Module 1 Periodontium, saliva, caries

What are the three types of oral mucosa?

Lining mucosa: Soft and stretchy

Masticatory: Rubbery, reisistant firm

Specialized: different from the norm

Describe oral epilithelium and it’s keratinization characteristics

• Stratiified squamous epithelium (can regenearate)

• can be keritinized (tough, resistant) or non-keritinized (capable of building keratin)

What structures make up the periodontium

• Alveolar bone

• Cementum

• Periodontal ligament

• Gingiva ( Free, attached, Sulcus, epithhelial attachement (EA)

Describe the Alveolar bone

• supportive bone of the teeth

• Is made of corticol and cancellous bone

• Is 1-2mm inferior/apical to the CEJ

• can resorb

Describe the Cementum 

• is the attachment for the PDL 

• Is protected by the PDL

Describe the Periodontal Ligament

• Is a fibrous connective tissue

• Sharpeys fibers connect the cementum to the alveolar bone

Describe the gingiva

Includes

• Free (marginal gingiva, interdental papilla) and attached gingiva (attached to the alveolar bone extends up the the mucojingival junction)

• Epithelial attachment ( the floor of the sulcus that attaches the gingiva to the tooth)

• Sulcus: is 1-3mm in health

Describe some characteristics of normal gingiva

• PINK

• Firm

• Stippled

• No bleeding

What are the types of Soft Deposits (dental deposits)

• Pellicle

• Materia alba

• Food Debris

• Plaque/ Biofilm

Describe pellicle

• easy forming

• Thin and clear

• made of Glycoproteins

• Becomes the attachment for plaque/biofilm

• Is removed after polishing

Describe biofilm/plaque

• microbial biofilm that adheres to tooth surfaces (80% are microbes)

• forms on areas that are least cleansed

• ARE THE BACTERIAL SOURCE OF ORAL DISEASES

• The more developed and mature they become the more anaerobic they become

• Is removed via mechanical action

Describe materia alba

• are loosely attached masses

• Forms on top of plaque (is a mixture of food debris and sloughing or epithelial cells)

describe the Hard deposit of calculus (inc: supra and sub)

• Is the mineralization of biofilm by calcium and phosphate in saliva

• Is firmly attached to tooth

• Encourages biofilm retention (is not responsible for disease) and complicated oral hygiene

• Can form Supragingival ( On the tooth surface) or Subgingivally ( Forms on root often on unhealthy teeth, require instruments to be removed. 

Describe Gingivitis (what is it? Symp, cause, Tx)

• Inflammation of the gum tissue (90% of adults have it and is reversible)

• Symp: Redness (erythma) Swelling (edema)

• Cause: biofilm/plaque or trauma

• TX: remove irritants, good OH

Describe Periodontitis

• Symp: loss of bone support, Inflammation, migration of EA, perio pocketing, bleeding and pus when probing

• Cause: subgingival microorganisms

• DX; X-rays or probing

• TX: root planing, surgery, RX, OH

Decribe the advanced periodontal disease of Necrotizing Ulcerative Gingivitis (NUG)

• Rapid onset, Painful gingivitis caused by STRESS

Describe the Parotid salivary gland

• largest ( in front below the ear)

• Stensons duct 

• produces 20-25% of saliva

Describe the submandibular glands

• inside the posterior of the mandible

• wharton’s duct (under the tongue)

• Produces 60-65%

Describe the sublingual glands

• Beneath the tongue

• Bartholin ducts

• Produces 101-15% saliva 

What are the three main functions of Saliva?

