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)
secondary/recurrent caries adjacent to previos restorations
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
biofilm that is apical to the margin of the free gingiva
biofilm origin is salivary glycoprotein forms a pellicle; microorganisms from saliva selectively attach to pellicle
biofilm origin is the downgrowth from supragingival biofilm
biofilm attaches to the acquired pellicle, other bacteria, tooth surfaces, unattached kind is loose and washes away
biofilm attaches to the tooth surface, subgingival pellicle, calculus, the flora is loose, floating, motile, between adherent biofilm on tooth and pocket epithelium
the biofilm is retained on rough surfaces, malpositioned teeth, and carious lesions
the biofilm is retained in pockets, they hold the biofilm against the tooth; overhang restoration margins that extend subgingivally
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
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
the structure of this biofilm is adherent, densely packed microbial layer; intermicrobial matrix; begins with small isolated colonies, merging to form covering
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
what microorganisms are present in supragingival biofilm in the early biofilm?
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?
What are 3 sources of nutrients for subgingival biofilm?
gingival sulcus fluid
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?
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?
in what stage of biofilm formation includes selective colonization of the pellicle by microorganisms?
in what stage of biofilm formation is the growth and maturation of biofilm?
What days of biofilm formation does the biofilm consist primarily of gram-positive cocci; and streptococci dominates the bacterial population?
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?
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?
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?
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?
what are 3 inorganic elements present in biofilm?
What are 2 organic components in biofilm?
What are 4 locations that biofilm might be distributed?
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?
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?
lower in caries susceptible perons
higher in careies-resistant persons
What is the pH for enamel demineralization? for root demineralization?
true or false. food particles are not needed in the mouth for biofilm to form
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
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.
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
calculus is white, creamy yellow, or gray, sometimes stained, and visible when dried
calc is light to dark brown, dark green, or black, stains are derived from blood pigments from diseased pockets
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
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
consistency of this calc is moderately hard; newer deposites are less dense and hard, porous surface covered with nonmineralized biofilm
consistency of this calc may be, brittle, flintlike, harder and denser, newest deposits are less dense and hard, surface covered with dental biofilm
this calc is found coronal to the gingival margin, and has a thin line to full coronal coverage
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
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
this calc is heaviest on proximal surfaces, lightest on facial surfaces, occurs with or without supragingival deposits
What percent of mature calculus is inorganic components?
what are the 6 main inorganic substances found in calculus?
list 12 trace inorganic elements that have also been identified in mature calculus.
true or false. fluoride is an inorganic substance that may be found in calculus.
2/3 of the inroganic matter of calculus is what?
crystalline, principally apatite
how mineralized are each of the follwing substances?
cementum and bone
What are 8 organic substances found in calculus?
What are the 3 steps of calculus formation?
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?
What are 3 types of calculus attachment?
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