Cariology 4

What is caries risk?

The probability that an individual will develop __ lesions, reaching a given stage of the _ progression, during a specific period of time

conditional on the __ of the his risk remaining stable during this time

carious, disease

factors

the most important activity in which we engage will be determining an individual’s __ that their current ? ? will result in formation of cavities requiring ?

__ _ most important diagnosis

risk, oral environment, restoration

risk determination

factors contributing to disease are dependent on ? (3)

dose, frequency, duration

Factors considered in the estimation of caries risk:

immediately involved in caries: __ + _ mechanisms

Those related to occurrence of cavities:

__ factors, _ factors, past ? experience

attack and defense

educational, socioeconomic factors, caries

2 attack mechanisms are ?

bacteria and fermentable carbohydrates

Mutants __ considered initiators of caries process

• __genic

• __uric

• Produce ___ substances (glycans and fructans) to assist in _ to tooth

• Produce substances that act as __ towards other strains, enabling _ in the flora

• Are capable of ___ _ and ?

streptococcus, acid, acid, extracellular, adherence, antibiotics, dominance, quorum sensing, competence

Attack: Dose

• high levels of mutants streptococci increase __ _

• By itself is/is not a good predictor of caries risk

• Low levels of mutants streptoocci are/are not a good predictor of future cavity avoidance

caries risk, is not, are

Bacteria: Frequency/Duration

Infrequent oral hygiene results in maturation of the __, which may then become more efficient at creating _

Frequent good plaque __ reduces ability of plaque to effeciently produce _, resulting in lower risk of ?

plaque, acid

removal, acid, caries

___:

• appears to rely on other strains to initiate lesion, then contributes to the __ of the lesion

• __genic

• __uric

• Acts as a yard stick for __ _ (larger numbers in individuals with frequent consumption)

lactobacillus

progression

acidogenic

acid

sugar consumption

Fermentable carbohydrates: attack mechanism

Associated with cavities more often than other sugars found in nature is ___

• Complex carb consists of __ + _

• Prime sugar contributing to formation of __ + _ which streptococcus uses to ? to the tooth

sucrose

glucose and fructose

glucans and fructans, adhere

Fermentable Carbohydrates: __

• Complex carb consisting of repeating __ molecules

• Contributes to the __ of _ which streptococcus utlizes to ? to the tooth

starch

glucose

formation glucans adhere

Fermentable Carbs: attack mechanism: Other sugars

__: fruits and veggies

• contributes to the formation of __ (similar to glucans) and does/does not seem to significantly increase cariogenicity

• __ cariogenicity

__: milk: _ cariogenicity

fructans

fructans, does not, moderate

lactose, low

Fermentable carbohydates: attack mechanisms, DOSE

• Does not take much __ to cause sig reduction in plaque _

• Within 5 mins, __% sucrose solution will cause the plaque pH to fall from neutral to ?

• Highly cariogenic plaque and low cariogenic plaque reduce pH by approx ?

• Low cariogenic plaque returns to neutral pH ?

• Additional sugar __ ? make the pH fall any lower but does increase the __ time of the sugar

sucrose, pH, 10, acidic (4-5), by the same amount, faster than high, does not, clearance

Ferementable carb: frequency/duration

_ sugar consumption results in frequent pH drops to ?

the longer the patient maintains an __ environment, the more _ of the tooth structure occurs

frequent, 4.5

acidic, dissolution

Defense Mechanisms:

Saliva __

• saliva contains numerous __ systems and water than can _ the acivity of the acids

• __ systems help to increase the _ back to near neutral levels

• __ in saliva helps to dilute the acids

• __ + _ components act to stabilize the ? equilibrium and decrease ? of the enamel

Components

buffer, counteract, buffer, pH, water, calcium, phosphate, enamel, dissolution

Defense Mechanisms: salivary components

• Stimulated saliva causing by what 3 stimulations, increases the amount of __ in the saliva

• __ contributes _ to the equilibrium equation and reduces the ? of the enamel crystal

chewing (maticatory), smelling (olfaction), taste (gustatory), bicarbonate

Bicarbonate, OH-, solubility

Defense Mechanisms:

Recent research suggests that the __ of certain salivary _ in saliva has an influence on cavity rates

proportion, proteins

Salivary Components: Defense mechanisms: Reduced salivary flow

• Multiple medications result in reduction of salivary flow: increasing ?

