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109 Cards in this Set
- Front
- Back
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What are the primary, secondary, and tertiary effort levels?
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Primary: before occurrence - prevention
Secondary: after occurrence - limit spread and recurrence Tertiary: after occurrence - restore function, prevent death |
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According to the evidence-based approach to disease prevention, what two factors give preventative activities the highest priority?
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1. research efficacy
2. ease of compliance for patient |
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What are the four things to consider during evidence-based decision making?
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1. clinical situation
2. research & literature 3. patient's preferences 4. clinician's experience |
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What are the three contributions you have to look at when it comes to caries prevention? (the "caries diagram")
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the host, the environment, and the agent
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What are the three ways to control caries?
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mechanical: brushing, flossing
chemical: rinses, fluoride vaccine: v. S. mutans (not available) |
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What is the active ingredient (and %) in Peridex rinse?
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0.12% chlorhexidine
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What is the percent stannous fluoride in stannous fluoride toothpaste?
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0.454%
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What is an example of an essential oil mouth rinse? Does it have anti-caries properties?
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Listerine. No. It has anti-gingival properties.
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What is an example of cetylperidinium chloride rinse?
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Crest Pro Health
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What are some benefits of sugarless gum? How much should you chew?
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More saliva, less food retention, increase buffering ability of saliva. Anticaries effect w/ 2 pieces/day.
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In a nutshell, how does fluoride enhance remineralization?
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It attaches to the lattice of the enamel and attracts calcium and phosphate ions while excluding carbonate
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What does fluoride do to hydroxyapatite?
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converts it to fluorapatite, which is actually better (prevents demineralization)
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How does fluoride inhibit bacterial action?
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Fluoride blocks enolase needed for glycolysis. It also incorporates acids from bacteria into cells in the biofilm.
It reduces mucopolysaccharides. |
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Which source of fluoride is most important for developing teeth?
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systemic fluoride
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How many ppm should be in a daily fluoride rinse?
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250
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What are some issues with the at home 0.4% stannous gels?
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They can pit restorations and cause staining.
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If one product has stannous fluoride and a similar product uses sodium fluoride, which will need more fluoride to be similarly effective?
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You need more sodium fluoride (it appears to be about 5:1).
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What does DMF stand for?
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decayed, missing, filled
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How much fluoride in varnish?
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5% sodium fluoride
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How much fluoride in traditional professional gels? How long should you leave them on?
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1.23% acidulated phosphate fluoride. 4 minutes
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With varnish, what precautions should the pt take?
With gel? |
Varnish - avoid toothbrush til bed time
Gel - don't eat, drink, or smoke for 30 minutes |
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What is the typical level of fluoridation of the water supply?
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1 PPM
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What is a lethal does of fluoride?
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5-10 grams NaF
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When are you old enough for some Fl supplementation/
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6 mos.
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About what percentage of US pop. gets fluoridated water?
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61%
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With ~70% carries reduction, what is the most effective preventative measure against occlusal decay?
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sealants
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Should sealants be place on primary teeth?
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probably not (weak evidence)
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How many teeth and surfaces are measured for DMF?
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Usually 28 and 128
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We looked at some stats for children 2-11. Which children would you expect to have the worst caries (income/race/sex)?
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poor Mexican-American females.
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We looked at some stats for adults >20. Which adults would you expect to have the worst caries (income/race/sex)?
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poor white females
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Which populations are likely to have untreated dental decay?
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current smoker, black, poor, less than high school education. Males more likely than females to have untreated decay.
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What is a cariogram?
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A chart showing how likely you are to avoid new caries based on diet, history, related diseases, etc.
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What are the agent and the environment when discussing caries?
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agent: plaque biofilm, S. mutans
environment: dietary fermentable carbohydrates |
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What three things should you look at when assessing caries risk?
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1. history of caries
2. current evidence of disease 3. risk of future disease |
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What should you ask a patient to determine their risk for future caries?
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Ask about level of saliva, their current oral hygiene routine, and their eating habits (snacking/sugar)
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What are the five steps of evidence based decision making?
