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Cariology 2 > Final Exam > Flashcards

Final Exam Flashcards

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1
Q

Why is caries a complex problem?

A

Because attitudes, ability, and the environment all have a role

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2
Q

Caries is defined as:

A

localized destruction of a dental hard tissue by acidic by-products from bacterial fermentation of dietary carbs

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3
Q

T/F The Disease process can be arrested at ANY point

A

True

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4
Q

Define the Ecological Plaque Hypothesis

A

Biofilm changes over time due to periodic drops in pH and metabolism of dietary sugars

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5
Q

Actinonmyces Bacteria is related to what caries

A

Root Caries

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6
Q

Are large or small chain sugars more cariogenic?

A

Small Chain

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7
Q

Demineralization occurs below what pH?

A

5.5

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8
Q

What two minerals are required for remineralization?

A

Calcium and Phosphate

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9
Q

What are three main factors that play a role in caries?

A

Enamel
Systemic Issues
Environment (diet, habits)

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10
Q

Define a white spot lesion

A

Changes in enamel associated with plaque accumulation

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11
Q

What does a white spot lesion look like 1 week in?

A

Dissolution of outer surface, NOT VISIBLE

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12
Q

what does a white spot lesion look like 2 weeks in

A

whitish, opaque, subsurface lesion

VISIBLE WITH Drying

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13
Q

what does a white spot lesion look like 3-4 weeks in

A 
Chalky
Rough Surface
Opaque
Marked dissolution/loss of minerals
VISIBLE WITHOUT DRYING
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14
Q

How does a white spot lesion look after 1 week of it being plaque free

A

IT CHANGES

reduced chalkiness

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15
Q

how does a white spot lesion look after 2-3 weeks plaque free

A

Hard and Shiny

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16
Q

What are the 3 steps in caries diagnosis?

A
  1. Early Detection
  2. Assessment of the severity
  3. Assessment of the activity
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17
Q

What does a typical active enamel carious lesion appear as?

A

Chalky and Rough

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18
Q

What does a typical active lesion of root/dentin look like

A

Soft
Leathery
Discolored

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19
Q

What do Inactive lesions look like

A

Smooth

Hard surface

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20
Q

What does the ICDAS score allow clinicians to do?

A

Categorize the visual characteristics of the occlusal surface of teeth

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21
Q

What does an ICDAS score of 0 indicate?

A

Sound Enamel
No caries
No change after drying for 5 seconds
Includes defects like enamel hypoplasia, fluorosis, tooth wear, stains

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22
Q

What does an ICDAS score of 1 indicate?

A 
First  visual change in enamel
Smooth surface
lesion visible only after 5 seconds of drying
*Contained in Pits/Fissures*
White/brown opacity
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23
Q

What does an ICDAS score of 2 indicate?

A

Distance visual change in enamel
Seen both wet/dry
Pit and Fissure lesion extended beyond pits and fissures
NO CAVITATION

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24
Q

What does an ICDAS score of 3 indicate?

A

Cavitated lesion
local enamel breakdown with no visible dentin
loss of tooth structure at entrance
Extended beyond pit and fissure

