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What compounds caries risk from recession?
- Poor Oral Hygeine
- High Carbohydrates
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
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
What biomarkers are found in saliva?
Dr Wong: IgA, amylase, proteins and mRNA
How do you treat xerostomia?
water, artificial saliva, mints, pilocarpine(salagen) Ach cholinergic agonist
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
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?
How are root caries clinically diagnosed?
- Surface loss, tactily
- NOT color
- in vitro/no histological eval
How should a xerostomic patient be treated?
- more frequent exams
- rinse mouth (alcohol-free)
What are S. mutans risk classifications?
- Low < 100K
- Medim 100K-500K
- high >500K: Rx: chlorhexidine (peridex), xylitol, recall
Which restorative material was superior?
Glass-ionomer conferred preventive effect on root surfaces
What is the role of floride in arresting root caries?
frequent topical application of F irrespective of type is successful for incipient RCLs
What is a drawback of Dr Shi lollipops?
Reduced presence of S. Mutans in saliva only.
Ozone is effective in reducing bacterial load.
What are some results of untreated root caries?
- chronic periradicular periodontitis
- opportunistic infection
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)
What are the classes of caries activity?
- moderate (1-3 new)
- high (>=4 new)
- extremely high (atypical surfaces)
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
What are the problems associated with oral care delivery?
Access, income, transportaion, providers, physician awareness , self-efficacy
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
What are some of the caries risk factors for elderly?
- residence in long term care facilities
- high Lactobacilli
- poor OH
- frequent sugar consumption
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
How does dementia affect oral health?
- higher incidence of coronal and root caires
- oral hygeine difficulties, neuroleptic meds, high anticholinergic effects
Which bacteria are specifically present with root caries in elderly?
- S. Mutans
- high variability
- maybe Atopobium, Olsenella, Pseudoramibacter,Propionibacterium, Selenomonas
What does Geriatric Minimal Intervention Dentistry do?
stop caries->stop possible domino effect, use EBD to find effective solutions.
What is CAMBRA?
- Caries Management By Risk Assessment
- asessing caries and making dental treatment recommendations based on patients risk
What are the predictors of root caries in elderly?
- OHI and RCI:
- # of teeth
- xerostomic meds (maxillary root caries)
- mand molars/premolars greatest risk
- interceptive dental therapeutics needed for high risk geriatric
Can prevention alone rather than intervention control oral diseases in elderly?
Yes according to canadians.
Which ionomeric materials had greatest effect on acidogenicity of S Mutans?
- Vitremer: highest release of Al
- Aluminum may enhance F effectiveness