Clinical Correlation: Mechanisms of Caries & Prevention

Question 1

what is caries?

Answer 1

infectious disease

multifactorial (not just one thing)
-biofilm, bacteria, time, diet, habits, education, socioeconomic factors

Question 2

manage caries disease ___

Answer 2

holistically

Question 3

disease of early childhood caries (ECC)

Answer 3

the presence of one or more Decayed, Missing, or Filled tooth surfaces in any primary tooth in a child under the age of six

DMFT=decayed, missing, filled teeth

Question 4

early childhood caries consequences

Answer 4

-higher risk of new carious legions
-hospitalizations and emergency room visits
-high treatment costs
-loss of school days, diminished ability to learn
-diminished oral health-related quality of life

Question 5

ECC is ___ times more common than asthma

Answer 5

5

Question 6

children @ or below the poverty level are ____

Answer 6

> 50% more likely to have ECC

Question 7

how is bacteria transmitted from caregiver to child?

Answer 7

transmitted vertically through salivary contact; affected by the frequency and exposure

Question 8

high levels of ___ is a result of untreated caries

Answer 8

Strep mutans

Question 9

horizontal transmission of bacteria

Answer 9

also occurs b/w other members of a family or children in daycare

Question 10

what happens to infants whose mothers have high levels of Step mutans?

Answer 10

they are at greater risk of acquiring the organism earlier than children whose mothers have low levels

Question 11

AAPD policy statements

Answer 11

-limit sugar
-implementing oral hygiene very early
-professionally applied fluoride varnish
-getting a dentist w/in 6 months of first tooth eruption
-work w/ medical providers to make sure there is access to oral healthcare
-educating legislators and policymakers

Question 12

dental caries

Answer 12

“decay and crumbling of tooth”

Question 13

how do caries form?

Answer 13

-bacteria in dental plaque “eat” carbohydrates from our diet
-bacteria secrete acids
-acids lower pH
-enamel demineralizes at pH of 5.5 or below
-results in carious lesion

Question 14

enamel demineralizes at what pH?

Answer 14

5.5

Question 15

dentin demineralizes at what pH?

Answer 15

6.5

Question 16

pit & fissure caries

Answer 16

?

Question 17

smooth surface caries

Answer 17

on the smooth surface of the tooth

Question 18

new caries lesion

Answer 18

attacking a previously INTACT surface

Question 19

recurrent caries lesion

Answer 19

occurs around margins of restoration

Question 20

residual caries lesion

Answer 20

caries left behind before filling is placed

Question 21

active caries

Answer 21

matte & mushy

Question 22

arrested (inactive) caries

Answer 22

shiny & firm

Question 23

incipient/initial lesion

Answer 23

hasn/t broken into dentin layer

Question 24

caries classification system

Answer 24

INITIAL caries
MODERATE caries
ADVANCED caries

Question 25

initial caries

Answer 25

lesion has started but not progressed into the dentin

Question 26

moderate caries

Answer 26

lesion has extended into dentin *drill and fill

Question 27

advanced caries

Answer 27

deeper lesions- getting close to the pulp *probably root canal or extraction

Question 28

caries is a(n) ______ disease

Answer 28

-infectious -manageable -preventable

Question 29

primary microbes in caries

Answer 29

-Strep mutans -Lactobacillus -Actinomyces

Question 30

requirements for caries

Answer 30

-susceptible host -bacteria -food source -time

Question 31

what is better for plaque pH? -eating 3 meals a day -snacking all day

Answer 31

eating 3 meals a day

Question 32

demineralization and remineralization is ____

Answer 32

a constant battle

Question 33

carious lesion form when...

