Combined Exam 1

Front 1

Eukaryotic Microbes are

Back 1

Single-celled or multicellular

Front 2

Prokaryotic microbes are

Back 2

single celle but may exist in chains or groups

Front 3

Acellular microbes are

Back 3

nucleic acid surrounded by protein

Front 4

What type of magnification do you need to see Eukaryotes to Bacteria to Viruses

Back 4

Low to High but 100-400 for Eukaryotes, 1000 for bacteria with oil immerision and >20000 to see viruses

Front 5

Key differences of eukaryotes to prokaryotes

Back 5

Eukaryotes have nuclei and inner membrane bound organelles

Prokaryotes only have a nucleoid. Ribosomes run free, translation can occur right away and have pilli and flagella

Front 6

What are the major targets for anitmicrobials on prokaryotes?

Back 6

Peptidoglycan cell walls and 70s ribosomes

Front 7

What majorly differs in composition between gram negative bacteria and gram positive bacteria?

Back 7

Gram-Negative bacteria has an outer Lipoplysaccharide layer that gets washed away by an alochol solution which makes it easy for the peptidoglycan membrane to be stained. The think peptidoglycan wall of gram positives make it difficult for the cell to be lysed.

Front 8

What endotoxin is specific to gram negative bacteria?

Back 8

Lipopolysaccharide, LPS

Front 9

What type of bacteria is found mostly in the oral cavity?

Back 9

The teethy have larger proportions of Gram-positive cocci and rods but older plaque, gingiva, and periodontium have elevated levels of anaerobic Gram-negative rods. Concentrations are higher than anywhere outside of the colon

Front 10

What are two ways disease can occur?

Back 10

1. Bacteria can be pathogenic which lead to symptoms of diseas and the virulence factors are waht make the hose sick.

2. Overgrowth of a normal microflora species can weaken host defenses and lead to an opportunistic infection

Front 11

How do bacteria create adhesion with the pellicle?

Back 11

The forces of attraction oercome the forces of repulsion. Initial adhesion occurs at the secondary minimum, 10-20nm, and is reversible. Irreversible adhesioin requires additional interactions and exist at <1nm

Front 12

Cross-sectional studies

Back 12

Compare the microflora in health and disease

Front 13

Prospective studies

Back 13

Look at changes in the microflora that accompny the change from health to disease

Front 14

Common Gram-Positive Genera

Back 14

Streptococcus, Peptostreptococcus, Micrococcus, Actinomyces, Propionibacterium, Rothia, Lactobacills, Bifidobacterium, Eubacteruim, Corynecbacterium

Front 15

The Totality of the Oral Flora

Back 15

The flora will almost certainly be more similar from site to site (within a niche) in a given individual than between identical sites in two different individuals

Front 16

Early vs Mature Supragingival Plaque

Back 16

Early - Mainly Gram-positive, mostly cocci, mostly facultative anaerobes

Mature - Increasing representation of Gram-negatives, many morphological types, facultative anaerobes and obligate anaerobes

Front 17

Supragingival vs. Subgingival Plaque

Back 17

Supra - Mix of Gram pos and neg., mix of cocci and rods, mix of facultatives and anaerobes, more carb fermenters, firmly adherent

Sub - Dominated by Gram neg, more gram neg rods and spirochetes, more obligate anaerobes, more proteolytic species, less adherent/more motile

Front 18

What are bacteriocins?

Back 18

Toxins produced by bacteria to kill other similar competing strains

Front 19

Biochemical or enzymatic non-specific means of plaque control

Back 19

1. Lysozyme- Break bonds in peptidoglycan, kill amphipathic sequences, induce bacteria to kill themselves, may agglutinate bacteria

2. Histatins - Mainly anti-fungal but also anti-bacterial, prevents coaggregation, inhibits bacterial prteinases

3. Peroxidase and thiocyanate - thiocyanate ion that inhibits bacterial growth and agglutinin (grouping of bacteria made easier to get rid of)

4. Lactoferrin - sequesters iron away from bacteria. Cleaved peptide is inhibitory for bacteria

5. Salivary mucins and parotid agglutinin

Front 20

Innate Immune Mechanisms non-specific means of plaque control

Back 20

1. Defensins and antimicrobial peptides

2. Neutrophils and other phagocytic cells

Front 21

Adaptive Immunity non-specific means of plaque control

Back 21

sIgA - Most abundant isotype in saliva and agglutiantes bacteria

IgG, IgM, lymphocytes - Traditional facets of immune response will operate within periodntal pockets because gingival crevicular fluid is similar to plasma

Front 22

Dr. Willoughby D. Miller, 1880s

Back 22

Incubated Bread, Saliva and a tooth. Tooth eventually dissolved

Front 23

What is the Non-specific plaque hypothesis?

