Exam 1 Flashcards

Question

What is dental caries?

Answer 1

1. chronic 2. site specific 3. multifactorial, diet mediated 4. dynamic (but not necessarily continuous) 5. disease process that invilves the shift of the balance between protective factors (that aid in remineralization) and destructive factors (that aid in demineralization) to favor demineralization of the tooth structure over time 6. the disease can be arrested at any time point

Answer 2

The manifestation of the stage of the process at one point in time (active or inactive)

Answer 3

Incipient, initial caries lesion or non-cavitated caries lesion demineralization without evidence of cavitation reversible by biochemical means

Answer 4

Cavity a caries lesion that has lost the outer surface leading to a discontinuity in the surface)

Answer 5

2 years after eruption

Answer 6

initial: \>2 years cavitation: \>4 years

Answer 7

* a lesion which not only exhibits convincing evidence of lesion arrest, but also one or more of other definite changes including: * increased mineral concentration * increased radiodensity * decreased size of white spot lesion * increased hardness of the surface * increased surface sheen compared to a previous matte surface texture

Answer 8

* visual * tactile * light * drying * magnification * tooth separation * radiographs

Answer 9

Hypomineralization of the dental enamel caused by excessive ingestion of fluoride during the post secretory maturation phase (immediate pre-eruptive phase) of amelogenesis (e.g., 15 months for maxillary anterior teeth). it is one of a variety of causes of defective enamel formation

Answer 10

Smooth surface Occlusal surfaces (pit and fissure) aproximal (surface that forms a contact with adjacent teeth) root surface secondary/recurrent caries

Answer 11

Have to do with restorative treatment site

Answer 12

It happens in little children that go to sleep while sucking intermittently from a bottle containing liwuid and sugar AKA baby bottle syndrome, nursing bottle caries, rampant caries

Answer 13

Caries of the cervical regions of the teeth, incisal edges, and cusp tips secondary to xerostomia induced by radiation therapy to the head and neck

Answer 14

multiple active caries lesions occurring in the same pt--\> involves surfaces not usually common for the development of caries AKA bottle or nursing caries, baby bottle, ECC, radiation caries, drug induced caries, meth caries, Mountain Dew caries

Answer 15

* Dental plaque is the causative of caries (non-specific hypothesis) * Prevention was based on continuous plaque control * Patient was responsible for caries lesions appearance * Everybody is at high risk * No diagnosis required * Everyone treated the same way * Lesion progression relatively fast * Irreversible sequence of events * Enamel demineralization * Collagen degradation * Logical treatment * Restorations planned at first apt. * Surgical excision of the pathological tissue * Extension for prevention (G.V. Black's Philosophy) * Placement of a "definitive" restoration

Answer 16

Caries left over by the dentist during restorative treatment (partial excavation)

Answer 17

restorations repaur the tooth structure, but do not stop caries and have a finite lifespan. they themselves are susceptible to disease since the caries can reoccur around a restoration

Answer 18

Initial lesions produced by direct extension from an external surface

Answer 19

* Stimulation of salivary glands * Fluorides * Mechanical plaqu control * Diet control * Antimicrobial therapies * Dental sealants * Resin infiltration * Behavioral management Not new ideas--\>from G.V. Black

Answer 20

85 vol% inorganic (hydroxyapatite) 12 vol% water 3 vol% protein 95 wt% inroganic (hydroxyapatite) 4 wt% water 1 wt% protein

Answer 21

Enamel rod (enamel prism) It is tightly packed, highly organized mass of hydroxyapatite crystals Ca10(PO4)6(OH)2

Answer 22

Outer surface: Ca, PO4, F Inner surface: Mg, CO3, Cl

Answer 23

55 vol% inorganic (hydroxyapatite) 20 vol% water 25 vol% protein 75 wt% inorganic (hydroxyapatite) 5 wt% water 20 wt% protein

Answer 24

Physically and chemically similar to bone odontoblasts cell bodies are outside of dentin but their processes exist in tubules within dentin harder than bone but softer then enamel

Answer 25

primary-formed before eruption, forms the bulk of the tooth secondary, begins formation after eruption tertiary-formed in response to irritation and appears as a localized deposit on the wall of the pulp chamber

