Dentition

Question 1

primary dentition

Answer 1

teeth start by 6mo

20 teeth by age 3 (8 incisiors +4 canines+ 8 molars = 20)

Question 2

adult dentition

Answer 2

8 incisors + 4 canine + 8 premolars +12 molars

=32 teeth

Question 3

dental caries

Answer 3

cavities

oral pain
poor eating = poor nutrition
missed school
impaired speech development
poor self-esteem
complications: cellulitis/abscess

Question 4

early childhood caries

Answer 4

infectious and transmissible
destroys tooth structure
affects kids under 5

“nursing caries” and “baby bottle tooth decay” previous names

triad:
oral bacteria (ex Mutans strep) break down dietary sugars into acids which eat away the tooth

Question 5

etiology of Bacteria for childhood caries

Answer 5

oral flora estab @6 mo

• mutans strep is vertically transmitted from primary caregiver (usually mom)
• caregivers w/ high bacteria lvls usually have:
• high levels of decay
• poor oral hygiene
• high frequency of sugar intake

Both bacteria and dietary habits are passed to child

Question 6

etiology: sugars

Answer 6

• enamel demineralizes in response to oral acids, then remineralizes as acid is buffered (saliva)
• oral bac produce acids that persist for 20-40 mins after sugar ingestion
• how often sugar is ingested is more imp than how much sugar is eaten at once
• if sugar intake is frequent, demineralization predominates, teeth @ risk

Question 7

white spots in mouth

Answer 7

• white spots indicate acids have demineralized enamel
• first clinical signs of caries
• white spots = risk for developing cavities
• indication for dental referral

Question 8

Preventing ECC

Answer 8

• screening
• oral hygiene: brush 2x daily, help til age 6
• dietary guidance
• fluoride– systemic and topical
• inform/advise about dental sealants
• encourage an age 1 dental visit
• improve parent oral health/dietary habits

Question 9

Oral cancer and pre cancer

Answer 9

alcohol and tobacco increase risk of oral cancers – including spit tobacco

• early lesions: may be asx
• sites: lateral tongue, floor of mouth, inside of lips, soft palate

Question 10

Periodontal disease

Answer 10

Etiology:

• chronic plaque at gum line
• bacterial infection
• host inflammatory response

Three types:
gingivitis
chronic periodontitis
aggressive periodontitis

Question 11

gingivitis

Answer 11

mildest form of PD:
mild gum swelling, tenderness, erythema, gums bleed during brushing
can occur acutely with foreign body
reversible

etiologies:
plaque
pregnancy
disease trauma

Question 12

chronic periodontitis

Answer 12

more severe than gingivitis
infec/inflamm induce loss of bone and tooth attachment
rare in children, present in 50% of adults
can start in teen years
smoking = major risk
prevention: good oral hygiene, brush and floss, avoid tobacco

Question 13

aggressive periodontitis

Answer 13

otherwise healthy
rapid attachment loss and bone destruction
amount of microbial deposits inconsistent with disease severity
familial association

Question 14

oral/systemic link

Answer 14

• infective endocarditis
• prosthetic device infection
• diabetes

emerging evidence:
obesity
coronary artery disease
adverse pregnancy outcome (preterm, low weight, preeclampsia), lower respiratory disease

Question 15

diabetes and periodontitis

Answer 15

poor glycemic control assoc with 3x inc risk of periodontitis

diabetics w/ good control? no signif increased risk
chronic infec like periodontal disease complicates glucose control

(pts with periodontal disease 2x more likely to devel diabetes)

Question 16

Obesity

Answer 16

fat tiss releases TNFalpha and IL6 which potentiate inflammation, including periodontal disease

TNFalpha also causes insulin resistance

Question 17

coronary heart disease and stroke

Answer 17

CHD and periodontitis are assoc
inflamm cytokines implicated in atherogenesis are also produced by periodontitis
dental plaque organism have been found in vascular plaque and induce platelet aggregation
systemic antibody response to periodontitis is assoc w/ CHD
smoking assoc w/ both
both share elevated CRP levels

Question 18

Tx in pregnancy?

Answer 18

• tx of periodontal disease in pregnancy is safe

- doesn’t alter rates of preterm birth or low birth weight

Question 19

Preeclampsia

Answer 19

women with periodontitis 2x as likely to get preeclampsia

endothelial cell damage due to inflammatory mediators is a proposed mechanism

Question 20

Lower resp disease

Answer 20

-chronic aspiration of oral bacteria:
COPD
acute pneumonia

• hosp/ventilated pts at risk
• ->need to provide oral care to reduce vent. assoc pneumonia

Question 21

xerostomia

Answer 21

dry mouth
decreased saliva promotes periodontal disease

many meds:
steroids
antihistamines
diuretics
antihypertensives
anticholinergics
antidepressants

Question 22

Cognitive and behavioral

Answer 22

• self care deficits
• chronic disease burden/multiple meds
• dietary changes
• compliance difficulty: meds, oral hygiene
• dependence on caregivers
• chewing and swallowing diff – nutrition
• lack of understanding leading to resistance to care

Question 23

most common chronic disease of childhood

Answer 23

dental caries

• 5x more common than asthma
• 50% in low income children, up to 70% in Native Americans

Question 24

Periodontal ligament

Answer 24

binds teeth to bone

Question 25

What can worsen diabetes?

Answer 25

periodontal disease