WEEK 5-10 QUIZ 2

Question 1

how do dental caries occur

Answer 1

disturbance in homeostasis of oral microflora

acidogenic bacteria metabolise fermentable carbohydrates = lactic acids

lactic acids = reduction in pH in oral cavity and plaque

when pH < 5.5 [critical pH] hydroxyapatite mineral is lost from tooth

Question 2

what are caries detection methods used in practice? describe each one

Answer 2

Radiographic imaging - bitewings, and OPGS reveal approximal caries

**Visual assessment **
Wet and dry visual assessment
white spot lesions [first stage carious breakdown of enamel]
Smooth surface active lesion = matte, chalky, feels rough
Enamel discolouration

Tactile sensation
Carious lesions - soft walls/ floors, sticky feeling

Question 3

difference between smooth surface, approximal surface and pit/fissue caries

smooth surface

Answer 3

smooth surface caries
- Active lesion = matte, chalky, feels rough
- Arrested lesion = hard and shiny, may be brown in colour
- White colour = ^ porosity of enamel → may be brown due to exogenous stains
- Cavitated carious lesion = Visual breakdown of tooth surface + soft walls or floors

**approximal surface [type of smooth surface caries] **
- Difficult to see clinically due to nature of location
- Bitewings essential in dx of proximal caries
- Cavitated lesions likely to be active
- Gingival health is mandatory to dx aproximal root caries

pit/fissue caries
- active non-cavitated lesion = often white, with a matte surface
- INACTIVE non-cavitated lesion = brown
- main cause of cavitated occlusal lesions = usually because patient cannot
clean plaque out of the cavity

Question 4

how are approximal caries diagnosed

Answer 4

• Bitewings essential in dx of proximal caries
• Cavitated lesions likely to be active
• Gingival health is mandatory to dx aproximal root caries
• Thoroughly dry teeth
• Pinkish-grey area shining through marginal ridge

Question 5

list and describe each stage in ICDAS II coronal coding system

Question 6

list and describe each stage in ICDAS II restorative and sealant history coding system

Question 7

describe appearance of non cavitated caries lesion

Answer 7

white spot lesions
* usually located where dental plaque accumulates
* all plaque must be removed and tooth dried –> no cavitations after visual/ tactile exam
* demin may extend to dentine but ename has not yet cavitated

smooth surface caries
Active lesion = matte, chalky, feels rough

Arrested lesion = hard and shiny, may be brown in colour

White colour = ^ porosity of enamel → may be brown due to exogenous stains

Question 8

list 3 major salivary glands

Answer 8

Parotid gland + duct
Sublingual gland
Submandibular gland and duct

Question 9

list and describe two types of saliva - how do we clinically assess them

Answer 9

**Unstimulated / resting saliva
**- at rest = unstimulated
- 60% comes from submandibular glands, 5% sublingual glands 5%, parotid glands 20% and minor glands 15%
- flow rate 0.03mL/min
- appears clear, watery, small amt of bubbles
- clinical assessment
= visual assessment of lower lip and pooling in floor of mouth, viscosity, pH testing [Healthy resting saliva = pH 6.7 - 7.4]

Stimulated saliva
- produced as result of some mechanical, gustatory, olfactory or pharmacological stimulus
- contributes to BULK of overall daily salivary production
- results from combined production from both major+minot glands [1.3mL/min]
- clinical assessment
= Secretion of saliva = stim by chewing
Volume of saliva collected over period of time
pH of stimulated saliva is tested [should be higher than resting saliva]

The total flow rate [both saliva types] = 500 - 1500mL / day

Question 10

describe important roles of saliva

Answer 10

helps taste sensation
- acts as solvent for ions which are distributed –> taste pores
- gustin [salivary protein] also necessary for growth/maturation of taste buds

keeps mucous membranes lubricated - prevents drying

role in dehydration - hyposalivation triggers water intake

Bicarbonate buffering system in saliva –> Prevent colonisation of potentially pathogenic microorganisms –> buffers and cleans acids produced by acidogenic microorganisms thus preventing demin

modulates remineralisation
reservoir for ions [calcium, phosphate, fluoride]

oral cleansing
Eliminates excess carbohydrates - limiting bioavailability of sugars to biofilm microorganisms

Question 11

what can affect saliva quality

Answer 11

dehydration

salivary gland pathology - infections, salivary stones

medical conditions // lifestyle

medications
- antidepressants
- antihistamines
- BP medications
- pain meds

side effects of recreational drugs
- methamphetamine / cocaine

Question 12

explain how fluoride prevents demineralisation

Answer 12

enamel = hydroxyapatite [HA] crystals

HA + fluoride = fluoroapatite [FAP] - incorporated into crystal by iso-ionic exchange
- harder than HA + more resistant to dissolution by acid ions
- less soluble than HA
- critical pH for FAP = 4.5, whereas HA =5.5
- can form in presence of fluoride when pH between 4.5-5.5

