Midterm I : Sugar Metablism + Intro Cariology

Question 1

1. what percentage of us people have had caries by age 35?

2. what percentage of seniors /over 65 have caries in permanent teeth

Answer 1

1. 95%

2. 94%

Question 2

what are protective factors for caries

Answer 2

• salivary flow
• proteins, antibacterial components and agents
• fluoride, calcium and phosphate

Question 3

what are pathologic factors for caries

Answer 3

reduced salivary function, mutans streptococci and lactobacilli, and diet with high frequency of carbs

Question 4

describe the type of bacteria of streptococcus mutans

Answer 4

• gram positive (thick cell wall) cocci with strepto-cell arrangement
• cocci means spherical, strepto means in chains

Question 5

what are vertical and horizontal transmissions

Answer 5

vertical is parent to child (mother to baby) and horizontal is within same generation, not parent to progeny

Question 6

what types of transmission of streptococcus mutans is there

Answer 6

both vertical AND horizontal

Question 7

describe the process of dental plaque formation

whats another word for dental plaque

Answer 7

plaque =biofilm
process:
-colonization: bacterial cells adhere to salivary pellicle which lies directly on the tooth and contains proteins. gp-340 in the pellicle binds to streptococcus mutans most commonly.
-there is a formation of microcolonies expressing extracellular polymers (glucan chains) which allows for adherence/accumulation of bacteria cemented by polysaccharides onto the salivary pellicle

Question 8

what sugar does s mucans ferment

Answer 8

a RANGE of sugars, making lactic acid.

Question 9

At what pH does enamel start to degrade?

Answer 9

5.5 and below= degredation!

Question 10

how many ATP does glycolysis produce

Answer 10

4 gross, net production is TWO!

Question 11

where does glycolysis occur? when is it used for energy production?

Answer 11

occurs in the cytoplasm of ALL cells. prokaryotes and eukaryotes!
-cells that have limited access to oxygen or dont have mitochondria rely on glycolysis/fermentation for their energy production!

Question 12

what is step 1 of glycolysis (enzyme, product and reactant)

Answer 12

hexokinase enzyme converts glucose to glucose-6-phosphate (uses 1 ATP)

Question 13

(enzyme, product and reactant) what is step 2 of glycolysis

Answer 13

phosphoglucose isomerase converts glucose-6-phosphate to fructose 6-biphosphate
-uses 1 atp

Question 14

(enzyme, product and reactant) what is step 3 of glycolysis

Answer 14

phosphofructokinase converts fructose 6-phosphate to fructose 1,6 biphosphate , uses 1 atp

Question 15

what is step 4 of glycolysis

Answer 15

last energy consuming step!!!
aldolase converts fructose 1,6 biphosphate to glyceraldehyde 3-phosphate. but triose phosphate isomerase converts it into dihydroxyacetone phosphate and back (reversible). only glyceraldehyde 3 phosphate can go on to next steps which drives it that way i think

Question 16

what is step 5 of glycolysis

Answer 16

first step in energy producing stage.

glyceraldehyde 3 phosphate dehydrogenase converts glyceraldehyde 3 phosphate to 1,3-biphosphoglycerate (makes 1 NADH)

Question 17

what is step 6 of glycolysis

Answer 17

second energy producing step

phosphoglycerate kinase converts 1,3 biphosphoglycerate into 3-phosphoglycerate. makes 1 atp!

Question 18

what is step 7 of glycolysis

Answer 18

phosphoglycerate mutase converts 3-phosphoglycerate to 2-phosphoglycerate

Question 19

what is step 8 of glycolysis

Answer 19

enolase converts 2-phosphoglycerate into phosphoenolypyruvate and water

Question 20

what is the last step of glycolysis

Answer 20

9th step total, 5th energy producing step..

pyruvate kinase converts phosphoenol pyruvate into pyruvate, makes 1 atp

Question 21

what are the 3 fates of pyruvate

Answer 21

• could be turned into lactate (fermentation) this process makes NAD+ allowing glycolysis occur again
• could be turned into acetyl coA and carbon dioxide, acetylcoa goes for further oxidation
• could be converted into acetaldehyde and co2, then ethanol (this makes NAD+)

Question 22

where does fermentation occur, how many atp is generated

Answer 22

cytosol, usually under anaerobic conditions. 2 generated from glycolysis

Question 23

what are obligate anaerobes

Answer 23

can only survive in anaerobic conditions, cant survive with oxygen around. use fermentation for enery

Question 24

how does fermentation valuable for energy production

Answer 24

it makes NAD+, cells have LIMITED NAD+ , it comes from vitamin niacin b3.
-because glyceraldehyde 3-phosphate reduced NAD+ to NADH in glycolysis, we now need more NAD+ to go again.