Answer 26

1. Host factor: tooth, saliva, pellicle 2. diet 3. dental biofilm/plaque (cariogenic bacteria) 4. time

Answer 27

Diet + plaque= plaque acids Reduction in salivary flow Low buffering and oral clearance Acidic saliva--\>erosive acids

Answer 28

Salivar buffering capactiy Ca²⁺ and PO₄^3- levels buffering and remineralization oral clearance proteins/glycoproteins fluoride contact developmental topical application

Answer 29

1. pellicle formation 2. biofilm/plaque formation 3. production of acid 4. diffusion of acid 5. demineralization

Answer 30

1. pellicle formation 2. attachment of early bacterial colonizers (0-24hrs) 3. co-adhesion and growth of attached bacteria leading to the formation of microcolonies (4-24hrs) 4. microbial succession leading to increased species diversity concomitant with continued co-adhesion and growth of microcolonies (1-7days) 5. climax community/mature dental plaque/biofilm (1 week or older)

Answer 31

* occlusal surfaces of posterior teeth * lingual pits and maxillary incisors * pit and fissure * approxial surface * gingival margin

Answer 32

CO₃^2- (the larger and more uniform the crystals, the less the specific surface area dn reactivity (solubility))

Answer 33

immediately after eruption and tends to decrease with age during eruption, more soluble carbonate-rich apatite is preferentially lost and replaced by apatite lower in carbonate and higher fluoride the reprecipitated crystals may grow to be larger than the original crystals--\>hypermineralization

Answer 34

* chronic or lifelong autoimmune disease (immune system attacks body instead) * attack typically starts on moisture producing glands--\> exocrine glands * 9/10 are women with avg age of symptom onset in the 40s * dryness symptoms worsen during menopause

Answer 35

* promotes plaque/biofilm formation and is selective bacterial adhesion, as well as to the movement of dissolution products from apatite out of the tooth * acellular, essentially bacteria free organic film deposited on teeth * between enamel surface and dental plaque

Answer 36

Simple sugars with sucrose being the main source of sugar

Answer 37

mutans streptococci lactobacillus species actinomyces species

Answer 38

* Critical pH is the pH at which a solution is just saturatedwith respect to a particular mineral * if pH of solution\>critical pH--\>supersaturated--\>precipitate * if pH of solutionundersaturated--\>mineral will dissolve until the solution becomes saturated * Critical pH of caries formation in enamel is often referred to as pH between 4.5 - 5.5 (5.5) * Critical pH of caries formation in dentin is often referred to as pH between 6.0 - 6.9 (6.6) * This range coincides with pH of acids formed when plaque bacteria ferment carbohydrates * Critical pH is not a fixed value, it depends on the levels of calcium and phosphate in plaque fluid

Answer 39

1. greater acid resistance of the surface layer due to compositional characteristics of the surface enamel 2. reprecipitation of minerals from dissolving sub-surface lesions

Answer 40

1. first reaction: tubular sclerosis 2. change in refractive index 3. demineralization continues: sclerosis continues 4. transparant dentin * major portion of inner carious dentin * tubule lumina fills with Ca and PO₄ * Saturation with Whitlockite-grow to form gigantic rhomboidal crystals * reduced permeability 5. Demineralization continues 6. Sclerosis continues 7. reactive dentin (tertiary dentin) is formed * pulp reaction * starts even before dentin bacterial invasion * irregular mineralization * irregular dentinal tubules

Answer 41

caries lesion that exists adjacent to restorations there is an outer lesion and a wall lesion outer lesion caused by plaque accumulation in a manner similar to the initiation of primary lesion the wall lesion was thought to be the result of microleakage

Answer 42

* soft, loose * white cheeselike accumulation * soft accumulation of salivary proteins, some bacteria, many desquamated epithelial cells, and occasional disintegrating food debris * easily displaced with a water spray

Answer 43

* synonymous with plaque biofilm * resilient clear to yellow-grayish substance * more structured than materia alba * primarily composed of bacteria in a matrix of salivary glycoproteins and extracellular polysaccharides * considered to be a biofilm * impossible to remove by rinsing or the use of sprays

Answer 44

* hard deposit that forms by mineralization of dental plaque * generally covered by a layer of unmineralized dental plaque

