Caries Flashcards by sophie rosen

definition of caries

decay and crumbling of tooth structure

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caries is a —

disease

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most common chronic disease of childhood

caries

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cavity

empty space or hole

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caries is a — disease

multifactorial

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requirements for caries (4)

host
food source
bacteria
time

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oral environment factors affecting caries (8)

fluoride
dental sealants
antibacterial agents
saliva
sugars
calcium and phosphate ions
plaque pH and species of microbes 
chewing gum

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personal factors affecting caries (8)

patient education
patient bevaiors
oral health literacy
socioeconomic status
income 
dental insurance
knowledge
attitude

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is it possible to impact personal factors?

very challenging or impossible

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main component of enamel

fluoride

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fluoride ions replace hydroxyl groups, creating

fluorapetite

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Fluorapatite is — resistant to demineralization than hydroxyapatite

more resistant to acid

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where is fluoride effective at reducing caries? (2)

crown (enamel)
root surfaces (cementum)

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systemic fluoride

found in water supply

used for drinking, cooking

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topical fluoride (2)

toothpastes (OTC and prescription)

fluoride treatments in dental office (foam, varnish, silver diamine fluoride)

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dental sealants

thin coating of resin painted on the chewing surfaces of molars (occasionally premolars)

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high concentration of — in pits and fissures

strep mutants

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dental sealants help to prevent

occlusal caries

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saliva properties (3)

physical
chemical
antibacterial

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physical saliva properties (3)

• Cleanses oral cavity
• Humans produce ~0.5-1 liter saliva per day
• Chewing gum increases saliva production
(• Xylitol ingredient also cariostatic)

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chemical saliva properties (3)

Sodium bicarbonate and phosphate ions neutralize environment
Calcium and phosphate ions help remineralize
Proteins raise salivary pH, help remineralize enanel

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antibacterial saliva properties (6)
• — clear bacteria
• — break down food particles that stick to teeth
• — lyse cell walls of bacteria
• — deprive bacteria of iron
• — forms free radical compounds in bacterial cells, leading to self destruction
• — block bacteria from adhering to tooth surface

Mucins
Amylases
Lysozomes
Lactoferrin
Peroxidase
Immunoglobulins

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bacterias favorite food

fermentable carbohydrates

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preferred sugar

sucrose

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--- is more important than --- when determining caries risk

frequency | quantity

lower pH= more --- environment

acidic

enamel demineralizes at

5.5

dentin and cementum are softer than enamel so they each demineralize at

6.5

``` Streptococcus ◦ especially --- (but not exclusively) ◦ Gram --- cocci ◦ Prefer pH ~--- ◦ Most prevalent in (2) ```

Strep mutans positive 5.5 pits and fissures

Lactobacillus ◦ Gram --- rods ◦ Prefer very --- pH

positive | low

biofilm

an aggregation of microorganisms adhering to each other in a matrix

dental biofilm is

dental plaque stuck to tooth

biofilm alone is not

cariogenic

biofilm must contain

caries causing microbes - streptococcus and lactobacillus - specific plaque hypothesis theory

Caries occurs when Demineralization --- Remineralization over time

Enamel demineralizes at pH

5.5

Normal oral cavity pH ~

6.7-7.3

Enamel components (3)

◦ 90% hydroxyapatite ◦ 8% water ◦ 2% organic material

Dentin components (3)

◦ 50% hydroxyapatite ◦ 30% organic material ◦ 20% water

Fermentable carbohydrates

• Food source for caries-causing (cariogenic) bacteria

Acidic food, drink

• Baseline environment lowers pH

Dry mouth (2)

* Lack buffers, rinse | * Age, medications contribute

Poor oral hygiene

• Bacteria able to thrive

MORE FREQUENT SUGAR = --- CARIES LIKELIHOOD

INCREASED

Saliva (3)

* Neutralizes pH * Rinses oral cavity * Ions to remineralize

Good oral hygiene

• Destroys bacteria’s habitat, they can’t stick to tooth

Lack of cariogenic ---

microbes

Reduced sugar consumption

• Bacteria starve

Why are sugary or acidic drinks so bad?

NO CHEWING. | Chewing increases saliva production. Sipping on a latte does not.

Drink your sugary drinks with

a meal

Certainly avoid Gatorade/powerade during workouts if possible ◦ Why?

◦ Salivary flow already decreased during strenuous activity.

What’s fluoride’s role in all of this? (3)

* When oral cavity pH drops below 5.5, hydroxyapatite dissolves * Fluoride ions enter to form fluorapatite * Enamel is now resistant to demineralization pH ~4.5

Pellicle

◦ Thin membrane on surface

Biofilm (2)

◦ Community of microorganisms held together by extracellular matrix ◦ Complex structure

Dental plaque forms itself into a Biofilm ◦ Can be comprised of (2) ◦ NOT --- debris ◦ Food debris can be removed by ---, dental plaque can not

microorganisms or pathogenic organisms food rinsing

What is the primary tool used to diagnose caries?

eyes

how to diagnose interproximal caries

Radiographs

Sharp --- > sharp explorer | ◦ “a stick” is not helpful

eyes

Explorer is helpful for (2) senses

tactile and acoustic

Soft, leathery feel when explorer is gently dragged across tooth=

carious

Firm, chalkboard feel and nails on chalkboard=

sound enamel

Caries progression | ◦Be familiar with progression to aid with diagnosis (2)

◦Slow to progress through enamel | ◦Faster once it reaches dentin

Caries is a disease ◦Must be managed --- ◦Treat the person (4)

comprehensively ◦Oral hygiene instruction ◦Dietary counselling ◦Fluoride therapy ◦Surgical treatment

Oral hygiene instruction (3)

◦Plaque free surfaces do not decay ◦Home care ◦Regular dental visits

Dietary counselling ◦This is part of our job ◦Stress on --- --- and frequency ◦Start with small --- changes

fermentable carbohydrates | habit

Fluoride therapy (4)

``` In office ◦ Fluoride Varnish ◦ Silver diamine fluoride At home ◦ Fluoride toothpaste ◦ May prescribe Prevident 5000 or similar Fluoride trays Education ◦ Can’t force this on patients, but you can educate them ```

--- must also be managed

Xerostomia

evaluate the patients medications, some may cause

dry mouth

recommend aids to assist such as (3)

fluoride xylitol chewing gum biotine (patient comfort)

recommend habit changes to assist

recommend water instead of sugary drinks

surgical caries management once the caries has progressed pas the ability to

remineralized | drill and fill

surgical caries management is a very important part of management but

not the whole picture