FINAL EXAM

Question 1

describe dental caries lesions

Answer 1

• lesions that occur due to activity within plaque that covers a tooth
• considered signs and symptoms of metabolisms within plaque
• can occur on enamel, dentin, or cementum

Question 2

in the formation of dental caries lesions, the ___ is left undisturbed for a period of time on any tooth surface, causing the potential for a ___ to form

Answer 2

• biofilm (plaque)
• caries lesion

Question 3

what is the best definition of dental caries lesions?

Answer 3

a multifactorial process of demineralization and concurrent remineralization, and is often reversible

Question 4

describe dental plaque

Answer 4

• a biofilm (a natural, physiological process)
• an active community of microorganisms that work together
• if left on a tooth too long, it will make a white, chalky lesion on the tooth

Question 5

what is the multifactorial model of the caries process?

Answer 5

Question 6

what are the host factors that contribute to caries lesions

Answer 6

• tooth anatomy, texture of surface, protected surfaces
• salivary flow rates
• salivary quality and buffering capacity
• systemic disease

Question 7

what are the environmental factors that contribute to caries lesions

Answer 7

• diet: including fermentable carbohydrates, frequency of meals, acidity of meals
• oral hygiene and compliance
• fluoride exposure

Question 8

what are the bacterial factors that contribute to caries lesions?

Answer 8

• streptococcus: mutans ans sobrinus
• lactobacilli
• other non-cariogenic bacteria can become cariogenic for short periods of time under certain conditions

Question 9

describe strep mutans

Answer 9

• gram positive organism
  
  • peptidoglycan layer in cell wall
• primary causative agent in the formation of dental cavities
• metabolizes sucrose to lactic acid

Question 10

describe enamel after eruption

Answer 10

• once erupted, enamel is in dynamic transformation
• teeth slowly erupt, therefore enamel undergoes subclinical changes, due to exposure to oral microbes, and salivary minerals
• once fully erupted into occlusion, enamel is also subjected to mechanical modifications

Question 11

what is the origin of dentin?

Answer 11

mesodermal

Question 12

what is the composition of dentin?

Answer 12

• 75% inorganic
• 20% organic
• 5% water

Question 13

dentin has ___ mechanisms and works in concert with ___

Answer 13

• reparative (odontoblasts)
• pulp (dentino-pulpal organ)

Question 14

what is the composition of enamel?

Answer 14

• 95% mineral
• 5% water

Question 15

what is dentin?

Answer 15

• living tissue made up of tubules, each of which contain an odontoblast
• is a series of tubules extending from pulp to the DEJ, which are widest at the pulp and hardest at the DEJ
  
  • 1/5 as hard as enamel

Question 16

how are caries lesions classified?

Answer 16

• according to their anatomical site
  
  • pit and fissure (common on occlusal), smooth surface (enamel caries, root caries)
• cavitated vs. non-cavitated
• activity level
  
  • active vs. inactive
• primary (lesions on natural, intact tooth surfaces) vs. secondary (recurrent, adjacent to a filling/restoration - same etiology as primary caries) vs. residual (demineralized tissue that has been left behind before a filling is placed)

Question 17

compare treatment of active vs. inactive lesions

Answer 17

• inactive lesions do not require any restorative action because the caries process has been arrested
• if active, steps should be taken to influence the metabolic activities and possibly the ecological balance in the biofilm in favor of arrest rather than further demineralization

Question 18

what are the disease causing factors of the caries balance?

Answer 18

BAD disease-causing factors include the following:

• Bad bacteria - acid-producing bad bacteria
• Absence of saliva
• Dietary habits (poor) - frequent sugars and acids lead to demineralization and a low pH, allowing bad bacteria to thrive, starting the decay process

Question 19

what are the protective factors of the caries balance?

