Caries 102 Final
Card Set Information
Caries 102 Final
Caries 102 Final
Caries 102 Final
What is the composition of saliva?
1% solids (electrolytes & proteins)
VARIABLE (with flow rate)
What is normal daily production of saliva?
90% produced by parotid, submandibular and submental
What are the 3 major salivary glands?
(largest to smallest) parotid, submandibular, sublingual
What type of saliva does the parotid produce?
Serous: thin, watery, amylase-rich
What type of saliva does the submandibular gland produce?
mixed mucous & serous
: thin, watery, amylase-rich
: viscous, slimy, mucin-rich
What type of saliva does sublingual gland produce?
mucous: viscous, slimy, mucin-rich
Where are the minor salivary glands located?
oral mucosa (labial, buccal, palatine, lingual)
10% saliva production
Large fraction of salivary protein
: oral tissue lubrication
What is salivary protein function of minor salivary glands?
oral tissue lubrication
Describe the functions of saliva.
: lubrication, remineralization, clearance, inhibit demineralization
: antifungal, antibacterial, antiviral
: taste, bolus, digestion
What are the roles of mucins?
lubrication and visoelasticity
What are the unconditioned salivary relexes?
masticatory-salivary reflex (chewing)
gustatory-salivary reflex (taste)
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)
What is the mechanism of the gustatory-salivary reflex?
taste activated chemoreceptors in the taste buds within the lingual papillae
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)
What are some conditioned relfex factors that may inhibit salivary flow?
stress (anxiety, yet stress can increase flow (will to fight))
What are the effects of stress on salivary flow?
increased flow (will to fight)
decreased flow (anxiety)
What components increase as salivary rate increases?
Na, Cl, HCO3, Ca, pH, ionic strength (submandibular/submental)
What components decrease as salivary rate increases?
Inorganic Phosphate, Mg, K (parotid)
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)
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
How does decreased flow affect clearance?
increases acid exposure time
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.
What is xerostomia?
SUBJECTIVE feeling of oral dryness affecting swallowing, speech & QOL
What is hyposalivation?
abnormally low salivary flow rates OBJECTIVELY measured by saliva producton
: <=0.1mL per minute
: <-0.5-0.7 mL/min
What is low saliva flow rates?
: 0.1-0.25 mL/min
: 0.7-1.0 mL min
What is normal salivary flow rates?
: > 0.25 mL/min
: > 1.0 mL/min
What are the causes of salivary gland hypofunction?
: antidepressants, antianxiety, antihistamines, antihypertensives (diuretics)
>3 different drugs taken daily (polypharmacy) CAMBRA risk facor
: autoimmune, hormonal, infectious, neurological
: sjogrens, rheumatoid arthritis, SLE (systemic lupus erythematosus
: diabetes mellitus (labile)
: HIV, HEP-C
: depression, cerebral palsy (open, dry mouth)
: (should prescribe fluoride trays & frequent recall) radiation tx to H&N, chemotherapy
What is polypharmacy?
>3 different drugs taken daily
CAMBRA high risk factor
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
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
What does ivoclar (CRT buffer) test?
buffering capacity only
What are the treatments of xerostomia?
from Ram "mgt of xerostomia and salivary gland hypofunction" 2011:
increased water intake (spray bottles)
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
What are contraindicated for treated xerostomia?
additives in toothpaste
lemon & glycerine swas/toothettes (turns to alcohol)
alcohol containing mouthwashes
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)
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
What is severe ECC?
distictive decay pattern beginnning in upper primary teeth (DEFG and laterally spreading as they erupt)
ethnicity risk factors
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.
reduced salivary flow
many competing health problems and needs
What are the risk factors for ECC?
lower socio-economic status
certain ethnic/cultural groups
disabilities and special needs (medication, OHI)
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
What are some avg cost figures to treat ECC?
12-15K if hospitalized
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.
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
Why are primary teeth important?
eating and nutrition
proper speech development
What are the pathological and protective factors of increasing caries risk (featherstone's model)?
reduced salivary funciton
: S mutans Lactobacilli
: frequent carbs
salivary flow & components
Fluoride, Ca, PO4
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
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)
What is the key to preventing ECC?
early intervention w pregnant mothers, young babies
What are the anticaries features of Fluoride?
inhibit plaque bacteria
What percentage of Californians have Fluoridated drinking water?
filters can remove impurities but not Fluoride
How should tootpaste be applied to toothbrush?
across width, not length
small pea-sized dab used morning and before bed
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)
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
What other technique proves to be successful with preventing caries?
sealants for occlusal surface
fluoride for smooth surfaces
What is the brand of children's drink that contains xylitol?
What kind of restrictions on fermentable carbohydrates should be used?
limit sugary foods, simple carbs
limit frequency and total amount (also effective against obesity)
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
What are the (anticipaory guidance) recommendations for ALL children and HIGH RISK?
: F in H20, F toothpaste (2x day), limit simple CHO
: F Varnish, anti-bacterials for mothers & older children, F mouthwash for spit, sealants
How can mothers alter their bacterial flora?
manage from birth to 2 yrs old
use anti-bacterials like chlorhexidine and xylitol
: Rx 10ml daily for 1 week per month for 1 year, (taste, mild staining)
: 5-10g daily, should be 1st listed ingredient, Carefree Koolerz 1.6 g/piece
What are the steps in infant oral health program for babies and young children?
: 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
What are the high risk factors for caries?
white spot lesions
impaired saliva composition or flow
frequent CHO exposure
What are the techniques used for anticipatory guidance?
: 1-2 key messages
use closed and open ended questions
non-judgemental and friendly
documentation & referral
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
What is intermediate therapeutic restoration?
minimal cavity prearation
Fluoride releaseing material (glass ionomer)
When should baby be seen by dentist?
within 6 months of 1st tooth but no later than age 1