The Host & Saliva

Question 1

4 Factors that determine caries risk:

Answer 1

1. Bacteria (“the Agent”)
2. Host Factors (“the host”)
3. Oral Cavity Environment (“The Environment”)
4. Time

Question 2

What caries factors factors do we have less control over

Answer 2

Disease indicators

Question 3

Explain what entails being genetically pre-disposed

Answer 3

They become pre-disposed because their salivary flow is not adequate, or their tooth morphology includes deep pits and fissures. Maybe they don’t
have enough phagocytic cells to fight off the bacterial infection, or their immune system doesn’t run efficiently enough to keep the infection under control.

Question 4

The ___ enamel allows for water and ion movement because it is more organic than the enamel rods are.

Answer 4

interrod

Question 5

If you are more genetically predisposed to having a little more organic material in your enamel, you might be more susceptible to caries

yes no?

___ ____ during formation, demineralization, and remineralization is also important. If you don’t have the correct ions needed to form (or re-form) enamel, the result is a weaker structure

Answer 5

yes

Ion exchange

Question 6

the mineral matrix of enamel and dentin are made up of hydroxyapatite. However, in teeth, it is an imperfect ________structure due to the addition of carbonate to the hydroxyl group – which is where it gets its name: hydroxyapatite.

Answer 6

hydroxyapatite

Question 7

A perfect ____mineral results in a very translucent, crystal structure – some of which are considered to be gemstones.

Answer 7

apatite

Question 8

2 of the main components in hydroxyapatite are ___ and ____!!!

Answer 8

Calcium

Phosphate

Question 9

Calcium is a large, necessary component of hydroxyapatite, but when there is a deficiency of calcium the body will replace it with ___ and ___. This makes a weaker structure

Answer 9

Magnesium Mg2+

Na Sodium

Question 10

In the presence of fluoride, however, the structure is strengthened. The F- replaces the ___group and makes it less soluble in an acidic environment

On the flip side, if there is not enough (or NO) fluoride exposure, then ____ may substitute for phosphate and the hydroxyl group of hydroxyapatite.

Answer 10

hydroxyl

carbonate

Question 11

Just as a general “rule-of-thumb,” dentin is ___ deficient.

the peritubular dentin that lines the dentinal tubules is highly mineralized

Answer 11

calcium

Question 12

ssp

Answer 12

sub species within that genus

Question 13

Corynebacterium

is normal or not normal oral flora

Answer 13

normal

Question 14

One of the benefits of these particular bacteria is their ability to take the metabolic waste by- products of more cariogenic bacteria and consume it, and then producing a less acidic waste product. In effect, they help to neutralize a more acidic environment.

Answer 14

Veillonella & Strep. Sanguinis

Question 15

Saliva has antimicrobial activity of enzymes and ____ that are present

Answer 15

immunoglobulins

Question 16

____, in particular, plays a role in reducing the bacterial infection due to its ability to effect and damage bacterial cell walls. It is also worth noting that you can find ___ in tears and human breast milk as well.

Answer 16

Lysozyme

Question 17

____ particularly alpha-____, plays a significant role not only in carbohydrate digestion but in bacterial clearance and metabolism.

Answer 17

Amylase,

Question 18

___ is primarily secreted by the von Ebner’s glands and serves as an antimicrobial agent against a variety of pathogens. It helps to regulate the oral flora balance – especially when new bacteria are introduced and unestablished.

Answer 18

Histatin

Question 19

high amount of Ca2+ and ____- in saliva, the caries rate is decreased. And when there are low amounts of these minerals, the caries rate is increased.

Answer 19

PO43

Question 20

Lymphocytes:

The small cells (T & ___ cells) create and release the Salivary Antibodies mentioned in the next slide and the

NK cells provide additional ___ of pathogenic cells

Answer 20

B

phagocytosis

Question 21

Salivary Antibodies: Secretory IgA aids in the agglutination of bacterial cells and marking them for phagocytosis through the _______.

Answer 21

opsonization

Question 22

The older a person is, the more susceptible they are to ______, the more medications that they may take, the weaker the immune system is overall.

Answer 22

co-morbidities

Question 23

4 Natural Defense Mechanisms

Answer 23

1. Anatomical Barriers
2. Normal Oral Flora
3. Saliva
4. Immune System

Question 24

Host Factor Importance:
An individual’s ____and physical
factors may increase their susceptibility, which
greatly increases the severity of the disease

___ tooth can be susceptible if the other criteria for caries is met

Answer 24

biochemical

ANY

Question 25

Enamel Structure: Hydroxyapatite - ___ enamel allows for water & ionic movement - May be more or less soluble depending on ion substitution and exchange - Contains _____CO^2^3

