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What compounds caries risk from recession?
- Xerostomia
- Poor Oral Hygeine
- High Carbohydrates
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What are the causes of xerostomia?
- medication: common, illicit (over 500 and interactions)
- Radiation Therapy (all HN malignancys, 80% hematopoeitic, 40% of chemo) low risk: myelosuppressive, high risk stomatotoxic (prolonged myelosuppresion)
- Sjogrens Syndroe: Autoimmune: Ab against salivary and tear
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What are the signs and diagnostics of Sjogren's syndrome?
- Dry, Sticky, cavities, thick/no saliva, swollen glands, smooth tongue, dry/cracked lips, sores corners
- biopsy of salivary gland lip: presence of lymphocytes in particular pattern
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What biomarkers are found in saliva?
Dr Wong: IgA, amylase, proteins and mRNA
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How do you treat xerostomia?
water, artificial saliva, mints, pilocarpine(salagen) Ach cholinergic agonist
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How do root caries progress?
- Spreads laterally to infect side branches of dentin tubules
- not necessarily cavitated
- varies (no surface->pulp infection)
- critical pH for root is higher than enamel
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What is ICDAS?
- International Caries Detection and Assessment System: standard measurement to identify enamel and dentin caries.
- Root surface visible?
- Dry color Change?
- Cavitiation Visible?
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How are root caries clinically diagnosed?
- Surface loss, tactily
- NOT color
- in vitro/no histological eval
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How should a xerostomic patient be treated?
- more frequent exams
- rinse mouth (alcohol-free)
- Floride(prescribed)
- floss
- sugar-free
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What are S. mutans risk classifications?
- Low < 100K
- Medim 100K-500K
- high >500K: Rx: chlorhexidine (peridex), xylitol, recall
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Which restorative material was superior?
Glass-ionomer conferred preventive effect on root surfaces
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What is the role of floride in arresting root caries?
frequent topical application of F irrespective of type is successful for incipient RCLs
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What is a drawback of Dr Shi lollipops?
Reduced presence of S. Mutans in saliva only.
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Ozone is effective in reducing bacterial load.
True
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What are some results of untreated root caries?
- fistulas
- chronic periradicular periodontitis
- opportunistic infection
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What are things you want to assess in health history?
- Independence or assistance level
- Quality and outcomes of intervention
- Assessment types: (caries, DMF, plaque index, perio probe, ADOH, CAMBRA)
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What are the classes of caries activity?
- moderate (1-3 new)
- high (>=4 new)
- extremely high (atypical surfaces)
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What is ADOH?
- Activities of Daily Oral Hygeine
- Helps assess one's oral hygeine ability
- Observer Fluoride application, rinsing, flossing, brushing
- 0=independent, 4=complete dependency
- 16 is most dependent
- 8 is most dependent for edentulous
- Claifies what assistance is needed, may need to assess caregiver's willingness too
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What are the problems associated with oral care delivery?
Access, income, transportaion, providers, physician awareness , self-efficacy
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Why does oral microflora change with advancing age?
- possibly due to impaired immune function and colonization of nonoral species (Staph, entero, yeast)
- also consider medication, xerostomia, dentures
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What are some of the caries risk factors for elderly?
- residence in long term care facilities
- high Lactobacilli
- poor OH
- frequent sugar consumption
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What did the Veterans dental study conclude?
- deleterious effects of xerostomic meds on oral mucosa
- xerostomic meds did NOT appear to increase coronal caries, or periodontal indext amoung people who were able to perform ROUNTINE PREVENTIVE ORAL CARE
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How does dementia affect oral health?
- higher incidence of coronal and root caires
- oral hygeine difficulties, neuroleptic meds, high anticholinergic effects
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Which bacteria are specifically present with root caries in elderly?
- Lactobacilli
- Actinomyces
- S. Mutans
- high variability
- maybe Atopobium, Olsenella, Pseudoramibacter,Propionibacterium, Selenomonas
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What does Geriatric Minimal Intervention Dentistry do?
stop caries->stop possible domino effect, use EBD to find effective solutions.
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What is CAMBRA?
- Caries Management By Risk Assessment
- asessing caries and making dental treatment recommendations based on patients risk
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What are the predictors of root caries in elderly?
- OHI and RCI:
- # of teeth
- calculus
- plaque
- xerostomic meds (maxillary root caries)
- mand molars/premolars greatest risk
- interceptive dental therapeutics needed for high risk geriatric
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Can prevention alone rather than intervention control oral diseases in elderly?
Yes according to canadians.
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Which ionomeric materials had greatest effect on acidogenicity of S Mutans?
- Vitremer: highest release of Al
- Aluminum may enhance F effectiveness
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