Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
156 Cards in this Set
- Front
- Back
Where is calcium stored in? |
saliva |
|
Calcium is good for? |
nutrient in health (bone, nerve,muscle strength) and inadequate amounts in diet (levels blood drop, body borrows from bones NOT TEETH and teeth are affected for reminerlization) |
|
What do buffers do? |
neutralize |
|
What can happen if you don't have enough calcium in your saliva or any saliva at all? |
low calcium can interfere w/ remineralization process, low saliva doesnt provide a reservoir for calcium for remineralization |
|
What do calcium and saliva both function as for oral pH? |
buffering agents |
|
What does Calcium reduce? |
hypersensitivity |
|
ACP contains the same minerals found in hydroxyapatite but in a small _________ shape |
spheroidal |
|
What does ACP do when combined with water? |
easily crystalizes onto the teeth in the form of new enamel |
|
When ACP is placed on tooth, what ions form and fill surface defects? |
calcium and phosphate |
|
What are ACP products unstablized? |
because calcium and phosphate salt are delivered seperately in a dual barrel syringe |
|
ACP is highly soluble in the oral cavity therefore it has low - |
substantivity (meaning its available when it lingers around) |
|
Disadvantage of ACP? |
doesnt stay in mouth long enough to be absorbed into teeth as well as CPP-ACP and other products |
|
What has ACP been shown to do? |
block dentin tubules in exposed tooth roots and reduces hypersensitivity |
|
Characteristics about CPP-ACP - (10) |
- stabilized ACP - milk protein, CPP, is added as a carrier for ACP - CPP increases substnativity - CPP helps insure that Ca & PO reach tooth before precipitating or crystalizing - bind to tooth and bacterial biofilm - inhibits bacterial adherence to teeth - requires an acid challenge to release the Ca and PO ions - used w/ white spot lesions - recaident is a trade name for CPP-ACP - available in toothpasts, gum and mouth rinse. |
|
CSP (novamin) is the ___________ generation. What did it reduce? |
latest, it reduced air/cold sensitivity |
|
What is Tri-calcium phosphate? |
NEWEST hybrid material that fuses beta tricalcium phosphate w/ sodium sulfate or fumaric acid, it is designed to increase efficacy of fluoride remineralization. |
|
What is used in FDA approved orthopedic bone growth procedures? |
Tri-calcium phosphate. |
|
Difference b/t in-vivo and in-vitro : |
in-vivo is tested on live subjects, in-vitro is tested on pulled teeth in labs. |
|
Dry mouth = |
calcium!!! |
|
Risks for caries : (8) |
malnutrition, calcium-deficient diets, acidic diets, reflux/hyperactive gag reflux, xerostomia (dry mouth), asthma, oxygen use, and prolonged feeding due to neurological disorders. |
|
Acid reflux = |
decalcification |
|
What does Xylitol do? |
inhibits attachment of Strep Mutans to teeth, can't be metabolized by SM, stimulates salivary flow and interrupts vertical transmisson from caregiver to child w/ long term benefit. |
|
What is Xylitol? |
polyol and a 5 carbon monosaccharide combined with hydrogen |
|
Xylitol medical uses? |
prevent ear infections and upper respiratory infections, wound healing, diabetic sweetener, and shown to increase bone calcification in rats. |
|
What form of Xylitol is the ideal delivery system since it remains in the mouth longer and provides SM to ingest Xylitol? |
gum |
|
What does Xylitol gum do? |
has pH balancers and buffering agents to raise pH and maintain neutrality. |
|
Laxation threshold for Xylitol is reached at ____ grams in children and ______ in adults daily. |
45, 15-200 grams |
|
Disadvantages of Xylitol? |
dont consume too much if you have bowel problems, people w/ crohns or down syndrome can't take it and fatal to dogs. |
|
Types of oral rinses? (8) |
biotene, oxyfresh, rembrandt, breathRx, BSGE, otimoist, spry, and epic. |
|
Types of dentrifrices? (5) |
biotene, breathRX, pxyfresh, rembrandt, and spry |
|
Types of oral sprays/gels? (5) |
mouthkote, theraspray, oral balance, spry rain and biotene |
|
Types of gums? (5) |
biotene, breathRx, epic, theragum, and spry |
|
Which conditions benefit from ACP products? 1. dry mouth suffers 2. mod-high risk caries pt's 3. perio pt w. recession 4. all of the above |
all of the above |
|
Who should use some form of calcium products? 1. dry mouth 2. sensitive teeth 3. caries risk 4. deficient diet 5. all of the above