Answer 45

1. salivary pellicle phase-salivary pellicle forms on tooth surface 2. plaque formation phase-initial adhesion and attachment of earlier colonizers to salivary pellicle--\> start of biofilm formation * note: as biofilm matures, there is a shift in microbial profile: gram positive cocci--\>gram negative filamentous species 3. Mineralization (calculus) phase: * calcification of plaque has been reported to occur in as little as 4-8 hours and persists for 1 to 14 days * plaque is hardened by the precipitation and incorporation of insoluble mineral salts

Answer 46

* can be removed off the tooth surface using a sharp curette * appears chalky and hard * common surfaces * lingual surfaces of mandibular incisors * saliva from Wharton's Duct (submandibular gland) and Bartholin's Duct (sublingual gland) empties onto the lingual surfaces of the mandibular incisors * buccal surfaces of the maxillary molars * saliva from stensen's duct (parotid gland) empties directly onto the buccal surfaces of the maxillary molars

Answer 47

* can only be detected by fine, careful tactile detection with a delicate dental instrument, such as an explorer * appearance * appears dark brown due to being exposed to gingival crevicular fluid, blood, or blood breakdown products * may be burnished on the root surface due to previous inadequate scaling * firmly attached to the root surface * supragingival calculus and subgingival calculus generally occur together, but one may be present without the other

Answer 48

* Supragingival-can be visualized by use of compressed air * Subgingival calculus can sometimes be detected by blowing air down the gingival crevice * usually detect sub g by probing the gingival sulcus with a fine tipped explorer * Radiographs * radioopaque deposits noted on the tooth surface * note that less than 50% of surfaces with actual calculus is detected radiographically * doesn't show lingual or labial calculi

Answer 49

* predominantly inorganic--\> mostly minerals * crystaline in nature * organic content (10-30%) * carbohydrates (galactose, glucose, mannose) * salivary proteins * lipids * desquamated epithelium * microorganisms * leukocytes * inorganic content (70-90%) * calcium phosphate salt * calcium carbonate * trace minerals * over 2/3 of the inorganic component is crystalline in nature--\> there are 4 main crystal forms: * hydroxyapatite, 58% * magnesium whitlockite, 21% * octacalcium phosphate, 12% * brushite, 9%

Answer 50

* inorganic (70-90%) * calcium phosphate salt * calcium carbonate * trace minerals * over 2/3 of the inorganic component is crystalline in nature-there are 4 main components * hydroxyapatite, 58% * magnesium Whitlockite, 21% * octacalcium phosphate, 12% * brushite, 9% * organic 10-30% * carbohydrate (galactose, glucose, mannose) * lipids * desquamated epithelium * microorganisms * leukocytes salivary proteins found in supragingival calculus is not typically foudn in subgingival calculus but supra and sub g calculus have similar inorganic composition

Answer 51

gingival crevicular fluid (GCF)- an inflammatory exudate that accumulates within the gingival margin exudate: an inflammatory infultrate that has left the blood vessels

Answer 52

1. attachment by means of an organic salivary pellicle--\> calculuse attachment is superficial because no interlocking or penetration into the tooth surface occurs 2. mechanical locking into surface irregularities (e.g. palato-lingual grooves extending to the root surface, mesial root concavity on maxillary premolar, furcation flutings, CEJ) 3. attachment into areas of resorption bays (i.e. mechanical damage to the surface of the tooth) * itrogenic: caused by dentist 4. direct penetration fo the calculus bacteria into the cementum

Answer 53

thin acellular layer of adsorbed proteins and macromolecules on the dental enamel surface formed within seconds of cleaning the surface

Answer 54

* protective effect-protects enamel from attrition and/or abrasion * buffering capcity * diffusion barrier * lubrication

Answer 55

Scaling and root planing devices used: universal curette, ultrasonic tips, gracey curette

Answer 56

predominantly viable gram-negative rods and cocci

Answer 57

The non-mineralized plaque on calculus is the primary irritant, but the underlying calcified portion Cementum Calculus may be a significant contributing factor to periodontal disease. By itself, it does not irritate the gingiva directly, but provides a fixed reservoir for the continued accumulation of plaque and retains it in close proximity to the gingiva. TA K E -HOME MESSAGE: Calculus is a contributing factor for periodontal inflammation, not the primary etiology!