Back 23

Concluded that caries was initiated due to the collective acidogenic properites of plaque bacteria.

Front 24

Work of Israel J. Kligler

Back 24

Certain species stood out with respect to producing acid and surviving low pH would be likely etiolgic agents. Found that lactobacilli dominated in advanced lesions. Lactobacilli increased as the health of the tooth decreased

Front 25

Work of J. Kilian Clark 1924

Back 25

Isolated bacterial species from carious lesion known as Streptococcus mutans. Higher frequency than lactobacilli and formed a sticky slime layer that help adher the bacteria.

Front 26

Name the 2 mutans streptococci that are most cariogenic

Back 26

1. S. mutans

2. Sobrins

Front 27

Experiment by F.J. Orland in 1954

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Gave conventional animals and germ free animals identical diets and sucrose water. Germ fre rats never developed carious lesions. Bacteria are necessary for decay

Front 28

Dr. Robert Stephan

Back 28

Demonstrated plaque pH varies depending on diet and depending on its microbial composition. Stephan curve.

Front 29

Unique characteristics of S. mutans

Back 29

Most cariogenic, causes smooth surface decay, produces acid at the fasat rate, forms highly adherent biofilm, levels of s mutans increased durin the transition from health to disease

Front 30

Marsh et al. 1990s

Back 30

Ecological Plaque Hypothesis: Greater emphasis on th eglobal compostion of the plaque. An imbalance of acidogens leads to caries. A change in the homeostatic balance of the resident microflora is responsible for conditions that promote the growth of pathogens. This change in balance may be initiated by frequent eating so that the resident microflora adapts to the low pH conditions which in turn further promotes an environment conducive to gowh of S.mutans and lactobacilli

Front 31

Host contribution to caries by

Back 31

Host matrix metalloprtoeases (MMPs) play a role in the development or severity of dental decay

Front 32

Van Houte et al, 1991

Back 32

Pooled samples of white spot lesions or healthy sites. S mutans levels were much higher on white spot lesions than on healthy sites. White spot lesion samples with high or low S mutans could exhibit a high rate of pH drop and pH minimum

Front 33

Hirose et al. 1993

Back 33

Measure salivary S. mutans and S. sobrinus levles in children. Children placed in groups based on microbiology. Sobrinus group hade higher levels of decay and increments of decayed srufaces over the 6-month period

Front 34

Window of Infectivity of S. mutans

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19-31 months for children, mean of 26 months

Front 35

Why is window of infectivity so Important?

Back 35

1. S. mutans colonization of tooth fissure may prime future areas for decay

2. Longer delay of S. mutans means more likely to remain caries free

3. 2nd window of infectivity may be around 6 yrs of age

Front 36

Sucrose Independent Adhesion

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Adhesion of S. mutans is thought to be to salivary proteins that are part of the acquired enamel pellicle. Not very efficient! Mediated by AgI/II

Front 37

Sucrose-dependent Adhesion

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Main basis for sucrose-dependent adhesion is glucan synthesis catalyzed by glucsyltransferases (GTFs). Glucans are produced from sucrosea and are what makes the S. mutans stick to surfaces. It makes it difficult to scrape off and very efficient.

Front 38

Why is glucan effective in promoting adhesion and accumulation?

Back 38

They have the opportunity to engage in weak-force interactions in proportion to the size of the polymer. Likely that the hydroxyl groups in glucan have the opportunity for extensive hydrogen bonding and provavly divalent cation interactions that help it stick tenaciously to tooth surfaces

Front 39

What acid is produced in majority under conditions of sugar excess or low pH conditions?

Back 39

Lactate

Front 40

Which gene is essential for S. Mutans for it to be cariogenic?

Back 40

LDH, Lactate Dehydrogenase

Front 41

Noorda 1988

Back 41

Consortia of bacteria may bring about uniquie acid properties such as more acid is produced with co-culture of S. mutans and Veillonella alcalescens than when either species is produced individually

Front 42

What are the unique aciduricity properties of S. Mutans?

Back 42

1. It ceases to grow under pH 5 but can carry out glycolysis down to pH 4 or lower

2. It can adapt to low pH

Front 43

Maintaining Intracellular pH

Back 43

Maintained by pumping protons out of the cell which is accomplished by F-ATPase and change in membrane fatty acids that are less permeable to protons.