|
all of the above |
|
Which calcium product has the best substantivity? 1. ACP 2. CPP-ACP 3. Bioactive silica (novamin) 4. Tri-sodium phosphate |
bioactive silica |
|
Xylitol is effective in caries prevention how? 1. acid reduction 2. bacterial reduction 3. adhesion reduction 4. all of the above |
all of the above |
|
How many grams of Xylitol are indicated daily? 1. one 2. two 3. three-five 4. five-eight |
five-eight |
|
Pt w/ dry mouth - what would you recommend? 1. ACP product 2. Fluoride TX 3. More frequent dental appointments 4. Xylitol 5. Avoiding surgary/acidic diets 6. All of the above |
all of the above |
|
Water fluoridation reduced decay by? |
30-50% |
|
High risk caries pt may need to take a BWX every ___ months. |
6 |
|
For caries treatment/prevention, you may need to recommend - |
frequent visits, fluoride therapy, dental sealants, and diet counseling. |
|
Differences b/t High risk caries group, moderate and low - |
High - you ARE SURE they will have new/larger lesions w/ time. Moderate - somewhere in b/t and may change status over time. Low - factors are negligible. you are sure they will NOT have any lesions over time. |
|
Poor oral hygiene has a plaque score of ____% or higher. |
30 |
|
Caries are susceptible to what? |
decay, pits and fissures and gingival or interproximal areas. |
|
What are some antimicrobial agents for caries? |
CHX (chlorahexidine), stannous, and sodium hypochlorite (bleach) |
|
What's diet counseling consist of? |
xylitol and calcium |
|
Which type of sealant would you use for caries treatment? |
glass ionomers (releases fluoride) |
|
Low risk caries pt = |
all ages, no decay present during last 3 years and no factors present, wont benefit from additional fluoride. |
|
Moderate risk caries pt = |
younger than 6: - no lesions in 3 years but presence of 1 factor Older than 6: - 1 or 2 lesions in last 3 years |
|
High risk caries pt = |
all ages: - any lesion during last 3 years - multiple factors - xerostonia - suboptimal fluoride exposure
|
|
Low risk status pt, recommend - |
use an ADA approved fluoridated dentrifrice twice a day |
|
Moderate risk status pt, recommend - |
diet counseling/plaque control, apply 5% sodium fluoride varnish twice a year, dental sealants, ADA approved dentrifrice 2/3 times daily, and low concentration fluoride rinse/gel prior to bed. |
|
High risk status pt, recommend - |
diet counseling/plaque control, dental sealants, 5% fluoride varnish 3 times a year, ADA dentifrice 3 times a day, prescribe acid balance rinse for 1 month, use high concentration fluoride gel/paste prior to bed - do not rinse. |
|
Characteristics of Chlorhexidine gluconate (mouth rinse) - |
more effective than listerine, effective against strep mutans and sobrinus, not effective against aerobic lactobacilli. |
|
Recommendations for Xerostonia and ACP-CPP: |
recaldent gum (10 mins daily) and MIpaste |
|
Histologically, what does a caries look like? |
appears to be an intact surface w/ a demineralized area underneath. |
|
Symptom of fluoride toxicity? |
nausea, vomiting, etc. |
|
What are 3 places that Ca can be found in the mouth to re-calcify enamel? |
saliva, diet, and tooth itself. |
|
What is a caries risk that automatically puts a pt into high risk? |
xerostonia |
|
Name a form of calcium that has highest substantibity - |
novamin |
|
At what level is a pt considered to have hypo salivation or dry mouth? |
less than 0.1 ml / minute |
|
How many grams of xylitol are recommended per day? |
"strive for 5" 4-8 g/day |
|
What does ADA recommend for low risk caries pts? |
none |
|
ADA what percentage for Stannous? |
8% |
|
Minimal amount of time for application of gel/fluoride trays? |
4 minutes |
|
2 post-op instructions for fluoride varnish? |
no crunchy foods for 4 hours, no brushing for 4 hours (optimally 12 hours) |
|
Fluoride tray/treaments/rinses should NOT be used for who? |
kids 6 and under, or those who can not control their swallowing reflex |
|
What mineral is necessary for remineralization? |
CALCIUM (fluoride also, but calcium is main) |
|
At what point would a tooth need to be restored because it can not repair itself? |
a tooth needs to have professional restoration when surface of enamel has broken (a hole) |
|
Root caries - |
doesnt happen unless root is exposed and is caused by anaerobic bacteria (actinonmyeces). Root cementum is less mineralized than enamel. Root caries grows faster. |
