Cariology Lecture 1

Question 1

More complex explanation of dental caries

Answer 1

1. bacterial disease
2. Dependent on presence of sugars and carbohydrates
3. Modified by salivary flow & composition
4. Modified by fluoride

Question 2

T or F, solubility of hydroxyapatite is affected by pH

Answer 2

True

Question 3

Exposure of enamel to acids may lead to 2 types of lesions:

Answer 3

1. Carious lesion

2. Erosion

Question 4

Difference between carious lesion and erosion

Answer 4

1. Caries: Chemical dissolution of the dental hard tissues by acidic bacterial products from degradation of low molecular weight sugars (weak acids..)
   * *Can remineralize
2. Erosion: Dissolution of the dental hard tissues caused by acids of any other origin or mechanical wear (Strong acids…)
   * *Cannot remineralize

Question 5

T or F, partially demineralized apatite cyrstals are unable to grow back to their original size

Answer 5

False, Can grow to their original size

- especially in the presence of fluoride

Question 6

In an erupting tooth, describe the enamel

Answer 6

Enamel is full minerlized, but the outermost surface layer is porous and low in fluoride
- This is why children are prone to decay shortly after eruption

Question 7

Describe the caries classification system (D1-D4)

Answer 7

D1: Clinically detectable enamel lesion
D2: Clinically detectable cavitation limited to enamel
D3: Clinically detectable lesions in dentin
D4: Lesions into pulp

Question 8

Where in the caries classification does the change from cavitate and non-cavitated occur?

Answer 8

During the D3 classification, however some D3 can be cavitated while others can be Non-cavitated

Question 9

Most children become permanently colonized with S. mutans at what age?

Answer 9

18-36 months
This is called the window of infectivity
***Can be as early as 3 months

Question 10

What percentage of children get MS from mom? How is it transmitted

Answer 10

70% approximately

- vertical transmission with an association with maternal salivary levels of bacteria

Question 11

How common is it for children to receive MS from someone other than parent? (Horizontal transmission)

Answer 11

Common
Swedish study had 45% horizontal transmission
Japanese study had 58% horizontal transmission

Question 12

What is the impact of delayed transmission of MS? How can we do this?

Answer 12

Delaying acquisition of MS reduces caries experience in both the primary and permanent dentition
- Delay transmission by reducing maternal bacterial load

Question 13

4 risk factors for early transmission of MS

Answer 13

1. High maternal levels of MS (> 105 CFU/mL)
2. Sweetened fluids taken to bed
3. Frequent sugar exposure and snacking
4. Sharing foods with adults

Question 14

Most studies measure what type of caries?

Answer 14

Most studies measure D2-D4 caries

- It is very difficult to standardize examiners at the D1 level

Question 15

T or F, Caries is the most common childhood disease

Answer 15

True

Question 16

According to studies from 1974 to the mid 1990’s, is the percent of caries increasing or decreasing in permanent teeth?

Answer 16

Decreasing! This is good!

Question 17

What would suggest reasons for the decline in caries?

Answer 17

Increased exposure to fluoride 
- Fluoride toothpaste & water
Improved preventive behaviors/services
- Better oral hygiene (F toothpaste)
- Dental sealants

Question 18

List in order of greatest to least the order of surfaces that have most distribution of caries

Answer 18

Occlusal (Pit & Fissures predominate) > Buccal & Lingual > Smooth surface

Question 19

There are high caries rates in what groups?

Answer 19

Low income children
Racial & Ethnic minorities
Children with special health care needs
***20% of children experience 80% of decay

Question 20

Is the prevalence of edentulism increasing or decreasing?

Answer 20

Decreasing, this means that some of our high risk patients are now becoming older patients with an increased caries rate

Question 21

Impact of decreased edentulism?

Answer 21

1. More teeth at risk of caries
2. Increasing caries rates in adults
3. The new “at-risk” population
   - Xerostomia (new carious lesions)
   - Previous restorative work (Larger restorations)
4. Caries, not PD, is the primary cause of tooth loss in adults

Question 22

What is the primary cause of tooth loss in adults?

