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Cariology Flashcards

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1
Q

what are the 4 requirements needed to cause caries?

A

Plaque, Time, Sugar, Surface

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2
Q

What is the process called that causes caries?

A

Fermentation

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3
Q

Name 5 studies used to determine whether carbodydrates effect the formation of caries

A

Vipeholm
Hopewood House
Turku
Inuit Eskamo
Triston Decuna

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4
Q

Explain the Vipeholm study

A
  • In Sweden
  • In a faculty for people with severe intellectual and developmental disabilities
  • 7 groups (1 being a control group)
  • fed sticky toffes, sweet bread, sucrose rinse, with their meals, between meals
  • conclusion was sticky toffees had the most effect as well as having sugar inbetween meals
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5
Q

Explain the Hopewood house study

A
  • In Australia
  • Boarding school for kids up to 12
  • Fed a lacto-veg diet
  • Was seen after the kids left school their caries rate sky highed and matched the rate of the state schools
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6
Q

Explain the Turku study

A
  • Finland
  • Studied differences in different sugars effect on caries
  • Over 2 yr period
  • Some groups chewed sucrose, fructose, and xylitol gum
  • conclusion was xylitol was advantageous, both fructose and sucrose caused harm to teeth, sucrose being worse
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7
Q

Explain the Inuit Eskamo study

A
  • Alaska
  • People living here hunted for their food
  • A post office was built in the town and imported sugary goods
  • Caries rate increased
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8
Q

Explain the Triston Decuna study

A
  • Remote island in South Atlantic - volcano eruption made them move to UK
  • Ate UKs diet
  • Caries rate increased
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9
Q

What are the zones of enamel?

A

Surface layer
Body of lesion
Dark zone
Translucent zone

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10
Q

Explain the translucent zone of enamel

A
  • innermost zone
  • first carious change
  • it appears structurless
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11
Q

Explain the dark zone of enamel

A
  • This zone is almost always present
  • Formed as a result of demineralisation
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12
Q

Explain the Body of the lesion of enamel

A
  • Largest zone
  • Represents areas of higher deminerlisation, most porous
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13
Q

Explain the surface layer of enamel

A
  • Topmost layer (outside zone)
  • Highest minerlised layer
  • Relatively unaffected
  • reminerlisation can occur due to replacement of ions from the saliva
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14
Q

What approach is used to treat WSL?

A

Preventative

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15
Q

How do you treat WSL?

A
  • Fluoride
  • Diet advice
  • OHI
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16
Q

What are the outcomes of WSL?

A
  • Reverse
  • Arrest
  • Cavitate
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17
Q

How do active WSL appear?

A

Chalky

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18
Q

How to arrested WSL appear?

A

Glossy

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19
Q

What are the zones of dentine caries?

A

Zone of destruction
Zone of bacterial invasion
Advancing front

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20
Q

Explain the zone of destruction in dentine

A

When enamel has been cavitated, bacteria infects the dentine. Dentine becomes necrotic and liquifies
infected dentine, collagen matrix has been broken down

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21
Q

Explain the zone of bacterial invasion in dentine

A

the tubules are invaded by bacteria, which then multiply within the tubule lumen. As well as decalcifying the dentine with acid, the bacteria dissolve the proteins (e.g collagen) within the tubules - this is called proteolysis
affected dentine
collagen matrix has not been broken down

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22
Q

Explain the advancing front of dentine

A

Acid produced by the bacteria travels down the dentinal tubules, causing demineralisation. The zone of demineralisation is the advancing front of the carious lesion, and may be very small (<1mm).
No bacteria present here only lactic acid. This zone is closest to the pulp

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23
Q

What are the signs and symptoms of reversible pulpitis?

A
  • not constant
  • not acute
  • doesn’t keep pt awake
  • not into pulp
  • not TTP
  • stops when stimulus is removed
  • sensitivity-mild discomfort
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24
Q

What are the signs and symptoms of irreverisble pulpitis?

