Caries Prevention/ Caries Risk Assessment (FINAL REVIEW) Flashcards
(119 cards)
1
Q
Biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues:
A
dental caries
2
Q
What pushes towards remineralization and away from demineralization:
A
- regular dental care
- fluoride
- Xylitol products
- adequate saliva flow
3
Q
CAMBRA:
A
CAries Management By Risk Assesment
4
Q
Caries disease indicators: (4)
A
- low socioeconomic status
- development problems
- current caries
- restorations placed in the previous 3 years
5
Q
Caries risk factors: (8)
A
- mutans streptococci
- lactobacilli
- plaque
- exposed roots
- insufficient saliva flow
- frequent snacks
- deep pits and fissures
- orthodontic appliances
6
Q
Caries Protective factors: (4)
A
- systemic and/or topical fluoride
- CHX use
- Xylitol
- Calcium & Phosphate paste
7
Q
Systemic fluoride is only beneficial to:
A
individuals whose teeth are developing (mainly kids)
8
Q
Describe the caries risk for the following scenario:
- no dental lesions
- no visible plaque
- optimal fluooride
- regular dental care
A
Low Risk
9
Q
Describe the caries risk for the following scenario:
- dental lesions in the past 12 months
- visible plaque
- suboptimal fluoride
- irregular dental care
A
Moderate Risk
10
Q
Describe the caries risk for the following scenario:
- one or more lesions
- visible plaque
- suboptimal fluoride
- irregular dental care
- high bacterial challenge
- impaired saliva
- medications
- frequent snacking
A
High Risk
11
Q
Describe the caries risk for the following scenario:
- patients with special needs
- severe hyposalivation
A
Extreme Risk
12
Q
What does axiom classify as disease indicators?
A
- active decay
- initial decay
- white spot lesions
- Treatment w/in 3 years
13
Q
Active caries automatically places a patient at:
A
high risk
14
Q
What does axiom classify as risk factors? How many risk factors places a patient at high risk?
A
- visible/heavy plaque
- frequent snacking
- exposed roots
- deep pits/ fissures
- ortho appliances
two
15
Q
What are modifying factors to caries?
A
- fluoride exposure
- biofilm
- saliva flow rate & composition
- oral hygiene
- diet
16
Q
When trying to modify caries through saliva flow rate and composition, what might you recommend to the patient?
A
- consider saliva substitutes like biotene
- sugar free gum
17
Q
How does dairy impact caries?
A
Studies have shown that cheese consumption increases remineralization and decreases demineralization (mechanisms of actions is ionizable calcium and phosphate). Also increases saliva and buffers
18
Q
Studies have shown that consumption of this increases remineralization and decreases demineralization. Also increases saliva and buffers:
A
dairy
19
Q
What is the mechanism of action of dairy on caries:
A
mechanism of action is ionizable calcium and phosphate
20
Q
Dessie the effects of nuts on dental caries
A
almond, Brazil nuts, and cashews are especially beneficial because they help fight tooth decay-causing bacteria
21
Q
What are some foods that should be avoided as they increase your risk for caries:
A
- breads
- pastas
- sweets
- alcohol
22
Q
List three dietary components that may negatively effect dental caries:
A
- fermentable carbs
- frequent snacking/sugared drinks
- pH of drinks
23
Q
What bacteria is responsible for most caries:
A
streptococcus mutans
24
Q
Fluoride is a ____ to caries prevention, not a ____
A
SUPPLEMENT: not a solution on its own
25
ingested fluoride agents that become incorporated into forming tooth structures:
systemic fluoride application
26
Give examples of systemic fluoride application:
1. water
2. supplements
3. food/beverages
27
Fluoride that strengthens teeth already in the mouth making them more resistant to caries:
Topical fluoride application
28
Give examples of topical fluoride application:
1. water
2. homecare products
3. in-office products
29
systemic fluoride is ___ and is incorporated into ___ during development of tooth structures
ingested; enamel
30
Topical fluoride promotes ____ and prevents ____ after eruption
remineralization; demineralization
31
What is the mechanism of action of topical fluoride?
inhibits glucoses in bacteria, thereby inhibiting the ability of bacteria to metabolize cabs and produce acid
32
What is water fluoridation?
An increaser in the natural fluoride level in a communities water supply to a level optimal for dental health
33
Considered one of the most cost-effective preventive dental program by public health:
water fluoridation
34
Benefits of water fluoridation include:
1) A 30-39% decrease in caries in primary dentition
2) A 35% decrease in children/adolescent permanent dentition
3) Approximately 20-30% decrease in coronal caries and 20-40% decrease in root caries in adult population
35
Optimal level of water fluoridation means:
minimal caries with minimal fluorosis
36
What level of water fluoridation is considered optimal?
0.6-1.2 ppm
37
.7 ppm decrease caries with less than ___% of the population with Fluorosis
10%
38
Changes in the appearance of enamel caused by too much SYSTEMIC fluoride:
fluorosis
39
Fluorosis is changes in the appearance of enamel caused by too much:
systemic fluoride
40
How does topical fluoride work?
