Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

ABPD 2021 > Prevention/Anticipatory Guidance > Flashcards

Prevention/Anticipatory Guidance Flashcards

(102 cards)

Start Studying
1
Q

Definition of anticipatory guidance

A

To provide developmentally relevant information about a child’s health to help prepare parents for milestones in the future

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Definition of dental caries

A

Chemical dissolution of tooth surface caused by metabolic events in the biofilm covering the affected area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Contributing factors to caries

A 
Oral hygiene
Diet
Microbiology
Fluoride
Genetics (immune, enamel, saliva)
Environmental factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Keyes Triad

A

Host and teeth
Microflora
Substrate (diet)

Very simplistic approach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Koch’s Postulates

A

Describes requirements for a microorganisms to be considered in an etiologic agent for disease

Found in all cases of disease
Organism should be grown on artificial media for several subcultures
Pure subculture should produce disease in susceptible animal

Not able to be done in caries
-many confounders (behavior, education, SES, genetics, etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Specific Plaque Hypothesis

A

Only certain species of bacteria are involved in caries process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Nonspecific Plaque Hypothesis

A

All plaque/bacteria are pathogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ecological Plaque Hypothesis

A

Shifts in pH of biofilm cause a shift toward cariogenic bacteria (S mutans) in the balance of resident oral flora, resulting in dsease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Extended Caries Ecological Hypothesis

A

Dental plaque as a dynamic microbial ecosystem in which non-mutans bacteria are key players for maintaining dynamic stability

Low pH environments can stimulate non-mutans bacteria to be more acidogenic

Variety of bacteria that are acid-producing, not just S mutans

Given the right environment, even the good bacteria can cause demineralization and destruction of tooth surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Composition of enamel

A

95% hydroxyapatite

  1. 5% water
  2. 5% organic matrix

Calcium phosphate crystals make up 99% of dry weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Active vs inactive carious lesion

A

Active lesions: white, opaque, rough

Inactive lesions: smooth, hard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

White Spot Lesion

A

Intact surface zone: 20-50um
Body of lesion - pore volume > 5%
Dark zone - pore volume 2-5%
Translucent zone - advancing front of lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dentin reaction to caries

A

Vital tissue that reacts to external insults

Most common reaction to caries progression is tubular sclerosis and occlusion of dentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pulp-dentin reactions

A

Histologically early signs of tubular sclerosis can be seen before the enamel lesion reaches the DEJ

Dentin demineralization does not extend laterally beyond contact area with enamel lesion

Reactionary dentin may form before dentin is invaded by bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Biofilm

A

Necessary but not sufficient to cause disease

Microbial biofilm on teeth is prerequisite of caries lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Primary route of transmission of caries

A

Saliva

Vertical transmission from mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Early colonizers of bacteria

A

S. Mitis
S. Salivarius
S. Oralis

Prior to tooth eruption, these bacteria are transient, usually on gingival tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Acquired pellicle formation

A

Acellular, proteinaceous film that forms on teeth within minutes after cleaning

Composed of salivary glycoproteins, phosphoproteins, lipids and components from gingival crevicular fluid

1 micron thick

Critical role in bacterial colonization

Facilitates remineralization by maintaining calcium and phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Microbial succession

A

Early bacteria create environment either favorable to others or unfavorable to themselves

Gradual replacement with other species who are better suited to modified environment

Microbial hemostasis is a state of equilibrium between microflora and local environment

Disruption can result in disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Characteristics of cariogenic bacteria

A

Rapid transport and conversion of sugars to acid

Ability to maintain metabolism under extreme conditions like low pH

Production of extracellular polysaccharides such as glucans that shift to acidic

Acid producing cocci and rods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SECC bacteria

A

More anaerobic cultures found

S sanguinis generates alkali from arginine and decreases cariogenicity of acidogenic bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Window of Infectivity

A

Between 19-31 months of age

Window appears to close after all primary teeth erupt

Once stable plaque or biofilm covers tooth surface, MS is less likely to be established

2nd window of infectivity at 6 years when 1st molars erupt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Transmission of caries

A

Vertical: parent to child (most often from mother)
Horizontal: spouses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Factors affecting acquisition of MS

