Oral Diagnosis Summer 09

Front 1

What is the most common chronic disease of children in the US?

Back 1

Dental Caries

Front 2

CAMBRA

Back 2

Caries Management by Risk Assessment
*an evidence based strategy for preventative and reparative care for early dental caries that can be implemented in any dental office setting.

Front 3

What percent of caries is found in permanent teeth?

Back 3

80% is concentrated in 25% of the US children.

Front 4

What is the main goal of CAMBRA?

Back 4

educate and motivate patients to improve their oral health behaviors

Front 5

How are micro-organisms passed?

Back 5

Vertical= parent to child
Horizontal=child to child

Front 6

What is the first line of defense in early caries prevention?

Back 6

Dental Hygienists
*flouride applications
*dietary counseling
*dental sealants

Front 7

Successful integration of CAMBRA depends on who?

Back 7

The entire dental team

Front 8

Transillumination

Back 8

*helps to identify vertical crown fracture/cracked teeth
*produces light and dark shadows at the fraction sight.

Front 9

What effect does a crack have on transillumination?

Back 9

the crack will block and reflect the light (diffract).

Front 10

Tooth pain analysis
(clinical diagnosis)

Back 10

1. hyperocclusion
2. pulpal diagnosis
3. periapical diagnosis

Front 11

Hyperocclusion

Back 11

*most common cause of percussion sensitivity
*Premature contact of 2 teeth.

Front 12

Causes of hyperocclusion

Back 12

1. recent restorations
2. trauma (inflamed PDL)
3. periodontal disease
4. edentulous areas/teeth shifting

Front 13

Normal Periapex

Back 13

Symptoms=none
Radiograph=no change
Pulp test=normal
Periapical test= not tender to percussion or palpation

Front 14

Reversible Pulpitis

Back 14

when decay, fracture, or irritation approaches the pulp, but doesn't invade.

Front 15

Irreversible Pulpitis

Back 15

When decay or fracture invades the pulp

Front 16

How does necrotic pulp lead to a pain?

Back 16

It leads to acute apical periodontitis, which is painful to pressure.

Front 17

Complications of Irreversible pulpits

Back 17

1. apical periodontitis
2. apical abcess
3. periodontal cellulitis

Front 18

Acute apical periodontitis

Back 18

symptoms=pain on pressure
radiograph=no change
pulp test=depends on pulp status (dying vs. dead)
Periapical test=tender to percussion or palpation

Front 19

Chronic apical periodontitits

Back 19

sypmtoms=none
radiograph=periapical radiolucency
pulp tests=no response
periapical test=not tender to percussion or palpation

Front 20

Tooth pain sequence

Back 20

1. irreversible pulpitis
2. necrotic pulp
3. acute apical periodontitis
4. chronic apical periodontitis

Front 21

Apical Abscess

Back 21

a localized, purulent form of apical periodontitis.
*may be acute or chronic

Front 22

Acute Apical Abcess

Back 22

symptoms=swelling and severe pain
radiograph=+/- periapical radiolucency
pulp test=no response
periapical test= tender to percussion and palpation

Front 23

Chronic Apical Abcess

Back 23

symptoms=draining sinus/usually no pain
radiograph=periapical radiolucency
pulp test=no response
periapical test=not tender to percussion or palpation

Front 24

Cellulitis

Back 24

*may follow apical periodontitis
*infection spreads into surrounding tissues
*painful swelling of tissue
*regional lymphadenopathy
*may spread into head or neck and comprise the airway
*may cause loss of vision or CNS involvement.

Front 25

Abscess Sequence

Back 25

1. apical periodontitis
2. apical abcess
3. acute abscess
4. chronic abscess

Front 26

When do you use antibiotics to treat an apical abcess?

Back 26

when cellulitis is present

Front 27

When is a root canal or extraction needed?

Back 27

irreversible pulpitis onward

Front 28

What medications increase a patients risk for dental disease?

Back 28

dilantin, steroids, cancer therapies, CCB's. contraceptives

Front 29

What are the 2 main types of bacteria associated with dental caries?

