IB Exam 3

3 factors of decay

tooth, bacteria, environment (diet, salivary flow)

life cycle of cariogenic food

carb broken by amylase, bacteria metabolize mono+disaccharides, acid by-product lowers pH, critical 5.5 pH reached after 5-15minutes, lasts 20-30 or even 45 if saliva is decreased

why is sucrose especially cariogenic

oral bacterial use glycosidic bonds in sucrose to synthesize glycans in biofilms, this ferments to lactate (lowers pH), biofilm won’t form without sucrose

hereditary fructose intolerance

rare genetic mutation in aldolase enzyme in glycolysis, these patients have low caries risk because they are unable to consum as much sugar

hopewood study

compared childrens diets in community vs group home, children on diet lacking redined carbs had less caries than children with high refined carbs

vipeholm study

dotted line = sugar during meal, solid line = sugar between meals, sugar between meals has greater impact (steeper slope) suggesting that saliva is an important buffer for meals, and the type of sugar (such as sucrose) may not be as important as the modality of how its eaten

there is _____ but _____ association between dietary sugar and caries

moderate but convincing

elderly patients with root caries consume ____ times the sugary liquids and _____ more cakes and cookies than a healthy group

2x as much sugary liquids and 50% more cakes and cookies

diet sodas contain

citric and phosphoric acid

saliva secretions during sleep

decrease, suggests non-sugary snacks before bed encourage oral hygiene to remove plaque, also consider baby bottle tooth decay

sweet score

considers liquid, solid/sticky, and slowly dissolving foods along with frequency to give patients a ‘caries risk’ score

starch

polysaccharide, amylose, amylopectin

insoluble fiber

polysaccharide, cellulose, wheat bran, cereals, fruits/veggies, constipation, cancer prevention by intestinal motility stimulation

soluble fiber

polysaccharides, gums, pectin, legumes, oat bran, fruit, aids in satiety, stabilizes blood sugar by delaying stomach emptying

unbranched

fiber, cellulose, indigestible, decrease transit time through large intestines

branched

starch, amylopectin, glycogen, fuel storage, hydrolyzed during digestion then reassembled as more highly branched glycogen storage

types of sugars in diet we want to limit most

added sugars and refined sugars

while sucrose is the most cariogenic, ____ prevents caries

xylitol

sweetener effectiveness?

they may reduce calorie intake and aid in weight management in short term, but not conclusive long term

what percent of daily calories is from added sugars?

13%

trend in added sugar over 20 years

had decreased but still remains high

minimal CHO/day for brain activity

130g/day

acceptable macronutrient range for CHO

45-65% of kcals <10% added sugars (AHA says 5%)

zinc inadequacies

80% of women with 35%+ sugar intake had zinc deficiencies

what age range is worst effected by added sugars

14-18

children who have high sugar intakes have low ___ intake

Calcium

recommended fruit juice for children under 1 year

none

__% of americans have diets deficient in fruits and vegetables

75%

__% of americans have diets that exceed limit of added sugars

63%

at least _____% of grains should be whole grains

50%, currently this is only 13% for americans

protein recommendations

.8g/kg or 10-35% (whichever is higher), additional needed for pregnancy, lactation, children, older, body builders (loss in sweat)

essential AAs

lysine (NH2 vegans add legumes), threonine (OH), tryptophan (2 rings), histidine (ring+N), branched: luecine, isoleucine, valine. phenylalanine (ring), tyrosine (ring+OH), methionine + cysteine (sulfur, limiting in US, highest in eggs)

average 150lbs person calories, protein and oz of meat per day

2500 calories, 60 grams of protein, 8oz of meat

grains can have proteins

between 3 grams up to 8 grams/2 slices of whole wheat bread

males and females with protein recommendations

males typically get excess, females get too little, both groups need more diverse sources of proteins

whole grains

bulk up protein intake

body mass the same with 2.4 or .8kg/day but had strain on kidneys

tour defrance level atheletes required

1.5g protein/day

vegans and protein

complete protein can be obtained from legumes and nuts, legumes also supply Fe and Ca. difficult to get adequeate calories however