Answer 19

SAFE protective factors include the following:

• Saliva and sealants - saliva neutralizes acid, encouraging good bacteria to thrive and aids remineralization. sealants seal the chewing surfaces of the teeth most susceptible to decay.
• Antimicrobials - helping rid the bad bacteria and establish health-promoting bacteria
• Fluoride - strengthening the tooth surfaces against demineralization, promoting remineralization
• Effective (healthy) diet

Question 20

what are the functions of saliva relative to the teeth?

Answer 20

Question 21

what are the functions of saliva relative to food?

Answer 21

Question 22

what are the functions of saliva relative to microbes?

Answer 22

Question 23

describe how dental biofilms are formed

Answer 23

1. pellicle formation - minutes to hours
2. attachment of a single bacterial cell - 0-24 hours
3. growth of attached bacteria leading to the formation of distinct microcolonies - 4-24 hours
4. microbial succession (and coadhesion) - leads to increased species diversity and continued growth of microcolonies
5. climax community/mature biofilm - >/= 1 week

Question 24

describe the ADA classification of a sound tooth

Answer 24

Question 25

describe the ADA caries classification of initial caries

Answer 25

Question 26

describe the ADA caries classification of moderate caries

Answer 26

Question 27

describe the ADA caries classification of advanced caries

Answer 27

Question 28

for a low risk patient, describe the frequency of radiographs, frequency of caries recall exams, antibacterials/chlorhexidine/xylitol, and fluoride recommendations

Answer 28

* frequency of radiographs - BWX every 24-36mo * frequency of caries recall exams - every 6-12mo * antibacterials/chlorhexidine/xylitol - per saliva test if done * fluoride - OTC fluoride-containing toothpaste twice daily; optional: NaF varnish if excessive root exposure or sensitivity

Question 29

for a moderate risk patient, describe the frequency of radiographs, frequency of caries recall exams, antibacterials/chlorhexidine/xylitol, and fluoride recommendations

Answer 29

* frequency of radiographs - BWX every 18-24mo * frequency of caries recall exams - every 4-6mo * antibacterials/chlorhexidine/xylitol - per saliva test if done; xylitol 6-10g/day * fluoride - OTC fluoride-containing toothpaste twice daily plus 0.05% NaF rinse daily; initially 1-2 app NaF varnish, then 1 app at 4-6mo recall

Question 30

for a high risk patient, describe the frequency of radiographs, frequency of caries recall exams, antibacterials/chlorhexidine/xylitol, and fluoride recommendations

Answer 30

* frequency of radiographs - BWX every 6-18mo or until no cavitated lesions are evident * frequency of caries recall exams - every 3-4mo * antibacterials/chlorhexidine/xylitol - chlorhexidine gluconate 0.12% (10ml rinse for 1min daily for 1wk each month), xylitol (6-10g/day) * fluoride - 1.1% NaF toothpaste 2x daily; optional 0.2% NaF rinse daily then OTC 0.05% rinse 2x daily; initially 1-3 app NaF varnish, then apply at each 3-4mo recall

Question 31

for a extreme high risk patient, describe the frequency of radiographs, frequency of caries recall exams, antibacterials/chlorhexidine/xylitol, and fluoride recommendations

Answer 31

* frequency of radiographs - BWX every 6mo or until no cavitated lesions are evident * frequency of caries recall exams - every 3mo * antibacterials/chlorhexidine/xylitol - chlorhexidine gluconate 0.12% (10ml rinse for 1min daily for 1wk each month), xylitol (6-10g/day) * fluoride - 1.1% NaF toothpaste 2x daily; OTC 0.05% NaF rinse when mouth feels dry, after snacking, breakfast, and lunch; initially 1-3 app NaF varnish, then apply at each 3mo recall

Question 32

what is the one factor that differentiates a high risk patient with an extreme high risk patient?

Answer 32

extreme risk patients will have the same criteria as high risk patients, but with the addition of **dry mouth** or special needs

Question 33

enamel is of ___ origin

Answer 33

ectodermal