|
Enamel caries - |
caused by S. mutans, gram + bacteria. higher mineralization. |
|
What are the steps to take if one suspects fluroide toxicity? |
1. call 911 2. induce vomiting 3. if no vomiting, give milk/ipecac syrup, milk of magnesia |
|
Which fluoride has the most antibacterial properties? |
stannous fluoride 8% |
|
In what 3 ways does calcium help prevent caries? |
1. calcium buffers acid 2. it remineralizes enamel, making it stronger 3. binds w/ fluoride to form fluorapatite, which is stronger than normal hydroxyapatite. |
|
What are 2 ways that xylitol helps prevent caries? |
1. cuts down on acid levels in mouth 2. interferes w/ adhesion of bacterium |
|
At what pH level does enamel decalcify? |
5.5 |
|
At what pH do root surfaces decalcify? |
6 |
|
What is the clinically lethal dose of NaFl? |
5-10 g/kg |
|
When does fluorosis occur (when and how?) |
during tooth development, overconsumption of fluoride (systemic) gets into blood and affects forming teeth (permanent brown staining) |
|
What are some ways saliva prevents caries? |
- keeps food from ahereing to teeth - antibacterial properties - helps buffer acids - if it has calcium, it holds and reserves. |
|
Do all teeth demineralize the same way? |
yes |
|
Is fluoride affective in preventing pits and fissures? |
no, would need sealants. |
|
What does pH have to do w/ carries? |
bacteria inject sugar & produce acid, which travel up enamel rods & demineralize therefore taking out calcium causing cavities. |
|
At what point must the tooth be restored/filling? |
if there is a break in the surface, must be filled because it can't remineralize. |
|
What does fluoride have to do w/ remineralization? |
makes teeth less soluble, buffers acid & bonds to calcium, raises pH because it disables bacteria to where it can't produce acid & stick to tooth. |
|
What are the main minerals we're concerned w/ during demineralization? |
calcium and phosphate |
|
What does diet have to do w/ carries? |
acid and sugar = polyscharrides |
|
Name of power bacteria that's most threatening - |
strep mutans |
|
2 places strep mutans colonize - |
1. pits/fissures 2. interproximals |
|
Other bacteria that shows up late but keeps demineralization going? |
lactobaccillis |
|
pH level tooth starts demineralization? enamel? |
6.2, enamel is 5.5 |
|
Why do root surfaces decay easier than enamel? |
softer, because it has fewer minerals than enamel...easier to get through. |
|
What are the 3 ADA fluorides - |
1. stannous 8% 2. sodium, min of 2% 3. APF 1.23%
|
|
For calcium, body borrows from ______ NOT _________. |
bones NOT TEETH! (board question) |
|
Out of acid and calcium, which has a low pH and which has a high pH? |
acid = low calcium = high |
|
What are tooth structures made from? |
calcium and phosphate minerals in a crystaline structure. (hydroxlapapetite crystals) |
|
Calcium can be replaced into the tooth ONLY as long as the surface is intact. T/F? |
TRUE |
|
What will not disolve acid as easy but protects calcium and is less soluble? |
fluorapatite |
|
Can bacteria/decay be transmitted from parent to child? |
YES |
|
What are the bacteria's that play a role in dental carries? |
1. S. mutans 2. Lactobacillus 3. Actinomyces |
|
Can S. mutans grow in an acidic environment? |
yes! |
|
Lactobacillus are _____________ invaders that promote the progression of caries. |
secondary |
|
What does Lactobacillus do? |
produce lactic acid, can grow in acidic environment, and if S Mutans are low --> they produce enough acid to demineralize teeth. |
|
What is Actinomyces? |
ROOT CARIES!! "Why you ACTIN on my roots?!" gram + bacteria, filamentous, |
|
3 patterns of caries? |
pits/fissures, smooth surface, and early childhood caries "bottle caries" |
|
How long does the mouth take on average to neutralize itself back? |
20-30 minutes |
|
What is the Caries Formular? |
sugar + bacteria = acid formation |
|
For early childhood caries, what does it initially affect? |
primary max incisors |
|
How can a child get early childhood caries? |
nursing bottle at sleep times or breast feeding after teeth have erupted. |
|
What kind of bacteria are on pits/fissures? |
S. mutans and lactobacillus |
|
What kind of bacteria are on smooth surface caries? caused from? |
S. mutans and acidic diet |
|
What kind of bacteria are on root surfaces? |
actinomyces |
|
