What are 2 indications of use for professional fluoride applications?
based on caries risk assessment for the individual patient
for individuals at risk for dental caries
Give 11 examples of pts who are at risk for dental caries.
primary teeth (varnish only)
posteruptive period
active caries
secondary/recurrent caries adjacent to previos restorations
ortho
compromised salivary flow
natural teeth supporting an over denture
exposed root surface following periodontal recession
lack of compliance for daily biofilm removal
low or no fluoride in drinking water
early carious lesions
What are 3 types of available professional fluoride applications?
2.0% sodium fluoride (gel or foam)
1.23% acidulated phosphate (gel or foam)
5% sodium fluoride as a varnish
What are contrainciations for use of 2.0% sodium fluoride?
the foam type has limited clinical evidence to demonstrate effectiveness in caries prevention
What are contraindiactions for 1.23% acidulated phosphate fluoride (APF)?
foam type is ineffective
do not use in presence of porcelain and composite restorations and sealants
What type of fluoride is the application of choice for those with dentin hypersensitivity?
5% neutral sodium varnish
What are 3 different types of self applied home fluorides?
dentifrices - toothbrushing
mouthrinses - rinsing
gels - tray
What are 4 indications for using home applied fluorides?
rampant enamel or root caries in persons of any age
xerostomia from any cause
exposure to radiation therapy
root surface hypersensitivity
Why are fluoride applications beneficial for post-eruptive period?
there is a rapid uptake of fluoride during this period, and it is very important for newly exposed enamel
biofilm that is coronal to the margin of the free gingiva
supra
biofilm that is apical to the margin of the free gingiva
sub
biofilm origin is salivary glycoprotein forms a pellicle; microorganisms from saliva selectively attach to pellicle
supra biofilm
biofilm origin is the downgrowth from supragingival biofilm
sub biofilm
biofilm attaches to the acquired pellicle, other bacteria, tooth surfaces, unattached kind is loose and washes away
supragingival
biofilm attaches to the tooth surface, subgingival pellicle, calculus, the flora is loose, floating, motile, between adherent biofilm on tooth and pocket epithelium
subingival biofilm
the biofilm is retained on rough surfaces, malpositioned teeth, and carious lesions
supragingival biofilm
the biofilm is retained in pockets, they hold the biofilm against the tooth; overhang restoration margins that extend subgingivally
subgingival biofilm
friction of the tongue, cheek, and lips limits the shape and size of this biofilm; it is thicker at the cervical third and proximal; healthy mouths, the biofilm is 15-20 cells thick; in unhealthy mouths, the biofilm is 100-300 cells thick
supragingival biofilm
the shape and size of this biofilm is molded by the pocket wall, follows the form of subgingival calc, and becomes thicker as the pocket wall loosens
subgingival biofilm
the structure of this biofilm is adherent, densely packed microbial layer; intermicrobial matrix; begins with small isolated colonies, merging to form covering
supraginvial biofilm
the strucure of this biofilm has 3 layers; tooth-surface attahced is gram -positive rods and cocci; unattached is gram-negative, motile, spirochetes, and leukocytes; and epithelium attached is gram-negative, motile, many leukocytes migrate through the epithelium
subgingival biofilm
what microorganisms are present in supragingival biofilm in the early biofilm?
gram-positive cocci
What microorganisms are present in supragingival biofilm 3-4 days?
filaments and fusiforms
What microorganisms are present in supragingival biofilm 4-9 days in?
complex flora w/rods, filamentous form
What microorganisms are present in supragingival biofilm 7-14 days in?
vibrios, spirochetes, gram-negative organisms
What microorganisms are present in subgingival biofilm? In diseased pocket subgingival biofilm?
What are 2 sources of nutrients for supragingival biofilm?
saliva
ingested food
What are 3 sources of nutrients for subgingival biofilm?
gingival sulcus fluid
exudate
leukocytes
what are 3 items of significance of supragingival biofilm?
cause of gingivitis, supragingival calculus, and dental caries
what are 3 items of significance of subgingival biofilm?
cause of gingivitis, perio infections, and subgingival calculus
When does the acquired pellicle form?
within minutes after all external material has been removed from the tooth surfaces
What primarily makes up the acquired pellicle?
glycoproteins from saliva
What are 4 areas that the acquired pellicle forms?
teeth
calculus deposites
retorations
complete and partial dentures
What are 4 items of significance of the acquired pellicle?
protective - provide a barrier againse acids
lubrication - keeps surfaces moist
nidus for bacteria - participates in biofilm formation by aiding in adherence of microorganisms
attachment of calc - calc can attach to it
in what stage of biofilm formation, are salivary glycoproteins adsorbed onto dental enamel to form the pellicle?
stage 1
in what stage of biofilm formation includes selective colonization of the pellicle by microorganisms?
stage 2
in what stage of biofilm formation is the growth and maturation of biofilm?
stage 3
What days of biofilm formation does the biofilm consist primarily of gram-positive cocci; and streptococci dominates the bacterial population?
days 1-2
in what days of biofilm formation do the cocci still dominate, but there is an increase in gram-positive filamentous form and slender rods; the filaments grow into the cocci layer and replace many of them?