A
  • constant, acute pain
  • may keep pt awake
  • TTP
  • into pulp
  • may be worsened by hot/cold- initially sensitive to cold but as condition worsens it becomes sensitive to hot
  • dull, throbbing pain
  • lingers when stimulus is removed
  • pain may radiate
  • pain is often spontaneous
  • moderate-severe
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25
What are cariogenic bacteria?
cause caries
26
What are acidogenic bacteria?
capable of producing acid
27
What bacteria is involved in caries?
Strep mutans Lactobactilli Strep sobrinus Actinomyces Rothia dentocariosa
28
Describe the Stephan curve
* A graph that shows what happens after consumption of sugar in relation to dental caries * after sugar intake, deminerlaisation of the tooth surface takes place due to drop in pH as bacteria in the mouth convert sugar to acid * After 20-30 minutes, the saliva buffers the pH and returns it back to normal level. This is more rapid in the presence of fluoride * Spacing periods of sugar intake hours apart allows pH to return to normal. however increased frequency of sugar intake means demineralisation occurs more often, and the time periods between drops in pH are not long enough to allow effective reminerlisation to happen
29
What is the purpose of using fluoride?
- can change morphology of developing teeth, resulting in more rounded cusps and flattened fissures - lowering stagnation areas - is bacteria static - doesn't kill but inhibits growth of bacteria - Reduces overall number of strep mutans in the mouth - lowers the critical pH to 4.5 - favours remineralisation - increases the abundance of calcium phosphate to the tooth surface
30
what are the 2 types of fluoride delivery?
topical systemic
31
What ae the topical fluoride delivery methods?
- fluoride varnish - fluoride toothpaste - mouthwash - APF (acidulated phosphate fluoride) gels
32
What are the systemic fluoride delivery methods?
- fluoridated water - drops - tablets - fluoridated milk and salt
33
what is the critical pH of enamel?
5.5
34
what type of crystals are enamel prisms made up of?
hydroxyapatite (Ca ions and OH ions)
35
When fluoride enters the hydroxyapatite molecule what happens?
F occupies the voids and bonds to Ca making calcium fluorapatite crystals
36
what strength of fluoride is recommended for <3 year old?
1000ppm (smear of TP recommended)
37
what strength of fluoride is recommended for >3 years old?
1350-1500ppm (pea size of TP recommended)
38
What is the strength of high fluoride toothpaste recommended for 10-16 yr olds?
2800ppm
39
What is the strength of high fluoride toothpaste recommended for >16 yrs old?
5000ppm
40
what strength of fluoride is in fluoride varnish?
22,600ppm
41
what strength of fluoride is in fluoride mouthwash?
225ppm
42
what are we looking for in a diet diary and what advice should we give?
sugar intake acid intake hidden sugars alcohol (also increases OC risk)
43
What does SOCRATES stand for?
Site Onset Character Radiation Associated symptoms Time/duration Exacerbating/relieving factors Severity
44
What is the gold standard pain assessment model?
SOCRATES
45
What are the different types of pulp tests?
Odontotest Electric pulp test TTP
46
What is rampant caries?
Suddenly appearing, rapidly burrowing type of caries, resulting in early pulp involvement. An example of this is nursing bottle caries
47
How do we classify caries?
According to severity: - ICDAS - E1, E2, E3, D1, D2, D3 - DMFT According to location: - surface - tooth substance (enamel, dentine) - anterior/posterior According to primary/secondary: - initial lesion (primary) - around existing restoration (secondary) According to active/arrested
48
What can influence caries risk?
- OH - siblings with caries - prev extractions/disease - FH - diet - smoking - xerostomia - saliva flow (rate/quantity) - fluoride - medications - socioeconomic factors (SIMD) - attendance - disability - can effect brushing/saliva - tooth morphology - wearing appliances - medically compromised
49
How often should radiographs be taken for someone with high risk caries rate?
every 6 months
50
How often should radiographs be taken for someone with moderate risk caries rate?
every 12 months
51
How often should radiographs be taken for someone with low risk caries rate?
every 24 months
52
What is the role of saliva in preventing dental caries?
- buffers acid - produces Ca phosphate which is alkaline therefore neutralises pH - contains antibacterial factors, such as enzymes, which fight bacteria (lisozymes and histatins) - forms a protective lubricated layer over the teeth and acts as a barrier
53
How do we diagnose caries?
- transillumination - radiographs - clinically - using spacers - caries dyes - fluroscents - drying the tooth - ensuring the tooth is clean
54
What can a pulp be diagnosed with?
* nomal pulp * dentine sensitivity * reversible pulpitis * irreversible pulpitis * necrotic pulp/pulp necrosis * effect on apical tissues (periapical periodontitis, apical abscess)
55
Are bacteria involved in caries gram +ve or -ve?
+ve
56
What is primary prevention?
aims to prevent disease before it actually occurs
57
what is secondary prevention?
aims to limit the progression and effect of disease at the earliest possible opportunity after onset
58
What is tertiary prevention?
aims to limit the extent of disability once a disease has caused some functional limitation
59
What is ICDAS?
International caries detection and assessment system 0 - sound tooth surface 1 - first visual change in enamel 2 - distinct visual change in enamel 3- localised enamel breakdown due to caries with no vsisible dentine 4- underlying dark shadow from dentine (with or without enamel breakdown) 5 - distinct cavity with visible dentine 6- extensive distinct cavity with visible dentine
60
How does sugar cause caries?
Bacteria consume sugar and convert it into lactic acid, this causes demineralisation
61
How do we prevent caries?
OHI F/S Fluoride Diet advice
62
What were the 3 conclusions from the Vipeholm study?
1. sugar causes caries 2. consistency had an effect - sticky toffes 3. frequency of sugar intake caused caries
63
when managing caries when do we restore occusal cavities?
ALWAYS
64
when managing caries when do we restore proximal lesions?
only intervene if ≥ 50% into dentine or visibly cavitated (this is why we place separators)
65
what is biofilm?
bacteria on a solid surface
66
what is a pellicle?
bacteria free salivary glycoproteins
67
what is occult caries?
occlusally the tooth is intact, but is grossly carious under the surface
68
what is reparative dentine?
quick, not as strong, odontoblast like cell, strong stimuli
69
what is reactionary dentine?
slower, strong and odontoblasts, mild stimuli

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