Intro To Dh Exam 2

Front 1

Where is calcium stored in?

Back 1

saliva

Front 2

Calcium is good for?

Back 2

nutrient in health (bone, nerve,muscle strength) and inadequate amounts in diet (levels blood drop, body borrows from bones NOT TEETH and teeth are affected for reminerlization)

Front 3

What do buffers do?

Back 3

neutralize

Front 4

What can happen if you don't have enough calcium in your saliva or any saliva at all?

Back 4

low calcium can interfere w/ remineralization process, low saliva doesnt provide a reservoir for calcium for remineralization

Front 5

What do calcium and saliva both function as for oral pH?

Back 5

buffering agents

Front 6

What does Calcium reduce?

Back 6

hypersensitivity

Front 7

ACP contains the same minerals found in hydroxyapatite but in a small _________ shape

Back 7

spheroidal

Front 8

What does ACP do when combined with water?

Back 8

easily crystalizes onto the teeth in the form of new enamel

Front 9

When ACP is placed on tooth, what ions form and fill surface defects?

Back 9

calcium and phosphate

Front 10

What are ACP products unstablized?

Back 10

because calcium and phosphate salt are delivered seperately in a dual barrel syringe

Front 11

ACP is highly soluble in the oral cavity therefore it has low -

Back 11

substantivity (meaning its available when it lingers around)

Front 12

Disadvantage of ACP?

Back 12

doesnt stay in mouth long enough to be absorbed into teeth as well as CPP-ACP and other products

Front 13

What has ACP been shown to do?

Back 13

block dentin tubules in exposed tooth roots and reduces hypersensitivity

Front 14

Characteristics about CPP-ACP - (10)

Back 14

- stabilized ACP

- milk protein, CPP, is added as a carrier for ACP

- CPP increases substnativity

- CPP helps insure that Ca & PO reach tooth before precipitating or crystalizing

- bind to tooth and bacterial biofilm

- inhibits bacterial adherence to teeth

- requires an acid challenge to release the Ca and PO ions

- used w/ white spot lesions

- recaident is a trade name for CPP-ACP

- available in toothpasts, gum and mouth rinse.

Front 15

CSP (novamin) is the ___________ generation. What did it reduce?

Back 15

latest, it reduced air/cold sensitivity

Front 16

What is Tri-calcium phosphate?

Back 16

NEWEST hybrid material that fuses beta tricalcium phosphate w/ sodium sulfate or fumaric acid, it is designed to increase efficacy of fluoride remineralization.

Front 17

What is used in FDA approved orthopedic bone growth procedures?

Back 17

Tri-calcium phosphate.

Front 18

Difference b/t in-vivo and in-vitro :

Back 18

in-vivo is tested on live subjects, in-vitro is tested on pulled teeth in labs.

Front 19

Dry mouth =

Back 19

calcium!!!

Front 20

Risks for caries : (8)

Back 20

malnutrition, calcium-deficient diets, acidic diets, reflux/hyperactive gag reflux, xerostomia (dry mouth), asthma, oxygen use, and prolonged feeding due to neurological disorders.

Front 21

Acid reflux =

Back 21

decalcification

Front 22

What does Xylitol do?

Back 22

inhibits attachment of Strep Mutans to teeth, can't be metabolized by SM, stimulates salivary flow and interrupts vertical transmisson from caregiver to child w/ long term benefit.

Front 23

What is Xylitol?

Back 23

polyol and a 5 carbon monosaccharide combined with hydrogen

Front 24

Xylitol medical uses?

Back 24

prevent ear infections and upper respiratory infections, wound healing, diabetic sweetener, and shown to increase bone calcification in rats.

Front 25

What form of Xylitol is the ideal delivery system since it remains in the mouth longer and provides SM to ingest Xylitol?

Back 25

gum

Front 26

What does Xylitol gum do?

Back 26

has pH balancers and buffering agents to raise pH and maintain neutrality.

Front 27

Laxation threshold for Xylitol is reached at ____ grams in children and ______ in adults daily.

Back 27

45, 15-200 grams

Front 28

Disadvantages of Xylitol?

