Caridology
CARIOLOGY FLASHCARDS
ENAMEL PROPERTIES
Q: What percentage of enamel is inorganic material? A: 96% - composed of calcium hydroxyapatite
Q: What percentage of enamel is organic material? A: 1% - composed of amelogenin (a lace-like network)
Q: How are enamel crystals organized? A: Crystal oriented in a complex 3-D pattern
ENAMEL FORMATION
Q: When does enamel formation begin? A: In the late bell stage
Q: What cells produce enamel? A: Ameloblasts
Q: What proteins are found in the enamel matrix? A: Amelogenins and enamelins
Q: What is the Tomes process? A: Secretory processes of ameloblasts that deposit enamel in tightly packed masses of hydroxyapatite crystals (enamel rods)
Q: What is the shape of enamel rods? A: 6-sided pyramidal shape creating a microscopic prism-shaped pattern
Q: Are Tomes processes left behind in calcified tissue? A: No, they are not left behind or embedded in the calcified tissue
Q: Can enamel grow after formation? A: No - enamel does not have vital cells and is incapable of tissue growth
Q: What trace minerals are found in enamel? A: Strontium, magnesium, lead, and fluoride
DENTIN FORMATION
Q: When does dentin formation begin? A: In the late bell stage
Q: What do odontoblasts produce? A: Collagen fibers and a rich ground substance
Q: How does dentin calcify? A: By deposition of crystals of calcium salts (hydroxyapatite) into the matrix
Q: What is left behind in dentinal tubules? A: The odontoblastic process
Q: Is dentin vital throughout life? A: Yes - dentin is vital throughout the life of the tooth and cells continue to produce dentin when needed
DENTIN COMPOSITION
Q: What percentage of dentin is organic? A: 18%
Q: What percentage of dentin is inorganic? A: 70%
Q: What percentage of dentin is water? A: 12%
Q: Where does dentin and enamel formation begin? A: At the DEJ (dentin) at the cusp or incisal edge (enamel) of the tooth and continues apically
CARIOLOGY BASICS
Q: What is cariology? A: The study of dental caries
Q: Define dental caries A: Biofilm mediated, diet modulated multifactorial disease of the hard tissues that results in demineralization of the tooth structure
Q: What is the paradigm shift in cariology? A: From an old restorative/surgical model to a new medical model focusing on prevention, risk assessment, and non-restorative therapies
FIVE ESSENTIAL ELEMENTS FOR CARIES
Q: What are the 5 essential elements for caries formation? A:
Bacteria
Diet/fermentable carbohydrate
Susceptible host/tooth surface
Saliva
Time
HOST FACTORS
Q: What factors influence host susceptibility to caries? A:
Individual's genetic constitution
Tooth anatomy (deep grooves and fissures)
Tooth hard tissue quality
Salivary properties
Host immunity
Oral microbiome composition
Interactions between host genes and environmental factors (fluoride exposure)
SUBSTRATE
Q: What types of foods serve as substrate for caries? A: Starchy, refined carbohydrates - chips, bread, crackers, pasta, candy
Q: How do simple sugars contribute to caries? A: They feed bacteria which produce acid
BACTERIA
Q: What bacteria is associated with early caries lesions? A: Streptococcus mutans - secretes lactic acid
Q: What other Streptococcus species causes caries? A: Streptococcus sobrinus
Q: What bacteria thrives in later stages of caries? A: Lactobacilli - thrives in low pH
Q: What is the normal pH range of saliva? A: 6.2 - 7.6 (average: 6.7)
SALIVA FUNCTIONS
Q: What are the protective factors of saliva? A:
Lubricates oral tissues
Aids in removal of food
Salivary pellicle formation
Contains sodium bicarbonate (buffers acids)
Initiates carbohydrate digestion
Possesses antibacterial properties
Serves as reservoir for calcium, phosphate, and fluoride
Q: What are the main functions of saliva? A:
Maintenance of oral health
Tissue repair
Digestive functions
Lubrication in mastication
Food bolus formation and swallowing
Taste sensation
Initiates digestion
Articulation of speech
Q: What is saliva composed of? A: 99% water, 1% small molecules, and non-glandular original components
Q: What are the 3 major salivary glands? A: Submandibular (65%), Parotid (20%), Sublingual (5%), Minor glands (10%)
pH AND BUFFERING
Q: What are the 3 major buffer systems in saliva? A:
Bicarbonate system (major)
Phosphate system
Protein system
DEMINERALIZATION/REMINERALIZATION
Q: What is demineralization? A: Loss of calcium and phosphate from the enamel surface when cariogenic bacteria use carbohydrates to produce acid and lower pH
Q: What is the first visible clinical sign of demineralization? A: White spot lesions
Q: What is remineralization? A: Natural repair process where calcium and phosphate use fluoride to rebuild crystalline subsurface
Q: What type of crystals are formed during remineralization? A: Fluorapatite crystals (more resistant to acid)
Q: At what pH does enamel demineralization occur? A: pH of 5.5 or lower
Q: At what pH does dentin demineralization occur? A: pH of 6.5-6.8 or lower
CARIES FORMATION PROCESS
Q: What are the steps in caries formation? A:
Intake of dietary sugars
Bacterial enzymatic activity
Fermentation on tooth surfaces
Organic acids formation
Low pH below critical pH 5.5
Demineralization & decalcification
Caries formation
CARIES DISEASE BALANCE
Q: What are protective factors against caries? A:
Saliva and components (calcium and phosphate)