A

Erupted teeth
Presence of hypoplasia
Diet high in fermentable carbohydrates
Antibiotic intake (?) - conflicting results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Stephan Curve
Curve that shows the pH drop after sucrose intake Shows time below 5.5 pH where demin is occurring Takes up to 30 minutes to buffer back to neutral Why frequency is important
26
Critical pH
Varies depending on total calcium and phosphate concentration in saliva Average 5.5 for hydroxyapatite Average 4.5 for fluorapatite Low concentrations of calcium and phosphate can increase the critical pH as high as 7 in some people
27
Remineralization
Saliva acts as source for calcium and phosphate that helps in maintaining supersaturation with respect to tooth minerals When saliva is stimulated, rapid rise in pH occurs, calcium phosphate and glycoprotein called salivary precipitin is formed - complex readily incorporated into dental plaque
28
Fluorapatite
Fluorapatite has higher pH for dissolution Displacement of hydroxide with fluoride removes a weakness of hydroxyapatite to lactic acid
29
Overview of Fluoride
Fluorine = most electronegative element Fluoride is widespread in nature (water, milk, vegetables) ``` NaF= sodium fluoride SnF2 = stannous fluodie Na2PFO3 = sodium monofluorophosphate (MFP) ```
30
Does fluoride cross the placenta?
Most does not cross No evidence that prenatal fluoride supplements taken by women during pregnancy are effective in preventing dental caries in offspring
31
Fluorosis and infant formula
Clinicians should consider potential fluoride exposure to infants when fluoridated water is used to reconstitute infant formula 1ppm = 1mg/L Ex: if baby drinks 2.5oz/lb/day, 10lb baby drinks 25oz or 3 cups per day -if powdered reconstituted with fluoridated water, 0.64-1.07ppm = 0.72mg F
32
Mechanism of Fluoride
Frequent exposure to topical fluoride is more effective in caries prevention than fluoride that is incorporated into enamel through systemic exposure during tooth development Main mechanism = enhance remineralization and inhibit demineralization (topical) Systemic effect (increase crystallinity of enamel) is minor Antimicrobial effect is minor
33
Fluoride in toothpaste
Sodium fluoride dentifrice offers greater cariostatic activity than MFP Increased fluoride concentration leads to increased cariostatic activity
34
Fluorosis
Permanent, intrinsic stain caused by excessive fluoride during tooth development Usually white, but can be brown/orange Severe cases damage tooth enamel Directly related to total fluoride ingested during tooth development Permanent maxillary molars most susceptible during first 3 years of life Can affect both dentitions
35
Community water fluoridation
0.7ppm Used to be 0.7-1.2ppm but changed in 2015 Goal is to maintain anti-caries effect but minimize risk of fluorosis
36
Amount of fluoride in regular toothpaste
1000ppm
37
Fluoride mouthrinse
Provides moderate dose (226mg/L) fluoride topically on daily basis for those using it Effective and available OTC Not for young children
38
Professionally applied fluoride gels
High dose (12,400pmp) of fluoride 1-2 times per year Contraindicated in younger children due to ingestion control concerns Frequent use is impractical and expensive
39
Professionally applied fluoride varnish
High dose (22,500ppm) of fluoride several times per year Effective under providers' control and locally retained for several hours Small amount used, less ingestion
40
Dietary fluoride supplements
Provides moderate dose (0.25-1mg per tab) on daily basis Designed to take place of fluoridated water Indicated if child not living in fluoridated community
41
Halo effect
People in non-fluoridated areas receive fluoride from foods and beverages processed in fluoridated areas Very difficult to perform research comparing effects of water fluoridation and non-fluoridation
42
Fluoride toxicity
Toxic effects at 5mg/kg body weight Lethal dose: 15mg/kg
43
Fluoride in toothpaste (g)
1gm: full brush size amount of toothpaste 0. 25mg: pea size 0. 125mg: smear (less than 3 years)
44
Fluoride supplements for 0-6 month old
None
45
Fluoride supplements for 6months - 3 year old
If water fluoride is <0.3ppm, 0.25mg If water fluoride is >0.3ppm, none
46
Fluoride supplements for 3-6 year olds
If water fluoride is <0.3ppm, 0.5mg If water fluoride is 0.3-0.6ppm, 0.25mg If water fluoride is >0.6ppm, none
47
Fluoride supplements for 6+ year old
If water fluoride is <0.3ppm, 1mg If water fluoride is 0.3-0.6ppm, give 0.5mg If water fluoride is >0.6ppm, none
48
Indications for fluoride supplements
Only for those at very high risk for dental caries with deficient water fluoridation Must determine all sources of fluoride
49
Sodium fluoride calculations
Fluoride toothpaste at 0.243% fluoride = 0.1215% fluoride ion 0.1215% fluoride ion = 1215ppm ?
50
Caries risk assessment - risk indicators