Answer 58

* start as free floating cells until they find a surface they have an affinity for adn attach * once attached--\>multiply--\>form microcolonies * at some point, the bacteria will pack and disperse and find other surfaces * once organized communities are formed, they stop growing and metabolism is low * most abx work while cell is growing so not good for these cells * they have a matrix to protect them and help them survive

Answer 59

when bacteria in one part of the biofilm send chemical signals to the other side of the biofilm

Answer 60

* good * bioreactors * waste-water treatment * environmental clean up * bad * corrosion * fouling * diseases

Answer 61

* redox potential-oral bacteria are mostly: * facultative anaerobes (grow in the presence or absence of oxygen) * these will be supragingival * obligate anaerobes (oxygen is toxic) * these will be subgingival * pH: 6.75-7.25 in saliva * acidogenicity * aciduricity * changes of pH in inflamed sites * sometimes saliva can;t penetrate biofilm to act as a buffer and decrease pH * nutrients: * endogenous-provided by saliva, or by other bacteria * exogenous--\>dietary * adherence

Answer 62

* the surfaces are bathed with salivary fluids * salivary glycoproteins adsorb to the surfaces * the glycoproteins lose their solubility * the glycoproteins may become altered by the action of the bacterial enzymes

Answer 63

Enamel: streptococcus Dentin: streptococcus and veillonella

Answer 64

No biofilm is sugar dependent--\> bacteria fermentation of sugar lowers pH

Answer 65

sucrose is the substrate for the production of the polysaccharide matrix

Answer 66

extracellular polysaccharide (glucan or fructan): adherence, protection; intracellular storage compounds: energy resources for tough times; energy pathway: provides energy and carbon sources

Answer 67

* Defines what an infectious disease should have * causative agent must do the following * be routinely isolated from disease individuals * be grown in pure culture in the lab * produce a similar disease when inoculated in susceptible lab animals * be recovered from lesion in a diseased lab animal

Answer 68

Non-specific: age and amount of plaque-when only small amounts of plaque are present, the noxious products are neutralized by the host; similarly, large amounts of plaque would cause a higer production of noxious products, which would essentially overwhelm the host's defences Specific:recognition of the differences in plaque at sites of different clinical status led to a renewed search for specific pathogens in periodontal diseases and a conceptual transition from nonspecific to specific plaque hypothesis

Answer 69

good lighting and clean, dry surface

Answer 70

clean/remove debris using side of explorer confirm and assess cavitations (breaks in teh continuity of the surface) check margins of restorations.crowns check cavity preparations feel the texture (roughness) of no-cavitated lesions (determination of caries lesion activity)

Answer 71

D component: decayed (cavitated) teeth/surfaces M component: missing teeth/surfaces due to dental caries F component: filled teeth/surfaces due to dental caries * a tooth may have several restorations but it counted as one tooth as filled F * a tooth may have restoration on one surface and caries on teh other it should be counted as decayed D * no tooth must be counted more than once, D M F or sound * non-cavitated lesions count as sound

Answer 72

* each tooth was recorded as 4 surfaces for anterior teeth and 5 surfaces for posterior teeth * retained root was recorded as 4D for anterior teeth, 5D for posterior teeth * missing tooth was recorded as 4M for anterior teeth, 5M for posterior teeth * tooth with crown was recorded as 4F for anterior teeth, 5F for posterior teeth

Answer 73

dull/opaque white area and feels rough

Answer 74

appears shinier and feels smooth

Answer 75

leathery/soft for probing, cavitationa and light borwn/yellowish

Answer 76

smooth for probing and dark brown/black

Answer 77

* whit areas on smooth surfaces, and as white patches on occlusal surfaces, often close to fissures; bot not extending into the fissure * can be * bilateral * on multiple teeth * more straight across smooth surfaces * does not follow the gingival contour * shinier * diffuse * less opaque

Answer 78

left-fluorosis and right-dental caries

Answer 79

Erosion-caused by gastric acid or food Caries- demineralizationa cid caused by dental plaque

Answer 80

* molar incisor hypomineralization * developmental condition caused by the hypomineralization of enamel during its maturation phase, due to interruption to the fxn of ameloblasts but the cause is unknown * only choldhood illness, fever in particular seems to be associated

Answer 81

* enamel is electrically isolated material--\>does not go through the electrical flow * when a lesion develops, crystals shrink and start to crate space--\>filled by saliva--\>mostly water--\>highly electrically conductive --\>lesion has high conductance and low resistance can use carise scan PRO enamel maturation can be monitored