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1. Ask a clinical question
2. Search for best evidence 3. Assess evidence 4. Apply evidence 5. Assess outcome |
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When "asking a clinical question" during evidence based decision making, what does PICO stand for?
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Problem
Intervention Comparison Outcome |
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What is caries?
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A mineral loss disease (caries/=cavities)
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What mineral is lost in caries?
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calcium phosphate
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When saliva has _____, calcium phosphate crystals dissolve in acid.
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low pH
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What three things do you need to get caries?
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A susceptible tooth, a diet rich in fermentable carbs, and the right bacteria.
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What is the difference between an affected tooth and an infected tooth?
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An affected tooth can still be remineralized, which an infected tooth has permanent tissue loss.
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Which three place (types of tissue, can you get caries in?
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enamel, dentin, and cementum
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What is the first sign of early caries?
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Larger spaces in the intercrystalline structure.
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_____ makes HAP more soluble. ____ makes HAP less soluble.
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Carbonate; fluoride
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What are the tubules in dentin carrying? Is dentin more mineral or organic?
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Cell processes of odontoblasts and fluid. It's more organic.
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What is the first step of dental plaque formation (what substance is involved in this)? About how long does it take a mature biofilm to develop?
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Pellicle formation (this is initiated by pellicle glycoproteins). 1 week.
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What are glucans?
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Sticky glucose polymers synthesized by bacteria that allow strong attachment to teeth and formation of plaque.
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Which two kinds of bacteria are repeatedly mentioned re caries?
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S. mutans and Lactobacilli
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What are aciduric bacteria?
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They are the bacteria that will survive and become dominant in plaque.
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What is the role of glycosyl transferase in S. mutans?
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It is an adhesin, and also helps polymerize glucose into glucans.
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When bacteria gets a hold of sugar, it can make what three things?
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1. Extrancellular polymers (e.g. glucans)
2. Intracellular polymers (glycogen-like) 3. Lactic acid |
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What two bacteria are know to cause caries on fissures, smooth enamel, and root surfaces?
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S. mutans and A. viscosus
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What is the pH of saliva?
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It hovers around 7.
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How much saliva is produced daily?
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500-1000 mL
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What percent water is saliva?
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95-99%
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What three properties does saliva have to prevent carries?
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antibacterial properties, mineralizing effects, and buffering effects
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What is the critical pH where enamel demineralization is possible?
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5.5
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What is an oral symptom of Sjogren's disease?
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dry mouth
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Which teeth have high susceptibility to caries?
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molars
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Which teeth have intermediate susceptibility to caries?
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premolars and maxillary incisors
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which teeth have low susceptibility to caries?
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canines and mandibular incisors
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What are the components of the medical history?
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- chief complaint (incl. history of present ailment)
- past medical history - past dental history - review of systems - medications history - family history - social history |
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A good medical history will...
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- give you a differential diagnosis
- point you toward specific tests - save you time |
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Does the ROS focus on signs or symptoms?
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symptoms
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S. mutans is both ____ and aciduric.
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acidogenic
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Is diet/carbs part of agent, host, or environment?
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environment
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Three main antimicrobial functions of saliva.
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1. Mucins aggregate bacteria
2. Lactoferrins inhibit attachment 4. Peroxidase inhibits use of glucose |
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How does medication cause xerostomia?
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Anti-cholinergic properties reduce quality and quantity of saliva.
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What are some types of medication that typically cause xerostomia?
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- anti-anxiety/anti-psychotic
- anti-hypertension - allergy/asthma (incl. inhaled glucocorticosteroids) |
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What is more cariogenic, sucrose from candy or fructose from fruit?
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same
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What are some dietary recommendations that will help avoid caries?
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1. avoid snacking
2. avoid frequency of sugary snacks 3. replace with healthier alternatives |
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What are the two ways to do diet analysis at Penn?
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1. One day diet recall
2. 3-5 diet journal |
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Who benefits most from diet analysis?