anorexia

semi-starvation state, 5-20% mortality, one of most common deaths of mental health disorders

kwashiorkor

estimated 1/3 of children under 5 in developing world were malnourished, food/protein introduced slowly, physically support head

protein stores

skeletal muscle (40%), actin myosin collagen, functional proteins: Hb, enzymes, hormones, structural, antibodies, lose functional proteins first after a few days of low protein diet, no evidence of protein stores

dietary protein micronutrients

B D E vitamins, selenium, zinc, copper, heme iron, essential FAs

protein conservation during starvation

during low protein intake 90% of AAs are recycled, host-colon nitrogen fixing via ammonia bacteria in gut allow reabsorption, 11-15g N2 excreted as urea/day with 70-100grams of protein/day

dental symptoms of anorexia

atrophy of mucosa and parotid ducts, xerostomia, swollen salivary glands

severe acute malnutrition

3 standard deviations below weight, 30-50% greater mortalitly rate, need therapeutic diet, if no appetite and medicaly complications require hospitalizations

oral mucosa cell turnover

3-7 days, makes them sensitive indicator of nutrient status

nutrients needed to maitain oral mucosa

B-complex, A vitamins and zinc = eat leafy greens, whole grains, shellfish, good protein sources too!

nutrients needed for immunity

vitamin C (citrus, red peppers), vitamin E (nuts, seeds, oils, whole grains), zinc (red meats, whole grains, shellfish)

maintenance of elasitn and collagen in oral cavity

matrix of dentin, cementum, bone, PDL, hydroxyproline 10-15% of AAs in collagen (crosslink stability)

nutrients needed for collagen and elastin synthesis

protein (40% decrease when fasting), energy, vitamin C for hydroxyproline crosslinking collagen

fats are more reduced/oxidized than carbs and are attached to glycerol via ___ linkages

more reduced and attached via ester linkages

carb reserves last , fat reserves last ___

carbs last a day, fat lasts 1-3 months

in nature FAs usually contain ___ number of carbons, if unsaturated the double bond is usually in the ___ position

an even number, double bond in cis position if unsaturated

types of oils

fish: linolenate 18:3 or w-3 (3 doubled bonds), coconut, butter (saturated), olive: oleic 18:1

essential fatty acids in diet

linoleate 18:2 cis/w-6: safflower or corn oil, linolenate 18:3 cis w-3 canola or soybean

dietary cholesterol and statin drugs inhibit ____

HMG CoA reductase translation, this is acetyl CoA to mevonate commited step for cholesterol synthesis

limit cholesterol to

300mg/day

fat percentages breakdown of diet

total fat should be 20-35% (true intake is 40%), saturated should be 10%, trans fat should be 0%

HDLs

protects against artherosclerosis, they remove cholesterol from macrophges, preventing them from becoming foam cells and plaque forming in arteries

cholesterol synthesis can be blocked by

statins, potent inhibitors of HMG CoA reductase

familial hypercholesterolemia

genetic defect in receptors for uptake of LDL

% reduction in blood cholesterol reduces risk of heart attack by __%

1% less blood cholesterol reduces heart attack by 2%

healthy eating for heart disease

fish, complex carbs (pasta, potatoes, legumes), less cholesterol, meat and cheese as side dishes

best fats for lowering blood pressure and triglycerides

omega-3 in the form of DHA and EPA: fish, flax, walnuts, soybeans, canola

trans fats

partially hydrogenated, raise LDLs cholesterol, and decrease ‘good’ HDL cholesterol, there is no recommended amount because any amount is harmful, margarine, shortening, fast food, processed food

dental caries is ___, ___, ___, ___, ___

preventable, communicable, localized, chronic multifactorial infection

dental caries, acute or chronic?

