On the tooth surface, a __________ process of demineralization and remineralization is goine on
constant
_________ ages are susceptible to dental caries
ALL
How does the basic caries process start?
certain acidogenic bacteria in dental biofilm act to metabolize the fermentable carbohydrates ingested by the patient
What occures after acids are formed that lead to cavity formation?
acids act to demineralize the enamel, cementum, and/or dentin
Where do the specific bacteria in the biofilm on the tooth surfaces metabolize acid from?
the fermentable carbohydrates ingested by the individual
What are infectious organisims that cologize the teeth and help to form the dental biofilm through their ability to create a sticky environment for survival and multiplication?
mutans streptococci
What are the 2 groups of bacteria that predominate in the caries process?
mutans streptococci: streptococcus mutans and streptococcus sobrinus
Lactobacillus species
Which group of bacteria predominates during the initial stages of demineralization and cavity formation, and which are more active during the progression of the cavity?
mutans streptococci
lactobacillus
What are 4 fermentable carbohydrates?
sucrose
glucose
fructose
cooked starch
What are 4 acids that are produced during the metabolic processes?
acetic
lactic
formic
proprionic
true or false. FREQUENCY of ingestion of sugary foods by the patient has a strong influence on the amount of acid produced and the extent of tooth destruction
true
The acid formed from fermentable carbs passes where?
rapidly into diffusion channels between the enamel rods
After the acid passes into diffusion channels between the enamel rods, what happens?
the acid dissolves the calium and phosphate mineral in the sugsurface of the enamel or dentin structure
the process by which the minerals of the tooth structure are dissolved by the organic acids produced from the fermentable carbohydrate by the acidogenic bacteria
demineralization
What happens with repeated bathing of the tooth surface with the acids produced in the course of a day?
the tooth demineralization can progress in time to the final stage of dental caries, the dental cavity
true or false. smooth surface caries as well as pit and fissures can result when cariogenic nutrients are available
true
___________can take over to halt or arrest the demineralization process
remineralization
What are 2 substances that provide protective factors in promoting remineralization?
saliva
fluoride
What functions to buffer the acids and to supply minerals to replace those calcium and phosphate ions dissoved from the tooth during demineralization?
saliva
Saliva is a continuing source for fluoride transport to the tooth surfaces, where can saliva derive fluoride from?
fluoridated water
fluoride products used by pt
fluoride products for professional application
What are 3 mechanisms of action of fluoride?
inhibits demineralization
enhances remineralization
inhibits bacteria in the biofilm
Which action of fluoride is described?
when fluoride is present in the fluid of the biofilm around the enamel crystals, it will pass through the diffusion channels with the acid and increase the fluoride of the subsurface lesion to prevent the continued dissolution of the minerals
inhibits demineralization
Which action of fluoride is described?
as the saliva flows over the biofilm, its buffering properties neutralize the acid produced by the bacteria. The pH rises toward neutral and prevents further dissolution of the minerals. Minerals in the saliva can go back into the tooth for remineralization
enhances remineralization
Which action of fluoride is described?
fluoride can change to HF (hydrogen fluoride) when it is contacted by the acid produced by the bacteria from the carbohydrates in the pt's diet. In the HF form it can then diffuse over the cell membrane of the acidogenic bacteria. Inside it dissociates again and the fluoride ions interfere with essential enzyme activity within the bacterial cell
Inhibits bacteria in the biofilm
What are 4 stages of caries?
initial
early
white area: early, later
cavitation: definitive lesion
Which stage of dental caries is described?
Mutans streptococci infect the tooth by: clinging to the smooth tooth surface, creating a biofilm, producing acid from available fermentable carbs, the acid produced diffuses through the microchannels between the enamel rods, dissolves the tooth minerals and creates the subsurface lesion
initial infection: invisible lesion
Which stage of dental caries is described?
Generally invisible
early subsurface infection
Which stage of dental caries is described?
examination with air under bright light can show the white area of subsurface demineralization; smooth surface, with blunt probe run lightly of the surface; careful examination; surface must not be broken or scratched; picking or scratching a mineralizing surface can prevent further mineralization; remineralization process starts with saliva action and increase fluoride
White area lesion: early
Which stage of dental caries is described?
examination: run blunt probe gently over the surface with no pressure; when there is a slight surface roughness, beginning breakdown: DO NOT scratch the surface; remineralization may still be effective and allowed to continue
white area lesion: late
Which stage of dental caries is described?
Open cavity can be observed directly; small proximal caries at the contact area need radiograph for confirmation of depth; can be observed on radiographs
cavitation
occlusal surfaces (pits and fissures) in premolars and molars; occlusal 2/3 of the facial or lingual surfaces of molars; lingual surfaces of maxillary incisors; are what classification of caries?
class 1
proximal surfaces of posterior teeth; occlusal surfaces are usually involved; are what classification of caries?
clss 2
proximal surfaces of incisors and canines; incisal angle is NOT involved is what classification fo caries?
class 3
the proximal surfaces of incisors and canines, including the incisal edge; is what classification of caries?
class 4
gingival third of facial or lingual surfaces of any tooth (and root caries); is what classification of caries?
class 5
Incisal edge of anterior teeth and the cusp tips of posterior teeth; is what classification of caries?
class 5
What are 3 objectives for caries management?
determine restorative tx needs: chart existing work; chart cavities (in need of restoration); chart secondary lesions; chart sealants that need repair
determine areas that require remineralization: chart white areas and white cervical lines; outline appropriate strategies for pt
define steps for remineralization program: explain needs and methods for pt understanding; prepare and explain risk assessment; select and demonstrate procedures that must be followed; plan for evaluation and reevaluation
habits, behaviors, lifestyles, or conditions that when present, increase the probability of a disease occurring