What's not as effective for pits and fissures? |
fluoride |
|
How do you usually get smooth surface caries? |
drug abuse and poor diet |
|
Root caries have 2 phases, what happends in phase 1 and 2? |
phase 1: recession phase 2: begins at apical to CEJ and has few clinical symptoms |
|
3 chemical plaque/biofilm control: |
1. toothpastes to lower ability of bacteria to adhere to enamel 2. antibiotics (applied topically) 3. antibacterial agents to directly kill bacteria (stannous fluoride and triclosan) |
|
What 2 antibacterial agents directly kill bacteria? |
stannous fluoride and triclosan |
|
Fluoride aides the remineralization process in the role of a __________ |
catalyst |
|
Fluoride can be bacterio____ and bacterio____ |
cidal (kill) and static (stop) |
|
Fluoride inhibits the production of what? |
glucotransferases |
|
What does ACP do? |
buffers free calcium and phosphate ion activities at tooth surface and enhances remineralization |
|
2 kinds of ACP products? |
recaldent (toothpaste/chewing gum) and arm & hammer toothpaste |
|
What is xylitol effective in reducing? |
cariogenic bacteria |
|
Which teeth are at the GREATEST RISK for caries? Which have the LOWEST RISK? |
- molars (harder to reach) - canines and mandibular incisors |
|
When is enamel most susceptible to demineralization? |
newly erupted teeth |
|
3 types of topical fluorides - |
1. professional products 2. OTC (over the counter) 3. Rx (script) |
|
Which topical fluoride has the highest concentration? |
professional product |
|
Advantages of topical application? |
reduced risk of fluorosis, provides anti-caries benefit for most people and easy use of application. |
|
When does fluorosis occur? |
when teeth are developing, too much fluoride (in kids) |
|
Which fluoride is most commonly used? |
sodium fluoride (NaF2) |
|
How often does Stannous have to be mixed up and what does Stannous do? |
mixed up fresh everyday (within 24 hours) and it STAINS! (white spot lesions tooth colored restorations) |
|
What is Stannous effective against? |
S. Mutans |
|
Which fluoride etches glass? 1. APF 2. NaF 3. SnF2 |
APF |
|
What is most important w/ fluoride trays? |
make sure it fits properly so its not ingested and covers all teeth |
|
Can babies from 6 months and older that are at risk for childhood caries recieve a varnish w/o risk of toxicity? |
yes |
|
Chronic Body systems associated w/ fluoride toxicity - |
1. blood (fluoride binds w/ calcium causing hypocalcaemia) 2. CNS (hyper-reflexia, convulsions, and parathesias) 3. Cardiovascular / Respiratory (cardiac failure or respiratory paralysis) |
|
What is the lethal dose for fluoride? (adults and kids) |
adults = 5-10 g kids = 0.5-1.0 g |
|
With saliva, are peptides antimicrobial and can neutralize viruses and toxins? |
yes |
|
Which teeth are most likely NOT to decay? |
mand anteriors |
|
Where do you get more calculus? |
where salivary ducts open up |
|
What is an abnormal unstimulated flow rate considered to be? |
<0.1 ml/minute |
|
What is an abnormal stimulated flow rate considered to be? |
<0.7 ml/minute |
|
What active ingredients are used for anti-carries? |
fluoride (sodium fluroide) |
|
What active ingredients are used for anti-plaque? |
triclosan, stannous fluoride and sanguinarine |
|
Which active ingredient for anti-plaque does NOT have ADA seal? |
sanguinarine |
|
What does patassium nitrate do for anti-sensitivity? |
acts directly on nerves in dentinal tubules reducing pain |
|
What does strontium chloride do for anti-sensitivty? |
occludes the dentinal tubules directly reducing sensitivity. |
|
USA dentrifrices are _____ or less. |
250 |
|
Sodium fluoride is ___% for gels and ___% for varnishes. |
2, 5 |
|
Which fluoride tastes like metal? |
stannous |
|
Sodium fluoride is best for remineralization of an ________ lesion. |
incipient (early caries lesion that is not cavitated) |
|
What kind of pH does sodium fluoride have? does it etch surfaces of materials? |
neutral, and no. |
|
When would you NOT use APF? |
pt's w/ restorations, porcelain & braces |
|
How does APF work? |
by etching tooth surface w/ acid and incorporating fluoride into holes. |
|
Side effects of using hydrogen peroxide or urea peroxide - |
candida albicans (yeast infection) or black/white hairy tongue. |
|
3 ways a tooth can be discolored - |
1. diet (tea, coffee, wine, cokes) 2. drugs (tobacco, chlorahexidine) 3. metallic stains |