Front 44

Prevalence

Back 44

Proportion with a disease in a population at a given point in time

Front 45

Incidence

Back 45

Proportion of new cases of a diseas in a population during a given time period

Front 46

Changing Oral Epidemiology

Back 46

Children ages 5 to 17 have seen DMFT scores drop while 2-4 have stayed steady over time

Front 47

Children see higher rates of caries in primary teeth or permanent teeth?

Back 47

Primary tooth caries rate are higher than for permanent teeth at young ages

Front 48

Flouride has had the best outcome on what type of tooth surfaces?

Back 48

Smooth surfaces

Front 49

Study of 2 to 11 year olds from 1988 to 1994 and 1999 to 2004

Back 49

Saw a general increases of dfs but it is due to a greater number of fillings seen in the primary dentition

Front 50

What is the root caries index?

Back 50

Surfaces with root caries experience/surfaces with recession

Front 51

Demineralization

Back 51

Loss of minerals (calcium, phosphate, carbonate) due to acidic environment

Front 52

Remineralization

Back 52

Gain of minerals (Calcium, phosphate, carbonate)

Front 53

What are incipient lesions?

Back 53

They are pre-carious lesions that show early signs of caries. A build up of plaque on the teeth are non cavitated but are prime sites to develop cavities/carious lesions

Front 54

Fissure caries

Back 54

1. Begin on sides of the fissure

2. Encompass the base of the fissure secondly

3. Less enamel to transverse to reach dentin

4. Rapid spread along DEJ

Front 55

Characteristics of Arrested or Inactive Caries

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1. White/brown

2. Shiny surface

Front 56

What is the main duty of saliva?

Back 56

Saliva saturates plaque which prevents demineralization

Front 57

Distribution of Elements in the enamel

Back 57

Outer layers contain Flouride, Calcium and Phosphate (majority) and Inner layers contain Water and Carbonate

Front 58

Critical pH of Enamel and Dentin

Back 58

pH 5.5 and pH 6.2

Front 59

What makes up the Enamel ultrastructure?

Back 59

Enamel ultrastructure is made from enamel rods which are composed of hydroxiapatite crystal. Hydroxiapatite is dissolved by the acid

Front 60

Enamel Demineralization patterns

Back 60

thin outer layer is removed first. Moves inward to remove inter-prismaic areas. Thus when remineralization reforms outer layer, demineralized areas underneath make it hard to be discovered

Front 61

Carious Dentinal tubule lesions

Back 61

Outer lesion of dentin occurs. Inner lesion is subdivided into turbid, transparent and subtransparent regions. and then a normal region follows. Inner region tries to protect from invasion of bacteria further from loss of apatite crystals by forming rhomboidal crystals known as whitlockite which are lower in hardness and calcium content

Front 62

What is tertiary dentin?

Back 62

Pulp's reaction to protect against dentin bacterial invasion. Irregular dentinal tubules and mineralization

Front 63

Selected messages for consumers: Foods to increase

Back 63

1. Make half your plate fruits and vegetables

2. Make at least half your grains whole grains

3. Switch to fat-free or low-fat (1%) milk

Front 64

Selected messages for consumers: Foods to reduce

Back 64

1. Compare sodium in foods and choose the foods with lower numbers

2. Drink water instead of sugary drinks

Front 65

Estimated Average Requirements (EAR)

Back 65

Amount of a nutrient that will maintain a specific biochemical or physiological funtion in half the people of a given age and sex group

Front 66

Recommended Dietary Allowances (RDAs)

Back 66

Average daily amount of a nutrient considered adequate to meet the known nutrient needs of practically all healthy people (EAR plus 2 standard deviations)

Front 67

Adequate Intake

Back 67

Average amount of a nutrient that appears sufficient to maintain a specified criterion

Front 68

Tolerable Upper Intake Level (ULs)

Back 68

Maximum amount of a nutrient that appears safe for most healthy people and beyond which there is an increased risk of adverse health effects

Front 69

Grains Group - Fiber

Back 69

Requirements are 20-40g/day

Soluble - Fruits, oats and beans

Insoluble - All plants

Decreased CV disease, reduced constipation and risk of GI disease, and assist with weight management

Front 70

Vegetables - Key Nutrients

Back 70

Folate - Food sources: Dark leafy greens, orange juice, wheat germ, fortified grains

