cariology: saliva, diet, fluoride
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What needs to be present on tooth surface for acid to form?
- fermetable carbohydrate
- and cariogenic plaque
Resting pH _____ with tooth surface.
Plaque within an active carious lession has lower or higher resting pH than plaque on inactive carious lesions.
single sucrose rinse can cause _______ lasting _______ and several hours.
- a. demineralization
- b. 20 minutes
How do you get pH back to baseline values?
have acids diffuse out of the plaque
Describe the Vipeholm Hospital.
- evidence linking diet and caries
- mentally handicapped individuals
- 6 experimental groups
- vary quanity and frequency of sticky or non-sticky sugar intake was studied
Describe the animal experiments with the rat and bacteria.
- rats, who had no bacteria in their mouths, were fed a cariogenic diet, caries did not develop
- compare cariogenicity of foods
What are the monosaccharies of sugar?
What are these disacchardies: sucrose, maltose, lactose?
- sucrose: glucose + fructose
- maltose: glucose + glucose
- lactose: glucose + galactose
What are the different categories for non-milk extrinsic sugars (NMES)?
- 1. intrinsic sugars: reside inside cellular structure
- sugars w/in fruits, vegies, grains
- 2. extrinsic sugars: reside outside of cellular structure
- added sugars, processed fruits
What are starches?
- long glucose chains
- likelihood of fermentation: slim
- oral motor limitations: pocketing
- cooked starched with sugar
what are the hydrolyzed starch products?
- glucose syrups (liquid glucose)
- maltodextrins (glucose polymers)
what are the high-fructose corn syrup?
- hydrolyzed corn starch followed by chemical isomerization
- a blend of glucose, fructose, and oligosaccharides
What are cariogenic?
- glucose and fructose
- mixed with short chain glucose units: adherence properties and susceptible to fermentation
- liquid energy: not as efficiently organized
What are some advice to pregnant and nursing mothers?
- breast-feeding recommended
- stop bottle feeding by 1st year
- don't add sugar or honey to baby foods
- no transfer of pacifier from mother to child
What are some advice for young children?
- quality snacks with reduced sugar
- only water at bed time
What are advices to chronically sick children?
- strict dietary control
- oral hygiene
- fluoride supplementation
- fissure sealants
What are advices for patients with dry mouth?
sugarless sweets, gums, water, and mouth lubricants
What is the dietary misconceptions?
- only refined sugars are harmful
- honey - health "natural sugar"
What should be identified on food labels?
- starches, sugars, sugar substitutes
- carogenicity of components
What are the nutritional recommendations for good health?
- enjoy your food
- eat a variety of different foods
- eat the right amount to be a health weight
- eat plenty of foods rich in starch and fiber
- eat plenty of fruits and veggies
- don't eat too many food containing lots of fat
- don't have sugary foods and drinks too often
- if you drink alcohol, drink sensibly
What are the food and drinks with low potential for dental caries?
- pasta, rice, starchy food
- cheese, fibrous foods
- low sugar breakfast cereals
- fresh fruit
- sugar-free chewing gum
- water, milk, sugar-free drinks
- tea coffee unsweetened
Quantity and ______ of cariogenic food has a big impact on caries disease.
List fluoride ingestion and dental flurosis.
- Dental fluorosis: gel, paste, mouthwash, gels, foam, garnism
- Fluoride ingestion: fluoridated water, fluoride supplements, food and fluoride
prior to 1980, thought that fluoride work was through _____.
The optimal amount of fluoride in water is ______. why tap water?
- 1 ppm
- inexpensive, cost-effective, potential to reach lots of people
what is mottling?
fluoride shown up on teeth.
How does fluoride help?
- reduces the rate of demineralization
- enhances the mineral uptake
- delays the progression of lesions
- inhibits caries activity through bacterial inhibiton.
Chemically, how does fluoride work?
- Forms fluoroapatite
- fluoroapatie is less soluable than hydroxyapatite
- newly erupted teeth takes up for fluoride because of bigger pores
in bottle water, there is ____ amount of fluoride.
- varied amount
- typically very low concentration
What does dietary fluoride provide? why made?
- provides moderal dose systemic fluoride
- designed to take place of fluoridated water
- can be effective in selected populations
Generally, how much fluoride should a these children have: 0-6 months, 6mon-3 yrs, 3-6 yrs, more than 6 yrs
- 0-6 months: none
- 6mon-3 yrs: 0.25mg or <0.3 ppm
- 3-6 yrs: 0.5mg-0.25 mg or 0.3-0.6 ppm
- more than 6 yrs: 0.5-1 mg or 0.3-0.6 ppm
Fluoride dentifrice. amount? example?
- about 1000 ppm
- young children are recommended small "pea-size"
- ex. prevident 5000 ppm
OTC Rinses and gels. Types? amount?
- OTC rinses: 226 ppm
- Prescription rinses: 1000 ppm
- home use gels: 1000ppm
Profesionally applied products. Types? Amounts?
- office gels and foams: 9000-12000 ppm
- fluoride varnish: 22,000 ppm
- dental composites: slow release fluoride. for rampant carries
some hidden sources of ingested fluoride.
- soups, cereals, rice, pasta, kool-aid, juice concentrated, infant formulas
- beverages: juices, soft drinks, tea
- foods: seafood, processed chicken, infant cereals
very low F beverages.
- breast milk
- herbal teas
- bottle water
What is acute F toxicity?
- Toxic effects at 5mg/kg body weight: nausea and vomiting, 1-2 ounces of toothpaste
- leath dose 15 mg F/kg body weight in children : 5 ounces of toothpaste
What is physiology and toxicological aspects of acute fluoride toxicity?
- absorption: fast through mostly stomach
- elimination: kidney - fecal less that 10%
- distribution: water compartments - all over
- deposited in bone and developing teeth and thru blood flow thru pulp with retention in infant skeletal structure as high as 80% and in adults about 50%
what is skeletal fluorosis?
- debilitating bone disease - brittle, malformed long bones
- how? long term exposure to inhaled fluoride. 20-80mg/day for more than 10 years
- chronic exposure to 4-8 ppm water F can cause change in bone density
- rarely seen in US
Is it well-known how F affects bone?
- it may affects cortical and trabecular bone differently
Describes dental fluorosis.
- It can occur in primary and permanent teeth
- Cause: excessive F ingestion during tooth development
- Description: intrinsice, permanent stain (usually white and can be dark brown or orange)
- severe cases: tooth enamel can be damaged
- can happen even with very low F intake
Describe the 4 scores of dental fluorosis.
- Score 1: earliest sign - thin, white, opaque lines across tooth surface
- Score 2: opaque white lines more pronounced. merge to form wider bands
- score 3: entire tooth exhibits cloudy, white opaque areas
- score 4: entirely white opaque enamel, part of the enamel may break away
What is the concentration of dental fluorosis in teeth? the amount and duration?
- greatest at the surface - enamel and pulp
- level in different layers of enamel reflect exposure during tooth development
- different teeth can be affected: upper central incisor - 15-30 months of age while children under 7 - minimize F ingestion
what is the risk factors for dental Fluorosis?
- high F level in water
- dietary F supplements
- F products - early or overuse
- higher income family
- amoxicillin in infancy
The saliva composition and flow rate are important host factors that modify ______ process.
What are saliva's protective role?
- clean food substances from mouth
- neutralize and buffer organic acids formed by microorganisms
- reduce demineralization rate
- enhance remineralization by providing Ca, PO4, and F
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