• __ injury to salivary glands will irreversibily reduce salivary _ + ?

• __ reduces salivary flow: nocturnal feedings _ the risk of cavities

caries risk, radiation, flow and composition, sleeping, increase

Defense Mech: salivary comp: Dose

• If you can increase the __ of saliva, you can increase effectivness

• If you can increase amount of __ + _ in saliva, you can decrease the solubility of the apatite mineral, which is the ? effect

• Higher __ in _ saliva

amount, Ca2+ (calcium), PO4 (phosphate), common ion, bicarbonate, stimulated

salivary components: frequency/duration

• The more __ you improve the salivary _ and ?, the lower the caries risk

• __ salivary flow while _ causes nocturnal feedings to be more damaging to teeth because of the loss of salivary protective ?

frequently, flow, composition

Reduced, sleeping, factors

Defense Mechanisms: Fluoride:

• There is __ fluoride in enamel when tooth first erupts into mouth

• The __ of hydroxyfluroapatite is lower than hydroxyapatite

• Thus, when a small amount of fluoride is present in the saliva and plaque, the solution will be considered __, with respect to _, and this mineral will form in prefence to what?

little, KSP, supersaturated, hydroxyfluroapatite, hydroxyapatite

Defense: Fluoride: Dose

• Greater concentrations of fluoride cause an increase in the __ of the solution, resulting in a greater _

• For children under the age of ?, excess fluoride can be swallowed and result in _ (hypomineralization of enamel caused by fluoride’s effect on ?)

• Current controversies on the effects of low concentrations of fluoride on bone __ + _

supersaturation, effect, 10, fluorosis, ameloblasts, strength, brittleness

Fluoride Frequency/Duration:

• The more __ addition of fluoride to saliva maintains the superaturation of saliva is respect to __, so more is formed

• the __ fluoride is present, the same above occurs

• Frequent low doses of fluoride have a __ effect on increasing the amount of hydroxyapatite formation than large, _ doses

Frequent, hydroxyfluorapatite

longer

greater, infrequent

Indirect factors: (5)

Socioencomic status, gingivitis, orthodontic/prosthetic appliances, tooth anatomy/hypoplastic teeth, special health care needs

Indirect factors: Socioeconomic status:

studies demonstrate inverse relationship in caries, decayed, missing, filled teeth and socioeconomic status. Only a __: not an actual correlation, thus socioeconimic status is only a _ indicator that can be offset by other factors

relationship, initial

Indirect factors: Gingivitis

Organisms responsible for gingivitis are/are not normally responsible for caries

Presence of gingivitis is an indication of poor or infrequent oral hygiene practices that increases ?

are not

risk of caries

Indirect Factors: Orthodontic/prosthetic appliances

Includes both fixed but not removable applicances: T/F?

Also, space maintainers, other devices that remain in mouth continuosly or for prolonged periods of time and which may trap __ + _, prevent oral hygiene, or compromise access to fluoride to the teeth

F: both

plaque and food materials

Indirect factors: Tooth anatomy/Hypoplastic teeth

Poorly formed __, developmental pits, and _ pits may predispose teeth to caries

enamel, deep

Indirect factors: Special health care needs:

Have or are at increased risk for chronic, physical, developmental, behavioral, or emotional condition and who also require health related services of a type or amount beyond that required by __ generally

children

View of role of dentist is changing

• Historically: first step is to __ the teeth and then provide _ on hygiene and diet control and trust that the patient will follow through and act on advice

• being challenged in courts of law

• Argument is similar to __ issues

  • Example: ___

restore, instruction

medical, streptococcus pyogenes

Clinically:

