PDBE Prevention/Caries
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- What is the definition of caries?
-
Dietary carbohydrate-modified infectious disease in which saliva is a critical regulator.
Most common chronic infectious disease of childhood.
Five times as common as asthma - Who first observed microorganisms in dental caries?
- van Leeuwenhoek in 1683
- Who was responsible for the non-specific plaque theory and what is its definition?
-
W.D. Miller at University of Berlin 1890.
All bacteria in mouth potentially cariogenic via acid production. - Who isolated streptococcus species from carious lesion? Did he prove that it caused dental caries/
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Clarke in 1924, named it Streptococcus mutans.
No. - Who demonstrated that specific organisms were responsible for caries and that the microorganisms were transmissible?
- Keyes in 1960
- What are the 2 characteristics of mutans streptococcus?
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1. Ecological niche in human oral cavity.
2. Cariogenic properties - What are the three cariogenic properties of mutans streptococcus? (Three A's)
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Acidogenicity
Aciduricity
Adherence to tooth - What are the products of MS metabolism of sugars?
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Lactic acid
Extracellular polyglucose (glucan from sucrose metabolism only) - Is MS responsible for initiation of caries?
- Yes. It is a necessary, but not solely sufficient, factor for caries.
- Acquisition of MS by infants ("classic") data includes what six ideas?
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1. Oral cavity colonized after eruption of teeth.
2. Window of infectivity opens when primary teeth erupt.
3. Second window of infectivity may open when permanent teeth erupt.
4. MS is poor competitor for colonization once stable biofilm is in place.
5. Infants who acquire S. sanquis early have less MS.
6. Most infants acquire MS between 19-33 mos; those who acquire it early may be at higher risk for caries. - Transmission of MS may be ________ or ____________?
- Direct or Indirect.
- Transmission of MS is ________, usually from ________.
- Vertical, Mother (fidelity >70% for parents; =90% for mother)
- Acquisition of MS by infants ("recent") data includes what four ideas?
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1. Transmission may occur at birth.
2. Fissures of tongue may be niche.
3. Early acquisition associated with Bohn's nodules (Wan et al. 2001-found in 30% of 3 mo-old-infants; associated with presences of Bohn's nodules and maternal MS levels)
4. Horizontal transmission may occur within or outside of family. (Mattos-Graner 2001). - In Wan et al., what percentage of infants in their sample were infected with MS by 6 mos of age? 24 mos of age?
- 50% and 84%
- In Wan et al., what was the mean age of MS colonization in dentate infants?
- 15.7 months
- What are the four factors associated with colonization of MS reported by Wan et al.?
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1. Sweetened fluids taken to bed.
2. Frequent sugar exposure; snacking.
3. Sharing foods with adults
4. Maternal MS levels >10 cfu/mL 5. - What are the two factors associated with non-colonization by MS?
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1. Tooth brushing.
2. Multiple courses of antibiotics. - What are the percentages of 2 yr old children infected with MS if mother is treated with Xylitol gum, CHX varnish, and F varnish?
- 10%, 8%, 48%
- What are the percentages of 3 yr old children infected with MS if mother is treated with Xylitol gum, CHX varnish, and F varnish?
- 28%, 37%, 65%
- What are the percentages of 6 yr old children infected with MS if mother is treated with Xylitol gum, CHX varnish, and F varnish?
- 52%, 87%, 84%
- In Soderling's research, what treatment given to mothers was found best to reduce children's MS levels?
- Xylitol gum followed by CHX varnish and F varnish last.
- What are the characteristics of lactobacilli?
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1. Opportunistic
2. Not an initiator
3. Numbers in cavity increase after DEJ is invaded
4. Good indicator of total CHO intake. - What did Hopewood House (Australia 1947-52)discover about children's diet?
- Extremely low caries prevalence among children who diets were devoid of sugar and white flour.
- What are the five principles taught from the Vipeholm study (1942-52) about dietary factors?
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1. Sugar consumption at meals can give slight increase in caries rate.
2. Sugar between meals gives marked increase in caries.
3. Sugar in sticky form produces greatest caries activity.
4. Caries activity differs among individuals with the same diet.
5. Caries activity declines with sugar withdrawl. - What does MS metabolism produce when sucrose is broken down?
- Sucrose=glucose + fructose; Produces glucans and fructan chains.
- What are the 4 properties of glucan?
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1. Water soluable
2. Extracellular "glue"
3. Enables MS adhesion
4. Inhibits plaque diffusion properties - What are the 2 properties of fructan?
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1. Intracellular
2. Can be used by MS as energy source. - Are fructose and glucose as effective in vitro as sucrose in the ability to cause plaque pH depression?
- Yes
- In animal studies, what is nearly as cariogenic as sucrose?