Factors that have been associated with risk of caries - modifiable ``` Poor oral hygiene Inadequate fluoride exposure Frequency of between meal carbohydrate snacks Inadequate saliva (drug use) Recreational drug use Radiation therapy ```
51
Caries risk assessment - risk factors
Part of causal chain or expose host to causal chain Genetic component to caries, susceptibility and resistance Demographic factors
52
Factors that predict future caries
Demineralized or cavitated lesions Stained occlusal pits or fissures
53
Indicies for caries
DMFS index does not establish if lesion is active or not Development of technology to detect and quantify early caries lesions and directly assess caries lesion status may prove to be best way to identify patients that require intensive prevention intervention
54
Caries Management
``` Relies on assessment of risk Classification of lesions Intervention Documentation of intervention provided Measurement of outcomes of care ```
55
Caries risk assessment tools
AAPD ADA CAMBRA
56
Disease indicators
WSL Cavities Restorations
57
Protective factors for caries
Exposure to topical fluorides Xylitol MI paste Antimicrobial rinse
58
Fluoride varnish
Concentrated topical fluoride (NaF 5%) Sets in contact with saliva Well-tolerated by infants and children Minimal risk for ingestion Should be high priority for children with developmental disabilities Apply 2-3 times per year depending on caries risk
59
MI paste
No significant difference between enamel lesions in subjects versus controls after 12 months with using fluoride toothpaste, MIP paste and MI varnish quarterly Better than no fluoride, but not better than fluoride (could be alternative for fluoride resistant parents)
60
Xylitol
Requires frequent high doses to be effective May reduce mother-child transmission of MS
61
Silver Diamine Fluoride
24.4-28.8% w/v silver + 5-5.9% fluoride (44,800ppm) Ammonia and silver fluoride combine to form a diamine silver ion complex pH of 10 Silver = antimicrobial and inhibits enzymes that break down dentin organic matrix Fluoride = remineralization of lesion
62
FDA and SDF
FDA approval for SDF for dentin sensitivity Used off label for caries arrest
63
SDF side effects
Metallic taste Black staining Transient gingival irritation Stains clothes, skin, floor, etc. No major adverse effects or systemic illness
64
Indications for SDF
``` High caries risk Behavioral/medical management issues Dentin hypersensitivity Caries stabilization Xerostomia from cancer/medications Difficult to treat caries lesions Patients with dental phobia Patients with limited access to restorative services Physical or cognitive disability Very young/very old ```
65
Contraindications for SDF
Silver allergy Ulcerative gingivitis/stomatitis Abscessed tooth needing extraction Irreversible pulpitis
66
Advantages of silver solutions
``` Controls pain by arresting caries Affordable Procedure is fast Minimal support in staff or equipment required Non-invasive and safe ```
67
Maternal Nutrition
Linear enamel hypoplasia in primary incisors is more common in malnourished children Caused by disruption during appositional stage of enamel formation in neonatal period Most common in middle third of maxillary central incisor and incisal third of lateral incisor
68
Enamel Hypoplasia
Quantitative defect of enamel formation Caused by variety of stresses during tooth development Neonatal line is present in almost all children either clinically or subclinically
69
Enamel hypoplasia in primary incisors
``` Correlated with poor prenatal care in first trimester Premature labor or birth Greater pre-pregnancy weight of mother Postnatal measles infection Maternal smoking ```
70
Enamel hypoplasia in permanent teeth
Localized (trauma, intubation, irradiation) | Postnatal (otitis media, other conditions)
71
Vitamin D
Essential for proper bone and tooth formation Regulates serotonin synthesis in brain 400 IU/day recommended in all infants from birth to 12 months Beyond 12 months, 600 IU/day recommended
72
Calcium
Works with Vitamin D for mineralization of bones and teeth Needed for nerve and muscle activity Intake of 500mg/day during childhood and adolescence Deficiency: most common in children with restricted diets
73
Food security
Access by all people at all times to enough food for an active and healthy life Food insecurity is limited or uncertain access to adequate food for a healthy life
74
Undernutrition
Insufficient ingestion of essential nutrients Failure to thrive in infants Marasmus: severe wasting Kwashiorkor: adequate calories but inadequate protein
75
Zinc
Important for immune function Severe deficiency in US is uncommon but can lead to stunted growth, altered immune response, xerostomia, poor appetite Zinc and iron supplementation should be staggered - interfere with each other's absorption
76
Overnutrition
Result = obesity and/or diabetes type II BMI: overweight is 85-95%, obese > 95%
77
Sugar consumption
