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D3 Ortho Final > White Spot Lesions (Tufekci) > Flashcards

White Spot Lesions (Tufekci) Flashcards

1
Q

What is the cause of white spot lesions in orthodontics?

A

It is difficult for the patient to brush and floss with fixed appliances

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2
Q

Where is the location of white spot lesions in orthodontics?

A

Buccal surface between bracket and gingival margins

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3
Q

What are the 2 most common acidogenic bacteria found in plaque during orthodontic therapy?

A
  1. Streptococcus mutans

2. Lactobacilli

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4
Q

How does the bacterial fermentation of carbohydrates lead to white spot lesions?

A

Acid produced by fermentation drops the pH and causes flow of minerals out of the enamel and into the oral environment

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5
Q

Why is there a constant ionic exchange between the dental tissues and the oral environment?

A

It is an attempt to reach ionic equilibrium

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6
Q

What are the ions that preventative therapy seeks to keep in order to prevent net loss of ions within the crystalline structure of enamel?

A
  1. Free fluoride
  2. Calcium
  3. Phosphate
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7
Q

What is the critical pH that causes the release of calcium and phosphate from the enamel that leads to demineralization?

A

Approximately 5.5

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8
Q

What does saliva have to offer to combat demineralization?

A

Buffering action which increases oral pH leading to teeth to incorporate calcium, phosphate, and fluoride free ions to remineralize

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9
Q

Demineralization is a cycle of what factors?

A

Bacteria + fermentable carbohydrates demineralizationtooth decay

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10
Q

Remineralization is a cycle of what factors?

A

Calcium + phosphate + fluoride  remineralization tooth repair

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11
Q

What goes out and what goes into the tooth during demineralization?

A

Acid goes in and calcium (Ca++) and phosphate (PO43-)

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12
Q

The oral environment will have a dynamic stability, and the goal to prevent white spot lesions during ortho is to keep that dynamic stability favoring what?

A

Higher pH

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13
Q

What will be the pH of the oral environment if oral hygiene is poor?

A

pH will be lower and demineralization will occur

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14
Q

Why do white spot lesions look white?

A

Enamel is more porous allowing more air into the enamel making it more opaque and increasing the defraction index

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15
Q

Is a white spot lesion as strong as or softer than the surrounding enamel?

A

Softer

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16
Q

How long after placement of a fixed appliance can significant demineralization occur?

A

Within 4 weeks (O’Reilly and Featherstone and Ogaard studies say within first month)

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17
Q

White spot lesions beyond what depth cannot be remineralized?

A

75 microns (um) or deeper

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18
Q

If less than ____ mm deep, there is a high chance the tooth will remineralize?

A

Less than 60 microns (um)

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19
Q

What is the variation of prevalence of white spot lesions among orthodontically treated patients?

A

2-96%

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20
Q

In the Gorelick study percentage of patients reported to have at least one white spot lesion after treatment?

A

50%

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21
Q

What are 4 things to consider to minimized demineralization during orthodontic treatment?

A
  1. Patient selection
  2. Oral hygiene
  3. Diet
  4. Fluoride delivery
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22
Q

Is a patient a good candidate for ortho if they have poor oral hygiene prior to placement of fixed appliances?

A

No

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23
Q

What should be done for a pt who is already retaining plaque prior to the placement of fixed appliances?

A

Do not start orthodontic therapy. Place on rigorous oral hygiene regime and reevaluate after 3 months

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24
Q

What is the problem with the target demographic for orthodontics dietary habit?

A

Diet contributes to demineralization because it is a carbohydrate-rich cariogenic diet

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25
Q

What are the requirements for a patient before fixed appliance placement to decrease the risk of demineralization to the patient’s teeth?

A
  1. Have an acceptable level of oral hygiene
  2. Understand the caries process including the role of the diet
  3. Accept responsibility for maintaining a certain level of oral hygiene under difficult circumstances of having braces
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26
Q

What should be documented at each visit during orthodontic treatment?

A
  1. Patient’s oral hygiene

2. Attempts made to educate patient and parents

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27
Q

What is the prophylaxis schedule a patient in ortho should be placed on?

A

3 month recalls

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28
Q

True or False. Despite preventative measures, there will always be a proportion of patients whose ability to clean their teeth decreases as treatment progresses?

A

True

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29
Q

What is the biggest reason for patient dissatisfaction at the completion of orthodontic therapy?

A

White Spot Lesions

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30
Q

What is the best defense against white spot lesions?

A

Good oral hygiene (fluoride toothpaste, fluoride mouth rinse, compliance

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31
Q

What is a good defense against white spot lesions that DOES NOT require compliance?

A

Fluoride varnish

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32
Q

The Schmit study showed what was the quality of fluoride varnish application: slow decrease or rapid decrease?

A

Rapid decrease

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33
Q

Due to the rapid decrease in fluoride varnishes after application, how many applications are recommended?

A

Several applications (3 / month or 2 / year)

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34
Q

The Todd, Schmit, and Nalbantgil in vitro studies of fluoride varnishes show how much reduction in white spot lesion depth?

A

35-50%, the studies were for 4 weeks

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35
Q

The Farhadian 3 month study on the fluoride varnish application and its affect on white spot lesions showed what percentage of decrease in lesion depth in those who received the varnish?

A

40%

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36
Q

The Stecksen-Blicks study of fluoride varnish applied every 6 weeks showed what percentage had white spot lesions?

A

7% had white spot lesions

25% had no white spot lesion

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37
Q

What are 3 factors to consider for multiple fluoride applications to combat white spot lesions during orthodontics?

A
  1. Need multiple applications
  2. Increased chair time and cost
  3. Temporary discolored teeth and gingiva
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38
Q

Pro-seal is what dental material?

A

High filled fluoride releasing light cure sealant with glass ionomer

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39
Q

What is the importance of the highly-filled nature of Pro-Seal?

A

Makes it durable against brushing and mastication

40
Q

What does Pro-Seal have that allows for easy monitoring of sealant coverage?

A

Fluorescing agent so it shows up under blacklight

41
Q

How is Pro-Seal placed in orthodontics?

A

Entire buccal surface sealed, light-cured, then bracket is bonded on top

42
Q

What does the literature show about the preventative effects of placing Pro-Seal before placing brackets?

A

Ortho literature says No significant preventative effect. A paper in 2011 said there was in vivo preventative effect

43
Q

Is opal seal, a fluoride releasing, highly filled bonding primer supported in the literature?

A

No

44
Q

What was the big deal with the Pennella Opal Seal study?

A

Done by a VCU resident in 2011

45
Q

What was the design of the Pennella Opal seal study?

A

22 pts, split mouth design, all pts would have premolars extracted, one premolar was control, one premolar had Opal Seal placed on it

46
Q

What was done to the planned-for-extraction premolars to ensure they collected plaque to test the white spot lesion prevention ability of Opal Seal?

A

Blue band placed over bracket to trap plaque

47
Q

What did the results show after extraction, view under blacklight, and hardness tests of the premolars in the Pennella Opal Seal study?

A

29% Opal Sealed teeth had white spot lesions
46% control teeth had white spot lesions
Overall 38% had white spot lesions
No significant difference

48
Q

What was a significant finding in the Pennella study?

A

Showed that if tooth in mouth greater than 90 days, 58% would have white spot lesions

49
Q

What is the significance of 90 days?

A

Fluoride breaks down at 90 days

50
Q

What was found in the Panella study with respect to hardness?

A

As depth go deeper (beyond 25 microns) the enamel was harder. Upper level softness attributed to etching, therefore, only etch area to be bonded

51
Q

What did the Farah (a VCU resident) study show about the fluoride recharging capability of ortho materials?

A

After 2 weeks, any fluoride material is depleted of its fluoride

52
Q

What was the significant time period the Farah study showed to be significant, and the one that the material company kept citing in their advertisements?

A

What at 24 hrs there was a recharging

53
Q

What part-per-million (ppm) of fluoride needed to prevent mineral loss?

A

1 ppm

54
Q

What is the ppm of fluoride needed in saliva to have a remineralization effect?

A

0.08 ppm

55
Q

What ppm did Opal Seal offer?

A

0.0442 ppm

56
Q

What ppm did ProSeal offer?

A

0.0186 ppm

57
Q

What ppm did Transbond offer?

A

0.0159 ppm

58
Q

What was the average ppm of the 3 above fluoride releasing bonding agents?

A

0.0262 ppm

59
Q

How long does the recharge of these materials last according to the Farah study?

A

6 weeks

60
Q

What is an alternative to Fluoride sealants?

A

Glass ionomer cements

61
Q

What is the character of the fluoride release of glass ionomer cements?

A

High fluoride release on first day, sharp decrease the second day, gradual decrease to undetectable levels in about 3 months

62
Q

Do glass ionomer cements have a high or low bond strength?

A

Low

63
Q

What do the controversial reports say about the fluoride recharging capability of glass ionomer cements?

A

They recharge better than sealants

64
Q

What is the fluoride release of glass ionomer cements in the first week of placement?

A

0.07 ppm/mm2

65
Q

What is the fluoride release of glass ionomer cements 17 weeks after placement?