Back 28

dont consume too much if you have bowel problems, people w/ crohns or down syndrome can't take it and fatal to dogs.

Front 29

Types of oral rinses? (8)

Back 29

biotene, oxyfresh, rembrandt, breathRx, BSGE, otimoist, spry, and epic.

Front 30

Types of dentrifrices? (5)

Back 30

biotene, breathRX, pxyfresh, rembrandt, and spry

Front 31

Types of oral sprays/gels? (5)

Back 31

mouthkote, theraspray, oral balance, spry rain and biotene

Front 32

Types of gums? (5)

Back 32

biotene, breathRx, epic, theragum, and spry

Front 33

Which conditions benefit from ACP products?

1. dry mouth suffers

2. mod-high risk caries pt's

3. perio pt w. recession

4. all of the above

Back 33

all of the above

Front 34

Who should use some form of calcium products?

1. dry mouth

2. sensitive teeth

3. caries risk

4. deficient diet

5. all of the above

Back 34

all of the above

Front 35

Which calcium product has the best substantivity?

1. ACP

2. CPP-ACP

3. Bioactive silica (novamin)

4. Tri-sodium phosphate

Back 35

bioactive silica

Front 36

Xylitol is effective in caries prevention how?

1. acid reduction

2. bacterial reduction

3. adhesion reduction

4. all of the above

Back 36

all of the above

Front 37

How many grams of Xylitol are indicated daily?

1. one

2. two

3. three-five

4. five-eight

Back 37

five-eight

Front 38

Pt w/ dry mouth - what would you recommend?

1. ACP product

2. Fluoride TX

3. More frequent dental appointments

4. Xylitol

5. Avoiding surgary/acidic diets

6. All of the above

Back 38

all of the above

Front 39

Water fluoridation reduced decay by?

Back 39

30-50%

Front 40

High risk caries pt may need to take a BWX every ___ months.

Back 40

6

Front 41

For caries treatment/prevention, you may need to recommend -

Back 41

frequent visits, fluoride therapy, dental sealants, and diet counseling.

Front 42

Differences b/t High risk caries group, moderate and low -

Back 42

High - you ARE SURE they will have new/larger lesions w/ time.

Moderate - somewhere in b/t and may change status over time.

Low - factors are negligible. you are sure they will NOT have any lesions over time.

Front 43

Poor oral hygiene has a plaque score of ____% or higher.

Back 43

30

Front 44

Caries are susceptible to what?

Back 44

decay, pits and fissures and gingival or interproximal areas.

Front 45

What are some antimicrobial agents for caries?

Back 45

CHX (chlorahexidine), stannous, and sodium hypochlorite (bleach)

Front 46

What's diet counseling consist of?

Back 46

xylitol and calcium

Front 47

Which type of sealant would you use for caries treatment?

Back 47

glass ionomers (releases fluoride)

Front 48

Low risk caries pt =

Back 48

all ages, no decay present during last 3 years and no factors present, wont benefit from additional fluoride.

Front 49

Moderate risk caries pt =

Back 49

younger than 6:

- no lesions in 3 years but presence of 1 factor

Older than 6:

- 1 or 2 lesions in last 3 years

Front 50

High risk caries pt =

Back 50

all ages:

- any lesion during last 3 years

- multiple factors

- xerostonia

- suboptimal fluoride exposure

Front 51

Low risk status pt, recommend -

Back 51

use an ADA approved fluoridated dentrifrice twice a day

Front 52

Moderate risk status pt, recommend -

Back 52

diet counseling/plaque control, apply 5% sodium fluoride varnish twice a year, dental sealants, ADA approved dentrifrice 2/3 times daily, and low concentration fluoride rinse/gel prior to bed.

Front 53

High risk status pt, recommend -

Back 53

diet counseling/plaque control, dental sealants, 5% fluoride varnish 3 times a year, ADA dentifrice 3 times a day, prescribe acid balance rinse for 1 month, use high concentration fluoride gel/paste prior to bed - do not rinse.

Front 54

Characteristics of Chlorhexidine gluconate (mouth rinse) -

Back 54

more effective than listerine, effective against strep mutans and sobrinus, not effective against aerobic lactobacilli.