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25
What does an ICDAS score of 4 indicate?
Can see shadow of discolored dentin through enamel | *"Hidden Caries" and undermined enamel*
26
What does an ICDAS score of 5 indicate?
Distinct cavitation with visible dentin | Lesion extends into middle 1/3 of dentin
27
What does an ICDAS score of 6 indicate?
Gross Caries with Visible Dentin | Involves 1/2 of tooth and possible pulp penetration
28
Active/Incipient Caries in Axium
No restoration needed except for esthetics
29
Moderate caries in axium
Most often need restoration | Caries in outer half of dentin
30
Severe Caries in axium
ICDAS of 4 5 or 6
31
4 Major types of oral bacteria
S. Mutans Lactobacillus Bifidobacteria Actinomyces (Root Surface)
32
Explain the "Iceberg"
D4 - lesion into pulp D3 - Lesions into Dentin D2 Lesion limited to Enamel D1 - Lesions with intact surface E2 - lesions only detectable with diagnostic aid E1 - Subclinical lesions in dynamic state of progress/regression
33
T/F you should debride before doing your findings in clinic
True
34
What are general color characteristics for caries detection
White/Yellow/Brown
35
What are surface characteristics for caries detection
Dull/Chalky/Rough/Cavitated
36
What is the texture for caries detection
Sticky/Soft
37
If the surface is still intact how should we classify a lesion
Incipient
38
What percentage of caries are detected WITHOUT the use of radiographs
30%
39
Define Sensitivity
Measures the number of actual positives that are correctly identified
40
Define Specificity
Measures the number of negatives where are correctly identified
41
What does a diagnosis of 0 on a radiograph indicate?
Sound Enamel on bitewings
42
What does a diagnosis of 1 on a radiograph indicate?
Radiolucency confined to enamel
43
What does a diagnosis of 2 on a radiograph indicate?
Radiolucency up to the DEJ
44
What does a diagnosis of 3 on a radiograph indicate?
Radiolucency in meal and outer 1/2 of dentin
45
What does a diagnosis of 4 on a radiograph indicate?
Radiolucency in enamel and inner half of dentin
46
What does a DIAGNOdent measure
measures the degree of bacterial activity | Can yield false positives
47
What has the ADA approved DIAGNOdent use to detect?
Pit and fissure caries smooth surface caries recurrent caries around amalgam restorations
48
What is the ECM best used to detect?
Root Caries
49
What is the "Gold Standard" of caries detection
QLF Blue light wavelength that is shined through tooth and absorbed reflected at green wavelength Direct relationship between fluorescence and mineral content
50
What is the only surface QLF is not able to image?
Interproximal surface
51
When you combine QLF with visual examination how specific and sensitive is it?
90. 9% specific | 49. 9% sensitive
52
What are the 4 main things QLF is able to do?
Detect early caries Assess lesion activity follow development of the lesion Assess remineralization treatement
53
What numbers are used to interpret DiagnoDENT results
0-10 - healthy 11-20 - E1 enamel caries 21-30 - E2 enamel caries 30+ dentin caries
54
What percentage of the adult population suffers from dental caries
Estimated 91%
55
Dental caries is a ____, and _____ mediated disease
Biofilm, pH
56
Remineralization can only occur in the presence which two ions?
Calcium | Phosphate
57
The low pH is generated from what?
Sugar metabolism not availability
58
What is CAMBRA
Caries management by risk assessment through: Disease indicators Risk factors Protective factors
59
What are Pathologic Factors in CAMBRA (BAD)
Bad Bacteria Absence of Saliva Diet
60
What are protective factors in CAMBRA (SAFE)
Saliva/Sealants Antibacterials Fluoride Effective Diet
61
What categories of meds could lead to a higher caries risk?
``` Tylenol Blood pressure meds antidepressants psychoactive drugs muscle relaxants alcohol mouth rinses asthma inhalers ```
62
What are 4 disease indicators
Visible Cavities or radiographic penetration of dentin Inter proximal lesions not into dentin White spots on smooth surfaces Restorations within the last three years
63
What are the 3 steps inCAMBRA
1. Identify Risk 2. Categorize Risk 3. Establish clinical protocols based on individual risk
64
What is the low caries risk
No disease indicators few risk factors outweighed by protective factors
65
What is moderate risk?
no disease indicators | Multiple risk factors
66
What is high risk?
Any disease indicators | Multiple risk factors
67
What is extreme risk?
High Risk + | Severe salivary hypofunction
68
What is the primary mode of fluoride?
topical
69
What are the most important factors influencing DMF?
Fluoride | Fermentable Carbs
70
T/F Fluoride is the most widely used agent for managing caries, supported by strong levels of evidence
T
71
How does cheese protect against caries?
Protects against oral pH decrease Increases flow rate Increase Calcium concentration
72
How does Xylitol effect caries risk
Non-cariogenic | Cariostatioc and anticariogenic is dose dependent
73
What is the only anticaries agent recognized by the FDA?
Fluoride
74
What is one the 10 greatest public health achievements of the 20th century
Community water fluoridation
75
How much does water fluoridation reduce caries n children/adults
Children - 18-40% | Adults - 31%
76
What is the Halo Effect?
When products made with fluoridated water are distributed to non-fluoridated communities
77
What is the greatest single source of ingested fluoride in children?
Toothpaste
78
What are some of the main cariogenic factors?
``` Poor OH Lots of Bacteria Lots of sugar tooth morphology root exposure xerostomia ```
79
What are some of the main protective factors?
``` Salivary Flow Fluoride Calcium and Phosphate Education OH Diet Analysis Xylitol Sealants ```