Deficiensy lead to neural tube defects and CV disease

Excess can mask B12 deficiencies

Front 71

100% Juice

Back 71

High energy, low nutrient

Infants < 6 months of age should not have any juice

1-6 year olds 4-6 oz a day

7-12 year olds 8-12 oz a day

Front 72

Vitamin C

Back 72

Antioxidant

Smokers have lower serum levels

Lower vitamin C may lead to increased perio bleeding

Ascorbic acid supplements _ chewable could increase risk of enamel erosion

Front 73

Incomplete protein

Back 73

Missing 1 or more essential amino acids; unable to support growth, maintain health

Front 74

Limiting amino acid

Back 74

essential amino acid not present or present in insufficient quantities

Front 75

Complementary proteins

Back 75

2 incomplete proteins missing different essential amino acids

Front 76

Marasmus

Back 76

Protein will be used for energy at expense of protein functions

Low body fat stores, ketosis, decreased growth

Front 77

Kwashiorkor

Back 77

Inadequate protein, adeaquate energy

Edema, poor immunity, fatty liver

Front 78

Vitamin B12

Back 78

Found only in animals

Absorption requires Stomach acid and intrinsic factor

A deficiency is a concern for the elderly; confusion, neuropathies

Front 79

Iron

Back 79

Anemia is deficiency

Leading cause of mental retardation and leads to behavioral problems

Iron toxicity leads to cirrhosis and CV disease

Heme iron is best dietary source

Acid facilitates absorption

Front 80

Vitamin D

Back 80

Adequate intake is 5ug/day 19-50 yr

Regulates calcium metabolism and maintains serum calcium/phosphorous levels via regulation of absorption and bone turnover

Deficiencies are rickets, osteomalacia, osteoporosis

Front 81

Dietary fat

Back 81

Provides energy (9 kcal/g)

Carrier of fat soluble vitamins

Provides satiety

Carries flavors, adds moisture, texture

Front 82

Fructose

Back 82

Found most commonly as high fructose corn syrup

Preferentially converted to triglycerides

Front 83

Benefits of vegetarianism

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Healthy body weights, lower blood pressure, less CV disease, lower cancer rates

Front 84

Concernes of vegetarianism

Back 84

Disordered eating and lack of nutrients

Front 85

Low Carbs mechanism

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Induce ketosis: Incomplete oxidation of fatty acids in absence of carbohydrate and appetite suppression

Restricted food choices and reduced energy intake

Front 86

Low Carbs bottom line

Back 86

Weight loss is due to energy restriction

Low CHO allows one to achieve energy restriction

Weight loss is not permanent because one must maintain energy restriction

Front 87

Glycemic Index

Back 87

System of ranking carbohydrate containing foods

Measure of how quickly dietary carbohydrates elevate serum glucose: Quick digestiona and absorption = Increased GI

Fiber, protein and fat slow digestion

Front 88

Glycemic Load

Back 88

Glycemic index x grams CHO in food volume to measure CHO quality

GL adjusts for food quantity and is the glycemic effect of a given quantity

Front 89

Significance of GI and GL

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High GL diet predictive of developing Type 2 diabetes. Low GI diet associated with decreased risk of obesity, colon cancer, breast cancer. Improve insulin sensititvity. Decreased serum lipids

Front 90

Oral significance of GI and GL

Back 90

High GI foods, likely to be easily fermentable by oral bacteria

Low GI foods, lilely to have less simple sugar (except fructose) and be less refined

Front 91

Hopewood House

Back 91

Birth-12 years: lactovegetarian diet emphasizing whole grains, raw vegetables and minimal sugar or white flour. 12 years+ westernized diety of local community. DMFT followed trend similar to the publics.

Front 92

Vipeholm, Sweden

Back 92

Object was to determine how caries incidence is influenced by Mealtime exposure to nonretentive sugars, mealtime exposure to retentive sugars and between meal exposures to retentive sugars.

Mental hospital was split by different wards into groups. At meal time caries increased slightly whereas between mealtime, caries increased significantly

Front 93

Turku, Finland

Back 93

Determine the effect of total substitution of fructose or xylitol for sucrose on dental caries. Sucrose and Fructose showed high caries rate

Front 94

Animal study of germ free environment with rats

Back 94

Showed that rats who were germ free never developed caries because there were no bacteria to take advantage of the sucrose

Front 95

Stephan Curve

Back 95

Fall in curve represents the fermentation of the bacteria. If curve falls below critical pH demineralization occurs. Coffee alone showed longer time of hovering by critical pH vs. eating egg and toast with the coffee. Same seen with delay of eating.

Front 96

What helps prevent bacteria fermentation?