Answer 25

Interrod 3% carbonate

Question 26

``` Exchange of Ions in Enamel: -___ and __ may substitute for Ca2+ -F- may substitute for _____ -______ may substitute for both PO 4^3-and OH- ```

Answer 26

Mg2+ and Na+ OH- (hydroxyl group) Carbonate

Question 27

Dentin is - _____ rich 5% - ____ deficient - Peritubular dentin is __-mineralized

Answer 27

Carbonate-rich Calcium Peritublar dentin

Question 28

Dentin | ____ + _____ + ______ = Greater Susceptibility to Dissolution

Answer 28

- Small Crystal - Deficient Structure (Reduced Ca++) - Higher Carbonate Content

Question 29

Why do caries progress so fast once it reaches dentin?

Answer 29

Its like Dentin has smaller crystal size so will erode faster

Question 30

Anatomical Barriers: "Ideal" Teeth

Answer 30

* Anatomically complete • Excellent coalescence of enamel lobes • Contact between teeth * Fluoride exposure * No tooth abnormalities present * Malformation factors * Malnutrition factors * Illness factors

Question 31

3 Anatomical Barriers:Mouth

Answer 31

1. Mastication 2. Speech 3. Mucosa (Desquamation, Keratinized, Non-keratinized)

Question 32

Acquired Pellicle provides

Answer 32

• Diffusion of small molecules (nutrition) • Adhesive proteins (glycoproteins) • Competition for sites - we want good bacteria on those sites • If bacteria are not attached, they will be washed away by saliva (except for perio “swimmers”)!

Question 33

Normal Oral Flora is predominately gram-postitive cocci and rods and Fungi List 4 gram posit. and 1 fugi

Answer 33

Gram Positive 1. Streptococcus ssp. 2. Veillonella ssp. 3. Actinomyces ssp. 4. Corynebacterium ssp. Fungi - Candida Albicans

Question 34

Veillonella and Strep. Sanguinis

Answer 34

• Provide some acid-neutralizing properties • Inhibit some colonization of A. israelii and S. mutans

Question 35

***Major Salivary Glands | Parotid Gland:

Answer 35

* Provides 25% of salivary volume * Secretes majority of NaHCO * Produces amylase * Serous secretions (primarily) * Produces majority of stimulated salivary flow * Contains statherin

Question 36

Parotid Gland:

Answer 36

``` • Provides 25% of salivary volume • Secretes majority of NaHCO • Produces amylase •Serous secretions (primarily) • Produces majority of stimulated salivary flow ****• Contains statherin ```

Question 37

Submandibular Gland

Answer 37

* Provides 60-65% of salivary volume * Mixed serous & mucous secretions * Secretes the majority of unstimulated saliva * Contains histatin and statherin * Controls Ca2+ & PO43- concentrations in saliva

Question 38

Submandibular Gland

Answer 38

• Provides 60-65% of salivary volume • Mixed serous & mucous secretions • Secretes the majority of unstimulated saliva ****• Contains histatin and statherin • Controls Ca2+ & PO43- concentrations in saliva

Question 39

Sublingual Glands:

Answer 39

* Provides 10% of salivary volume * Mucous secretions (primarily) * Contributes a minor amount of unstimulated saliva

Question 40

Palatal, lingual, labial, buccal: * Most are mucous secreting but some are serous * _____ glands are only serous * Produce a significant amount of histatins * Contribute ___ * Contribute approximately ___of total saliva

Answer 40

von Ebner’s fluoride 1/10th

Question 41

5 Protection Functions of Salivar

Answer 41

- Lubrication - Antimicrobial activity - Buffering - Flushes and Rinses ***- Saturated with minerals (Ca2+, PO 4^3-, F-) # posteruptive maturation

Question 42

Salivary glands secrete several major groups of | organic molecules in addition to electrolytes:

Answer 42

* Lysozyme (among other protective enzymes) * Amylase * Mucins/agglutinins * Histatin * Statherin

Question 43

keeps the salivary Ca2+ levels high which helps to prevent the dissolution of teeth

Answer 43

Statherin

Question 44

antifungal function with some antimicrobial activity; assists host with control over resident microflora

Answer 44

Histatin(S)

Question 45

Relationship of Ca2+ & PO 3- | 4

Answer 45

look at slide

Question 46

relationship of ca2+ and PO43-

Answer 46

``` The amount of time that is required to 4 3- present in saliva & 4 3- are inversely related to caries development! • Saliva is supersaturated compared to the tooth demineralize tooth structure has to do with the amount of Ca2+ and PO biofilm • Concentrations of Ca2+ and PO ```

Question 47

``` • An infectious agent that can cause disease • Non-host, potential disease-causing cells ```

Answer 47

Pathogen

Question 48

``` • Has a receptor that specifically identifies a unique portion of a pathogen as non- host • The portion that it is identified by the antibody is called the antigen ```

Answer 48

Antibody host cell

Question 49

``` Area of the pathogen identified by host antibodies that labels it for destruction • ANTIbody GENerator ```

Answer 49

Antigen

Question 50

Immune System monitors the body for foreign invaders and is comprised of 8 systems list them

Answer 50

1. Complement System 2. Thymus 3. Hormones 4. Antibodies 5. WBC 6. Bone Marrow 7. Spleen 8. Lymphatic System

Question 51

PMNs are

Answer 51

Polymorphonuclear cells | Phagocytosis

Question 52

Lymphocytes

Answer 52

``` - Langerhans Cells: antigen-presenting cells of the mucosa (and skin) - Lymphocytes • Large: ‘NK’ (natural killers) • Small: T & B cells ```

Question 53

Salivary Antibodies

Answer 53

IgA IgG IgM Complement

Question 54

* Main immunoglobulin found in saliva | * Aids in the agglutination of bacterial cells

Answer 54

IgA

Question 55

* Prevents microbial adhesion & metabolism | * Activates complement

Answer 55

IgG

Question 56

• Promotes complement binding to the antigen for | opsonization

Answer 56

IgM

Question 57

• Activates neutrophils & other phagocytic cells | to the site = inflammation!

Answer 57

Complement

Question 58

6 Risk Factors

Answer 58

1. Co-morbidities 2. Polypharmacy 3. Age 4. Gender 5. Periods of growth 6. Wounds and burns

Question 59

Xerostomia • Results in a greatly increased risk of caries 4 These limitations are often found in the presence of GOOD oral hygiene & dietary habits!

Answer 59

``` • Limited buffering capability • Limited immune response • Limited ability to wash pathogens away • Limited suspension of Ca2+, PO43-, F2 for remineralization ```