Answer 82

* light propagates across tooth tissue to nonilluminated surfaces (examination surface) * when lesion exists light is not going to pass through the area * can use carivu or diagnocam

Answer 83

when there is a caries lesion the intensity of the light is lower than in the sound structure

Answer 84

Diagnodent detects chromophore (bacteria by-product, not necessarily bacteria)

Answer 85

PTR/LUM canary heats up the tooth surface--\> creates heat and luminescence machine picks up the luminescence from the tooth structure company claimed it could detect caries with this info

Answer 86

true positive ratio:the proportion of diseased patients correctly identified as positive

Answer 87

true negative ratio: the proportion of disease-free patients correctly identified as negative

Answer 88

* 46% * 8.7% mild * 30% moderate * 8.5% severe

Answer 89

* health * gram positive * non motile * aerobic * disease * gram negative * motile * anaerobic

Answer 90

salivary glycoproteins and extracellular ploysaccharides (very dense and non-mineralized) When it become mineralized it becomes a calculus

Answer 91

* barrier against acids * prevents drying of surfaces * aids in the adherence of microorganisms * (one) mode of attachment for calculus

Answer 92

1. Acquired pellicle coats the tooth surface * occurs immediately after the tooth is erupted or after prophy 2. initial colonizers attach to tooth 3. bacteria coaggregation 4. formation of the extracellular slime layer * protects the whole mass--\>don't want to use systemic abx w/o disrupting the plaque first 5. mature biofilm * can potentially detach and flow through other areas

Answer 93

fusobacterium nucleatum

Answer 94

* Tooth-surface-attached bioflim * next to tooth * associated with root caries, calculus formation and root resorption * Unattached biofilm * b/w the two (tooth-surface; and epithelium) * a fluid biofilm that contains many WBCs * Epithelium-attached biofilm * pocket epithelium * gram-negative bacteria, WBCs infiltrate

Answer 95

* cleaned teeth at beginning and didn't brush for 21 days * not everyone will develop gingivitis at the same rate * teeth showed gingivitis as a dental plaque accumulation * once dental plaque removed--\> reverse process * avg of 21 days for gingivitis to develop * about one week of good oral hygeine to reverse process

Answer 96

* these initial inflammatory changes occur in response to microbial activation of resident leukocytes and the subsequent stimulation of endothelial cells in respinse to bacterial plaque * the first manifestations of gingival inflammation are vascular changes consisting of dilated capillaries and increased blood flow * subclinical PMN is the polymorphonuclear leukocyte which is a neutrophil you can see the fusobacterium bridging bacteria here JE=junctional epithelium

Answer 97

* clinically noticeable: signs of inflammation (erythema along gingival margin: proliferation of capillaries and increased formation of capillary loops), bleeding on probing may be evident * histologically: rete pegs forming while some of the coronal epithelium is disappearing, more vascular proliferation

Answer 98

* clinically: blood vessels are engorged and congested * microscopic: * intense chronic inflammatory reaction * predominance of plasma cells and B lymphocytes * plasma cells invade deep into the connective tissue * JE reveals widened intercellular spaces and develops rete pegs or ridges that protrude into the connective tissue * plasma cells produce ABs, mainly IgG * shift from gram + to gram - and from aerobic to anaerobic * may have spontaneous bleeding

Answer 99

* micro * widespread manifestations of inflammatory and immunopathologic tissue damage * clinically characterized by periodontal breakdown and the extansion of the lesion into alveolar bone

Answer 100

CAL= PD + CEJ-gingival margin distance

Answer 101

ICDAS=0 no clinically detectable lesion dental hard tissue appears normal in color, translucency and gloss

Answer 102

ICDAS=1-2 earliest clinically detectable lesion compatible with mild demineralization mildest forms detectable only after drying lesions may be white or brown and enamel has lost its normal gloss visually non-cavitated

Answer 103

ICDAS=3-4 visible signs of enamel breakdown or signs the dentin is moderately demineralized (shadow) established, early cavitated, localized enamel break down (microcavitation)

Answer 104

ICDAS=5-6 enamel is fully cavitated and dentin is exposed--\> dentin lesion is deeply/severely demineralized spread/disseminated, late cavitated, deep cavitation