Front 55

Recommendations for Xerostonia and ACP-CPP:

Back 55

recaldent gum (10 mins daily) and MIpaste

Front 56

Histologically, what does a caries look like?

Back 56

appears to be an intact surface w/ a demineralized area underneath.

Front 57

Symptom of fluoride toxicity?

Back 57

nausea, vomiting, etc.

Front 58

What are 3 places that Ca can be found in the mouth to re-calcify enamel?

Back 58

saliva, diet, and tooth itself.

Front 59

What is a caries risk that automatically puts a pt into high risk?

Back 59

xerostonia

Front 60

Name a form of calcium that has highest substantibity -

Back 60

novamin

Front 61

At what level is a pt considered to have hypo salivation or dry mouth?

Back 61

less than 0.1 ml / minute

Front 62

How many grams of xylitol are recommended per day?

Back 62

"strive for 5" 4-8 g/day

Front 63

What does ADA recommend for low risk caries pts?

Back 63

none

Front 64

ADA what percentage for Stannous?

Back 64

8%

Front 65

Minimal amount of time for application of gel/fluoride trays?

Back 65

4 minutes

Front 66

2 post-op instructions for fluoride varnish?

Back 66

no crunchy foods for 4 hours, no brushing for 4 hours (optimally 12 hours)

Front 67

Fluoride tray/treaments/rinses should NOT be used for who?

Back 67

kids 6 and under, or those who can not control their swallowing reflex

Front 68

What mineral is necessary for remineralization?

Back 68

CALCIUM (fluoride also, but calcium is main)

Front 69

At what point would a tooth need to be restored because it can not repair itself?

Back 69

a tooth needs to have professional restoration when surface of enamel has broken (a hole)

Front 70

Root caries -

Back 70

doesnt happen unless root is exposed and is caused by anaerobic bacteria (actinonmyeces). Root cementum is less mineralized than enamel. Root caries grows faster.

Front 71

Enamel caries -

Back 71

caused by S. mutans, gram + bacteria. higher mineralization.

Front 72

What are the steps to take if one suspects fluroide toxicity?

Back 72

1. call 911

2. induce vomiting

3. if no vomiting, give milk/ipecac syrup, milk of magnesia

Front 73

Which fluoride has the most antibacterial properties?

Back 73

stannous fluoride 8%

Front 74

In what 3 ways does calcium help prevent caries?

Back 74

1. calcium buffers acid

2. it remineralizes enamel, making it stronger

3. binds w/ fluoride to form fluorapatite, which is stronger than normal hydroxyapatite.

Front 75

What are 2 ways that xylitol helps prevent caries?

Back 75

1. cuts down on acid levels in mouth

2. interferes w/ adhesion of bacterium

Front 76

At what pH level does enamel decalcify?

Back 76

5.5

Front 77

At what pH do root surfaces decalcify?

Back 77

6

Front 78

What is the clinically lethal dose of NaFl?

Back 78

5-10 g/kg

Front 79

When does fluorosis occur (when and how?)

Back 79

during tooth development, overconsumption of fluoride (systemic) gets into blood and affects forming teeth (permanent brown staining)

Front 80

What are some ways saliva prevents caries?

Back 80

- keeps food from ahereing to teeth

- antibacterial properties

- helps buffer acids

- if it has calcium, it holds and reserves.

Front 81

Do all teeth demineralize the same way?

Back 81

yes

Front 82

Is fluoride affective in preventing pits and fissures?

Back 82

no, would need sealants.

Front 83

What does pH have to do w/ carries?

Back 83

bacteria inject sugar & produce acid, which travel up enamel rods & demineralize therefore taking out calcium causing cavities.

Front 84

At what point must the tooth be restored/filling?

Back 84

if there is a break in the surface, must be filled because it can't remineralize.

Front 85

What does fluoride have to do w/ remineralization?

Back 85

makes teeth less soluble, buffers acid & bonds to calcium, raises pH because it disables bacteria to where it can't produce acid & stick to tooth.

Front 86

What are the main minerals we're concerned w/ during demineralization?