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People with chronic disease (diabetes, HIV, CVD) and the elderly
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Deficiency in what vitamins can cause tongue pain/burning and lesions on tongue/lips/mouth?
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B vitamins (riboflavin, niacin, pyridoxine, cobalamin)
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_____ is a term used to describe a non-destructive form of periodontal disease. It may progress to ____.
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Gingivitis; periodontitis
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Periodontal disease is linked to what systemic health problems?
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1. CVD
2. diabetes 3. respiratory disease 4. pre-term delivery/low birth weight |
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What are the four steps in the periodontal disease model (colorful ovals slide)?
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1. infectious burden
2. susceptible host 3. epithelium, connective tissue, and bone metabolism 4. Bleeding, pockets, loss of attachment, bone loss |
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With gingivitis, what can lead to target organ pathogenesis?
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1. pathogenesis by bacteria and by-products
2. inflammatory mediators 3. chronic inflammation/ immune response |
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There is evidence that controlling ____ leads to better blood glucose and HbA1c levels.
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periodontal disease
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What host response abnormalities increase periodontal disease risk in diabetics?
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- altered collagen metabolism
- altered monocyte response - vascular abnormalities - changes in crevicular fluid |
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______ has been found in atheromas.
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Periodontal bacteria
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Inflammation caused by periodontal bacteria in atheromas may destabilize the atheroma and cause_____.
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thrombosis
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Thickness of ______ correlates with presence of 5 periodontal pathogens.
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carotid artery wall
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What are CRPs? What are some associated diseases?
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C-reactive proteins (levels rise in response to inflammation). CVD, periodontal disease, diabetes
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What kind of bacteria reside in hard-to-access gingival pockets?
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Gram negative anaerobes
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More than 50% of adult periodontitis cases are attributable to ______.
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smoking
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What is the most recommended method for brushing?
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Bass method
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What are some benefits of a power brush?
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Take away some compliance and dexterity issues. They remove more plaque in less time. They reduce gingivitis.
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What's best, waxed, unwaxed or fluoridated floss?
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No difference
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What are some issues with .12% chlorhexidine rinse?
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Stains, alters taste, strong flavor. Will be rendered inactive upon reaction with sodium lauryl sulfate in toothpaste.
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Which rinse is not ADA approved?
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Crest Pro Health (0.07% CPC)
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Colgate Total has three functions:
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1. anti-plaque
2. anti-caries 3. anti-gingivitis |
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Pyrophosphates and zinc chloride are used for what?
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tartar/calculus control (cosmetic)
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What is periodontal debridement?
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Dentist scrapes of plaque. Reduces supra and sub-gingival biofilm.
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What enzyme does S. mutans possess that acts as an adhesin and also catalyzes glucans formation?
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glycosyl transferase
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Is chemical treatment more effective for caries or periodontal disease?
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periodontal disease. Cariogenic plaque is difficult to remove chemically
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How much sodium fluoride in common toothpaste?
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0.2%
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Besides anti-caries effects, what other benefits can fluoride toothpaste have?
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combats xerostomia
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Who should use at home topical fluoride gels?
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Not for those under 6 yrs.
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Who can use fluoride varnish?
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Anyone. Even infants.
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When would you not want to use acidulated phosphate gel?
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If the patient has aesthetic restorations. (Varnish is the best bet.)
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Who should receive systemic fluoride supplements?
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Children 6 mos.-16 yrs. if they don't get enough from the water supply (<.3 mg).
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How much fluoride supplementation fro 6-16 yrs old when fluoride in water <.3 mg.
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1 mg
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What are the five principles addressed in the CO2015 ethical code?
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autonomy, veracity, justice, non-maleficence, and beneficence
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The study of ethics answers what two questions?
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1. What should we do?
2. Why should we do it? |
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Which kinds of hepatitis are spread through fecal contamination? Which are not?
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A and E are spread through fecal contamination. B, C, and D are spread through blood and other sources.
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What is the most common BBP in the world?
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Hep B
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Which kind of hepatitis can be asymptomatic for 10-12 years?
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Hep C
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