- Fructose
- Raw starch causes on a slight _________ in plaque pH.
- Drop
- Soluble and refined starch can be broken down by salivary amylase in to sugars. What effect does this have on plaque pH?
- Can cause plaque pH drops comparable to sucrose.
- Plaque pH after sucrose challenge: pH drop (Stephan curve) below ______ begins demineralization.
- 5.5
- What can occur with frequent sucrose challenges?
- Keeps pH below critical level for prolonged periods.
- What are the five characteristics of food or the "Food Factors" which contribute to caries development?
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1. Retentiveness/clearance
2. pH
3. Salivary stimulation
4. Fat content (protective)
5. Metabolism by MS - Did (Majewski 2001)find a relationship between adolescent intake of caffeinated carbonated beverages and dental caries?
- Yes
- What relationship did Heller et al. (2001) find between soft drink consumption and DMFS?
- No relationship in persons <25 or in dfs in those <12.
- What are the four tooth factors that can contribute to the development of caries?
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1. Quality of enamel.
2. Presence/depth of pits and fissures.
3. Hypoplasia.
4. Fluoride exposure. - What are the ten characteristics of saliva that can mediate caries development?
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1. Mineral content
2. pH
3. Flow rate
4. Buffering capacity
5. Antimicrobial components
6. Fluoride
7. Supersaturated with Ca, P.
8. Principal buffer is bicarbonate (also phosphate)
9. Proteins
10. Immunological components - What are the 8 immunological components of saliva?
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1. Lysozyme
2. Lactoferrin
3. Lactoperoxidase
4. Myeloperoxidase
5. Agglutinins
6. Secretory IgA
7. Serum-derived IgG
8. IgM - Salivary flow rate can be reduced by what five factors?
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1. Medications
2. Disease
3. Dehydration
4. Radiation
5. Age - Salivary flow rate can be increased by what two factors?
-
1. Gustatory stimulants
2. Masticatory stimulants - What are the 8 "Modifying Factors of the etiology of caries?
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1. Race/ethnicity
2. Healthcare delivery system (access to care)
3. Socioeconomic status
4. Behavior/Education
5. General health
6. Culture
7. Stress
8. Others - In the 19th century, caries was seen as a disease of the __________.
- Affluent
- In the 20th/21st century, caries is seen as a disease of ____________.
- Poverty
- Epidemiological study of caries from 1900 to 1950, the disease had what 4 characteristics?
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1. PANDEMIC
2. Presumption of caries inevitability
3. Dental disease among highest causes of time lost from school/work
4. Could not target preventive efforts - Epidemiological study of caries from 1950's to 1970's (era of fluoridation), the disease had what 3 characteristics?
-
1. 50% reductions in caries
2. About 56% of U.S. population on fluoridated water.
3. Prevention could be targeted to non-fluoridated areas-still a broad target - population strategy - Epidemiological study of caries from 1970's to present, the disease had what characteristic?
- NIDR documented decline in caries prevalence.
- Edelstein and Douglass postulated that 50% caries free was a "myth". What three principles was this based on?
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1. Only 16% of 17 yr olds caries free in 1986-87
2. "50%" fails to consider primary teeth
3. 50% of children had caries by first grade. - What is the main shift in ethnic/SES distribution in relation to caries epidemiology?
-
80% of caries in 20-25% of population.
(Children of poverty; disproportionately more caries found in lower SES groups, minority groups; access to care is problem. - Caries is a "_________ ________" disease with variable expression over time.
- Steady State
- Caries is a static process - constant demineralization/remineralization. T or F
- False
- How does enamel acts as a diffusion matrix?
- It has lower mineral content by volume than by weight.
- What are the 5 zones of the early lesion?
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1. Surface - relatively unaffected; 5-10% mineral loss
2. Body of lesion - principal area of mineral loss (60%)
3. Dark zone - mineral loss intermediate to surface and body zones
4. Translucent zone - 5-10% mineral loss
5. normal enamel - What two factors enable enamel to remineralize?
-
1. Intact surface, ie. no cavitation.
2. Fluoride available - If the lesion progresses to DEJ with surface breakdown, can the lesion remineralize?
- No
- Primary teeth have more rapid progression of caries (lower mineral content). True/False
- True
- Primary teeth have enamel and dentin that are _________ than permanent teeth.
- Thinner
- Primary teeth have a pulp chamber that is relatively smaller. True/False
- False. The pulp chamber is relatively larger.
- The ______ contacts make clinical diagnosis more difficult with primary teeth.
- Flat
- What is the tooth sequence for caries?
- Mandibular molars, maxillary molars, maxillary anteriors (w/ exception of ECC)
- Are second molars more susceptible to caries than first molars?
- Yes