Fluoride
Antibacterial agents (xylitol)
Q: What are pathologic factors for caries? A:
Acid-producing bacteria (strep mutans and lactobacilli)
Consumption of fermentable carbohydrates (frequency)
Reduced salivary flow
FREQUENCY VS. QUANTITY
Q: What is the difference between frequency and quantity regarding diet? A:
Frequency: how often (affects oral cavity) - example: 1 can soda all day long
Quantity: how much (affects waistline) - example: 3 cans soda at mealtimes
CARIES DETECTION
Q: What are key tools for caries detection? A:
Good lighting, magnification, and clean, dry tooth surface
Visual inspection (avoiding sharp explorers on early lesions)
Bitewing radiographs for interproximal caries
Q: What are caries detection methods? A:
Visual inspection (mirror, explorer, air)
Tactile inspection (shepherd's hook explorer, ball tipped probe, pigtail explorer)
Radiographic detection (BWX)
Emerging technologies (AI, fiber optics, fluorescence, LED, lasers)
GV BLACK CLASSIFICATION
Q: Who developed the classification system for caries? A: G.V. Black in the late 1800s
Q: What is Class I caries? A: Cavities in pits or fissures - occlusal surfaces of posterior teeth, lingual pits of maxillary anteriors, buccal pits of mandibular molars, lingual pits of maxillary molars
Q: What is Class II caries? A: Involves proximal surfaces of posterior teeth (could be 1, 2, 3 or more surfaces - MO, DO, MOD, MOL, MOB)
Q: What is Class III caries? A: Proximal surfaces of anterior teeth that does NOT involve the incisal edge
Q: What is Class IV caries? A: Involves both the proximal AND incisal edge of anterior teeth
Q: What is Class V caries? A: Involves the cervical region (facial or lingual) typically at the gingival margin on anterior or posterior teeth
Q: What is Class VI caries? A: Cusp tip caries of posterior teeth or incisal edge of anterior teeth
ICDAS CLASSIFICATION
Q: What does ICDAS stand for? A: International Caries Detection and Assessment System
Q: What is ICDAS Code 0? A: Sound - no evidence of caries
Q: What is ICDAS Code 1? A: Distinct first visual change - a change in enamel color when surface is dry, but tooth looks sound when wet
Q: What is ICDAS Code 2? A: Distinct visual change - a lesion seen when tooth is wet
Q: What is ICDAS Code 3? A: Localized enamel breakdown - a physical hole in enamel without visible dentin exposure
Q: What is ICDAS Code 4? A: Underlying dark shadow - a dark shadow from dentin shows through enamel
Q: What is ICDAS Code 5? A: Distinct cavitation - a cavity that exposes visible dentin
Q: What is ICDAS Code 6? A: Extensive cavitation - a cavity that involves half or more of the tooth surface
RADIOGRAPHIC CLASSIFICATION
Q: What is incipient caries radiographically? A: Less than 1/2 through enamel
Q: What is moderate caries radiographically? A: 1/2 through enamel but not to DEJ
Q: What is advanced caries radiographically? A: Through DEJ, less than 1/2 way to pulp
Q: What is severe caries radiographically? A: Through DEJ, more than 1/2 way to pulp
TYPES OF CARIES
Q: What is pit and fissure caries? A: Caused by incomplete closure of enamel plates
Q: What is smooth surface caries? A: Caused by incomplete removal of biofilm
Q: What is primary caries? A: Initial/virgin caries; may be incipient
Q: What is recurrent caries? A: Caries adjacent to existing restoration
Q: What is arrested caries? A: Lesion that does not change or progress
Q: What is rampant caries? A: Rapidly spreading caries; typically 10+ new lesions yearly (seen in early childhood, adolescent, xerostomia-induced)
ROOT CARIES
Q: What are characteristics of root caries? A: Rapidly progressive, shallow, spreads laterally
Q: What causes root caries? A: Recession and xerostomia
Q: Who is typically affected by root caries? A:
Older adults with recession
Lower socioeconomic status
Tobacco users
History of root caries
Gingival recession
Poor biofilm control
Higher levels of S. mutans and lactobacilli
NON-INVASIVE MANAGEMENT
Q: What is fluoride varnish? A: A highly effective, professionally applied topical treatment
Q: What is Silver Diamine Fluoride (SDF)? A: A minimally invasive treatment for arresting caries lesions, particularly in difficult-to-treat populations
Q: What are dental sealants? A: Protective coatings for pits and fissures of molars to prevent decay
Q: How does xylitol help prevent caries? A: It inhibits bacterial growth (found in gums, mints)
PATIENT EDUCATION
Q: What is the hygienist's core responsibility in caries management? A: Acting as a health coach to empower patients
Q: What should dietary counseling focus on? A: Reducing the frequency of sugar intake, not just the quantity; explaining the role of acidic foods and drinks
Q: What should oral hygiene instruction include? A: Personalized instructions on brushing and interdental cleaning; demonstrating proper techniques and recommending appropriate products
HYGIENIST'S ROLE
Q: What is the hygienist's role in team-based caries management? A:
Collaboration: Working with dentist to implement comprehensive care plan
Communication: Clearly documenting and communicating patient risk and intervention success
Monitoring: Regularly reassessing patient risk and status of caries lesions
Empowerment: Motivating patients to take ownership of oral health through education and support