

49
Q

What is COntinuing Professional Development [CPD] registration standard for an OHT?

A

Minimum of 60 hours of CPD activities over three year cycle
80% clinical or science based
20% non scientific activities

Each 3 year CPD cycle begins Dec 1 ends Nov 30, 3 years later
Current cycle = dec 1 2022 - nov 30 2025

50
Q

When would an OHT need to pursue a mandatory notification of AHPRA

A

in certain situations where there are concerns about the conduct, health, or performance of a registered health practitioner
Misconduct
Performance
Impairment
Sexual misconduct
Notifiable conduct [eg intoxicated practice, departure from standards]

51
Q

Purpose of oral hygiene assessment

A

Determine pt

Amount
Location and classification of hard/soft deposits
Oral hygiene status
Oral self care effectiveness
Motivation related to oral seal care
Establish baseline for oral health/ progression of diseases
Demonstrate patient education

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