chronic, most common chronic infectious disease of childhood, 5x more than asthma, 7x more than hay fever

dental caries, infectious

both infectious and communicable, can be transferred vertically and horizontally, direct or indirect, and can occur from birth

multifactorial factors of caries

bacteria, fermentable carbs, tooth surface

caries prevalence in kids

lowest in 2-5 age group (20%) but doubles to 50% in 6-19 age group. roughly 10-20% is untreated caries

caries by race

hispanic > black > asian > white

early childhood caries defined as

presence of one or mored decayed (cavitated or noncavitated), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months old or younger. SEVERE score is their number of lesions being 1 greater than their age (ex: 4+ lesions in a 3 year old)

characteristics of early childhood caries

distinc pattern, may affect many teeth, rapid development, can develop on surfaces typically low risk

implications of early childhood caries

higher risk of future caries, usually expensive and requires general anesthesia, associated with malnutrition, missed school, poor sleep

bottle associated caries presentation pattern

liquid pools around maxillary incisors and primary first molars, tongue protects mandibular incisors

why is caries progression more rapid in primary teeth

lower mineral content, thinner enamel and dentin layers, larger pulp chambers, flat proximal contacts compared to point contacts of adult teeth make diagnosis difficult

old treatment theory for caries

it was considered unavoidable, so the goal was to supress infection for as long as possible, 3 years was considered okay to come to dentist, but in reality this was too late, these kids were already experiencing pain and caires

modern goal of dental caries management

minimize lifelong caries while using the least invasive intervention, consistent with level of risk

why do caries allow us to take medical approach

its site specific, external interface with disease, biphase symmetric expression of disease, steady state phenomenon, variable expression, behavior dependent infectious disease

3 step strategy for dental caries management

determine caries experience, estimate risk of future caries, develop plan to address current problems and prevent future ones

when should we start education about caries

at conception, pregnancy education about oral health of baby, vertical transmission, proper nutrition, age 1 dental visit. very important to reduce S. mutans in mothers mouth via hygiene, xylitol, chlorhexidine

caries risk assessment, what it is and isn’t

it is: an evaluation of presence and intensity of factors that provides estimation of susceptibility and targets preventative strategies, it isn’t actually a diagnosis or treatment

anticipatory guidance

counseling that focuses on childs needs at each stage of life

age 1 dental visit information should include

first tooth at 6 months, eruptions complete at 2 years, feeding behaviors, oral hygiene, fluoride, sucking habits, injuring prevention

what is pressure threshold for translating maxillary canines

78KPa or 360 cN, this provides sufficient force but prevents out stripping of constraints and distopalatal rotation

does higher stress mean faster tooth movement

between 26-53 kPa yes (120-240cN), above this it does not make much difference

measurement of biomarkers in crevicular fluid in tooth movement study

they measured IL-1b and IL1RA which is its counter part receptor that deactivates it, they found linear relationship between activity of IL-1 and speed of tooth movement

Allele 1 and 2 with IL-1B secretion

patients with at least one copy of allele 2 had much more IL-1B and corresponding receptor secretion in crevicular fluid than homozygous allele 1 patients. patients with at least one copy of allele 2 also showed increased speed of tooth movement

a-linolenic acid, linolenate, 18:3(n-3) or omega-3 (PUFA)

linoleic acid, linoleate, 18:2(n-6) or omega-6 (PUFA)

PUFA

poly unsaturated fatty acid, membranes, gray matter, retina, chemical messengers for inflammation, linolenate and linoleate (omega 3+6 or essential fatty acids)

curing osteoporosis + calcium supplements

there is not curing osteoporosis once you’re old you can only prevent it in teenage female patients by making sure adequate calcium is included in diet

calcium makes up _% of total body weight

1.5%

major minerals

magnesium, chloride, sodium, potassium, phosphorus

trace minerals

iodine, copper, manganese, zinc, fluorine, selenium, iron

roles of Ca

99% of Ca is in bones, also used in muscle contraction, enzymes, and blood coagulation in plasma

mineralization of bone

collagen matrix, osteoblasts lay down CaPO4 in amorphous mass, combines with amino acids into apatite, growth and crystallization displaces fluids

mineralization of teeth

osteoblasts release Ca and PO4 ions, minerals deposit ponto collagen matrix, nucleation occurs, crystals form and displace fluid, enamel mineralization and matrix forms at same time, involves phosphoproteins in nucleation, very little matrix remains

calcium input and output

1gram a day, most filtered through kidneys is reabsorbed, bone calcium is also highly dynamic. only about 1/3 of dietary Ca is absorbed however