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Flashcards in CAMBRA baby! Deck (93):
1

Dental caries is an ______ microbiological disease of the teeth that results in localized dissolution and destruction
of the calcified tissues.

infectious

2

What are the two categories of factors that have our caries balance?

1.Pathological 2.Protective

3

BOOM: WHAT ARE THE 4 indicators of HIGH caries risk in CAMBRA?

1.Visible Cavities Present 2.Caries restored in last 3 years 3.Interproximal Caries lesions/radiolucencies 4.White Spots on enamel surfaces

4

LETS GET IT!!!! What are the 9 indicators for MODERATE caries risk in CAMBRA?

1. MS and LB medium/high by culture 2.visible heavy plaque 3.frequent snacks (>3x/day) 4.Deep P&F 5.Drugs 6. Bad Saliva Flow (meds, radiation, Sjogrens) 7.Exposed roots 8.Ortho Appliances

5

ASSIGN A RISK LEVEL!!! Disease Factors: None Risk Factors: None Protective Factors: one or more

low risk

6

ASSIGN A RISK LEVEL!!! Disease Factors: None Risk Factors: One or more Protective Factors: need to increase

medium risk

7

ASSIGN A RISK LEVEL!!! Disease Factors: one or more Risk Factors: blank Protective Factors: need to increase

high risk

8

ASSIGN A RISK LEVEL!!! Disease Factors: one or more Risk Factors:low saliva flow Protective Factors: need to increase

extreme risk

9

What are the 4 ways we can INCREASE PROTECTIVE FACTORS??

1.Topical Fluoride 2.Saliva Stimulation/Supplement 3.Antibacterial Tx 4.minimally invasive restorative dentistry

10

Hey heres a concept that works!!! ______ the tooth and _____ the bacterial infection!

restore...treat

11

CAMBRA DAWG!!! Antimicrobials: Low Risk

Not indicated

12

CAMBRA DAWG!!! Antimicrobials: Moderate Risk

Not indicated

13

CAMBRA DAWG!!! Antimicrobials: High Risk

CHX-10mL rinse for 1 min daily at bedtime for 1 wk/month

14

CAMBRA DAWG!!! Antimicrobials: Extreme Risk

CHX-10mL rinse for 1 min daily at bedtime for 1 wk/month

15

CAMBRA DAWG!!! Bacterial Test/Saliva Flow: Low Risk

basline reference

16

CAMBRA DAWG!!! Bacterial Test/Saliva Flow: Moderate Risk

baseline/suspision

17

CAMBRA DAWG!!! Bacterial Test/Saliva Flow: High Risk

tests at EVERY periodic oral exam

18

CAMBRA DAWG!!! Bacterial Test/Saliva Flow: Extreme Risk

tests at EVERY periodic oral exam

19

CAMBRA DAWG!!! Fluoride...Low Risk

otc fluoride toothpase 2x day

20

CAMBRA DAWG!!! Fluoride...Moderate Risk

otc fluoride- toothpaste, mouth wash

21

CAMBRA DAWG!!! Fluoride...High Risk

varnish at all visits, Rx toothpaste 2x day

22

CAMBRA DAWG!!! Fluoride...Extreme Risk

varnish, Rx toothpaste, AND gel in trays daily

23

CAMBRA DAWG!!! Freq of RGraphs---Low Risk

BW's 18-24 mo

24

CAMBRA DAWG!!! Freq of RGraphs---Moderate Risk

BW 18-24 mo

25

CAMBRA DAWG!!! Freq of RGraphs---High Risk

BW 6-12 mo, until no caveated lesions

26

CAMBRA DAWG!!! Freq of RGraphs---Extreme Risk

BW every 6 mo until no caveated lesions

27

CAMBRA DAWG!!! Freq of POEs (Periodic Oral Exams) Low Risk

1/yr!

