Caries 102 Final

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Caries 102 Final
2012-06-05 18:47:42
Caries 102 Final

Caries 102 Final
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  1. ´╗┐What is the composition of saliva?
    • 99% water
    • 1% solids (electrolytes & proteins)
    • VARIABLE (with flow rate)
  2. What is normal daily production of saliva?
    • 0.5-1.0 L
    • 90% produced by parotid, submandibular and submental
  3. What are the 3 major salivary glands?
    (largest to smallest) parotid, submandibular, sublingual
  4. What type of saliva does the parotid produce?
    Serous: thin, watery, amylase-rich
  5. What type of saliva does the submandibular gland produce?
    • mixed mucous & serous
    • serous: thin, watery, amylase-rich
    • mucous: viscous, slimy, mucin-rich
  6. What type of saliva does sublingual gland produce?
    mucous: viscous, slimy, mucin-rich
  7. Where are the minor salivary glands located?
    • oral mucosa (labial, buccal, palatine, lingual)
    • 10% saliva production
    • Large fraction of salivary protein: oral tissue lubrication
  8. What is salivary protein function of minor salivary glands?
    oral tissue lubrication
  9. Describe the functions of saliva.
    • Teeth: lubrication, remineralization, clearance, inhibit demineralization
    • Microbes: antifungal, antibacterial, antiviral
    • food: taste, bolus, digestion
  10. What are the roles of mucins?
    • inhibits demineralization
    • antibacterial
    • antifungal
    • anti viral
    • bolus
    • lubrication and visoelasticity
  11. What are the unconditioned salivary relexes?
    • masticatory-salivary reflex (chewing)
    • gustatory-salivary reflex (taste)
  12. How does the masticatory-salivary reflex work?
    • chewing activates mechanoreceptors in the PDL
    • could be a problem in denture wearing pts (must be stimulated by different mechanism)
  13. What is the mechanism of the gustatory-salivary reflex?
    taste activated chemoreceptors in the taste buds within the lingual papillae
  14. What are the conditioned reflexes for salivary secretion?
    • impulses from higher brain centers to salivary nuclei (non-mechanical, non-physical)
    • power of suggestion (think about favorite food)
  15. What are some conditioned relfex factors that may inhibit salivary flow?
    • sleep
    • fear
    • mental depression
    • stress (anxiety, yet stress can increase flow (will to fight))
  16. What are the effects of stress on salivary flow?
    • increased flow (will to fight)
    • decreased flow (anxiety)
  17. What components increase as salivary rate increases?
    Na, Cl, HCO3, Ca, pH, ionic strength (submandibular/submental)
  18. What components decrease as salivary rate increases?
    Inorganic Phosphate, Mg, K (parotid)
  19. Explain the features of dynamic saliva composition.
    • Final composition of saliva depends on flow rate
    • In stimulated saliva: increased bicarbonate, buffering and pH (more alkaline)
  20. What is salivary clearance?
    • 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
  21. How does decreased flow affect clearance?
    increases acid exposure time
  22. How does plaque affect salivary clearance?
    • [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.
  23. What is xerostomia?
    SUBJECTIVE feeling of oral dryness affecting swallowing, speech & QOL
  24. What is hyposalivation?
    • abnormally low salivary flow rates OBJECTIVELY measured by saliva producton
    • Unstimulated: <=0.1mL per minute
    • Stimulated: <-0.5-0.7 mL/min
  25. What is low saliva flow rates?
    • Unstimulated: 0.1-0.25 mL/min
    • Stimulated: 0.7-1.0 mL min
  26. What is normal salivary flow rates?
    • Unstimulated: > 0.25 mL/min
    • Stimulated: > 1.0 mL/min
  27. What are the causes of salivary gland hypofunction?
    • 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
  28. What is polypharmacy?
    • >3 different drugs taken daily
    • CAMBRA high risk factor
  29. What are the signs of salivary deficiency
    • 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
  30. What is saliva check?
    • 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
  31. What does ivoclar (CRT buffer) test?
    buffering capacity only
  32. What are the treatments of xerostomia?
    • 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
  33. What are contraindicated for treated xerostomia?
    • additives in toothpaste
    • lemon & glycerine swas/toothettes (turns to alcohol)
    • alcohol containing mouthwashes
  34. Why is perinatal oral health important?
    • 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)
  35. What is ECC?
    • 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
  36. What is severe ECC?
    • distictive decay pattern beginnning in upper primary teeth (DEFG and laterally spreading as they erupt)
    • ethnicity risk factors
  37. Who are children with disabilities and special needs and what are their risk factors for ECC?
    • 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
  38. What are the risk factors for ECC?
    • lower socio-economic status
    • certain ethnic/cultural groups
    • disabilities and special needs (medication, OHI)
    • genetics
  39. What is the status of ECC in California?
    • children fall well below nation in oral health
    • about 1/3 preschoolers and 70% of children K-3 have experienced tooth decay
  40. What are some avg cost figures to treat ECC?
    • 2-5K
    • 12-15K if hospitalized
  41. What is the decay recurrance rate of treated children?
    • 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.
  42. What are the effects of ECC?
    • 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
  43. Why are primary teeth important?
    • eating and nutrition
    • holding space
    • proper speech development
    • smiling
  44. What are the pathological and protective factors of increasing caries risk (featherstone's model)?
    • reduced salivary funciton
    • bacteria: S mutans Lactobacilli
    • Diet: frequent carbs
    • Protective
    • salivary flow & components
    • proteins, antibacterial
    • Fluoride, Ca, PO4
    • Dietary components: protective
  45. Discuss the tranmissibility of ECC.
    • 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
  46. What are white spot lesions?
    • 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)
  47. What is the key to preventing ECC?
    early intervention w pregnant mothers, young babies
  48. What are the anticaries features of Fluoride?
    • inhibit demin
    • enhance remin
    • inhibit plaque bacteria
  49. What percentage of Californians have Fluoridated drinking water?
    • 30%
    • filters can remove impurities but not Fluoride
  50. How should tootpaste be applied to toothbrush?
    • across width, not length
    • small pea-sized dab used morning and before bed
  51. What kind of fluoride should high risk children below 6 use?
    • 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)
  52. How should fluoride varnish be used?
    • 3x in a 2-week period for reminerlaization of white spot lesions
    • 3-4x per year for high risk babies and young children
  53. What other technique proves to be successful with preventing caries?
    • sealants for occlusal surface
    • fluoride for smooth surfaces
  54. What is the brand of children's drink that contains xylitol?
    talking rain
  55. What kind of restrictions on fermentable carbohydrates should be used?
    • limit sugary foods, simple carbs
    • limit frequency and total amount (also effective against obesity)
  56. How and when should a child be weaned from the breast?
    • use cup at 6 months
    • weaning at 12-14
    • don't put baby to bed w/bottle or cup
  57. What are the (anticipaory guidance) recommendations for ALL children and HIGH RISK?
    • 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
  58. How can mothers alter their bacterial flora?
    • 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
  59. What are the steps in infant oral health program for babies and young children?
    • 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
  60. What are the high risk factors for caries?
    • white spot lesions
    • carious lesions
    • visible plaque
    • family history
    • impaired saliva composition or flow
    • frequent CHO exposure
  61. What are the techniques used for anticipatory guidance?
    • 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
  62. What are the factors to change behavior?
    triggers over a period of time in combination with individual experience and values necessary to change health behavior
  63. What is intermediate therapeutic restoration?
    • minimal cavity prearation
    • Fluoride releaseing material (glass ionomer)
    • "medicine"
    • Triage material
  64. When should baby be seen by dentist?
    within 6 months of 1st tooth but no later than age 1