Answer 33

demineralization is greater than remineralization over time

Question 34

process of demineralization

Answer 34

-bacteria consume carbs from your diet -acid is the waste product -acid results in demineralized enamel

Question 35

things that contribute to remineralization

Answer 35

-saliva -good hygeine -decrease fermentable carb consumption -fluoride

Question 36

functions of saliva

Answer 36

-raises pH to non-demineralizing levels -flushes away floating microbes -antibacterial properties -calcium & phosphate ions that can re-enter the tooth for remineralization

Question 37

good oral hygiene

Answer 37

removes bacterial habitat

Question 38

diet

Answer 38

"starves" bacteria

Question 39

fluoride

Answer 39

hydroxide ion is replaced by fluoride ion --> makes enamel more resistant to acid

Question 40

enamel

Answer 40

-outer layer -most highly mineralized tissue in the body -96% calcium hydroxyapatite crystals -4% organic materials and water -there is no secondary or post-natal production of enamel

Question 41

amelogenesis

Answer 41

enamel formation -ends at tooth eruption

Question 42

dentin

Answer 42

-45% hydroxyapatite crytals -33% organic material -22% water -can be produced postnatally (secondary or tertiary dentin)

Question 43

dentin enamel junction (DEJ)

Answer 43

-where the dentin and enamel meet -weak spot *probably should add more but that's all she said

Question 44

amelogenesis cycle

Answer 44

-cyclical -dentin forms first

Question 45

steps of amelogenesis

Answer 45

1. pre-secretory stage 2. secretory stage 3. transition stage 4. maturation stage- RA 5. maturation stage- SA 6. post-maturation stage

Question 46

pre-secretory stage of amelogenesis

Answer 46

growing the enamel out from the dentin

Question 47

secretory stage of amelogenesis

Answer 47

enamel matrix proteins (EMPs) constantly secreted near dentin--> create aprismatic enamel near dentin (very hard to bond to)

Question 48

ameloblasts form...

Answer 48

individual enamel rods via their Tome's processes

Question 49

aprismatic enamel is closest to

Answer 49

dentin

Question 50

progress of carries

Answer 50

-attachment -colonization -biofilm development

Question 51

pellicle formation

Answer 51

streptococci first filamentous follow (actinomyces)

Question 52

strep mutans participate in...

Answer 52

formation of biofilms on tooth surfaces

Question 53

PEP group translocation

Answer 53

distinct method used by bacteria for sugar uptake which uses phosphoenolpyruvate as an energy and phosphate source

Question 54

what process makes lactic acid?

Answer 54

glycolysis *anaerobic

Question 55

how does the carie expand deeper into dentin?

Answer 55

region becomes more acidic --> promotes greater colonization

Question 56

factors determining dental caries sensitivity

Answer 56

-differences in the gram-positive composition of supragingival microbial biofilms -dietary carbohydrate ingestion (sucrose content & freq. of ingestion) -saliva access to teeth surfaces & its flow rate -fluoride in the drinking water & toothpastes -antibodies to Strep mucans in blood & oral cavity

Question 57

how does saliva resist caries?

Answer 57

rinses & neutralizes w/ bicarbonate ion

Question 58

what stimulates saliva secretion?

Answer 58

primarily parasympathetics but some sympathetics

Question 59

sympathetic stimulation of saliva

Answer 59

more viscous saliva, slower secretion rate

Question 60

production of bicarbonate ion from CO2 is catalyzed by...

Answer 60

carbonic anhydrase enzyme *present in saliva and salivary glands

Question 61

what is the most abundant enzyme in human saliva?

Answer 61

amylase

Question 62

how does amylase PROMOTE caries formation?

Answer 62

aids in breakdown of carbohydrates

Question 63

how does amylase PROTECT AGAINST caries formation?

Answer 63

aids in clearing carbohydrates from tooth surfaces --> bacteria has less time to digest maltose

Question 64

fluoride can rarely cause...

Answer 64

fluorosis (mottled teeth)

Question 65

fluoride may become ineffective below a pH of what?

Answer 65

4.5

Question 66

3 mechanisms used by fluoride to protect against caries

Answer 66

1. inhibition of demineralization 2. enhancement of remineralization 3. inhibition of bacterial enolase activity inhibiting lactase production from ingested carbohydrates

Question 67

biofilms are resistant to...

Answer 67

destruction