Back 96

Calcium phosphate and fat

Front 97

Affected vs. Infected Dentin

Back 97

Affected inner dentine -few bacteria, remineralisable, vital, sensitive, useful

Outer infected dentine - bacteria invasion, unmineralisable, dead withou sensation, not useful

Front 98

Clinical Visual Examination steps

Back 98

1. Clean Teeth

2. Thoroughly Dry teeth

3. Acute visualization and magnification with adequate light

4. Probe/Explorer - Used as an adjunct to determine consistency and texture of lesion. USE GENTLE PRESSURE

Front 99

Use transillumination for what types of caries?

Back 99

Proximal caries

Front 100

ICDAS Classification 0

Back 100

Sound enamel. No evidence of caries, no change after air-drying for 5 seconds. Includes Enamel hypoplasias, fluorosis, tooth wear and extrinsic and intrinsic stains

Front 101

ICDAS Classification 1

Back 101

First visual change in enamel. Smooth surface: Nothing seen on wet tooth, lesion visual after 5 seconds air-drying. Pit and Fissure - Lesion contained to pit and fissure. Opacity, White or Brown.

Front 102

ICDAS Classification 2

Back 102

Distinct Visual Change in Enamel. Smooth surface: Lesion seen when both wet and dry. Pit and fissure - Lesion extended beyond the pit/fissure. Located in inner enamel to outer 1/3 dentin

Front 103

ICDAS Classification 3

Back 103

Localized enamel breakdow due to caries with no visible dentin. When viewed wet may have clear darkening of dentin though enamel. After 5 seconds air-drying: carious loss of tooth structure at entrance to or within pit/fissure. Pit/fissure may appear substansitally and abnormally wider than normal but dentin is not visible in the walls or based of cavity. Lesion depth may be down into the middle 1/3 of dentin

Front 104

ICDAS Classification 4

Back 104

Non-cavitated surface with underlying dark shadow from dentin. UNDERLYING GREY/BLUE/BROWN SHADOW. Shadow of discoloured dentin through apparently intact enamel surface. Lesion depth is well into the dentin

Front 105

ICDAS Classification 5

Back 105

Disctincty Cavity with Visible Dentin. Cavitation in opaque or discoloured enamel which exposes dentin beneath. Lesion depth middle 1/3 dentin

Front 106

ICDAS Classification 6

Back 106

Obvious loss of tooth structure and possible reaches pulp. Cavity both deep and wide. Dentin clearly visible on walls and base.

Front 107

Colors of active and inactive lesions

Back 107

White is the indication of active lesions. Brown is indication of inactive lesion.

Front 108

Visual Luster as classification of avtive or inactive lesions

Back 108

Active lesion has loss of luster. Inactive lesion is shiny.

Front 109

Visual/Tactile classification of active or inactive lesions

Back 109

Rough/surface breakdown is an indication of an active lesion. Smooth/Hard/Surface intact is indication of an inactive lesion.

Front 110

Primary prevention

Back 110

Prevent onset of disease to reverse or arrest disease process. Examples are brushing flossing and dental sealants.

Front 111

Secondary prevention

Back 111

To stop disease process and restore tissues. Fillings, endo, extractions, and perio surgery.

Front 112

Tertiary Prevention

Back 112

Replace lost tissues and rehabilitate function. Examples are bridges, dentures and implants

Front 113

Gingival index

Back 113

0 = No inflammation

1 = Redness and Inflammation no bleeding on probing

2 = Bleeding on probing

3 = Spontaneous bleeding

Front 114

Plaque Index

Back 114

0 = No Plaque

1 = Plaque detectable

2 = Plaque from interproximal to interproximal

3 = Plaque on more than 1/2 tooth surface

Front 115

Bass Technique

Back 115

Tooth is scraped witha an up and down motion. Scraping works best when fine unwaxed floss or fine waxed floss is used. This method is suitable only for class 1 flossers.

Front 116

Bass Flossing Technique Step by Step

Back 116

Obtain a peice of floss 18" long, waxed or unwaxed. Wind floss around middle fingers with thumb and fore fingers available to guide the floss. Leave approx. 1/2 to 1" space between fingers. To inser, gently see-saw back and forth through contact to avoid "snapping"/trauma. Adapt floss to each interproximal surface- a c-shape. Move floss apically into sulcus and back to contact area several times- until surface is squeaky clean. Repeat procedure on adjacent surface - use care shifting floss to prevent dapage to papilla. A clean unuse portion to be used for each proximal area.

Front 117

Dentrifice

Back 117

A substance used with a toothbrush for the purpose of cleaning the accessible surfaces of the teeth

Front 118

Shut it down

Back 118

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