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BDS2 CLINICAL Operative Dentistry > Caries > Flashcards

Caries Flashcards

1
Q

what is the critical pH where demineralization can occur

A

5.5

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2
Q

what is the definition of caries

A

ecological shift in dental biofilm environment, driven by frequent access to carbohydrates, leads to change from balanced population of microorganism of low cariogencfty tomicroorganisms that are of high cariogenicity

this leads to an increased production of organic acids > this promotes dental hard tissue net mineral loss >results in a carious lesion

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3
Q

what are the plaque bacterias

A

s. mutans

lactobillus and biffidobacteria species

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4
Q

what are the various organic acids produced

A

lactic
acetic
propionic

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5
Q

why is time a factor in the etiology of caries

A

even though the drop in pH can happen rapidly, sufficient time is required for the plaque biofilm to produce a net mineral loss equating to hard tissue damage to the tooth surface

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6
Q

what can the time of progression of caries be altered by

A

oral hygiene techniques
saliva buffering
dietary modification
use of fluoride

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7
Q

what is rampant caries

A

caries process is accelerated and many lesions form rapidly

often involving surfaces of teeth ordinarily relatively caries free

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8
Q

who is often affected by rampant caries

A

primary dentition
teenagers/young adults with high sucrose diets
adult patients with xerostomia

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9
Q

what are possible reasons for xerostomia

A

radiation fo the salivary glands - used for orofacial malignant growth
sjrogens
drugs

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10
Q

what is the cross sectional shape of smooth surface caries

A

inverted cone

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11
Q

what is the clinical manifestation of the active white spot lesion

A

initially smooth/frosty/white/opaque and non cavitated

as the lesion develops over time it becomes somewhat chalky, eventually becoming roughened or microcavitated

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12
Q

how do we detect a microcavitated WSL

A

running a blunt probe across the lesion surface

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13
Q

what is the dentine pulp complex reaction during the white spot lesion

A

no symptoms

DPC reaction mediated by cytokines and bacteria breakdown products within the dentine matrix and tubules

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14
Q

what happens when the carious process reaches dentine

A

defence reactions in the dentine/pulp complex are stimulated at this stage with evidence of translucent dentine at the lesion boundary and tertiary dentine deposition at the dentine-pulp interface beneath advancing lesions

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15
Q

what does the lesion look like once it has reach the middle third of dentine

A

often clinically cavitated on both occlusal and smooth surfaces with plaque now able to accumulate on the exposed dentine surface - the spread of the lesion will undermine the overlying enamel with an associated grey shadowing/opacity which becomes brittle and prone to fracture under occlusal loading

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16
Q

what are the different zones to carious dentine

A

carious infected dentine

carious affected dentine

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17
Q

what is carious infected dentine

A

Outermost, superficial, irreparable, necrotic zone of destruction

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18
Q

how is the carious infected dentine clinically distinguished

A

Clinically distinguished as a dark, brown, soft, wet, ‘mushy’ layer

19
Q

why should the carious infected dentine be clinically removed

A

as it is necrotic and cannot be repaired and also provides a poor quality bonding substrate for adhesive materials to achieve an adequate seal

20
Q

what is caries affected dentine

A

Inner layer of carious dentine that can be repaired by the dentine-pulp complex, often distinguished as paler brown, harder, ‘sticky and scratchy’

21
Q

what can the deepest layer of infected dentine be described as

A

hypermineralized translucent dentine (due to its glassy appearance in cross section) - it is one of the several reparative reactions of the dentine-pulp complex to the carious process

22
Q

what happens as the advancing front of the carious lesion approaches the dentine/pulp boundary

A

bacteria and toxins will penetrate the pulpal tissues causing an acute inflammatory response

23
Q

what is the first response of the pulp

A

initial acute pulpitic response (sharp pain) then it evolves into a chronic response that is a dull pain

24
Q

what happens if the pulp is breached by a lesion

A

a carious exposure may be created when excavating deep caries. The exposed pulp will bleed. Prognosis depends on age of patient - younger patients have a more vascularised pulp

25
Q

why must the dentine and pulp be considered together

A

they are intimately connected (odontoblasts)

26
Q

what are the 3 defense reactions of the dentine/pulp complex

A

translucent dentine
tertiary dentine
pulp inflammation

27
Q

what is translucent dentine also known as

A

sclerotic dentine

28
Q

what is translucent/sclerotic dentine

A

tubular infill with mineral crystals

29
Q

what is the purpose of sclerotic dentine

A

attempt to wall off the advancing lesion

30
Q

what is the appearance (glassy) of sclerotic dentine due to

A

Appearance due to the party of refractive indices of intertubular and intratubular mineral so allowing light to pass through the sectioned boundary

31
Q

why is sclerotic dentine softer than the deeper sound counterpart

A

due to the weaker crystallite orientation compared to HA

32
Q

what is tertiary dentine

A

Dentine that is laid down at the dentine-pulp border in response to noxious stimulis

33
Q

what is the structure of tertiary dentine

A

Has an irregular/atubular structure

34
Q

what is reactionary dentine

A

deposited as a result of a mild irritant where original odontoblasts survive and are metabolically upregulated

35
Q

what is reparative dentine

A

deposited in response to a strong irritant which compromises the vitality of the original odontoblasts

36
Q

what are the 2 types of plural inflammation

A

acute

chronic

37
Q

in a slowly progressing lesion what will happen in regards to pulp inflammation

A

toxins reaching the pulp may provoke chronic inflammation

38
Q

what happens once organisms actually reach the pulp (Carious exposure)

A

acute inflammation may supervene

39
Q

what happens in chronic inflammation of the pulp

A

cellular components predominate and there may be increased collagen production leading to fibrosis but without immediately endangering the vitality of the tooth

40
Q

what happens in acute inflammation

A

the vascular changes predominate

41
Q

what is the most common cause of pulpal inflammation

A

infection

42
Q

what will dentine caries result in

A

ulpal inflammation and chronic inflammatory cells will infiltrate the pulp near the odontoblast layer - this reaction may even be seen in response to intial enamel caries - this chronic inflammatory reaction is mainly due to the bacterial toxins moving through the dentinal tubule

43
Q

what can acute pulpal inflammation result in

A

pulpal necrosis

BDS2 CLINICAL Operative Dentistry (12 decks)

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