Incorporating in hydroxyapatite crystal - reducing acid solubility [demineralisation]
Promoting remin on incipient caries lesions [white spot lesions]
Inhibition of bacterial metabolism

Question 13

how does fluroide have antimicrobial effect

Answer 13

Can affect bacterial metabolism via
- Actions on bacterial enzymes
- Enhance membrane permeability impacting bacterial cell homeostasis
- Bactericidal in high concentration

Question 14

benefits of water fluoridation

Answer 14

Cost effective way to decrease caries risk
Aids in remin of lesions and prevents cavity formation
Saves community time and money
Reduces discomfort and pain caused by caries
Provides benefit to all people - esp low SES communities who have less access to other forms of fluoride treatments

Question 15

recommended fluoride conc for
* 5 yo pt
* 29 yo pt

Answer 15

• Adults 1000-1500 ppm F
• Children 250; 400; 500 ppm F
• children <5 = 0.4-0.5 mg F/g

Question 16

steps in class I cavity prep and composite resotration

Answer 16

Tooth selection
RD isolation
Clean surface [pumice/water]
Caries removal
Apply lining if required - if into dentine [cure 30 sec]
Etch - wait 30 sec, wash/dry 10-20 sec
Bond - light cure 10 sec
Restore - light cure 40 sec
Cure in increments if resto material = deeper then 2mm

f/s - light cure 20 sec
Remove RD
Check occlusion

Question 17

what are the indications and rationale for PPR

Answer 17

rationale: minimal interventional approach, avoids removal of sound tooth tissue

indications: small cases of small carious lesions confined to enamel or just involving the dentine eg pits on occlusal surface, remove caries, restore lost tooth structure and seal remaining fissue system –> maintains MID principles

Question 18

two guidelines that apply in establishing outline form for all class I preps - why are these important and what is the outcome of not following these

Answer 18

1. Active carious lesion should be removed
   - w/ spoon excavator, SS hp
   - prevent secondary caries
2. Margins should be placed on sound tooth structure [enamel should be supported by dentine]
   - Sound cavity prep is important for restoration success and longevity
   - Unsupported enamel will likely result in a failed restoration - further damage to tooth and patient

Question 19

compare gingivitis to periodontitis

Answer 19

gingivitis
- reversible tissue damage - tissue health will resolve when contributing factors removed
- does not always progress to periodontitis
- clinical signs - swelling, redness, bleeding, pseudopockets
- can EITHER be classified as
- 1. dental biofilm induced [poor OH = plaque accumulation]
-2. non dental biofilm induced [eg pregnancy, medication, trauma]

periodontitis
- bacterial infection of all parts of periodontium [gingiva, PDL, bone, cementum
- IREEVERSIBLE tissue damage
- histological changes – apical migration of junctional epithelium, CT destruction, root cemetum exposed to plque biofilm
- clinical signs - gingival margin = swollen/ fibrotic, bleeding upon probing, suppuration [pus], recession, mobility

Question 20

define fluorisis

Answer 20

Molting of teeth from excessive ingestion of fluoride during teeth development eg diet, supplements, toothpastes, topical application

Looks like fine, pearly white mottling, flecking or lines on tooth surface

Question 21

describe a healthy periodontium

Answer 21

Pink, firm, no bleeding
JE coronal to CEJ
Supragingival fibers intact
Alveolar bone intact
PDL intact

Question 22

what are the two types of bone loss - how do they occur

Answer 22

1. horizontal bone loss
   - more common = results in even reduction in bone height
   - inflmmation spreads from gingival CT –> bone = detachment and destruction of PDL = even reduction of alverolar crest
2. vertical bone loss
   - less common = uneven bone height reduction = creates trenches [bony defects]
   - trench described by # walls
   - inflammation spreads from gingival CT –> PDL = destruction of PDL

Question 23

what indicates an active disease site

Answer 23

Continued progression of disease over time
Presence of bleeding = clinical indicator of inflammation and activity, but not necessary indicator of activity

Question 24

what is furcation involvment and what does it indicate abt the severity of the disease

Answer 24

occurs when there is bone loss at furcation of tooth

indicates severe progression of the infection spreading from gingival CT past the PDL

Question 25

function of dental board of australia

Answer 25

Set registration standards and register dental practitioners Develop codes and guidelines for the profession Handle notifications, complaints Assess overseas trained practitioners Accreditation