days 2-4
in what days of biofilm formation do the filaments increase in numbers and more mixed flora appears with rods, filamentous forms, and fusobacteria, biofilm near margin thickens and develops mature flora with gram-negative spirochetes and vibrios?
days 4-7
in what days of biofilm formation do vibrios and spirochetes appear, and the number of white blood cells increase, more gram-negative and anaerobic organisms appear, and signs of inflammation begin to appear in gingiva?
days 7-14
in what days of biofilm formation are vibrios and spirochetes prevalent in older biofilm, densly packed filamentous microorganisms arrange themselves perpendicular to tooth surface, and gingivitis is evident clinically?
days 14-21
what are 3 inorganic elements present in biofilm?
calcium
phosphorous
fluoride
What are 2 organic components in biofilm?
carbohydrates
proteins
What are 4 locations that biofilm might be distributed?
supragingival
gingival
subgingival
fissure
What area will probably have the least amount of biofilm? and why?
palatal surfaces of maxillary teeth because of the tongue
What are 3 ways to detect biofilm?
direct vision
tactile - probe or explorer
used of disclosing agent
What are 4 items in the significance of dental biofilm?
plays a major role in initiation of caries and periodontal infection
perio disease and caries are infections transmissible diseases caused by microorganisms in biofilm
calculus is mineralized biofilm
oral cleanliness depends on daily removal of biofilm
When does acid formation form on teeth?
immediately when the cariogenic substance is taken into the biofilm
what is the biofilm pH before eating?
6.2-7.0
lower in caries susceptible perons
higher in careies-resistant persons
What is the pH for enamel demineralization? for root demineralization?
4.5-5.5
6.0-6.7
true or false. food particles are not needed in the mouth for biofilm to form
true
true or false. The friction of mastication has been shown to affect only the occlusal and incisal thirds of the crowns of teeth. But apples may remove some food debris.
both are true
a loosely adherent mass of bacteria and cellular debris that frequently occurs on top of dental biofilm where biofilm removal is neglected
materia alba
a white material that appears as a bulky, soft deposit that is clearly visible without application of a disclosing agent. It is white or grayish white, and may resemble cottage cheese.
materia alba
this is a product of informal accumulation of living and dead bacteria, desquamated epithelial cells, disintegrating leukocytes, salivary proteins, and possibley a few particles of food debris
materia alba
calculus is white, creamy yellow, or gray, sometimes stained, and visible when dried
supragingival calc
calc is light to dark brown, dark green, or black, stains are derived from blood pigments from diseased pockets
subgingival calc
the shape of this calc is amorphous, bulky, gross deposites form a ledge, shape is determined by tooth anatomy, gingival contour, pressure from tongue, cheek, and lips
supragingival calc
shape of this calc is flattened to conform with pressure from the pocket wall, it is a combination of, crusty, spiny, or nodular, ledge or ringlike, thin, smooth veneers, finger or fern-like, or individual calculus islands
subgingival calculus
consistency of this calc is moderately hard; newer deposites are less dense and hard, porous surface covered with nonmineralized biofilm
supragingival calc
consistency of this calc may be, brittle, flintlike, harder and denser, newest deposits are less dense and hard, surface covered with dental biofilm
subgingival calc
this calc is found coronal to the gingival margin, and has a thin line to full coronal coverage
supragingival calc
this calc is found apical to the gingival margin, extends to the bottom of pocket, following contour of soft tissue attachment with recession, subgingiva may become supragingival
subgingival calc
this calc is symmetrical, except with: malpositioned teeth, unilateral hypofunction, inconsistent personal care, and abrasion from food; it is opposite salivary ducts, and can be with our without subgingival deposits
supragingival calc
this calc is heaviest on proximal surfaces, lightest on facial surfaces, occurs with or without supragingival deposits
subgingival calc
What percent of mature calculus is inorganic components?
70-90%
what are the 6 main inorganic substances found in calculus?
calcium
phosphorous
carbonate
sodium
magnesium
potassium
list 12 trace inorganic elements that have also been identified in mature calculus.
chlorine
zinc
strontium
bromine
copper
manganese
tungsten
gold
aluminum
silicon
iron
fluorine
true or false. fluoride is an inorganic substance that may be found in calculus.
true
2/3 of the inroganic matter of calculus is what?
crystalline, principally apatite
how mineralized are each of the follwing substances?
enamel
dentin
cementum and bone
calculus
96%
65%
45-50%
70-90%
What are 8 organic substances found in calculus?
cholesterol
cholesterol esters
phospholipids
fatty acids
carbohydrates
keratins
nucleoproteins
amino acids
What are the 3 steps of calculus formation?
pellicle formation
biofilm maturation
mineralization
how long does it take for more and more calc mineralization centers to develop close to the underlying tooth surface, eventually the centers grow large enough to touch and unite?
24-48 hrs
What are 3 types of calculus attachment?
acquired pellicle
minute irregularities to tooth surface by mechanical locking into undercuts - cracks, lamellae, carious defects, cemental irregularities
direct contact between calcified intercellular matrix and the tooth surface - interlocking of inorganic crystals of the tooth with the mineralizing dental biofilm