Question 25

what enzyme is involved in lactic acid fermentation

Answer 25

lactate dehydrogenase (pyruvate->lactate)

Question 26

what is the warburg effect and why does it occur

Answer 26

cancer sells selectibvely do aerobic glycolysis because: - produces lactic acid/acidification of environment facors tumor invasiveness and inhibits local immune response - cancer cells grow faster than blood vessels that nourish them, so cancer cells experience hypoxia.. aerobic glycolysis reduces need of oxygen. - high levels of biosynthetic intermediates (NAD+, nucleotides , etc) supports rapid growth.

Question 27

what is 2-deoxy-o-glucose

Answer 27

modulator, target is hexokinase. hexokinase is first enzyme in glycolysis. so it binds it and glycolysis doesnt occur. tumor cells die

Question 28

what does cambra stand for/what is it

Answer 28

caries management by risk assessment - uses caries risk assessment (CRA) to measure risk of future caries disease - followed by diagnosis and prognosis - determines specific treatments based on unique risk of individual patient

Question 29

what are the 3 general areas where caries occurs

Answer 29

pits and fissures smooth surface root surface

Question 30

what percentage of carious lesions in 5-17 yr olds is pit and fissures and where are they typically found

Answer 30

84% | -usually found on maxillary lingual pits and buccal mandibular pits

Question 31

what is a white spot lesion

Answer 31

earliest sign of subsurface demineralization. the surface IS intact, and can be remineralized. surface still prevents bacterial penetration. incipient lesion

Question 32

what is a brown spot lesion

Answer 32

previously white spot lesion that has become more porous (some demineralization is happening) and exogenous stain has entered into the lesion. this lesion can also be remineralized, become smooth and shiny. but remains stained.

Question 33

what are: prevalence, incidence, and trends

Answer 33

prevalence: number of individuals with the disease at a specific point in time incidence: number of people in a population who experience new disease during a specific period of time trends: changes or differences in prevalence of incidence of disease with respect to time

Question 34

what are DMFT and DMFS

Answer 34

decayed missing filled teeth/surfaces DMFT: 0-28, doesnt include 3rd molars, unerupted, congenitally missing, supernumerary teeth, teeth removed for other than caries reasons, DMFS: (0-128) posterior teeth each have 5 surfaces, anterior teeth have 4 surfaces (doesnt include 3rd molars either)

Question 35

what are the limitations to the DMF index?

Answer 35

- values dont relate to number of teeth at risk - gives equal weight to missing, untreated, decayed or well restored teeth. - doesnt account for teeth lost for reasons other than decay (perio disease) - data isnt useful in estimating individual treatment needs - doesnt account for sealed teeth (sealants didnt exist) - DOESNT CONSIDER PRECAVITATED LESIONS!!!

Question 36

what is a case control study

Answer 36

weakest type of research (vs cohort and randomized controlled clinical trials) - it involves identifying subjects with a clinical condition (cases) and subjects free from the condition (controls), and investigating if the two groups have similar or different exposures to risk indicators or factors associated with the disease - -- visit slide 24 for more weakest->strongest!!

Question 37

what is a cohort study

Answer 37

in between case control and randomized controlled clinical trial in terms of strength of evidence - involves identifying two groups (cohorts) of patients, one which did receive exposure of interest, and one which didn't, and then following these cohorts forward for the outcome of interest. - -- visit slide 24 for more weakest->strongest!!

Question 38

what is a randomized controlled clinical trial

Answer 38

stronger evidence than both case control and cohort studies' - study randomly assigns participants of a defined population to receive one or two or more interventions. one of the interventions acts as standard of comparison or control. the control may be the standard of practice, a placebo or no intervention. Another intervention is/are the treatments under investigation. these groups are followed over time for outcome of interest. - -- visit slide 24 for more weakest->strongest!!

Question 39

what is the evidence hierarchy (top to bottom)

Answer 39

- systematic reviews (BEST) - randomized controlled trials (REALLY GOOD- these top two are strong to support recommendations) - cohort studies - case reports - narrative reviews/expert opinions/editorials - animal and laboratory studies

Question 40

what are systematic reviews, what are some sources for it

Answer 40

scientific investigations that use rigorous methods to review original research. - synthesize results from multiple trials addressing the same question - statistically combines data - distills large quantities of data into clinically useful info ``` cochrane collaboration (international), database of abstracts and reviews of effectiveness (UK), national institute of clinical excellence (UK), agency for healthcare research and quality (US) https://ebd.ada.org ```

Question 41

what impacts the demin/remin cycle

Answer 41

(demineralization/remineralization) - saliva, pellicle, diet, structure of mineral

Question 42

what is the specific plaque hypothesis

Answer 42

only a limited species of bacteria in plaque can cause disease. Mutans streptococci and lactobacilli are main culprits

Question 43

what is the nonspecific plaque hypothesis

Answer 43

states that plaque is considered the etiologic agent of dental disease. There is no bacteriological difference acknowledged to exist between plaque from diseased and nondiseased sites

Question 44

what is the ecological plaque hypothesis | what is EXTENDED ecological plaque hypoth.