Question 26

how might plaque biofilm appear clinically and what do the different presentations indicate

Answer 26

biofilm = dense, non-mineralised mass of bacterial colonies which adhere to teeth, calculus, fixed/ removable appliances clinical presentations - stained biofilm = extrinsic sources eg tobacco, food may stain - yellow, green - mature/ thick biolfilm = tooth may appear dull w/ matted, fur like surface - debris = materia alba or food debris can collect over biofilm

Question 27

differences in sub and supragingival calculus [other than location]

Answer 27

supragingival calculus - above free gingiva margin - predominantly white, can be stained by food, bev, tobacco subgingival calculus - below free gingiva margin - often on root - light-dark brown, dark green or black [stained by blood] - often gives tissue a cyanotic appearnace - tenacious [difficult to remove]

Question 28

CPP-ACP

Answer 28

CASEIN PHOSPHO-PEPTIDE AMORPHOUS CALCIUM PHOSPHATE - milk product = aids in remin - eg tooth mousse, tooth mousse plus, recaldent, chewing gum - may have fluoride added [ACFP - amorphous calcium fluoride phosphate] - FUNCTION = **buffers plaque pH + promotes ^ saturation for calcium and phosphate** for remin of enamel and subsuface lesions - treats = white spot lesions, childhood caries, root caries, reduces # bacteria which cause caries

Question 29

describe sickle scalers

Answer 29

rigid periodontal instrument - removes med-large calc depo from CROWN of tooth triangular cross section - supragingival use 2 cutting edges/ working end inner cutting edge = distal surfaces outer cutting edge = mesial surfaces working end --> lower shank = parallel to tooth // func shank = up and over

Question 30

Fluoride MOA for Remin + Demin

Answer 30

When outer enamel surface is exposed to fluoride [>50ppm], calcium fluoride [CaF2] can be formed Can be precipitated on enamel surface and act as source of fluoride ions [may also act as barrier to denim CaF2 released in acidic conditions and either diffuse rapidly into underlying enamel = FAP and subsequent enamel hardening ot ^ fluoride levels in saliva FAP can form in presence of F when pH is below 5.5 but above 4.5 F = incorportated into solid HA crystal via iso ionic exchange, forming FAP which is stronger, less soluble and more resistant to acidic dissolution with a critical pH of 4.5 compared to 5.5 in HA. - promotes remin of white spot lesions, inhibits bacterial metabolism, arrests or slows progression of caviated coronak lesions, remins root surface lesions

Question 31

components of saliva

Answer 31

- derived from blood as filtrate from serum - 99% of volume = water - acts as solvent fot other components - composite of secretions from minor + major salivary glands and material from gingival sulcus

Question 32

Benefits of water fluoridation [1ppm]

Answer 32

Cost effective way to decrease caries risk Aids in remin of lesions and prevents cavity formation Saves community time and money Reduces discomfort and pain caused by caries Provides benefit to all people - esp low SES communities who have less access to other forms of fluoride treatments * Level should remain in range 0.6-1.1mg/L (ppm)

Question 33

Etch

Answer 33

37% phosphoric acid which creates microtags for micromechanical adhesion of a resin based material Sits for 30 sec, washed/dried 10-20 sec until matte, chalky appearance

Question 34

bond

Answer 34

Resin which allows the composite resin to adhere to tooth and stay in prep via CHEMICAL BOND Difference between bond and composite = bond has more filler material Distribute with triplex air - 5 sec - to create even application and evaporate solvents - cure 10 sec

Question 35

liner

Answer 35

RMGIC - Vitrebond - cure 30sec Required if cavity prep > 2mm [into dentine] Remove from enamel walls - only have thin layer on cavity floor - line until DEJ function Seals dentine tubules Prevents thermal conduction Prevents toxins from dental materials reaching pulp Prevents post op sens

Question 36

No extension for prevention - GV black

Answer 36

cavity preparations should be limited to removing only the diseased or decayed tooth structure [no need to remove more unless it is necessary for retention or resistance form "No extension for prevention" = preserve as much healthy tooth structure as possible = maintain the strength and integrity of the tooth + reduces risk of complications - pulp exposure - tooth weakening minimizes the invasiveness of dental treatment. This is in line with the concept of MID

Question 37

Define simple, compound, complex cavity design

Answer 37

Simple = one surface Compound = two surface Complex = three or more surface

Question 38

GV Black Classification of Caries Lesions

Answer 38

Class 1 =pit and fissure carious lesions [occ of post teeth] [lingual surface max incisors] Class II = proximal surfaces of posterior teeth [MO, MOD, DO] Class III = restorations on proximal surface of anterior teeth not involving incisal edge Class IV = Class III + incisal edge Class V = involving gingival ⅓ of all teeth [NOT INCLUDING PITS/F/S]

Question 39

Outline Form Objectives

Answer 39

Access caries Reach sound tooth structure Resist fracture of tooth / filling Retain filling in tooth

Question 40

How Does Class I Cavity Prep Differ if it is for Amalgam

Answer 40

Depth of 2 - 2.5mm instead of 1-2mm Then requires Vitrebond lining Requires resistance and retention features Slight undercuts required for retention of amalgam Outline form larger than CR More rectangular cavity prep than cup shaped for CR

Question 41

How does caries removal differ for enamel only lesions and enamel/dentine lesions for a PRR?