A

0.01 ppm / mm2

66
Q

What is the optimal ppm for remineralization?

A

0.08 ppm

67
Q

What is the ppm needed for remineralization to start?

A

0.03 ppm

68
Q

What does ten Cate (?) say about using the glass ionomer cements?

A

Use them because even low ppm fluoride can keep the dynamic stability in favor of no white spot lesions / favor the remineralization process

69
Q

Can OTC fluoridated toothpastes recharge fluoride releasing dental materials?

A

Yes, you want a continuous exogenous source of fluoride

70
Q

The Benson study in 2005 showed there was evidence that glass ionomers and resin modified glass ionomers reduce prevalence and severity of white spot lesions coupled with evidence that fluoride mouthrinses and fluoride gels in children and adolescents reduce dental caries. What is the problem dental material in this comparison and why?

A

Mouthrinse because it requires compliance.

71
Q

What is compliance with mouth rinse?

A

15%

72
Q

If there is a white spot lesion after ortho treatment, should it be remineralized, either by saliva or by application of fluoride and why?

A

o. Because it will only remineralized the most superficial layer of enamel but will leave deeper enamel crystals unaffected

73
Q

How long should you wait after debanding to prescribe high concentration fluoride?

A

3 months (from Ogaard study)

74
Q

What is the problem with thinking remineralization of white spot lesions will occur naturally from saliva?

A

Results vary from patient to patient from site to site in the mouth

75
Q

When brackets are removed, should high concentration fluoride toothpaste be prescribed?

A

No. Have the patient use normal toothpaste and flossing because there is a drastic improvement in their oral hygiene simply because the brackets are off?

76
Q

What is the term for repeated applications of pumice and 18% hydrochloric acid slurry to the demineralized tooth surface whose goal is to remove the discolored enamel and leave the tooth surface smooth and lustrous?

A

Microabrasion

77
Q

Should microabrasion be done immediately after brackets are removed?

A

No. Wait at least 3 months to allow initial remineralization.

78
Q

Are there any therapeutic effects to micro abrasion?

A

No. Only esthetics.

79
Q

What must be placed prior to performing microabrasion?

A

Rubber dam

80
Q

Success of micro abrasion depends chiefly on what?

A

How deeply the lesion extends into enamel (Pliska study)

81
Q

Magic elixir that contains the active compound recaldent (CPP-ACP) which is derived from the milk protein Casein Phosphopeptide (CPP)?

A

MI paste

82
Q

What does the milk protein Casein Phosphopeptide (CPP) carry?

A

Calcium and phosphate ions in the form of amorphous calcium phosphate (ACP)

83
Q

MI-Paste with its CPP-ACP is contraindicated in which patients?

A

Patients with milk allergy

84
Q

What are the results of studies of MI Paste (Beerens study, Huang study, Robertson study, Akin and Basciftici)?

A

Beerens and Huang found no clinical efficacy of MI paste plus.
Robertseon, Akin and Saciftici found reduction in white spot lesions.

85
Q

What does VCU ortho think of MI paste?

A

Skeptical of results. Don’t give it out much anymore.

86
Q

What is the refraction index of normal enamel?

A

1.62

87
Q

Does enamel with a white spot lesion have a higher or lower refraction index?

A

Lower

88
Q

What is the refraction index of watery medium?

A

1.33

89
Q

Another method that is NOT THERAPEUTIC, but seeks only to improve the esthetics of a demineralized tooth?

A

Resin infiltration

90
Q

What are the steps for masking white spot lesions with resin infiltration

A
  1. Etch surface with 15% HCl
  2. Occlude mircoporosities with low viscosity light curing resin (5 mins)
  3. Apply resin again to minimize enamel porosity
  4. Polish with disks and silicone polishers
91
Q

What does Resin infiltration do to the enamel?

A

Fills in microporosities to increase refraction index back towards sound enamel?

92
Q

What is the low viscosity light curing resin used to accomplish resin infiltration?

A

Icon by DMG America

93
Q

What is the best prevention of enamel decalcification during ortho treatment?

A

Good oral hygiene

94
Q

What products are indicated if the patient has poor oral hygiene while in brackets to reduce the risk of white spot lesions?

A

Products that do not require compliance

95
Q

What are the products indicated for less-compliant patients?

A

Bonding systems that have continuous release of fluoride, fluoride-containing sealants and varnishes

96
Q

Why did the teeth in the Pannella study show a difference based on 90 days (those in oral environment less than 90 days had fewer white spot lesions than those in oral environment greater than 90 days)?

A

Fluoride breaks down at 90 days

D3 Ortho Final (6 decks)

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