WHO recommendation that no more than 10% of adult's calories (ideally less than 5%) come from added or natural sugars Children and adolescents in US obtain 16% of total caloric intake from added sugars alone
78
Vipeholm Study
Institutionalized adults Compared types of sugar consumption - sucrose, bread, chocolate, caramel, sticky toffee Stickiness, clearance time, and frequency increase caries risk
79
Turku Sugar Study
Compared fructose, sucrose, xylitol Xylitol was acceptable for human consumption and showed dramatic reduction in caries incidence after 2 years
80
Feeding Infants
``` No bottles in bed No sweetener on pacifier Introduce cup by 6 months Avoid cariogenic foods/beverages between meals No sweetened beverages Avoid introducing juice ```
81
Feeding Toddlers
``` Avoid excessive juice Discontinue bottle by 12 months Avoid unrestricted use of sippy cup Avoid cariogenic snacks between meals Avoid candy, soda, etc. ```
82
AAP Juice Recommendations
0-1: no juice 1-3 years: limit to <4oz/day with snack or meal 3-6 years: <6oz/day with snack or meal 7-12 years: limit to 8oz daily
83
Grapefruit juice
Should be avoided by any child taking medication metabolized by CYP3A4 Decreases P450 enzymes Leads to increase levels of drugs and side effects Ex: cyclosporine, tacrolimus, others
84
Adolescent Oral Health
``` Unique needs High caries rate Traumatic injury and periodontal disease Poor nutrition Esthetic desire/awareness Complex ortho/restorative needs Dental phobia Risky behaviors Pregnancy Eating disorders Unique social/psychological needs ```
85
Oral findings of anemia
Angular cheilitis Atrophic glossitis Iron, B12 or folate deficiency can result in anemia
86
Leukemia oral findings
May present with paleness of oral mucosa, gingival bleeding, oral petechiae, painless gingival hyperplasia Be concerned about spontaneous gingival bleeding in absence of plaque, caries, calculus or trauma Oral manifestations can be presenting clinical signs, especially in AML
87
Langerhan's Cell Histiocytosis oral findings
Alveolar bone invasion by histiocytes commonly occurs in the mandible Can result in pain, loose teeth, fractures X-ray appearance of teeth "floating in space" due to radiolucent areas in bone Precocious eruption or exfoliation of primary teeth Can also cause gingivitis and oral ulcers
88
Inflammatory Bowel Disease oral findings
8-10% of cases of Crohn's have oral manifestations that may precede GI involvement Aphthous ulcers and angular cheilitis found in Crohn's disease and ulcerative colitis (IBD ulcers are painful) Cobblestoning or mucosal modularity of buccal mucosa and gingiva indicative of Crohn's
89
Diabetes oral findings
Poorly controlled diabetes increases periodontal attachment loss Xerostomia = increased caries risk Increased risk for candidiasis
90
Bulimia Oral findings
Enamel erosion, especially lingual surfaces of maxillary incisors Increased risk for caries and gingivitis Patients should rinse mouth with water with baking soda or fluoride mouth rinse (don't brush for 30-60min) Counsel to avoid acidic drinks Need to be referred for medical/psychological evaluation
91
AAPD Policy on Tobacco Use
90% of smokers started by age 18 6.7% of middle school students and 23% of high school students used tobacco products in 2012 Decrease in cigarettes, smokeless tobacco Increase in cigarillos, E cigarettes
92
5 As of tobacco cessation
``` Ask (ask if they are smoking) Advise (tell them to stop) Assess (see if they are ready) Assist (help them) Arrange (follow up) ```
93
Pharmacological tobacco cessation strategies
Nicotine replacement therapies - best if used along with behavioral treatment Bupropion and Varenicline tartrate prescription drugs
94
E-Cigarettes
5mL vial contains 100mg of nicotine Lethal dose of nicotine is 10mg for children, 30-60mg for adults Most e-cigs have a battery, heating element, and a place to hold liquid
95
Ingredients of E-cigarettes
Nicotine Ultrafine particles Formaldehyde Other carcinogens
96
Concerns of e-cigs with children?
Gateway drug for cigarettes Youth use is associated with appealing flavors
97
Substance Use Disorder
A maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to repeated use of substance
98
Signs of Substance Use Disorder
Changes in behavior Emotional or mental changes Physical changes
99
Dental findings of substance abuse
``` Excessive tooth decay Malnourished appearance Unreliability in keeping appointments Excessive tooth wear from grinding/clenching Xerostomia Hypersensitive teeth ```
100
Most common drug used by teens
Alcohol
101
Adolescents and confidentiality
Each state varies to what age an adolescent can make their own decisions and when parents can or should be told Can call the pediatrician and ask their advice
102
When to transition care for adult patients
Have a clear policy and give patients information with enough time to find a general dentist for care Consider a different timeframe for patients with SHCN

ABPD 2021 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions