Spolsky.txt

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Spolsky.txt
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2012-03-15 13:09:22
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Spolsky Cariology Qs
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Spolsky Cariology Qs
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  1. 1. Of the two mechanisms by which the body eliminates fluoride, is skeletal deposition the more rapid in younger individuals than in adults?
    a. More Rapid in Children
  2. 2. Within the first six hours after a teenager drinks a glass of optimally fluoridated water, approximately what percent of the fluoride is taken up by the hard tissues of the body and the remainder is eliminated by the kidneys?
    a. ?????
  3. 3. What is the Environmental Protection Agency (EPA) and the U.S. Surgeon General’s stand on objectionable dental fluorosis?
    a. “Objectional dental fluorosis is a cosmetic effect with no known health effect”
  4. 4. What is the relationship between the prevalence of dental caries experience and the optimal concentration of fluorine in the drinking water?
    • a. As the concentration of fluorine in drinking water INCREASES to the optimal level, prevalence of dental caries experience DECREASES
    • b. Fluoride Concentration is INVERSELY PROPORTIONAL to DMF (decayed, missing, and filled teeth)
    • i. At low [F] => High DMF
    • ii. At high [F] => Low DMF
    • iii. Optimal balance of low DMF + low Fluorosis => 1.0ppm
  5. 5. What were the major findings of the Vipeholm study? [on the next lecture]
    • a. Decreased quantity of sucrose decreases dental caries
    • b. Physical form of sugar is more important than the quantity
    • c. Limited Sucrose to meal times ONLY decreased caries
    • d. Frequency of BETWEEN MEAL snacks directly related to caries
    • e. Eating sticky RETENTIVE foods BETWEEN meals is very detrimental
    • f. Sucrose must come in CONTACT with teeth to be detrimental [also in Toverud Study]
  6. 6. Based on the most recent survey of children (5-17 yrs., NHANES III [1989-91]) what was the proportion of children with zero DMFT?
    a. 55% KIDS WITH ZERO DMFT IN ’89-91
  7. 7. What is the relationship between the prevalence and severity of fluorosis and the concentration of fluorine in the drinking water? [I’m not really sure what this is asking.. but this was on one of the slides…]
    • a. Prevalence has INCREASED
    • i. At 1.0ppm in 1950’s => 10% (7-16%)
    • ii. At 1.0ppm in 1985 => 22.3% (18.5-25.8%)
    • b. Severity has NOT increased
  8. 8. Does the National Research Council of the National Academy of Sciences support the conclusion that optimally fluoridated water is not a genetic hazard?
    a. YES
  9. 9. Which teeth are most susceptible and least susceptible, respectively, to dental caries experience?
    • a. Most Susceptible => Mand. 2nd Molar + Mand. 1st Molar
    • b. Least Susceptible => Mand. Central Incisor + Mand. Lateral Incisor + Mand. Canine
  10. 10. Based on multiple fluoride exposures, what happens to the prevalence of dental fluorosis and the severity of fluorosis?
    • a. If concentration of fluorine is constant, the prevalence of fluorosis increases, but severeity stays constant
    • b. If concentration of fluorine increases, you would have an increase in severity as well as prevalence
  11. 10. How many parts per million (ppm) of fluoride ion are there in one ml of a 5 % NaF varnish? [calculations on final]
    • How to Calculate?
    • 1) Take the %F in Compound
    • 2) Multiply Specific Compound by molecular weight ratio
    • 3) Multiply by 10 (to get mg F/1 mL)
    • 4) Multiply by 1000 to get ppm
    • a. 5% x (1/2.2) x 10 x 1000 = 22,727.2727
  12. 11. What is the concentration of F in mg. in one ml of a 5 % NaF varnish? [calculations on final]
    • a. 5% x (1/2.2) x 10 = 22.727mg/mL
    • How to Calculate?
    • 1) Take the %F in Compound
    • 2) Multiply Specific Compound by molecular weight ratio
    • 3) Multiply by 10 (to get mg F/1 mL)
    • 4) Multiply by 1000 to get ppm
  13. 9. Based on the most recent U. S. data source (NHANES3), what is the mean number of DMFT for the 35-44 age group?
    • a. (NHANES II) Age 35-44 => 11.8
    • b. (NHANES III) Age 35-49 => 13.5 [he said to remember 8.1 for Age 20-34 and 13.5 for 35-49 in class]
    • c. (NHANES II) Age 45-54 => 15.5
  14. 11. When is the most critical time for F uptake by the enamel?
    • a. First 6 years of life
    • b. While the teeth are still developing
  15. 12. What is the sequence of caries attack by tooth surface (most to least)?
    • a. Occlusal [most]
    • b. Mesial
    • c. Distal
    • d. Facial
    • e. Lingual [least]
    • (Maxillary switch d and e)
  16. 13. After what age will dental fluorosis not occur even if 3 times the optimal level of fluoridated water is consumed daily?
    a. 6 years of age
  17. 14. What is the principal cause of tooth loss at most ages, except for the oldest ages (i.e.,>60 yrs)?
    • a. Periodontal Disease
    • b. Tooth Caries
  18. 15. Scientific evidence shows that it is probable that approximately what percentage of children consuming optimally fluoridated water, in the absence of fluoride from ALL other sources, will develop very mild dental fluorosis?
    a. Around 23% at optimal levels
  19. 16. Based on the most recent U. S. data source (NHANES3), what is the mean number of DMFT for the 35-44 age group?
    • a. (NHANES II) Age 35-44 => 11.8
    • b. (NHANES III) Age 35-49 => 13.5 [he said to remember 8.1 for Age 20-34 and 13.5 for 35-49 in class]
    • c. (NHANES II) Age 45-54 => 15.5
  20. 17. If water fluoridation were to be instituted today, one could reasonably expect to decrease the average number of DMFT (from birth to 14 yrs of age) by approximately what percent?
    a. 15-35% reduction is realistic
  21. 18. What is the topical fluoride of choice for home use for patients with composite restorations, gingival recession, veneers or porcelain crowns?
    • a. Probably 1.1% NaF (cheapest and safest)
    • b. 1.1% APF => starts to etch restorations
    • c. 0.4% SnF2 => could pigment teeth [attaches to decalcified areas and stains teeth]
  22. 19. How many parts per million (ppm) of fluoride ion are there in one ml of a 5 % NaF varnish? [calculations on final]
    • a. 5% x (1/2.2) x 10 x 1000 = 22,727.2727
    • How to Calculate?
    • 1) Take the %F in Compound
    • 2) Multiply Specific Compound by molecular weight ratio
    • 3) Multiply by 10 (to get mg F/1 mL)
    • 4) Multiply by 1000 to get ppm
    • a. 5% x (1/2.2) x 10 x 1000 = 22,727.2727
  23. 20. What is the concentration of F in mg. in one ml of a 5 % NaF varnish? [calculations on final]
    • a. 5% x (1/2.2) x 10 = 22.727
    • How to Calculate?
    • 1) Take the %F in Compound
    • 2) Multiply Specific Compound by molecular weight ratio
    • 3) Multiply by 10 (to get mg F/1 mL)
    • 4) Multiply by 1000 to get ppm
    • a. 5% x (1/2.2) x 10 x 1000 = 22,727.2727
  24. INSTRUCTIONS: Questions 21 and 22 are based on the 24-hour diet diary of an adult male.
    • TIME FOODS
    • 7:00AM Small glass orange juice
    • 12 noon Corned Beef Sandwich
    • Potato Chips
    • Cola
    • 5:00 PM 2 dishes of spaghetti with tomato sauce
    • 2 glasses beer
    • Piece of cake
    • 9:00 PM Candy Bar
    • Coffee (cream and sugar)
    • 21. What is the total number of acid exposures (resulting from sucrose) in the above 24 hour diary?
    • 22. What is the total amount of time (in minutes) that the man's teeth experienced acid exposure?
    • 9
    • 80 min (20 min/eating time for pH recovery)
  25. 23. If a person used a 0.4% SnF2 toothpaste to brush twice per day (AM & PM), and 0.76% Na2FPO3 to brush after lunch, how much fluoride in mg would his/hers teeth be exposed to during one week?0.4/4.1*10=~1mg/brush X2 per day X 7 days in a week=13mg
    0.76/7.6*10=1mg/brush*7 days in a week=7mg TOTAL=~20mg/week
  26. 24. What amount of toothpaste does the ADA recommend be used for children under six years of age?
    0.3-0.5 mg F per brushing
  27. 25. Does eating 1/2 lb. of chocolate rapidly at one time or sipping on coffee with sugar or "Coke Classic" over several hours have a greater cariogenic potential?
    Sipping
  28. 26. What is considered the greatest risk factor for dental fluorosis in young children?
    Swallowing fluoride toothpaste
  29. Questions: Fill in the table below by selecting the best answer for the correct quantity of fluoride under the conditions stated. This is based on the prescribing of Fluoride Supplements.
    • a. 0 mg of F
    • b. 0.25 mg of F
    • c. 0.50 mg of F
    • d. 1.00 mg of F.
    • AGE <0.3ppm 0="" 3="" to="" 6="" ppm="">0.6ppm
    • 6 mon.-3yrs 0.25 0 0
    • 3 yrs.-6yrs 0.50 0.25 0
    • 6yrs.-16yrs 1 0.50 0


  30. 27. What is the optimal level of fluoride, and does the majority of bottled water on the market contain optimal levels of fluoride?
    • 0.7ppm
    • No
  31. 28. What is the average % reduction in dental caries experience that can be expected from using a daily fluoride rinse in schoolchildren living in a fluoride deficient community?
    30%
  32. 29. How is it thought that chewing of sugarless gum (salivary stimulation) reduces the drop in salivary pH?
    Saliva has calcium carbonate and proteins to promote raising pH and remineralization
  33. 30. Which forms of fluoridation, when given at optimal dosages, produces the greatest decrease in the incidence of dental caries at the lowest cost?
    NaF
  34. 31. Which sugars (or sweetening agents) in chewing gum reduces plaque, the development of caries and increases salivary flow?
    Xylitol, sorbitol
  35. 32. Should fluoride supplements be prescribed only for children living in nonfluoridated areas to decrease the risk of dental fluorosis in permanent teeth.
    No, fluoride supplements would increase the risk of dental fluorosis.
  36. 33. What is the median % effectiveness in reducing occlusal surface caries on permanent first molars after five years if a one-time application of pit and fissure sealants is used?
    55%
  37. 34. What is the average % reduction in dental caries experience that can be expected from professionally applied concentrated gels in trays (applied 2x/year) in schoolchildren living in a fluoride deficient community?
    26%
  38. 35. What is the percentage concentration of NaF in the OTC fluoride rinse Act™ ?
    0.05%
  39. 36. What is the % reduction in dental caries experience that can be expected from using a fluoridated dentifrice in schoolchildren living in a fluoride deficient community?
    25-30% reduction
  40. 38. By definition, the Safely Tolerated Dose (STD) is what fraction of the Certain Lethal Dose (CLD)?
    STD = ¼ CLD
  41. 37. What is the most effective method to decrease the incidence of occlusal caries?
    Occlusal sealants
  42. 39. The Council on Dental Therapeutics of the ADA recommends that prescriptions for
    fluoride supplements be limited to 120 mg per prescription. (prescription is a 4 mo supply)
  43. 40. OTC fluoride rinses are limited to ?? mg F/bottle.
    120
  44. 41. If the CLD is 320 mg for a 2-year-old child weighting 22 lbs., what is the STD?
    STD, the Safely Tolerated Dose, is 80 mg. Remember: STD is ¼ of the CLD (certain lethal dose)
  45. 42. Of the ingredients that go into the manufacture of toothpastes, which is usually present in the largest percentage?
    Abrasive systems (commonly silica, calcium pyrophosphate, and calcium carbonate) used to clean and polish the teeth are present in the largest percentage (20-60%)
  46. 46. Is an adult patient with visible cavitation (D3) or radiographic decay a High caries risk
    • patient?
    • D3 cavitation is a carious lesion that spread to the dentin. I don’t have definitive notes for this question, but according to CAMBRA, the presence of dental caries places the patient in a higher risk category, so I would say yes.
  47. 47. Which ingredient that goes into the manufacture of toothpastes imparts the property of
    • preventing hardening and retaining moisture?
    • Humectants: sorbital, glycerin, polyethylene glycol
  48. 48. Which ingredient that goes into the manufacture of toothpastes imparts the property of
    • thickening or cohesion of ingredients?
    • Binders: xantham gum, carbomer, gantrez, carrageenan
  49. 49. Which ingredient that goes into the manufacture of toothpastes imparts the property of
    • lowering the surface tension and penetrating debris and stains?
    • Detergents: sodium lauryl sulfate
  50. 50. Which ingredient that goes into the manufacture of toothpastes imparts the property of
    • being a solvent?
    • Water!!
  51. 51. What ingredients are examples of an abrasive?
    calcium pyrophosphate, and calcium carbonate
  52. 52. What ingredients are examples of a binder?
    xantham gum, carbomer, gantrez, carrageenan
  53. 53. What ingredients are examples of a humectant?
    sorbital, glycerin, polyethylene glycol
  54. 54. What ingredients are examples of a detergent?
    Sodium lauryl sulfate
  55. 55. How do you define dental caries?
    • Dental caries is a disease. People have caries, teeth have carious lesions. (WARNING: this is from Hewlett’s lecture, Spolsky did not define caries specifically.)
    • He does mention that Dental Caries Experience is synonymous with DMFT/DMFS, however this does NOT mean dental caries.
  56. 56. Will you certainly develop dental caries if you have S. mutans in the dental plaque?
    No, the fate of caries development is not certain if S. mutans is present in dental plaques. The presence of sugar (substrate) over time must occur to develop caries.
  57. 57. In most cities, does every $1 invested in water fluoridation save $38 in dental treatment
    • costs?
    • Yes! This tidbit comes from the CDC.
  58. 58. Have European countries imposed a “ban” on water fluoridation, or have they simply not been implemented for a variety of technical, legal, financial or political reasons?
  59. There is no ban on fluoridation, but rather various local communites have not implemented this strategy for various reasons (stated above). This goes back to the truth that fluorosis is not pathological, but purely esthetic
  60. 59. What is the index of choice in measuring dental caries experience in a clinical trial of a new anti-decay tooth paste?
  61. DMFS (decayed missing filled surfaces) would be used because it is the most sensitive measurement
  62. 60. The studies carried out by Dean in the 1940’s are examples of what epidemiological method or approach?
    • Dean (1942) was a classical epidemiological study which established a 6 point index by which to measure fluorosis based on opacity. Part of the 21 city study
    • ***This was a Controlled observation study***
  63. 61. What is the DMF (DMFT or DMFS) index dependent on and/or what is it estimating?
    • This index estimates the total dental caries experience for each person
    • Dependent on the number of decayed, missing, filled teeth/surfaces
  64. 62. Are there any confirmed cases of allergy to fluoride, in humans or animals?
    NO
  65. 63. The initial studies on the occurrence of dental fluorosis carried out by McKay in the early 1900s are examples of what epidemiological method or approach?
    • Uncontrolled Observation
    • Studied mottled teeth in Colorado
  66. 72. Is dental caries experience synonymous with dental caries?
    NO. Dental caries experience = dental caries susceptibility
  67. 73. What are the scales of measurement that are used most frequently in epidemiologic studies?
    Ratio scale
  68. 74. What is the difference between DMF index and dmf index?
    DMF is for permanent, dmf = primary
  69. 75. In the full range of carious lesion development (D1–D3), what does D1, D2 and D3 indicate?
    • D1 = initial caries, surface is intact w/ white spots and discoloration
    • D2 = enamel caries, pit and fissure caries w/ or w/out white spots
    • D3 = caries in dentin, visible on radiographic and tactile
  70. 76. Has any court of last resort ever determined fluoridation to be unlawful? Have the highest courts of any states confirmed the constitutionality of fluoridation?
    No.
  71. 77. What did Former U.S. Surgeon General David Satcher say is a powerful strategy in efforts to eliminate health disparities among populations?
    H2O fluoridation is a powerful strategy to eliminate health disparities among populations
  72. 78. Does water fluoridation have an impact on the acidity or pH of drinking water and will it cause lead and copper to be leached from water pipes?
    No.
  73. 79. Does DMF remain relatively constant with increasing income?
    No.
  74. 80. How are the D and M components of DMF related to increasing income?
    D and M are inversely related to income
  75. 81. Does the F component of DMF increase or decrease with increasing income?
    F is directly related to income so it increase w/ income
  76. 82. The D component of DMF increases with increasing age to about what age?
    34 yrs
  77. 83. Does the M component of DMF increase or decrease with increasing age?
    M increases w/ age
  78. 84. Does the F component of DMF increase or decrease with increasing age?
    F increases w/ age
  79. 85. Does the total DMF increase or decrease with increasing age?
    DMF increases w/ age but young and very old are at the greatest risk
  80. 86. Does the total DMF show a slight increase or decrease with increasing education?
    Slight inverse relationship to increasing education (slight decrease in DMF w/ increasing education)
  81. INSTRUCTIONS 87-93: Questions 87-93 may be answered by selecting the appropriate data from TABLE A. Circle the best choice of an answer for each question.
    • TABLE A: Mean number of Decayed, Missing and Filled teeth (DMFT) or Dental Caries
    • Experience, and components for 1,000 children, 6 to 11 years of age, 2002 and 2004, Los
    • Angeles, CA.
    • YEAR NUMBER EXAMINED AVERAGE SCORES PER CHILD

    • 87. The prevalence of dental caries experience among children in 2002 was 800 80%
    • 88. The prevalence of dental caries experience among children in 2004 was 900 90%
    • 89. Using mean numbers to express dental caries experience, the prevalence in 2004 was 10
    • 90. Using mean numbers, the incidence of DMFT for the period 2002 to 2004 was
    • 91. The annual attack rate from 2002 to 2004 for dental caries experience was
    • 92. In 2002, the average tooth mortality was 1.
    • 93. In 2004, the average tooth fatality was .2.
  82. INSTRUCTIONS 94-104: Which of the following choices best answers or describes the relationships that are listed below in questions 94-104?
    • a = increases or increased or increasing (directly)
    • b = decreases or decreased or decreasing (inversely)
    • c = high or higher
    • d = low or lower
    • e = increases with increasing age to a specific point and then decreases
  83. 94. Among adults (NHANES III), Whites tend to have a (higher, lower) dental caries experience than Blacks.
    higher
  84. 95. Among adults (NHANES III), Blacks tend to have a (higher, lower) dental caries experience than Mexican-Americans.
    higher
  85. 96. The prevalence of dental caries experience (Increases, decreases) with increasing age.
    increases
  86. 97. The pattern of decayed teeth (DT) (Increases, decreases) with increasing age.
    increases
  87. 98. On a worldwide basis, dental caries experience in the U.S. is relatively (high,low).
    low
  88. 99. In adults, dental caries experience (Increases, decreases) with increasing levels of income and education.
    decreses
  89. 100. The pattern of missing teeth (MT) (Increases, decreases) with increasing age.
    Increases
  90. 101. The pattern of filled teeth (FT) (Increases, decreases) with increasing age.
    Increases
  91. 102. Although the differences are small, males tend to have a (higher, lower) dental caries experience than females.
    lower
  92. 103. On a regional or geographic basis, people living in the Southwest have a (higher, lower) dental caries experience than people living in the Northeast.
    lower
  93. 104. Adults living in rural areas have a (higher, lower) dental caries experience than adults living in urban areas.
    lower
  94. 105. The critical pH for most individuals is thought to occur at approximately what point?
    5.5
  95. 106. As the flow rate of normal saliva increases you see a corresponding increase in what else?
    Buffering capacity
  96. 107. What is the predominant buffering system in the saliva?
    Bicarbonate anion in saliva, HCO3-
  97. 108. Glucosyl transferases derived from Streptococcus mutans are
    capable of synthesizing long chain polymers that are branched  glucans.
  98. 109. What is the basic mineral structure of enamel?
    Hydroxyapatite Ca10 (PO4)6 (OH)2
  99. 110. Which ions, when present in enamel, is thought to increase the acid reactivity of hydroxyapatite?
    Ca and Phosphate (PO4)
  100. 111. Which enzymes is responsible for the conversion of pyruvate to lactate during bacterial glycolysis?
    Lactate dehydrogenase
  101. 112. It has been shown experimentally that a short sucrose exposure (2 min.) will cause the plaque pH to fall below the critical pH for approximately what time period?
    10-20 minutes
  102. 113. Of the glucans produced by oral bacteria, which are believed to be the most water insoluble?
    Branched
  103. 114. What are the molecular weight ratios for NaF, SnF2 and Na2FPO3?
    • NaF = 1-2.2
    • SnF2 = 1-4.1
    • Na2fPO3 = 1-7.6
  104. How does a decrease in salivary flow influence the risk for
    dental caries?
    Saliva acts as a buffer; reducing saliva prolongs the affects of acid
  105. During the formation of hydroxyapatite, what element may occur in the voids created bythe disordering of the hydroxyl groups of the hydroxyapatite crystal?
    Fluoride
  106. In the delicate balance between remineralization and demineralization, what is the critical pH for most individuals thought to be?
    <5.5 demineralization occurs
  107. In our contemporary concept of dental caries, what set of parameters need to be present in order for dental caries to occur?
    Nutrition, Bacteria, Time, Host
  108. What immunoglobulin is associated with salivary secretions?
    IgA
  109. What is the general formula for the calcified matrix of enamel?
    Ca10(PO4)6H2O
  110. Who proposed the Chemo-parasitic Theory?
    Miller
  111. What are the reparative mechanisms for an acellular tissue
    such as tooth enamel?
    • There are no repair mechanisms for
    • enamel.
  112. What is the most acidic organic acid produced through glycolysis by plaque bacteria?
    Lactic Acid
  113. What is the approximate percentage of inorganic material in enamel and dentin?
    96% in Enamel, 70% in Dentin
  114. Under normal physiologic conditions what ion is the saliva saturated with?
    Bicarbonate
  115. What enzyme is responsible for the conversion of pyruvate to lactate during bacterial glycolysis?
    Lactate Dehydrogenase
  116. Which dental plaque organism is thought to be a key bacterium in the induction of pit and fissure caries?
    S. mutans
  117. After a short sucrose exposure the plaque pH will fall below the critical pH for approximately how long?
    20 minutes
  118. Which of the glucans are thought to be the most caries
    promoting?
    Branched (insoluble) Glucans
  119. How are the bacteria that cause dental caries transmitted
    from one individual to another?
    From care-giver to child

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