80
What is the primary force driving demineralization
Diffusion of hydrogen ions into the tooth which draws out Calcium and Phosphate
81
What are the mechanisms of fluoride?
1. promotes remineralization 2. Stabilizes tooth surface 3. Inhibits dental plaque 4. slows demineralization 5. Converts hydroxyapatite --> fluoroapetite
82
How does fluoride effect metabolism of sugars
Retards it
83
What is the recommendation for the amount of fluoride in water?
.7 mg/L
84
At what level is Fluoride considered a contaminant?
4 mg/L
85
How much does community water fluoridation reduce caries?
by 60%
86
How much does dentifrice reduce caries in children?
Up to 23%
87
What is a major factor leading to increased fluorosis prevalence
Halo Effect
88
Are fluoride products good at protecting secondary caries?
Research currently leans towards products not being able to protect against secondary caries
89
What is bioavailable fluoride?
The sum of ionic fluoride, precipitated fluoride and absorbed pro fluoride compounds that become available in the oral cavity after brushing
90
Does Stannous fluoride or sodium fluoride have a lower bioavailability in a dentifrice?
Stannous Fluoride
91
When does the ADA recommend fluoride varnish?
For caries prevention and in "At-Risk Patients"
92
What is the method in which fluoride varnishes works?
Slows demineralization by blocking "kink" sites
93
What are the 5 mechanisms that increase biofilm resistance
1. Slows penetration 2. Stress response by biofilm 3. Altered microenvironment 4. persistent bacteria 5. antimicrobial depletion
94
What is Prevident 5000
Prescription toothpaste with 5000 ppm of Fluoride
95
What is Acidulated Phosphate Fluoride
5x fluoride concentration of normal toothpaste pH of 5.6 DO NOT APPLY to porcelain or glass ionomer
96
What is the key benefit to Fluoride Varnish
It does not depend on patient compliance
97
What is MI paste
Only product that provides the correct bio-available ratio of 5Ca - 3 Phosphate - 1 Fluoride Reduces dentinal sensitivity b occluding tubules
98
What allergy is a contraindication for MI paste
Dairy
99
What is the mechanism of action of MI paste
Alters the pH of the oral environment
100
Which product can be considered Non-Cariogenic at Any concentration and frequency, but can only be cariostatic and anticariogenic depending on the dose, frequency and duration
Xylitol
101
What are the negatives of Glass Ionomer Composite for Root Caries?
It has poor wear resistance
102
What is the negative of composites for Root Caries
Low Fluoride Release
103
What is the pH that demineralization occurs in root caries?
Below 6.7
104
T/F if you are unsure of the cause, then assume that it was due to caries
True
105
What categorizes someone as Low Caries Risk
No disease indicators | Protective factors outweighs risk factors
106
What categorizes as someone with Moderate Caries risk
No Disease indicators | Risk Factors outweigh protective factors
107
What categorizes someone as High Caries Risk
Any disease indicator | or Multiple Risk Factors
108
What categorizes someone as extreme caries risk?
Severe disease indicators | Severe salivary hypo function
109
Prior to a saliva test a patient should not smoke, eat, drink or rush their teeth for how long?
1 hour
110
How do you visually inspect the level of hydration
Lower lip labial gland watch for droplets
111
If droplets don't form in 60 seconds or less what does that say about salivary flow?
It is Low
112
What does Sticky/Frothy saliva indicate
High viscosity | At Risk
113
What does Frothy Bubbly Saliva Indicate?
Increased Viscosity | Medium Risk
114
What does Water clear saliva indicate
Normal Viscosity | Low Risk
115
What is the normal pH range in the mouth?
6.5-6.8
116
If you have less than 3.5 saliva after 50 minutes of collecting do you have normal or low saliva quantity?
Very Low
117
What does 0-5. 6-9, and 10-12 points indicate in Buffering Capacity
``` 0-5 = Very low 6-9 = Low 10-12 = Normal ```
118
What lesions are responsible for the majority of restorations in children?
Occlusal Caries
119
What lesions are ideal to remineralize because topical fluoride works well on smooth surfaces?
Approximal Lesions
120
What lesions are the most difficult to restore? Why?
Root Lesions Bonding to dentin and cementum is a challenge
121
What is the treatment recommendation for an ICDAS score of 0,1 or 2
Sealants
122
What is the tx recommendation for an ICDAS score of 3
Sealant or restoration
123
What is the tx recommendation for an ICDAS score of 4, 5, or 6
Restoration
124
What are examples of disease indicators
Cavitation into dentin Smooth surface enamel lesions White spots on smooth surfaces Restoration in the last 3 years
125
What is the x-ray and recall interval for Extreme Classification?
6 mo - X Ray | 3 mo Recall
126
What is the x-ray and recall interval for High Classification?
6-18 mo - X Ray | 3-4 mo Recall
127
What is the x-ray and recall interval for Moderate Classification?
18-24 mo - X Ray | 4-6 mo recall
128
What is the x-ray and recall interval for LowClassification?
24-36 mo - X ray | 6-12 mo recall
129
Of the following which would be used for Low/Moderate/High/Extreme Risk: - Everyone Brush 2x Daily** 1. Tooth Paste (OTC /w Fluoride) 2. Reduce Snacking (Nuts, cheese, celery/carrots) 3. Xylitol (3-4x daily) 4. Fluoride Rinse (5000 ppm) 5. Prescription Mouth Rinse (Chlorahexadine/Peridex 10 mL for 60 seconds 1 week per month, ALSO 1 hr post brushing due to interaction with SLS) 6. ACP/MI Paste (at least 3 minutes without rinsing) 7. Baking Soda Rinses (after eating/drinking)
Low - 1 and 2 Moderate - 1, 2, 3 and 4 High - 1, 2, 3, 4, 5, and 6 Extreme - All

Cariology 2 (1 decks)

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