Back 86

calcium and phosphate

Front 87

What does diet have to do w/ carries?

Back 87

acid and sugar = polyscharrides

Front 88

Name of power bacteria that's most threatening -

Back 88

strep mutans

Front 89

2 places strep mutans colonize -

Back 89

1. pits/fissures

2. interproximals

Front 90

Other bacteria that shows up late but keeps demineralization going?

Back 90

lactobaccillis

Front 91

pH level tooth starts demineralization? enamel?

Back 91

6.2, enamel is 5.5

Front 92

Why do root surfaces decay easier than enamel?

Back 92

softer, because it has fewer minerals than enamel...easier to get through.

Front 93

What are the 3 ADA fluorides -

Back 93

1. stannous 8%

2. sodium, min of 2%

3. APF 1.23%

Front 94

For calcium, body borrows from ______ NOT _________.

Back 94

bones NOT TEETH! (board question)

Front 95

Out of acid and calcium, which has a low pH and which has a high pH?

Back 95

acid = low

calcium = high

Front 96

What are tooth structures made from?

Back 96

calcium and phosphate minerals in a crystaline structure. (hydroxlapapetite crystals)

Front 97

Calcium can be replaced into the tooth ONLY as long as the surface is intact. T/F?

Back 97

TRUE

Front 98

What will not disolve acid as easy but protects calcium and is less soluble?

Back 98

fluorapatite

Front 99

Can bacteria/decay be transmitted from parent to child?

Back 99

YES

Front 100

What are the bacteria's that play a role in dental carries?

Back 100

1. S. mutans

2. Lactobacillus

3. Actinomyces

Front 101

Can S. mutans grow in an acidic environment?

Back 101

yes!

Front 102

Lactobacillus are _____________ invaders that promote the progression of caries.

Back 102

secondary

Front 103

What does Lactobacillus do?

Back 103

produce lactic acid, can grow in acidic environment, and if S Mutans are low --> they produce enough acid to demineralize teeth.

Front 104

What is Actinomyces?

Back 104

ROOT CARIES!! "Why you ACTIN on my roots?!" gram + bacteria, filamentous,

Front 105

3 patterns of caries?

Back 105

pits/fissures, smooth surface, and early childhood caries "bottle caries"

Front 106

How long does the mouth take on average to neutralize itself back?

Back 106

20-30 minutes

Front 107

What is the Caries Formular?

Back 107

sugar + bacteria = acid formation

Front 108

For early childhood caries, what does it initially affect?

Back 108

primary max incisors

Front 109

How can a child get early childhood caries?

Back 109

nursing bottle at sleep times or breast feeding after teeth have erupted.

Front 110

What kind of bacteria are on pits/fissures?

Back 110

S. mutans and lactobacillus

Front 111

What kind of bacteria are on smooth surface caries? caused from?

Back 111

S. mutans and acidic diet

Front 112

What kind of bacteria are on root surfaces?

Back 112

actinomyces

Front 113

What's not as effective for pits and fissures?

Back 113

fluoride

Front 114

How do you usually get smooth surface caries?

Back 114

drug abuse and poor diet

Front 115

Root caries have 2 phases, what happends in phase 1 and 2?

Back 115

phase 1: recession

phase 2: begins at apical to CEJ and has few clinical symptoms

Front 116

3 chemical plaque/biofilm control:

Back 116

1. toothpastes to lower ability of bacteria to adhere to enamel

2. antibiotics (applied topically)

3. antibacterial agents to directly kill bacteria (stannous fluoride and triclosan)

Front 117

What 2 antibacterial agents directly kill bacteria?

Back 117

stannous fluoride and triclosan

Front 118

Fluoride aides the remineralization process in the role of a __________

Back 118

catalyst

Front 119

Fluoride can be bacterio____ and bacterio____

Back 119

cidal (kill) and static (stop)

Front 120

Fluoride inhibits the production of what?

Back 120

glucotransferases

Front 121

What does ACP do?

Back 121

buffers free calcium and phosphate ion activities at tooth surface and enhances remineralization

Front 122

2 kinds of ACP products?

