Caries 102 Final

• 99% water
• 1% solids (electrolytes & proteins)
• VARIABLE (with flow rate)

• 0.5-1.0 L
• 90% produced by parotid, submandibular and submental

(largest to smallest) parotid, submandibular, sublingual

Serous: thin, watery, amylase-rich

• mixed mucous & serous
• serous: thin, watery, amylase-rich
• mucous: viscous, slimy, mucin-rich

mucous: viscous, slimy, mucin-rich

• oral mucosa (labial, buccal, palatine, lingual)
• 10% saliva production
• Large fraction of salivary protein: oral tissue lubrication

oral tissue lubrication

• Teeth: lubrication, remineralization, clearance, inhibit demineralization
• Microbes: antifungal, antibacterial, antiviral
• food: taste, bolus, digestion

• inhibits demineralization
• antibacterial
• antifungal
• anti viral
• bolus
• lubrication and visoelasticity

• masticatory-salivary reflex (chewing)
• gustatory-salivary reflex (taste)

• chewing activates mechanoreceptors in the PDL
• could be a problem in denture wearing pts (must be stimulated by different mechanism)

taste activated chemoreceptors in the taste buds within the lingual papillae

• impulses from higher brain centers to salivary nuclei (non-mechanical, non-physical)
• power of suggestion (think about favorite food)

• sleep
• fear
• mental depression
• stress (anxiety, yet stress can increase flow (will to fight))

• increased flow (will to fight)
• decreased flow (anxiety)

Na, Cl, HCO3, Ca, pH, ionic strength (submandibular/submental)

Inorganic Phosphate, Mg, K (parotid)

• Final composition of saliva depends on flow rate
• In stimulated saliva: increased bicarbonate, buffering and pH (more alkaline)

• diluctiona dn elimination of substances from the oral cavity (ex fermentable carbohydrates)
• sucrose intake->salivary gland stimulation (taste & chewing)-> swallowing-> [Sucrose] in saliva decreases to zero

increases acid exposure time

• [Sucrose] in plaque rises rapidly with sugar intake and remains high despite [Sucrose] saliva decreasing
• sugar is available for plaque bacteria long after [sugar] in saliva falls below the taste threshold.

SUBJECTIVE feeling of oral dryness affecting swallowing, speech & QOL

• abnormally low salivary flow rates OBJECTIVELY measured by saliva producton
• Unstimulated: <=0.1mL per minute
• Stimulated: <-0.5-0.7 mL/min

• Unstimulated: 0.1-0.25 mL/min
• Stimulated: 0.7-1.0 mL min

• Unstimulated: > 0.25 mL/min
• Stimulated: > 1.0 mL/min

• Medications: antidepressants, antianxiety, antihistamines, antihypertensives (diuretics)
• >3 different drugs taken daily (polypharmacy) CAMBRA risk facor
• Systemic disease: autoimmune, hormonal, infectious, neurological
• autoimmune: sjogrens, rheumatoid arthritis, SLE (systemic lupus erythematosus
• Hormonal: diabetes mellitus (labile)
• infectious: HIV, HEP-C
• neurological: depression, cerebral palsy (open, dry mouth)
• cancer treatment: (should prescribe fluoride trays & frequent recall) radiation tx to H&N, chemotherapy

• >3 different drugs taken daily
• CAMBRA high risk factor

• difficulty eating or swallowing
• tongue sticking to palate (may affect speech)
• mouth/cheeks sticking to teeth
• burning sensation of mucosa and tongue
• changes in taste
• inadequate denture retention (especially maxillary)
• increased rate of decay
• soft tissure trauma

• objective measure of quality and quantity of saliva (pH and buffering capacity)
• production, consistency, resting and stimulated pH and flow, buffering capacity
• useful for planning, risk assessment, montitoring
• not for in vivo diagnostic use
• stimulation via paraffin wax chewing

buffering capacity only

• from Ram "mgt of xerostomia and salivary gland hypofunction" 2011:
• increased water intake (spray bottles)
• change meds
• saliva substituetes (biotene and oral balance)
• lubricating gel intraorally (KY jelly, GC dry mouth gel)
• Vaseline on lips
• toothpastes without additives (Biotene), some additives cause irritation
• xylitol gums, mints, candies
• DO NOT USE lemon & glycerine swabs (turns to alcohol)
• DO NOT USE alcohol contatining mouthwashes

• additives in toothpaste
• lemon & glycerine swas/toothettes (turns to alcohol)
• alcohol containing mouthwashes

• pregnant women have high risk for erosion and perio disease
• untreated maternal decay increases risk in child
• untreated infections can complicate pregnancy (esp w diabetes)