Answer 41

Enamel only Remove unsupported enamel and visually/ mechanically inspect pit/fis anatomy ensuring there is no denim and no active caries penetrating dentine Enamel/dentine Remove unsupported enamel Remove infected dentine w SS round bur / spoon excavator Ensure DEJ = caries free Apply Vitrebond liner - cure 20 sec - remove from enamel walls

Question 42

List and describe each stage in ICDAS II Coronal coding System

Answer 42

0 = sound tooth surface, no evidence of caries after 5 sec air dry 1 = first visual change in enamel → opacity or discolouration [white/brown] is visible at entrance to pit or fissure after prolonged air DRY 2 = distinct visual change in enamel visible when WET, lesion must be visible when dry 3= LOCALISED enamel breakdown [w/o dentinal involvement] - seen when WET and after prolonged DRYING 4 = underlying dark shadow from dentine 5 = Distinct cavity with visible dentine 6 = extensive [more than half of surface] distinct cavity w visible dentine

Question 43

List and describe each stage in ICDAS II Restorative and Sealant Hx Coding System

Answer 43

0 = surface not restored or sealed 1 = partial sealant 2 = full sealant 3 = tooth coloured restoration [GIC/CR] 4 = amalgam resto 5 = stainless steel crown 6 = porcelain/ gold/ PFM crown/Veneer 7 = lost of broken resto 8 = temp resto 9= 96 = tooth surface cannot be examined 97 = tooth missing from caries 98 = tooth missing for reason other than caries 99 = unerupted

Question 44

Compare active vs inactive lesions according to ICDAS II criteria

Answer 44

**Active** ICDAS I - III Enamel surface = whitish yellow opaque, loss of lustre, feels rough Lesion is in plaque stagnant area eg p/f/s, near gingival and approximal surfaces ICDAS IV Probably active ICDAS V - VI Cavity feels soft or leathery on probing dentin **Inactive** ICDAS I - III Enamel surface = whitish. Brownish, black Enamel may be shiny, hard, smooth On smooth surfaces → caries lesions typically located some distance from gingival margin ICDAS V - VI Cavity may be shiny and feels hard

Question 45

Define Gingival pocket

Answer 45

In gingivitis → coronal portion of JE detaches from tooth = slight increase in probing depth - pseudopockets [exacerbated by gingival swelling] NO apical migration

Question 46

Define periodontal pocket

Answer 46

Clinical attachment loss of JE > 4mm probing depth As disease progresses Apical migration of JE PDL destruction Alveolar bone destruction Horizontal bone loss = suprabony pocket Vertical bone loss = Infrabony pocket Can be spiral at twist around multiple tooth surfaces [different depths]

Question 47

Clinical signs of periodontitis

Answer 47

swollen/fibrotic gingiva, absence of knife edged interdental papilla Bluish - purple hue of gingiva Bleeding upon probing, suppuration Pocket depth of 4mm or greater

Question 48

Histological process associated with periodontitis

Answer 48

Apical migration of junctional epithelium Destruction of gingival connective tissue [collagen] Destruction of PDL and alveolar bone Root cementum exposed to plaque biofilm

Question 49

What is COntinuing Professional Development [CPD] registration standard for an OHT?

Answer 49

Minimum of 60 hours of CPD activities over three year cycle 80% clinical or science based 20% non scientific activities Each 3 year CPD cycle begins Dec 1 ends Nov 30, 3 years later Current cycle = dec 1 2022 - nov 30 2025

Question 50

When would an OHT need to pursue a mandatory notification of AHPRA

Answer 50

in certain situations where there are concerns about the conduct, health, or performance of a registered health practitioner Misconduct Performance Impairment Sexual misconduct Notifiable conduct [eg intoxicated practice, departure from standards]

Question 51

Purpose of oral hygiene assessment

Answer 51

Determine pt Amount Location and classification of hard/soft deposits Oral hygiene status Oral self care effectiveness Motivation related to oral seal care Establish baseline for oral health/ progression of diseases Demonstrate patient education