Answer 22

Caries, Not periodontal disease

Question 23

Increased prevalence of dental fluorosis corresponds to what?

Answer 23

Decline in caries (mostly “very mild” and “mild”)

Question 24

It takes an average of about how many years for a lesion to progress through the enamel of permanent teeth?

Answer 24

4 years

- Progression is faster in primary teeth

Question 25

5 guiding principles for caries management

Answer 25

1. Assess caries risk status 2. Diagnose the disease early 3. Treat the disease by: - remineralizing tooth surfaces - controlling the infection 4. Avoid or delay operative intervention 5. Restore "active" disease only

Question 26

Name some risk factors for caries you CAN change

Answer 26

1. Levels of cariogenic bacteria 2. Fluoride exposure 3. Diet 4. Oral hygiene 5. Salivary flow

Question 27

T or F, Children with caries in primary teeth are 2 times more likely to have caries in their permanent teeth

Answer 27

False, 3 times more likely

Question 28

T or F, Identical twins tend to have the same caries rate, parental twins do not have the same caries rates

Answer 28

True

Question 29

Describe the relationship between sugar & dental caries

Answer 29

1. Sugar intake drops oral pH 2. Drop in pH leads to: - demineralization - altered plaque ecology (favors aciduric bacteria like MS) 3. Impact dependent on presence of fluoride

Question 30

T or F, DMFS decreased as sucrose intake decreased

Answer 30

True

Question 31

Two issues to consider when thinking about sugar and caries

Answer 31

The form of sugar | Frequency vs. total amount consumed

Question 32

T or F, Its not how much sugar you eat, its how often you eat it that is important

Answer 32

True

Question 33

What are the recommendations for total amount of sugar intake and Frequency

Answer 33

``` Total amount: limit intake of free sugars to - 40 grams/day in non-fluoridated areas - 55 grams/day in fluoridated areas - 6-10% of energy intake Frequency: Limit sugar intake to 4x/day - preferable at meals ```

Question 34

T or F, There is evidence that removal of plaque by brushing (with a non-F toothpaste) or flossing decreases the incidence of caries

Answer 34

False, No evidence

Question 35

#1 factor with caries

Answer 35

Salivary concentration of S. mutans

Question 36

Best ways to remove plaque

Answer 36

1. Brushing 2. Flossing - introduce floss only when brushing is mastered - We don't know the best frequency

Question 37

3 levels of caries diagnosis

Answer 37

1. Detection: describe patient and oral tissues 2. Diagnosis: level of disease 3. Intervention: What will you do

Question 38

Prerequisites for detection of caries

Answer 38

1. Clean teeth 2. Dry teeth 3. Sharp eyes & magnification 4. Lighting

Question 39

T or F, White-spot lesions visble when dried have penetrated about 1/2 of the enamel

Answer 39

True

Question 40

T or F, White/brown lesions visible when dry have penetrated through the enamel

Answer 40

False, Visible when WET

Question 41

Why do we look at dried teeth to identify caries?

Answer 41

When dried, air replaces water in enamel. The refractive index of air is farther away from enamel than water, making lesions easier to see

Question 42

Is detection of cavitated lesions an appropriate diagnosis of dental caries?

Answer 42

No, we need systems that allow us to diagnose before cavitation! If detected before cavitation, caries is reversible

Question 43

We cannot detect caries until is is how far through enamel?

Answer 43

1/3-1/2 way through

Question 44

Probing with a sharp explorer may:

Answer 44

1. Cause damage to newly erupted teeth 2. Create a cavity at the site of a superficial lesion 3. Transmit bacteria to uninfected fissures

Question 45

What are the 4 main new diagnostic technologies being used to diagnose caries

Answer 45

1. Digital imaging fiber optic trans-illumination (DIFOTI) 2. Laser Fluorescence (LF) - DIAGNODent 3. Quantitative light fluorescence (QLF) 4. Infra red light imaging

Question 46

T or F, DIFOTI can detect incipient or recurring caries before they are visible on x-rays

Answer 46

True

Question 47

T or F, DIAGNODent can be relied on as a clinician's primary diagnostic method

Answer 47

False, Should not be relied on