Midterm 1: Cariology I Pit & Fissure Caries

Question 1

What are dental caries?

Answer 1

Disease where ecological shift within dental biofilm environment

Question 2

What is biofilm?

Answer 2

Aggregation of microorganisms in which cells adhere to each other forming small communities
held together by extracellular polymeric matrix
Ex. Dental plaque

Question 2

What does acidogenic mean?

Answer 2

something that produces acid
Ex. cariogenic bacteria

Question 2

What does it mean to be of higher cariogenicity?

Answer 2

more acid
acidogenic

Question 3

In dental caries, the population shifts from a balanced population of microorganisms of ____________________ to a microbiological population of _______________.

Answer 3

low cariogenicity
high cariogenicity

Question 3

What does the microbiological population of high cariogenicity increase production of?

Answer 3

organic acids

Question 4

What does the microbiological population of high cariogenicity promot?

Answer 4

dental hard tissue net mineral loss
carious lesions

Question 5

What is the disease of dental caries driven by?

Answer 5

frequent access to fermentable dietary carbohydrates

Question 6

What does demineralization mean?

Answer 6

chemical process by which minerals are removed from dental hard tissues (enamel/dentin/cementum)
occurs through dissolution by acids or chelation
can be replaced with remineralization

Question 6

What is a carious lesion?

Answer 6

The clinical manifestation of caries disease
can have a few or many

Question 7

What does cariogenic mean?

Answer 7

the ability to cause dental caries
Ex. a cariogenic diet contains sugar

Question 8

What does cavitated mean?

Answer 8

Denotes a loss of surface intergrity
refers to total loss of enamel and exposure of underlying dentin
inability to biologically replace loss of hard tissue

Question 9

What is dental plaque?

Answer 9

organized community of many different microorganisms that forms itself into a biofilm
can vary from healthy to harmful microorganisms

Question 10

What are monosaccharides?

Answer 10

Simplest forms of carbohydrates

Question 11

What does noncavitated mean?

Answer 11

initial caries lesion development before cavitation occurs
change in color, glossiness, or surface structure

Question 12

What is a pellicle?

Answer 12

A thin cellular membrane of salivary proteins adsobed to the enamel or cementum

Question 13

What is remineralization?

Answer 13

The chemical process by which minerals (esp Ca) are replaced into the substances of the dental hard tissue
requires supersaturation with calcium and phosphate ions, fluoride, and adequate buffering

Question 14

What 3 factors must be considered in evaluating Caries Disease?

Answer 14

1. Personal Factors
2. Oral environmental factor
3. Factors that directly contribute to caries development

Question 15

What is a substrate?

Answer 15

material metabolized by specific microorganisms in dental plaque to produce acids that lead to demineralization

Question 15

What are the 4 requirements for active caries disease process to occur?

Answer 15

1. susceptible tooth area
2. acid producing bacteria from biofilm
3. fermentable carbohydrates in diet
4. time

Question 16

What are some causes of Caries disease?

Answer 16

1. bacteria
2. diet
3. saliva
4. genetics
5. biofilm dysfunction - prolonged exposure to low pH: 100%

Question 17

What is the primary pathogen in the biofilm?

Answer 17

Streptococcus Mutans

Question 18

What does the carbonate ion do to the carbonated hydroxyapatite?

Answer 18

makes the mineral more acid-soluble than pure hydroxyapatite

Question 18

What is dentin primarily composed of?

Answer 18

small thin crystal flakes embedded in a protein matrix of cross-linked collagen fibers

Question 19

What is the structure of enamel?

Answer 19

repeating molecular units of hydroxyapatite Ca19(PO4)6(OH)2

Question 20

What mineral is in enamel and dentin?

Answer 20

carbonated hydroxyapatite a calcium phosphate with numerous impurity inclusions

Question 21

What are some susceptible tooth surfaces?

Answer 21

1. occlusal of posterior teeth 2. lingual anteriors 3. mesial/distal approximal surfaces 4. free smooth surfaces (gumline)

Question 21

Dental caries is a _________ disease that results in localized destruction of tooth tissues by acids that are produced in mouth as oral bacteria ferment ____________.

Answer 21

Biofilm dietary carbohydrates

Question 22

What does the odontoblast do?

Answer 22

secretes organic matrix regulates mineralization

Question 23

What is dentin composed of?

Answer 23

1. tubules 2. inorganic apatite crystals 3. organic matrix 4. water

Question 24

What are some other tooth surfaces caries disease can occur on that are not considered susceptible?

Answer 24

1. white spot lesion (smooth surface) 2. root caries on exposed cementum

Question 25

What is a biofilm?

Answer 25

An aggregate of microorganisms in which cells adhere to each other and/or to a solid substrate exposed to an aqueous surface

Question 26

What happens if the pH in the biofilm becomes too acidic? What pH would it have to drop below for this to happen?

Answer 26

Demineralization of tooth enamel pH < 5.5

Question 27

Caries are not caused by an infectious agent but what?

Answer 27

a shift in oral microflora to caries-causing bacterial types in response to shift in pH

Question 28

What are some fermentable carbohydrates?