Physical

Antibacterial

Chemical

Describe the Physical function of saliva

• Lubricates

• aids in digestion (moistens bolus)

Describe the Antibacterial function of saliva

• as glycoprotins that trap bacteria

• Has immunoglobulins that stop the growth of and kill bacteria

describe the chemical function of saliva

• buffers with bicarbonate

• Neutralizes the oral environment thus decreasing the amount of decay

• Mineral protect the teeth from acid

• Enzymes in the salivaWhat are some gener break down food

What are some general saliva facts

• 99% water

• Is neutral pH: 6.8-7.2

• We make abt 2-3 pints a day of saliva

Describe Xerostomia ( What, cause, effects)

• Dry mouth (less saliva than normal)

• Cause: Diabetes, medication, radiation

• Effects: higher caries/decay

Describe the dentino-enamel junction

• dentinal tubules pass through the surface of the dentin

• The fluid in dentin what experiences sensitivity when exposed

Describe the functions of the pulp

• Nourishment and support of the dentin

• The defense system of the tooth

• Identifies the temperature and bacterial changes

Briefly describe Dental caries

• disease of tooth structure due to demineralization

• is the most prevalent childhood disease

• Is infectious( the bacteria is aquired and not naturally occruing)

Describe demineralization and remineralization and how it relates to dental caries

De: Loss of phosphate and calcium from tooth into saliva 

Re: deposit of phosphate, calcium and fluoride into tooth from saliva

When DE exceeds RE caries occurs

Dental caries CANNOT occur in the absence of?

• Biofilm (bacteria)

• Tooth surface (host)

• Carbohydrates ( nutrition of bacteria)

• Time

What is the Dental decay equation?

Sugar + plaque = Acid + tooth = decay

Describe in general the development of caries?

1) Cariogenic foods (carbohydrates taken into biofilm)

2) Dental Biofilm ( After eating the pH of biofilm drops)

3) Acid formation ( forms immediantly and due to frequent exposures to acid)

4)Demineralization (Caries process is initiated and minerals are drawn out by the tooth leaving a white lesion.

What are the caries causing bacteria?

• Mutans Streptococci:  enamel caries

• Lactobacilli: root caries

Not normal flora (gets transmitted)

What is CAMBRA?

Caries Management by Risk Assesment ( asseses a patients risk and protective habits

What are the pathological factors for dental caries risk?

• Visible biofim

• frequent meal snacking

• Deep pits and fissures

• inadequate saliva flow

• drug use

What are the the caries protective factors?

• Living in a fluoridated community

• using fluoride toothpaste and mouthrinse

• adequate saliva flow

Describe incipient caries (severity)

• early stage of caries

• can be stopped/reversed

• no cavitation (does not go through the enamel)

Describe Frank caries (severity)

• cavitation into enamel

• may have a color change

Describe advancing caries (Severity)

• caries have gone into the dentin

• will appear darker brown

describe pulpal caries (severity)

• abscess

• pain

Describe rampant caries (severity)

are rapid and generalized

Describe smooth surface caries (location)

• caries in the smooth enamel surfaces (mesial, buccal, lingual, distal)

Describe pit and fissure caries 

• are in developmental grooves and pits

Describe secondary caries and root caries (location)

Secondary: reccurent caries/ adjacent to an existing resoration

Root caries: on exposed root surfaces

What is the definition of early childhood caries ECC

The presence of 1 or more decayed, missing, or filled tooth surfaces in a primary tooth in a child of the age of 6 and under

Define Severe ECC

The sign of any caries during the first 3 years of age

What are some consequences of ECC?

• high risk for new caries

• pain and infection

• loss of school days

• increased treatment costs

• insuficiant physical development

• decreased self esteem

What can be done to prevent ECC

• educate parents on not to share the same spoon

• teach parents to properly teach their kids to brush and floss their teeth

• Take kids for their cleanings and fluoride application 9school, community etc)

What is the purpose of the plaque index

• provide an indivudual assesment to help the patient recognize the state of their oral health

• Asseses the effectiveness of the patient oral hygiene practices

• Provides a good visual aid

What is the purpose of the PHP

asess the extent of biofilm and debris present on the tooth surfaces

Can also provide motivation the patients

A disclosing agent is used

How is PHP done and calculated

• diclosing agent added

• Teeth surfaces of Facial: 3, 8, 24, 14 and Lingual 19 and 30

• The score of each tooth is determined from how much plaque is found on five surfaces of the tooth 

• Then add up all of the individual toooth scores and divide them by 6 (the total ammount of teeth examined)

What are the ranges of PHP scores?

0= excellent

0.1-1.7= good

1.8- 3.4= fair

3.5-5.0= poor