28

CAMBRA DAWG!!! Freq of POEs (Periodic Oral Exams) Moderate Risk

1/yr

29

CAMBRA DAWG!!! Freq of POEs (Periodic Oral Exams)

every 6-12 mo to re-eval and apply F- varnish

30

CAMBRA DAWG!!! Freq of POEs (Periodic Oral Exams)

every 3-6 mo to re-eval and apply F- varnish

31

CAMBRA DAWG!!! Xylitol/Baking Soda- Low Risk

none

32

CAMBRA DAWG!!! Xylitol/Baking Soda- Moderate Risk

2 sticks/mints 2x/daily

33

CAMBRA DAWG!!! Xylitol/Baking Soda- High Risk

2 sticks/mints 4x/daily

34

CAMBRA DAWG!!! Xylitol/Baking Soda- Extreme Risk

2 sticks/mints 4x/daily AND Baking Soda 4-6x/day

35

CAMBRA DAWG!!! Sealants--Low Risk

none

36

CAMBRA DAWG!!! Sealants--Moderate Risk

for deep P&F's

37

CAMBRA DAWG!!! Sealants--High Risk

for deep P&F's

38

CAMBRA DAWG!!! Sealants--Extreme Risk

for deep P&F's

39

When doing Caries Risk Assesment which factor had BY FAR the highest odds of having a cavity?

Interproximal Enamel Lesions! 13.6 (vs white spots 3.3 and visible plaque 2.7)

40

_________ does not reduce the bacterial loading in the rest of the mouth!

Placing restorations

41

Reducing caries risk status by ________ markedly reduced the level of new caries.

chemical therapy

42

Enamel: Hexagonal crystals are closely packed, but with protein/_____/water channels between them

LIPID!

43

Enamel rods are _______ to the surface of the tooth.

PERPENDICULAR

44

What are the 4 Functions of Saliva? What is the MOST important one??

1.Antibacterial 2.Clearance 3.Lubrication 4.MINERAL EXCHANGE (most important)--buffering & re-mineralizatoin

45

What is the "normal" stimulated saliva flow rate? Where do we draw the line and call it LOW saliva flow?

1.0 (haha or 1.4) mL/min....draw the line at 0.7mL/min

46

What are the two most important inorganic compounds in saliva?

Calcium and Phosphate

47

IMPORTANT! the LIPIDS in our saliva are high in ________.

Phosphate (a BUFFER)

48

What are the pellicle forming proteins found in saliva? They inhibit spontaneous precipitation of ______ by binding to it. (making it available for Remineralization!!)

Proline-Rich-Proteins (PRP's)...Calcium

49

What is the salivary protein that helps with pellicle formation and inhibits PRIMARY precipitation of Ca AND PO4?

Stat-Her-Ins

50

What is the AWESOME pellicle former, antibacterial, AND anti fungal protein in saliva?

His-tat-ins (histidine rich proteins)

51

What Pellicle forming protein in saliva ALSO inhibits periodontal distruction!

Cys-tat-ins

52

Antibacterial Salivary Proteins: ________ aggregation and lysis of oral micro-organisms; aggregation of bacteria

LysoZyme

53

Antibacterial Salivary Proteins: _______: Binds iron needed for cell wall. Effective against S. mutans

Lacto-Ferrin

54

Antibacterial Salivary Proteins: _________: Effective against S. mutans. WOO (hint, and cuts on skin)

Salivary Peroxidase

55

Antibacterial Salivary Proteins: ________ Inhibits attachment of S. mutans to tooth surface.

sIgA

56

Other salivary proteins: ______ DIGESTIVE
and antibacterial. Breaks down starch.

Amylase

57

Other salivary proteins: _________: lubrication, bacterial aggregation, pellicle

Mucins

58

THE SALIVARY PELLICLE: Thin film on the surface of the enamel, Comprised of strongly adsorbed specific _______ and _____ from the saliva, Begins immediately. Forms within _____. Matures in days. Multiple layers.

proteins....lipids....HOURS

59

The Pellicle is also a protective layer for ________, protection from _______, and is a mineral store needed for ________..NOT ALL BAD!!

lubrication....demineralization....remineralization

60

THE GOOD in SALIVA: Salivary proteins contribute to the _______ to protect the outer surface

pellicle

61

THE GOOD in SALIVA: Salivary proteins maintain supersaturation of _________.