• dentist is being held more responsible for __ high risk individuals and _ treatment to address pathologic organisms responsible for disease

diagnosing, targeting

View of dentist changing:

• Currently: dentists needs to identify those at __, inform them of the cause of their disease, and provide treatment options that address the _ and habits causing the disease

• THEN __ those teeth cannot be treated non-surgically and those that do not respond to _ treatment methods (weird sentence but from slides)

high risk, bacteria

restore, non-surgical

Non-Surgical Caries management:

Addressing __

These next 3 below are what dentistry has been doing historically but not effectively

• Appropriate __ _ by the patient

• Appropriate use of topical __ (right dose and _)

• Appropriate __ (_ and frequency)

NEW:

• Alteration of the __ _ of the ? by appropriate measures

bacteria

• Oral hygiene

• Fluorides, frequency

• Diet, content

Bacterial content, biofilm

Appropriate measures by which we can alter bacterial content of biofilm (5)

antibacterial mouthwashes, xylitol, fluoride, amorphous calcium phosphate, possible future aids

Antimicrobial Mouthwashes:

• Determine S mutans __ with culturing techniques

  • If greater than ___ colony forming units (cfu) then…

  • Prescribe __ __ 0.12% QD or BID x for ? days

  • __ s mutans to ensure bacterial response

  • __ if insufficient reduction in ?

  • Repeat this prescription q __ months as determining by bacterial culturing

  • Once you have __ consecutive bacterial cultures with low (_) cfu, prescription can be stopped

  • Repeat culturing as clinically indicated

load, 1,000,000, chlorhexidine gluconate, 14 days, reculture, repeat, cfu, 3-6, 2, less than 100,000

Xlyitol:

• If or once cfu are below 1,000,000 bacterial control may be controlled with __ products

• Appropriate use of xylitol includes __ grams/day in _ divided doses

• Multiple forms available (_, candies, sprays, ?)

• Compliance can be __

xylitol, 5-10, 3-5, gums, gels, difficult

The most effective non-surgical method of reducing caries risk is ? for over the age of?

high dose topical fluorides, 10

Fluoride content calculation:

• 1 part per million (ppm) = 1 mg _/liter water (wt/vol)

• By definition, a 1% solution has __ ppm

• Look for the __ listed on the ingredients of fluoride containing product

• Calculate the ppm of the product

  • 0.14% w/v fluoride: __ ppm of fluoride

  • 0.15% w/v fluoride: __ ppm of fluoride

Fl-, 10,000, wt/vol%, 1400, 1500

Prevident 5000 has __ ppm of flurodie

use of gels/pastes with high fluoride in trays overnight or prior to bedtime reduces caries risk by increasing the __ of the tooth mineral from dissolution

5000, resistance

Fluoride Varnish

• Fluoride varnishes have ___ ppm of fluoride, but the volume used is so small that there is no __ if swallowed

• Ideal for use with __ at high caries risk

• Fluoride can be released over period of __ hours

• Can/cannot eat and drink immediately after placement (either way, especially avoid __)

• __times per year very effective

• ___% better caries reductions as compared to other __ fluoride applications

22,500, toxic dose, children, 4-6, can, hot liquids, 2-3, 14%, in-office

Silver Diamine Fluoride:

• reportedly has ___ caries fraction reduction

• Turns __ structure _

• Arrests the _ for a significant amount of time (greater than ? months)

• Greatly reduces the risk of __ _

• __ _ has significant ? properties

70-80%, deminerlized, black, decay, 6, future demineralization, silver ion, antimicrobial

Potential future means to control bacterial content:

__ root

• Specific chemical isolated has excellent __ activity against S mutans _

• One study demonstrated reduced S mutants after __ weeks of _ use a day

• Was available in __ but discontinued

licorice, antimicrobial, in vitro, 3, 2x, lollipops

Potential future means to control bacterial content: ___ bombs

• __ __ (or similar compound) against s mutans _, conjugated with ? agent

• Good __ results

smart, monoclonal antibodies, specifically, bacteriocidal, in vitro

Potential future means to control bacterial content:

• __ interference

quorum sensing