Fluoride is deposited in enamel during enamel maturation phase results in a concentration of fluoride in the enamel
41
The highest concentration of fluoride taken into the enamel by topical fluoride occurs on the ____ portion and ____ as you move toward the dentin
outermost; decreases
42
With topical fluoride application ___ are substituted into the ____ and form a stable, more compact bond making the tooth resistant to ___.
fluoride ions; hydroxyapatite crystal; demineralization
43
Can topical fluoride application cause fluorosis?
NO
44
What influences enamels reaction to fluoride?
1. concentration of fluoride
2. pH of fluoride
3. length of exposure
45
Acidic fluoride typically forms:
calcium fluoride
46
Higher concentrations of fluoride form:
calcium fluoride
47
In-office fluorides are ____ ppm so they typically form ____
greater than 9000 ppm; calcium fluoride
48
Neutral fluorides are ___ ppm and form ____
less than 100 ppm; fluoroapatite
49
What type of fluoride do you typically buy at the store? (OTC)
neutral fluoride
50
List the benefits of topical fluoride: (3)
1. remineralization
2. interference with bacterial metabolism
3. prevention
51
List the three discussed types of topical fluoride application:
1) 2% neutral sodium fluoride (9000 ppm)
2) 1.23% Acidulated phosphate fluoride (APF) (12,300 ppm)
3) 5.0% NaF (22,600 ppm)
52
This type of in-office fluoride is available as a foam or gel application (rarely used in practice today), and is 9,000 ppm:
2% Neutral sodium fluoride
53
This type of in-office fluoride is available as foam or gel application (rarely used in practice today), and is 12,300 ppm:
1.23% Acidulated phosphate fluoride (APF)
54
This type of in-office fluoride is available as a varnish application and is commonly used in dental practices today with a ppm of 22,600:
5.0% NaF
55
After every application of topical fluoride there is an increase in the amount of:
permanently bound fluoride in the outermost layer of enamel
56
After every application of topical fluoride there is an increase in the amount of permanently bound fluoride in the outermost layer of enamel ad this causes:
a decrease in caries susceptibility (initiation and progression)
57
Most desired form of fluoride for enamel and caries prevention:
Fluorohydroxyapatite
58
Desired source of fluoride for remineralization of enamel:
Calcium fluoride
59
What type of fluoride is desired for caries prevention?
Fluorohydroxyapatite
60
What type of fluoride is used for enamel remineralization?
Calcium fluoride
61
The benefits of topical fluoride treatment are directly related to:
the amount of topical fluoride treatments provided
62
T/F: The type of topical fluoride system used does not affect the benefit:
True
63
T/F: Fluoride does NOT benefit sound enamel:
True
64
T/F: Greater uptake into enamel occurs with higher concentrations of fluoride:
true
65
When should topical fluoride be used in office?
1. High caries risk individuals
2. Sensitive teeth
3. Exposed root surfaces
4. Around margins of older restorations
5. Overdentures (with natural teeth)
6. Xerostomia
7. Newly erupted teeth
66
PTD:
probable toxic dose
67
The probable toxic dose of fluoride is based on:
body weight
68
What is the PTD of fluoride considered?
5mg/kg of body weight
69
If a patient is showing signs of fluoride overdose and has received less than 5mg/ kg:
office use of available calcium, aluminum or magnesium products
70
If a patient is showing signs of fluoride overdose and has received more than 5mg/ kg (but less than 15mg/kg):
office use of available calcium, aluminum, or magnesium products plus hospital observation
71
If a patient is showing signs of fluoride overdose and has received more than 15mg/ kg:
Emergency response
72
Concentrated fluoride salts can cause ___ when in contact with oral mucosa
chemical burn
73
List three outcomes of fluoride toxicity:
1. Inhibits enzyme systems
2. Binds calcium
3. Cardiotoxic due to hyperkalemia
74
Signs and symptoms of too much fluoride include: (5)
1. nausea
2. vomiting
3. diarrhea
4. abdominal cramping
5. increased salivation/dehydration
75
Fluoride varnish is composed of:
5% NaF (sodium fluoride)
76
List the pros of sodium fluoride varnish (5%)
1. Proven efficacious in decreasing caries, especially in early childhood
2. Easy to apply following oral exam and prophylaxis
3. Easy to follow post-op instructions
77
List the cons of sodium fluoride varnish (5%)
1. Leaves a thin visible film on teeth that some patients don't like
2. Possible allergies linked to specific brands of fluoride varnish
78
How often should fluoride varnish application occur?
every 3-6 months dependent on caries risk
79
With water fluoridation and use of fluoridated toothpastes in the U.S, approximately 75% of the public is considered low-risk for dental caries.