calcium phosphate

62

THE GOOD in SALIVA: Salivary calcium and phosphate inhibit _______ and enhance ________.

demineralization...remineralization

63

THE GOOD in SALIVA: Saliva carries ______ around the mouth

fluoride

64

THE GOOD in SALIVA: Salivary components ______ plaque acids

buffer

65

THE GOOD in SALIVA: Salivary proteins have _______ properties

antibacterial

66

THE GOOD in SALIVA: With low saliva, caries activity grows
_________.

exponentially

67

What is the FIRST bacterial to colonize the teeth? How? (oxygen preferences, pH)

S. Sanguinis..aerobic, pH of 7

68

What is this term used to describe S.Mutans? Produce acids that can dissolve the tooth..

Acidogenic

69

What is this term used to describe S.Mutans? Can survive in a low pH environment.

AcidUric

70

S. Mutans can adhere to the tooth structure using the extracellular _______ they produce.

GLUCANS!

71

What is the critical point pH?

5.5

72

Levels of S. Mutans in a White Spot Lesion are __-___ times higher then on adjacent sound enamel.

10-100x

73

What is the other main bacterial family associated with Caries? The presence of this bug may indicate a _____ lesion.

Lactobacilli...deeper!

74

S. Mutans can survive without ______, Colonize in furrows of the ______.

teeth...tongue

75

By what method does acid get to the enamel and how does Ca2 & P04 leave the enamel?

diffusion!

76

About ___% of the hydroxyapatite crystal is CARBONATED and is therefor more easily dissolved by acids.

20%!!

77

In the early stages of demineralization, some of the dissolved mineral gets ______ at the surface as it exits the tooth...SO we can have a NON-cavitated lesion (with a cover on top!)

re-deposited

78

How can I tell the difference between demineralization and gastric acid exposure?

Gastric acid/Citric Acid exposure is MORE damaging and gets Mulitple surfaces of multiple teeth

79

What form of F- must we have in order to gain access to bacteria? What bacterial enzyme does it block?

HF...Enolase

80

If the Pt is ingesting LIQUID sugar, then multiply by...

1

81

If the Pt is ingesting Solid & Sicky sugar, then multiply by...

2

82

If the Pt is ingesting Slowly Dissolving sugar, then multiply by... What is a high DIETARY risk?

3..Total of 9 or more

83

In a pH test you record the pH every ______ for ___ minutes total.

minute...20

84

What # is low risk for AMOUNT of SMutans via a bacteria test?

< 1500

85

What does a HIGH bacterial test indicate for OVERALL caries risk?

>1500 on the bacteria test indicates Moderate caries risk in CAMBRA

86

CHX: Use ____ml and swish in mouth for __ minute

10mL...1min

87

CHX: Spit out without ______, Continue daily for a total of __ days and then discontinue use Using same routine, rinse with NaF rinse for ___ weeks. See your dentist for ______ testing and re-evaluation If necessary, continue Chlorhexidine and NaF rinse regime used earlier

rinsing...7 days...3 weeks...bacterial

88

Drawbacks of CHX: _______ & alters ______ if used for prolonged period, the 1% gel is not available in the ___. It is _______ for cariogenic bacteria.

stains & alters taste...US...NOT specific

89

Is Iodine more effective in Children or adults?

Children

90

Rank Xylitol, F- Varnish, CHX in prego moms not to pass S. Mutans to kiddo.

Xylitol > CHX > F- Varnish

91

What is the THERAPUTIC dose of Xylitol/Day??

5-10mg/day

92

What is MI paste made of? What are the 3 methods of delivery?

Amorphous Calcium Phosphate...1 Rub on teeth 3-5x/day 2.Tray 3.prohpy paste

93

OK this is just fun now.....What are the 6 systemic diseases we, as the ORAL PHYSICIAN, can test for in the saliva??

1.Myocardial Infarction (c-reactive proteins released) 2.Renal disease (elevated nitrate/urea) 3.Breast Cancer (antigen) 4.Type II Diabetes (proteins) 5.Sjogren's Syndrome (proteins) 6. DNA analysis (forensics, who the daddy)