Quiz 3: Caries Management, Biofilm, stain, calc, chemical agents

When and where was CAMBRA developed?

What does it focus on preventing?

Early 2000 at UCSF

Focuses on preventing/arresting caries

CAMBRA:

What are the disease factors?

What are the protective factors?

Disease Factors:

Bacteria, plaque, snacking, and saliva quality and quantity

Protective Factors:

Fluoride, antimicrobial rinses, good saliva

Describe Caries in order

1. Sugars, acidogenic bacteria, susceptible host

2. Acids produced by bacteria

3. Acids accumulate and lower pH

4. Demineralization

5. Remin/demin cycle

What is the primary goal of oral hygiene intervention?

Re-establish mineralization balance

What are sealants?

Resin material placed into pits and fissures of teeth at risk for caries.

What does acid etch do in sealants?

Creates a mechanical bond to tooth surfaces

How do sealants work?

Create a physical barrier between the bacteria and the susceptible pit and fissure surfaces of the tooth

What are contraindications for sealants?

Allergies to sealant material

Caries that extend into the dentin

Partial tooth eruption

Shallow or fused fissures

Proximal caries (cannot be used)

What does topical fluoride do?

Strengthens teeth already present in mouth

Inhibit demineralization

Enhance remineralization

Inhibit biofilm formation

What is the chemical and biological functions of fluoride?

Chemical: Enamel solubility decreases by the incorporation of fluoride ions

Biologic: Enamel is more resistant to carious dissolution

What does systemic fluoride do? What is ideal community water fluoridation?

Incorporates into the formation of tooth structure

Ideal 0.7ppm

Excess fluoride during tooth development can result in what?

What would it look like?

Fluorosis

White spots on enamel

What is the pH of APF?

What % of fluoride is in APF gels/foams?

pH of 3.5 (allows faster Fl uptake into tooth)

1.23% fluoride

What are the advantages and contraindications to APF?

Advantage: pH allows for faster uptake of FL into tooth

Contraindications: Can stain or etch Ceramic/composite restorations

What are the advantages of Sodium Flouride (NaF)?

Chemically stable

Tastes acceptable

Minimal side effects

Does not irritate gums

What are the advantages and disadvantages of stannous fluoride?

Advantage:

Relieve sensitivity

Reduce calculus formation

Disadvantage:

Staining can occur with tannins (tea, coffee, wine)

What topical fluoride forms fluoride salts on the surface of the teeth?

Sodium Fluoride (NaF)

What does SDF contain to promote remineralization?

Silver and Fluoride

What happens to carious tooth structure after SDF application?

Tooth stained black (due to silver oxide)

What is the main antimicrobial component of SDF?

silver antimicrobial

(limits reinvasion of cariogenic bacteria)

What remineralization agent contains calcium and phosphate ions?

(ACP)

Amorphous Calcium Phosphate

What remineralization agent contains bioactive glass therapy?

(CSP)

Calcium Sodium Phosphosilicate

What remineralization agent enhances fluoride remineralization?

(TCP)

Tricalcium phosphate

What remineralization agent is a fluoride-free enamel alternative?

(nHA)

Nano-hydroxyapatite

What fluoride product is beneficial for gingival health?

SnF2 (stannous fluoride)

How often in a day is xylitol recommended for effectiveness?

What is the needed concentration?

4 times a day at more than 10%

What is the mechanism of Xylitol?

Cariogenic bacteria are unable to metabolize sugar alcohols so decreases amount of s. mutans in biofilm and saliva

Which bacterium is strongly associated with dental caries?

S. Mutans

Which fluoride product is contraindicated on porcelain restorations?

APF

Which caries prevention agent is no longer recommended specifically for caries prevention?

Chlorhexidine Gluconate

What is an example of high potency, low frequency fluoride?

(professionally applied in office)

APF

Fluoride varnish

SDF

What is an example of low potency, high frequency fluoride?

(Self Applied)

APF

Stannous flouride

Toothpaste with sodium

What are the two types of stain? State levels and examples

Intrinsic: Discoloration within tooth, cannot be altered

Endogenous- during development (fluorosis)

Exogenous-outside sources (tetracycline, trauma)

Extrinsic: Discoloration on outside from external factors

(tea, coffee, red wine, colas, tobacco)

What are the stages of polymicrobial biofilm formation?

1. Initial attachment (pellicle)

2. Irreversible attachment (bacteria to pellicle)

3. Maturation I (initial colonization)

4. Maturation II (colony formation)

5. Dispersion (subgingival biofilms)

Supragingival Plaque Formation

Diet and Saliva

Sucrose plaque formation and adherence

Lowers plaque pH = increased risk for caries

Soft foods tend to encourage plaque retention

What is the composition of plaque biofilm?

- 80%

water and extracellular matrix

- 20%

organic solids (CHO, PRO) and inorganic solids (Ca, P, Mg, Fl)

What is materia alba? What is it made of?

Biofilm different from plaque in strength and adherence

Made of: Living and dead bacteria, sloughed epithelial cells, salivary proteins, food debris

Easily removed by rinsing

What is calculus?

Calcium and phosphate salts deposited into biofilm from saliva and crevicular fluids

Covered with non-mineralized biofilm later containing active bacteria

What is the composition of mature calculus?

70-90% Inorganic (2/3 hydroxyapetite)

10-30% organic and water

What are the three steps in calculus formation?

1. Pellicle Formation (Acellular, from saliva)

2. Biofilm formation (colonies form)

3. Mineralization (24-72 hours)

What are the common forms of calculus?

Rings: Encircles buccal and lingual

Spicules: small pointed pieces at M or D line angle

Ledges: Subgingival shelves parallel to CEJ

Veener: Sheet/coating

What is the function of prophylactic paste? What does it contain?

Cleansing: Exogenous stain, pellicle and materia alba

Polishing: Smooth surface of restorations w/o etching

Contains abrasives often pumice

How does the FDA define a cosmetic drug?

Applied to human body to cleanse, beautify or promote attractiveness or appearance

How does the FDA define a therapeutic drug?

Use for diagnosis, cure, mitigation, treatment, disease prevention, affect structures of the body

What does the FDA regulate for therapeutic monographs of dentifrices? What are their current statuses?

1. Anticaries (FM=Final)

2. Anti-plaque/anti-gingivitis (TFM= tentative final)

3. Tooth Desensitizer (ANPR= advanced notice of proposed rulemaking)

What is the dentifrice monograph?

FDA published document stating active ingredients and requirements for marketing products

Includes parameters like intended use, dosage, drug interactions

What are the active ingredients in anti-caries therapeutic dentifrices?

1. Sodium Fluoride

2. Sodium Monofluorophosphate

3. Stannous Fluoride

Xylitol and ACP

What are the active ingredients in anti-plaque/gingivitis therapeutic dentifrices?

1. Stannous Fluoride

2. Triclosan (recently removed due to negative outcomes)

What are the active ingredients in dental hypersensitivity therapeutic dentifrices?

1. Stannous Fluoride

2. Potassium Nitrate

What is Neutral sodium mechanism?

1. Sodium Fluoride (forms Fl salts)

2. Sodium Monofluorophosphate

Forms fluoride salts on surface of teeth and binds to calcium ions in hydroxyapatite to resist acids

What is the mechanism of stannous flouride?

Forms a stable acid resistant layer converting calcium mineral

Tin and fluoride mediate anti-erosive actions by interacting with salivary proteins

What is the dosage and frequency of toothpaste based on age?

Adults: pea size twice daily for 2 min

Children above 3: pea size twice daily for 2 min

Children under 3: Smear of rice