• any tooth decay including extrations and fillings in primary dentition
• most prevalant chronic childhood disease
• 5x more prevalant than asthma
• 7x more than hay fever

• distictive decay pattern beginnning in upper primary teeth (DEFG and laterally spreading as they erupt)
• ethnicity risk factors

• has difficulty accessiong dental care because of complicated medical, physical, social or psychological situations.
• sweetened medications
• reduced salivary flow
• restricted diets
• difficulties brushing
• many competing health problems and needs

• lower socio-economic status
• certain ethnic/cultural groups
• disabilities and special needs (medication, OHI)
• genetics

• children fall well below nation in oral health
• about 1/3 preschoolers and 70% of children K-3 have experienced tooth decay

• 2-5K
• 12-15K if hospitalized

• 40-50% have new decay within 4-12 months
• must treat infection reasons (CAMBRA)
• general anesthesia full mouth rehab come back within 2 years with new or worse caries.

• pain, infection, self-esteem
• some may not realize pain/emotional problems arise from caries
• pain->missed school days, impaired concentration, school readiness, sleep and overall health and well being
• infection->failure to thrive and delayed growth patterns
• self-esteem->steel crowns/unattractive smiles

• eating and nutrition
• holding space
• proper speech development
• smiling

• reduced salivary funciton
• bacteria: S mutans Lactobacilli
• Diet: frequent carbs
• Protective
• salivary flow & components
• proteins, antibacterial
• Fluoride, Ca, PO4
• Dietary components: protective

• S mutans, lactobacilli ( about 600 spp of bacteria contribute)
• acidogenic from carbohydrates->demineralization before visible decay
• 40-50 species protect
• horizontal-child to child
• vertical-parent/caregiver to child
• colonization can occur BEFORE eruption

• 1st visible sign of tooth decay
• decay is reversible (put floridated tootpast on teeth, last to touch teeth before bed)
• Remineralization-> Ca & PO4 from saliva and enhanced by fluoride to become more resistant
• Do BEFORE penetrates dentin otherwise RESTORE (intermediate therapeutic restorations-glass ionomer)

early intervention w pregnant mothers, young babies

• inhibit demin
• enhance remin
• inhibit plaque bacteria

• 30%
• filters can remove impurities but not Fluoride

• across width, not length
• small pea-sized dab used morning and before bed

• toothpaste (more for 2-6 that can spit, DO NOT RINSE)
• varnish (3-6 months, professionally applied)
• no mouthrinses, gel or foam (only for good spitters around 7-8 yrs old)

• 3x in a 2-week period for reminerlaization of white spot lesions
• 3-4x per year for high risk babies and young children

• sealants for occlusal surface
• fluoride for smooth surfaces

talking rain

• limit sugary foods, simple carbs
• limit frequency and total amount (also effective against obesity)

• use cup at 6 months
• weaning at 12-14
• don't put baby to bed w/bottle or cup

• ALL: F in H20, F toothpaste (2x day), limit simple CHO
• HIGH RISK: F Varnish, anti-bacterials for mothers & older children, F mouthwash for spit, sealants

• manage from birth to 2 yrs old
• use anti-bacterials like chlorhexidine and xylitol
• Chlorhexidine gluconate: Rx 10ml daily for 1 week per month for 1 year, (taste, mild staining)
• Xylitol: 5-10g daily, should be 1st listed ingredient, Carefree Koolerz 1.6 g/piece

• Supplies: gauze, light, toothbrush, varnish, gloves, optional
• 1. Interview and CAMBRA: F H20, home practices, family history, weaning, diet habits
• 2. Knee to knee position: (with mother and child in lap)
• 3. Toothbrush Prophy: remove plaque, discuss home care, reinforce toothpaste use (small dab)
• assess older children's and caregiver's OH skills
• 4. Oral Assessment: thick plaque, chalky white spots, brown spots or obvious cavities, tooth defects, abscesses
• explain what to look for and how to lift the lip
• 5. Apply F Varnish: wipe & paint each tooth when dried with guaze, egin with lower outsides then insides then upper
• may leave yellowish brown brushable film, should not be brushed for at least a day
• 6. Summarize and Anticipatory Guidance: follow-up, anticipatory guidance and home care based on risk

• white spot lesions
• carious lesions
• visible plaque
• family history
• impaired saliva composition or flow
• frequent CHO exposure

• small steps: 1-2 key messages
• remain positive
• culturally appropriate
• respect
• multiple methods
• use closed and open ended questions
• listen
• non-judgemental and friendly
• documentation & referral

triggers over a period of time in combination with individual experience and values necessary to change health behavior

• minimal cavity prearation
• Fluoride releaseing material (glass ionomer)
• "medicine"
• Triage material

within 6 months of 1st tooth but no later than age 1