Therefore, the use of any professionally applied fluoride should be limited to those individuals and communities deemed to be at:
Moderate to high-risk for developing dental caries
80
SDF:
silver diamine fluoride
81
antimicrobial properties of silver with the benefits of high dose fluoride:
SDF
82
SDF resulted a precipitate that:
occludes dentinal tubules and reduces hypersensitivity
83
___% SDF was found to be the most superior at arresting caries compared to lower concentrations
38% SDF
84
T/F: SDF is superior at arresting dental caries and preventing new caries compared to fluoride varnish alone
True
85
T/F: Multiple applications of SDF found to be equally successful at arresting dental caries as one-time placement of SDF
False- multiple applications of SDF found to be more successful
86
1. SDF gained clearance from the FDA in ____
2. Approved for use to treat ___ in adults
3. SDF award title of:
1. 2014
2. dentin hypersensitivity
3. breakthrough therapy
87
Mechanism of acton of SDF:
Fluoride and silver are made soluble in water by addition of:
ammonia
88
Mechanism of acton of SDF:
The ____ are a broad-spectrum antimicrobial that has high biocompatibility and low toxicity in humans
silver ions
89
Mechanism of acton of SDF:
The silver ions act as tiny silver bullets that damage and degrade ____, disrupt _____ & ____ and disrupt _____, eventually leading to cell death
bacterial cell walls; bacterial DNA synthesis & replication; intracellular metabolic activity
90
Mechanism of acton of SDF:
When SDF kills bacteria, the killed bacteria further act as a carrier of ___ and can kill living bacteria nearby in a process known as the ____.
silver ions; "zombie effect"
91
Once SDF is applied, a ____ precipitates out of the clear solution on the the carious lesion
physical barrier
92
Once the SDF has formed a physical barrier that predicates out onto the carious lesion, 2 products form:
1. silver phosphate
2. calcium fluoride
93
Once the SDF has formed a physical barrier that predicates out onto the carious lesion, 2 products form:
1. Silver phosphate:
2. Calcium fluoride:
Describe the role of each:
1. the silver phosphate acts as a reservoir of phosphate ions
2. the calcium fluoride is a pH regulated fluoride supply available during cariogenic challenge
94
Product of SDF action that is a reservoir of phosphate ions:
silver phosphate
95
Product of SDF action that is a pH regulated fluoride supply available during cariogenic challenge
calcium fluoride
96
What are the 2 products that SDF forms on carious lesions?
1. silver phosphate
2. calcium fluoride
97
Why does the carious lesion treated with SDF turn black?
The black color occurs when free silver ions are reduced by environmental oxygen
98
What is a major non-medical side effect of SDF:
carious lesion turning black
99
What does it mean if carious lesion treated with SDF turns black?
the decay has been arrested
100
5% SDF solution contains ____ppm fluoride
44,800
101
T/F: 5% SDF solution contains almost twice as much fluoride as 5% NaF varnish
true
102
In the 5% SDF solution, SDF reacts with calcium and phosphate ions to produce ______ , which are less susceptible to solubility and crucial to tooth remineralization
fluorohydroxyapatite crystals
103
T/F: One application of SDF is sufficient for ultimate results
False- may need to place SDFD a few times for effectiveness in treating the area
104
When is SDF indicated?
1. dentin hypersensitivity
2. Uncooperative patients
3. root surface caries on elderly patents with existing restorations
4. patients without access to care
5. difficult to treat lesions
105
T/F: SDF has an unpleasant metallic taste
True
106
What are two contraindications to use of SDF?
1. silver allergy
2. pulpal involvement
107
At home fluoride products include:
1. toothpaste
2. mouth rinse
3. MI paste plus
108
The average concentration of fluoride in OTC toothpaste=
0.22% NaF (1000 ppm)
109
____ is the most effective dentrifice system for caries prevention
sodium fluoride (NaF)
110
What risk come with OTC fluoride toothpaste?
risk of fluorosis and toxicity if ingested (hence pea-size amount for small children)
111
Give three examples of fluoride rinses:
1. ACT kids
2. Listerine fluoride defense
3. ACT anti-cavity
112
What does OTC fluoride mouth rinse do?
1. remineralizes tooth structure
2. strengthens enamel to prevent caries
3. kills bad breath
113
For mouth rinses that are labeled 0.02% NaF this contains ____ ppm.
For mouth rinses that are labeled 0.05% NaF this contains ____ ppm.
100ppm; 225ppm
114
Uses RECALDENT (a milk-derived protein that relates calcium and phosphate to the surface of teeth) to relieve tooth sensivity (NOT TO PREVENT DECAY)
MI Paste
115
What is the goal of MI paste? What does it NOT do?
goal: relieve tooth sensitivity
It does not prevent decay
116
MI paste PLUS has 0.20% NaF (900ppm) and can be used for:
BOTH caries prevention and tooth sensitivity
117
What is the fluoride concentration for PreviDent toothpaste?
1.1% NaF (5000ppm)
118
What is the fluoride concentration for PreviDent mouth rinse?
0.2% NaF (900 ppm)
119