Answer 44

pathogens may be present at sound tooth sites, but in too low numbers to cause disease -disease will result when there is a shift in the homeostatic balance of the resident microflora due to a change in pH conditions which favors growth of pathogens. -its the pH not the sugar which causes pathologic shifts in biofilm EXTENDED: -- in presence of low pH, non-Mutans streptococci (MS) and Actinomyces (normally non-pathogenic) can adapt to produce acid --- the destabilization of homeostatic biofilm. causes a shift to a more acidogenic biofilm ---- MS and lactobacilli can predominate at a lower pH

Question 45

how do MS and LB bacteria change when pulsed with glucose and lowered pH

Answer 45

they prevail and result in a larger percentage of bacteria (study done)

Question 46

what is the relationship between bacteria in the mouth and the heart

Answer 46

a study found that the positive rate of S mutans in cardiovascular specimens from patients who dental plaque was also positive for s mutans was 78% , significantly higher than any other tested species when same analysis was done. -- specific oral bacterial species like s mutans and A actinomyectemcomitans are related to bacteria in the blood, can be factors for cardiovascular diseases

Question 47

what role does saliva play (factors)

Answer 47

- produces salivary pellicle - proteins (statherins, PRPs, histatins, and cystatins) - antimicrobial (IgA, lysozyme, lactoferrin, peroxase) - clears bacteria and carbs - buffers acids - contains calcium/phosphate/fluoride - lubricates oral mucosa - mediates taste acuity - enzymes

Question 48

what is the difference between xerostomia and salivary gland hypofunction

Answer 48

xerostemia is how a patient feels (subjective) salivary gland hypofunction (SGH) is objectively measured using a flow rate measurement. (rested and stimulated rates)

Question 49

what can cause xerostomia

Answer 49

medications, cancer treatment (radiation/chemo), sjogrens syndrome or other autoimmune CT diseases, diseases like HIV or diabetes, metabolic disturbances, stress and depression, physiological blockage of salivary gland ducts, dehydration (amphetamines, antimicrobials, analgesics/narcotics, antipsychotics, anti-inflammatories, asthma drugs, nsaids, ace inhibitors, anticonvulsants, calcium channel blockers, anti anxiety drugs, gastric acid drugs, antidepressants, smoking cessation drugs, antihistamines)

Question 50

what aspect of saliva should be analyzed /salivary assessment

Answer 50

assessment: resting flow rate, resting pH, stimulated flow rate(>1ml/min is WNL), stimulated pH important things also include: - resting consistency/hydration - buffer test

Question 51

what are complex vs simple carbohydrates

Answer 51

carbohydrates (CHO) btw - complex (starches) - simple (sucrose, glucose, fructose)

Question 52

if surface layer is intact but you see dark spot in dentin, what does it mean

Answer 52

staining, not caries/cavity. if this is left untreated, it will cavitate and bacteria can then get into the dentin- surgical restoration required at that point

Question 53

describe the demin/remin process

Answer 53

enamel crystal (carbonated apatite) ->combines with acid-> partly dissolved crystal --> combined with calcium/phosphate/fluoride will remineralize--> recreate crystal nucleus ca10(PO4)5(F)2= fluoroapatite like coating on crystals leads to crystal nucleus , can be formed when we add calcium/phosphate/fluoride at the right time SLIDE 70

Question 54

how does ion exchange strengthen the tooth

Answer 54

replacing carbonate (CO3 2-) with phosphate (PO4 3-) in hydroxyapatite makes it stronger.

Question 55

what are the zones of an early lesion

Answer 55

surface zone, body, dark zone, and translucent zone (In order) -- slide 75

Question 56

what is the stephan curve

Answer 56

curve shows pH throughout the day as we eat acidic foods , and rise as our saliva buffers.

Question 57

what are the protective factors for caries

Answer 57

SAFER ---- Saliva & sealants, Antibacterials, Fluoride/calcium/phosphate, Effective lifestyle habits , Risk based reassessment SAFER acronym to remember it

Question 58

what are the risk factors forcaries

Answer 58

BAD -- Bad bacteria, Absence of saliva, Destruction of lifestyle habits

Question 59

what are the disease indicators for caries

Answer 59

WREC (total wreckage) | -White spots, Restorations < 3 yrs, Enamel lesions, Cavities/dentin

Question 60

what categories will you see in axium for risk assessment

Answer 60

disease indicators, risk factors, protective factors, bacteria/saliva test results

Question 61

how can you tell if there is a low flow rate?

Answer 61

thick stringy saliva or very frothy saliva

Question 62

what is pilocarpine hydrochloride used for

Answer 62

- stimulates saliva production! | i. e. salagen 5 mg, one tablet 3 times a day - lowest dose tolerated (have to consult physician)

Question 63

what is cariscreen

Answer 63

'caries susceptibility test' measures bacterial load. real time (15 seconds) inexpensive test for identifying high /low risk people. -ATP bioluminescence, acidogenic bacterial load detected. correlates to caries risk levels reaction: ATP + luciferin+ O2 with luciferase and MG -----> light is a product