Saliva and caries

Dental caries is defined as localized destruction of dental hard tissues by acidic by-products from bacterial fermentation of dietary ________

carbohydrates

The caries disease process is initiated within the bacterial ________

biofilm

Cariogenic plaques are an overgrowth of ________ and ________ bacterial species

acidogenic / aciduric

When plaque pH drops below ________ acid-induced demineralization of enamel and dentin occurs

5

Cavitation is a ________ (early/late) event in the pathogenesis of decay

late

The Surgical Model focuses on repair of existing damage but does ________ reduce the caries process

not

The Medical Model addresses caries by behavior change / plaque modification / salivary stimulation / and ________ (bacterial elimination)

sealants

The Medical and Surgical Models are ________ (mutually exclusive / not mutually exclusive)

not mutually exclusive

Glandular saliva is composed of ________ % water and ________ % solids

99% / 1%

Whole saliva is the fluid in the mouth in contact with teeth and also includes GCF / epithelial cells / and ________

bacteria

The body produces ________ to ________ liters of saliva per day

0.5 / 1

________ % of glandular saliva volume comes from the 3 major salivary glands

90

The Parotid gland produces ________ secretion that is watery and enzyme-rich (mainly amylase)

serous

The Submandibular gland produces ________ secretion and is the major contributor to ________ saliva

mixed / resting

The Sublingual gland produces primarily ________ saliva which is thick and lubricating

mucous

Minor salivary glands contribute ________ % of saliva volume and produce mainly mucous saliva

10

Saliva forms a protective film called the ________ on teeth reducing mechanical wear

pellicle

Saliva supplies ________ / phosphate / and fluoride to strengthen enamel and repair early caries lesions

calcium

Salivary antimicrobial enzymes include lysozyme / lactoferrin / and ________ as well as immunoglobulin IgA

peroxidase

Saliva suppresses cariogenic bacteria such as Streptococcus mutans and ________ through antimicrobial proteins

Lactobacillus

Salivary secretion is controlled by the trigeminal / facial / and ________ nerves via parasympathetic and sympathetic input

glossopharyngeal

Parasympathetic stimulation uses the neurotransmitter ________ and increases saliva volume making it watery and enzyme-rich

acetylcholine (ACh)

Parasympathetic salivation is triggered by chewing / tasting / thinking about food / and certain reflexes such as ________

nausea

Sympathetic stimulation uses the neurotransmitter ________ and produces thicker protein-rich saliva

norepinephrine (NE)

Sympathetic stimulation is triggered by ________ / fear / and dehydration

stress

Acinar cells secrete a primary saliva that is ________ (isotonic/hypotonic) and rich in electrolytes and proteins

isotonic

As primary saliva passes through the ducts ________ and chloride are reabsorbed while potassium and bicarbonate are secreted

sodium (Na⁺)

Final saliva becomes ________ due to selective ion reabsorption in the ducts

hypotonic

Bicarbonate in saliva increases ________ capacity helping to neutralize plaque acid

buffering

At higher flow rates saliva has a higher concentration of ________ causing pH to increase from 6.0 to as high as 7.5

bicarbonate

Xerostomia (dry mouth) occurs when unstimulated salivary flow is less than ________ mL/min

0.1

Low salivary flow is a ________ risk factor for caries and can cause lesions on surfaces not usually susceptible

major

Consequences of hyposalivation include rampant caries / oral candidiasis / fissured tongue / burning mouth and changes in ________ / chewing and swallowing

speech

Common medication classes that cause hyposalivation include antidepressants / antihypertensives / anticoagulants / and ________

antiretrovirals

Non-medication causes of hyposalivation include radiotherapy to head and neck / Sjögren's syndrome / diabetes / and ________

depression / anxiety / stress

Interventions for caries risk from hyposalivation include saliva substitutes / Rx fluoride / meticulous oral hygiene and ________

other supportive care

Caries must be managed as a ________ disease requiring periodic recall / risk assessment and active ongoing prevention

chronic

Chronic disease management of caries includes risk-stratified prevention / conservative lesion management and effective ________ interventions

behavioral