Answer 28

1. Sugars (sucrose, glucose, fructose, lactose) 2. Starches

Question 29

What are two examples of cariogenic bacteria?

Answer 29

1. stretococci mutans 2. lactobacilli

Question 30

What is the process called where bacteria convert glucose, fructose, and sucrose into acids?

Answer 30

glycolysis

Question 31

A shift in plaque ecology, in which ______________ bacteria, such as S sanguinis are less able to survive. When pH neutral, S sanguinis keeps acid production low and increases remineralization.

Answer 31

Acid-sensitive

Question 32

Increased sugar intake results in _________ acid production

Answer 32

more frequent

Question 33

When the pH drops, there is an ecological shift from _______________ and _______________ to ____________, ______________, and ________________. ** all bacteria names

Answer 33

S. sanguinis S. gordonii S. mutans lactobacilli bifidobacteria

Question 34

What is the solubility of enamel?

Answer 34

pH 5.5

Question 35

What is cavitation?

Answer 35

collapse of enamel surface due to compromised dentin structure no longer support enamel rods reach dentin may reach pulp

Question 36

Where does pit/fissure formation begin?

Answer 36

cusp tips

Question 37

What causes the formation of pits and fissures?

Answer 37

imperfect fusion at interfaces

Question 38

Variations in ____________________ anatomy affects caries suceptibility.

Answer 38

pit and fissure anatomy

Question 39

Depth of a pit is very near ___________.

Answer 39

dentin

Question 40

What fills the inaccessible spaces of pits and fissures?

Answer 40

biofilm

Question 41

What can diffuse into pits and fissures filled with biofilm?

Answer 41

Fermentable carbohydrates

Question 42

What are the signs of an incipient occlusal lesion?

Answer 42

chalky enamel bordering darkly stained plaque

Question 43

Does incipient occlusal lesions require surgical treatment?

Answer 43

No

Question 44

What part of dentin responds to the chemical threat of caries?

Answer 44

Vital dentin

Question 45

What is the ICDAS system?

Answer 45

How to diagnose pit and fissure caries International Caries Detection and Assessment System 0-6 scale visual criteria

Question 46

Describe an ICDAS 0.

Answer 46

sound tooth structure no change after air drying no hypoplasia (incomplete development) no wear no erosion no histological depth

Question 47

Describe an ICDAS 1.

Answer 47

changes in enamel after drying colored changes limited to pits and fissures histological depth: 90% enamel 10% dentin

Question 48

Describe an ICDAS 2.

Answer 48

Distinct change in enamel seen when wet widening of pit/fissure 50% into inner enamel 50% into outer dentin

Question 49

Describe an ICDAS 3.

Answer 49

localized enamel breakdown no underlying dentin shadowing widening of fissure 77% into dentin

Question 50

Describe an ICDAS 4.

Answer 50

underlying dark shadow in dentin WITH or WITHOUT enamel breakdown 88% into dentin

Question 51

Describe an ICDAS 5.

Answer 51

distinct cavitation dentin visible involving less than half the tooth surface 100% into dentin

Question 52

Describe an ICDAS 6.

Answer 52

Extensive cavitation within dentin involves more than half the tooth structure 100% reaching inner third of dentin

Question 53

Secondary prevention covers ICDAS ______ to ______

Answer 53

1-3

Question 54

Tertiary prevention covers which ICDAS classifications?

Answer 54

4-6

Question 55

What is CAMBRA?

Answer 55

Caries Management by Risk Assessement Focus on treating/preventing disease at patient level rather than surgical/restorative approach

Question 56

What is CAMBRA used for?

Answer 56

determine patient's caries risk rate as: extreme/high/moderate/low risk

Question 57

CAMBRA risk assessment is based on:

Answer 57

1. disease indicators 2. risk factors 3. protective factors

Question 58

What does fluoride do?

Answer 58

Rinses Gels Varnishes Toothpastes Fluoridated water

Question 59

How do you form a crystal nucleus?

Answer 59

Take a partly dissolved crystal and remineralize with calcium, phosphate, and fluoride

Question 60

What is the main characteristic of a crystal nucleus?

Answer 60

acid resistant fluorapatite-like coating on crystals

Question 61

What does CPP-ACP do?

Answer 61

aids in remineralization with nano particles of hydroxyapatite

Question 62

What do sealants do?

Answer 62

creates a smooth occlusal surface removes food source of bacteria

Question 63

TRUE OR FALSE Dental caries are transmissible.

Answer 63

TRUE

Question 64

What is vertical transmission?

Answer 64

Passage of bacteria from mother to baby during the period after birth

Question 65

What is horizontal transmission?

Answer 65

Transfer of bacteria between individuals of the same generation

Question 66

Prolonged periods of low pH leads to what?

Answer 66

demineralization of teeth ultimate damage to the tooth

Question 67

Treatment strategies aim to eliminate the biofilm dysfunction, or prolonged periods of __________ (high/low) pH.

Answer 67

low

Question 68

How does saliva help against dental caries?

Answer 68

hydrate neutralize and support the pH