Back 122

recaldent (toothpaste/chewing gum) and arm & hammer toothpaste

Front 123

What is xylitol effective in reducing?

Back 123

cariogenic bacteria

Front 124

Which teeth are at the GREATEST RISK for caries?

Which have the LOWEST RISK?

Back 124

- molars (harder to reach)

- canines and mandibular incisors

Front 125

When is enamel most susceptible to demineralization?

Back 125

newly erupted teeth

Front 126

3 types of topical fluorides -

Back 126

1. professional products

2. OTC (over the counter)

3. Rx (script)

Front 127

Which topical fluoride has the highest concentration?

Back 127

professional product

Front 128

Advantages of topical application?

Back 128

reduced risk of fluorosis, provides anti-caries benefit for most people and easy use of application.

Front 129

When does fluorosis occur?

Back 129

when teeth are developing, too much fluoride (in kids)

Front 130

Which fluoride is most commonly used?

Back 130

sodium fluoride (NaF2)

Front 131

How often does Stannous have to be mixed up and what does Stannous do?

Back 131

mixed up fresh everyday (within 24 hours) and it STAINS! (white spot lesions tooth colored restorations)

Front 132

What is Stannous effective against?

Back 132

S. Mutans

Front 133

Which fluoride etches glass?

1. APF

2. NaF

3. SnF2

Back 133

APF

Front 134

What is most important w/ fluoride trays?

Back 134

make sure it fits properly so its not ingested and covers all teeth

Front 135

Can babies from 6 months and older that are at risk for childhood caries recieve a varnish w/o risk of toxicity?

Back 135

yes

Front 136

Chronic Body systems associated w/ fluoride toxicity -

Back 136

1. blood (fluoride binds w/ calcium causing hypocalcaemia)

2. CNS (hyper-reflexia, convulsions, and parathesias)

3. Cardiovascular / Respiratory (cardiac failure or respiratory paralysis)

Front 137

What is the lethal dose for fluoride? (adults and kids)

Back 137

adults = 5-10 g

kids = 0.5-1.0 g

Front 138

With saliva, are peptides antimicrobial and can neutralize viruses and toxins?

Back 138

yes

Front 139

Which teeth are most likely NOT to decay?

Back 139

mand anteriors

Front 140

Where do you get more calculus?

Back 140

where salivary ducts open up

Front 141

What is an abnormal unstimulated flow rate considered to be?

Back 141

<0.1 ml/minute

Front 142

What is an abnormal stimulated flow rate considered to be?

Back 142

<0.7 ml/minute

Front 143

What active ingredients are used for anti-carries?

Back 143

fluoride (sodium fluroide)

Front 144

What active ingredients are used for anti-plaque?

Back 144

triclosan, stannous fluoride and sanguinarine

Front 145

Which active ingredient for anti-plaque does NOT have ADA seal?

Back 145

sanguinarine

Front 146

What does patassium nitrate do for anti-sensitivity?

Back 146

acts directly on nerves in dentinal tubules reducing pain

Front 147

What does strontium chloride do for anti-sensitivty?

Back 147

occludes the dentinal tubules directly reducing sensitivity.

Front 148

USA dentrifrices are _____ or less.

Back 148

250

Front 149

Sodium fluoride is ___% for gels and ___% for varnishes.

Back 149

2, 5

Front 150

Which fluoride tastes like metal?

Back 150

stannous

Front 151

Sodium fluoride is best for remineralization of an ________ lesion.

Back 151

incipient (early caries lesion that is not cavitated)

Front 152

What kind of pH does sodium fluoride have? does it etch surfaces of materials?

Back 152

neutral, and no.

Front 153

When would you NOT use APF?

Back 153

pt's w/ restorations, porcelain & braces

Front 154

How does APF work?

Back 154

by etching tooth surface w/ acid and incorporating fluoride into holes.

Front 155

Side effects of using hydrogen peroxide or urea peroxide -

Back 155

candida albicans (yeast infection) or black/white hairy tongue.

Front 156

3 ways a tooth can be discolored -

Back 156

1. diet (tea, coffee, wine, cokes)

2. drugs (tobacco, chlorahexidine)

3. metallic stains