Back 29

1. mutans streptococci
2. lactobacillus

Front 30

When is caries the most severe in primary dentition?

Back 30

the earlier in infancy, when high levels of MS is attained.

Front 31

Xylitol has ___ fewer calories than sugar?

Back 31

40%

Front 32

Recommended Dose for Xylitol

Back 32

*6g to 10g daily
*3-5 times
*chewed for 5 min. each time

Front 33

Xylitol reduces the levels of what?

Back 33

S. mutans and lactic acid

Front 34

How long to xylitol benefits last?

Back 34

Years after use has been discontinued

Front 35

What are the 2 ways xylitol provides benefits?

Back 35

1. sugar substitute
*doesnt produce lactic acid
2. anti-microbial

Front 36

which type of film is best used for caries diagnosis?

Back 36

bitewing.
also sometimes periapical
*dentist=d film
*educators recommend=f film

Front 37

F speed film reduces exposure by how much"?

Back 37

approximatly 60% less

Front 38

How much demineralization is required for radiographic detection?

Back 38

approximatly 50%

Front 39

Factors effecting the appearance of caries

Back 39

1. buccolingual thickness of tooth
2. two-dimensional film
3. x-ray beam angle (hor/vert)
4. exposure factors
*lower kVp=higher contrast

Front 40

Caries Classification

Back 40

I=Incipient (stage 1)
M=Moderat (stage 2)
A=Advanced (stage 3)
S=Severe (stage 4)

Front 41

Detecting Interproximal caries

Back 41

Posterior= radiographs
Anterior= transillumination

Front 42

Interproximal Caries (Incipient)

Back 42

Up to half the thickness of enamel. Treat with flouride

Front 43

Interproximal Caries (Moderate)

Back 43

more than halfway through the enamel (up to DEJ)

Front 44

Interproximal Caries (Advanced)

Back 44

From DEJ to halfway through dentin

Front 45

Interproximal Caries (Severe)

Back 45

More than halfway through dentin

Front 46

Occlusal Caries

Back 46

*must penetrate dentin
*diagnose w/clinical exam
*diff to see on x-rays
*explorer may contribute to spread
*thin radiolucent line

Front 47

Buccal/Lingual Caries

Back 47

*identified by clinical exam
*no very radiolucent
*depth cannot be determined by x-rays

Front 48

Root Caries

Back 48

*saucer-like cratering
*involves cementum
*found on pt.'s with recession or periodontitis.
*may be confused with cervical burnout

Front 49

Cervical Burnout

Back 49

*radiolucency found just below CEJ on the root.
*Due to anotomical variaiton

Front 50

When does caries occur on the root of the tooth?

Back 50

Only when there is loss of alveolar bone and gingival tissue, due to recession or periodontitis.

Front 51

Recurrent Caries

Back 51

found around the margins of existing restorations.

Front 52

Rampant Caries

Back 52

found in children and teens with poor diet and inadequate oral hygiene

Front 53

How is acid formed?

Back 53

When sugar gets into the plaque and is used by bacteria.

Front 54

Demineralization

Back 54

*results from acids being produced by bacteria in plaque biofilm
*dissolution

Front 55

What is the mineral part of a tooth composed of?

Back 55

calcium phosphate

Front 56

T/F
Enamel is more soluble than apatities

Back 56

true

Front 57

Remineralization

Back 57

calcium phosphate penetrating into the tooth itself and crystallizing, filling the spaces

Front 58

What is the normal vehicle for calcium phosphate?

Back 58

saliva

Front 59

When does demineraliztion begin?

Back 59

When the pH is dropped below 5.6 or 5.4

Front 60

Demineralization is more likely to occur where?

Back 60

*occlusal fissures
*proximal surfaces
*cervical areas around the gingiva

Front 61

Calcium Phosphate

Back 61

inhibit demineraliztion as much as they help remineraliztion

Front 62

Caries is a _______?