Answer 105

hard to distinguish from normal enamel when it is wet--\>air-dry for 5 seconds--\>become more opaque and can be detected visually (white) on approxiaml surfaces, can onlu be detected from the buccal or lingual/palatal direction

Answer 106

* When wet, code 2 lesions exhibit either: * white spot lesion (caries opactity) and/or * brown caries discoloration * for occlusal surfaces, white opacity (white line) and/or brown caries discoloration is wider than the base of the natural fissure/fossa and has an appearance which is not consistent with the clinical appearance of sound enamel

Answer 107

enamel surface begins to break down and surface discontinuity can be visualized in the pits and fissures, this is wider than the natural fissure/fossa this breakdown can appear substantially and unnaturally wider than normal DENT HA NOT BEEN EXPOSED a ball ended probe can be used gently acorss a tooth surface to confirm the presence of breakdown

Answer 108

* appear as shadows of discolored dentin visible through apparently intact enamel which may or may not exhibit localized enamel breakdown * shadow is often more noticeable when wet, and may appear as gray, blue or brown * if a tooth is restored with amalgam, can be difficult to distinguish the shine-through of the restoration from a caries shadow

Answer 109

* cavitation present due to caries in opaque or discolored enamel exposing the dentin beneth * in pits and fissures, there is visual evidence of demineralization (white, brown or dark brown walls) at the entrance to or within the pit or fissure, and dentin is exposed * involve less than half of the surface of the tooth * ball ended probe can confirm the presence of a cavity in dentin

Answer 110

* at least half the tooth surface is cavited to expose dentin * cavity is deep and wide

Answer 111

* in stains you tend to see only the bottom of the fissure system and it's a very fine thin line * cavity is wider and might be less dark on the outer edges

Answer 112

root surface caries can become softened and bacteria penetration further into tissue at an earlier stage of lesion development

Answer 113

Exclusion if patient has healthy gingiva that means root has not been exposed--\>cannot asses root caries because there is no root exposed--\>E when calculus covers a lot og gingiva and you cannot see the root surface--\>E

Answer 114

does not exhibit any discoloration has a natural anatomical contour

Answer 115

* there is a clearly demarcated area on the root surface or at the cemento-enamel junction that is discolored (light/dark brown, black) * there is no cavitation present * loss of anatomical contour \<0.5mm

Answer 116

* a clearly demarcated area on the root surface or at the cemento-enamel junstion that is discolored * there is cavitation present (loss of anatomical contour \>/= 0.5mm)

Answer 117

To see things we cannot see on visual inspection

Answer 118

posterior interproximal caries, possible bone loss due to periodontal disease, incidental odontogenic and bony pathosis

Answer 119

soft tissues 2D images of a 3D person static view vs dynamic process technique errors (spring)

Answer 120

shows the entire tooth and at least 2mm of surrounding bone want to see around apices

Answer 121

display upper and lower teeth, OPEN interproximal spaces, and bone levels

Answer 122

capture the "3rd dimension": helps to localize foreign objects, impacted teeth, etc. Common before CBCT, still used in pediatrics

Answer 123

"broad overview" of general structures in the dentition, alveolar bone, sinuses, airway, TMJ, cervical vertebrae, and surrounding soft tissues

Answer 124

commonly used in ortho to determine skeletal/dental developmental and maxillomandibular relationships

Answer 125

complete 3D view of the head and neck only aquired when 2D images are inadequate due to high radiation dose

Answer 126

ideal: bitewings should always be correlated with visual clinical findings small lesions that are not evident clinically, usually present as dark triangles between teeth limitation: only visible once 30-50% of demineralization has occured radiographically smaller than it looks clinically

Answer 127

* mention tooth #, surface(s) involved, and depth (ex:12M-D2) * E1: outer half of enamel * E2: inner half of enamel * D1: outer third of dentin * D2: middle third of dentin * D3: inner third of dentin/pulpal invasion

Answer 128

* ideal: bitewings * look at bone levels in between teeth * normal: about 1-2mm from CEJ * complete periodontal diagnosis is not based on radiographs * PD, recession, attachment loss, BOP, calculus plaque scores, gingival color, etc.

Answer 129

* horizontal * vertical * generalized * localized * mild (cervical third of root) * moderate (middle third of root) * severe (apical third of root) * Special considerations * furcation involvment * apical involvement * calculus

Exam 1 Flashcards

(167 cards)