Back 62

transmissable bacterial infection

Front 63

Pathological factors

Back 63

*acid producing bacteria
*fermentable carbohydrates
*reduced salivary function

Front 64

Protective factors

Back 64

*salivary components
*flouride
*anti-bacterial therapy

Front 65

What is the primary requirment for dental decay?

Back 65

the presence of acid-producing (acidogenic) bacteria

Front 66

What are the 2 most common bacteria that appear in plaque?

Back 66

S. mutans and S. sobrinus

Front 67

Acidogenic bacteria occupy how much of the total flora in the plaque?

Back 67

1% or less

Front 68

What type of antibacterial should we use to reduce or eliminate acidogenic bacteria?

Back 68

broad spectrum

Front 69

Common fermentable carboydrates

Back 69

*glucose
*sucrose
*fructose
*cooked starch

Front 70

What is the key factor with carbohydrates?

Back 70

Frequency of ingestion

Front 71

Defintion of Demineralization

Back 71

the loss of mineral (calcium and phosphate) from the tooth as a result of attack by the acids produced.

Front 72

Definition of Remineralization

Back 72

the natural repair process that replaces some of the mineral lost during the formation of a carious lesion.

Front 73

What does flouride do?

Back 73

inhibits demineralization and enhances remineralization

Front 74

What is the mineral in our teeth and bones?

Back 74

carbonated hydroxyapetite

Front 75

Pathological Factors of the Caries Process

Back 75

1. acidogenic bacteria
2. frequency of ingestion of fermentable carboydrates
3. salivary disfunction

Front 76

Protective Factors

Back 76

1. salivary components and flow
2. flouride, calcium phosphate, and remineralization
3. antibacterial therapy
4. sealants

Front 77

dental caries reversal is determined by what?

Back 77

the balance between pathological and protective factors

Front 78

The dental profession has shifted away from a pure surgical approach in favor of what?

Back 78

more preventive and curative clinical protocols

Front 79

Who developed the first dental hygiene program?

Back 79

Alfred Fones in 1914

Front 80

Dental decay remains a problem in especially in what population?

Back 80

Children and underserved communities

Front 81

____% of caries in permanent teeth is concentrated in ___% of U.S. children.

Back 81

80%, 25%

Front 82

What is the goal of CAMBRA?

Back 82

to educate and motivate patients to improve their behaviors and give them strategies and products to attain and maintain a healthy oral environment

Front 83

T/F: Improvements in restorative materials have allowed the dentist to place smaller, more conservative restorations

Back 83

True

Front 84

Who is the first line of defense in early caries intervention strategies?

Back 84

Dental hygienists

Front 85

Dietary recommendations that hygienists give for caries-prone patients include:

Back 85

consuming acid-buffering dairy products, selecting xylitol as a sugar substitute, and reducing the frequent consumption of fermentable carbs

Front 86

T/F: Caries is a transmissible bacterial infection.

Back 86

True

Front 87

Caries pathological factors include:

Back 87

-acid-producing bacteria
-fermentable carbs
-reduced salivary function

Front 88

Caries protective factors include:

Back 88

-salivary components
-fluoride together with calcium and phosphate
-antibacterial therapy

Front 89

T/F: Only one species is involved in in the caries process.

Back 89

False: multiple species are involved

Front 90

Out of the mutans streptococci group what are the two most common bacteria that appear in human plaque?

Back 90

S. mutans
S. sobrinus

Front 91

Acidogenic bacteria only occupy ___% or less of the total flora in the plaque/

Back 91

1%

Front 92

T/F: We need to use a narrow spectrum antibacterial to reduce or eliminate bacteria in order to control caries.

Back 92

False: we need to use a BROAD spectrum

Front 93

T/F: Studies have now established that early colonization, even before teeth erupt, can occur in infants by transmission from the mother or caregiver.

Back 93

True

Front 94

What is the byproduct of acidogenic bacteria after they have metabolized carbs?

Back 94

organic acid

Front 95

What is the key factor rather than total amount of carbs?

Back 95

Frequency