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Questions and Answers
What is the primary byproduct produced by anaerobic bacteria that contributes to enamel demineralisation?
What is the primary byproduct produced by anaerobic bacteria that contributes to enamel demineralisation?
Which type of bacteria is most commonly associated with enamel caries?
Which type of bacteria is most commonly associated with enamel caries?
According to the findings from the Vipeholm study, what dietary factor increases the likelihood of developing caries?
According to the findings from the Vipeholm study, what dietary factor increases the likelihood of developing caries?
What condition results when sugar is consumed more frequently than every 2-3 hours?
What condition results when sugar is consumed more frequently than every 2-3 hours?
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What was a significant ethical concern regarding the Vipeholm study?
What was a significant ethical concern regarding the Vipeholm study?
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What is the primary cause of dental caries?
What is the primary cause of dental caries?
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Which tissue types are affected by dental caries?
Which tissue types are affected by dental caries?
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Which statement best describes the carious process?
Which statement best describes the carious process?
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Which of the following is NOT a factor in the aetiology of dental caries?
Which of the following is NOT a factor in the aetiology of dental caries?
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How does understanding dental caries contribute to professional practice?
How does understanding dental caries contribute to professional practice?
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What psychological or sociological factor can contribute to poor oral health?
What psychological or sociological factor can contribute to poor oral health?
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Which statement best captures the reversibility of dental caries?
Which statement best captures the reversibility of dental caries?
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What is a necessary component of the patient assessment process for dental caries?
What is a necessary component of the patient assessment process for dental caries?
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What is the primary cause of dental caries?
What is the primary cause of dental caries?
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Which structure of the tooth is most susceptible to carious lesions?
Which structure of the tooth is most susceptible to carious lesions?
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What type of microorganisms are primarily involved in the development of dental caries?
What type of microorganisms are primarily involved in the development of dental caries?
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What is the role of time in the aetiology of caries?
What is the role of time in the aetiology of caries?
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How do plaque bacteria contribute to the process of caries?
How do plaque bacteria contribute to the process of caries?
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Which part of the tooth structure is least susceptible to caries?
Which part of the tooth structure is least susceptible to caries?
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What defines the process of dental caries as per the comprehensive definition?
What defines the process of dental caries as per the comprehensive definition?
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What nutritional component do plaque bacteria primarily depend on?
What nutritional component do plaque bacteria primarily depend on?
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Which type of enamel is more vulnerable to caries formation?
Which type of enamel is more vulnerable to caries formation?
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Which areas of the tooth are recognized as particularly vulnerable to caries?
Which areas of the tooth are recognized as particularly vulnerable to caries?
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Which type of sugars are considered intrinsic sugars?
Which type of sugars are considered intrinsic sugars?
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What is the primary difference between intrinsic and extrinsic sugars?
What is the primary difference between intrinsic and extrinsic sugars?
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Which carbohydrate is most rapidly metabolised to produce extracellular polysaccharides?
Which carbohydrate is most rapidly metabolised to produce extracellular polysaccharides?
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How do simple sugars affect dental health?
How do simple sugars affect dental health?
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What happens when the pH becomes critical in relation to tooth enamel and dentine?
What happens when the pH becomes critical in relation to tooth enamel and dentine?
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Which carbohydrate is likely to be less cariogenic?
Which carbohydrate is likely to be less cariogenic?
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What type of sugar is lactose considered, and where is it found?
What type of sugar is lactose considered, and where is it found?
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What does saliva become when the environment is acidic?
What does saliva become when the environment is acidic?
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What is the critical pH for enamel?
What is the critical pH for enamel?
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What is the effect of a pH below the critical level on teeth?
What is the effect of a pH below the critical level on teeth?
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Which of the following carbohydrates is packaged intracellularly?
Which of the following carbohydrates is packaged intracellularly?
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Which carbohydrate is not completely digested within the mouth?
Which carbohydrate is not completely digested within the mouth?
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What happens in a neutral environment regarding tooth minerals?
What happens in a neutral environment regarding tooth minerals?
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How long did Stefan's studies indicate for the pH to return to normal after sugar exposure?
How long did Stefan's studies indicate for the pH to return to normal after sugar exposure?
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What is the relationship between frequency of acid attacks and caries risk?
What is the relationship between frequency of acid attacks and caries risk?
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Which bacteria are favored as pH drops in dental biofilms?
Which bacteria are favored as pH drops in dental biofilms?
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What occurs when the pH is higher than the critical pH?
What occurs when the pH is higher than the critical pH?
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Why does time play a critical role in the caries process?
Why does time play a critical role in the caries process?
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What substance returns to teeth during the remineralization process?
What substance returns to teeth during the remineralization process?
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What happens to the microbial population in plaque biofilm as it thickens?
What happens to the microbial population in plaque biofilm as it thickens?
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Study Notes
Aetiology of Dental Caries
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Dental caries is a localized, chemical dissolution of tooth surface due to metabolic activity in a biofilm (a microbial deposit) on the tooth.
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All dental hard tissues are susceptible to caries, although some areas are more prone.
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Four main aetiological factors contribute to dental caries:
- Susceptible tooth surface
- Fermentable carbohydrates
- Plaque bacteria
- Time
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The average cost of a tooth extraction in hospital for a 5-year-old and under is £836. Between 2015-2016, approximately £50.5 million was spent on tooth extractions on those under 19, and £7.8 million on those under 5.
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Caries is a reversible process, especially in its early stages.
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Caries occurs when the pH of the mouth drops below critical levels.
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Key factors in the process include:
- Involves microbes and their metabolites
- Involves chemical dissolution
- Affects all hard tissues
- Involves fermentable carbohydrates
- Often localized
- Can be reversible
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Factors that affect susceptibility to caries:
- Pits and fissures
- Smooth surfaces
- Proximal surfaces
- Defective margins/ledges/overhangs
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Bacteria in the biofilm require food to survive. Sugars in the diet provide a substrate for oral commensal bacteria to metabolise and produce lactic acid.
- Simple sugars (glucose, fructose, sucrose) are quickly metabolised and cause a rapid drop in pH. More of these in the diet results in higher risk.
- Complex carbohydrates like starch are less cariogenic, because they aren't completely digested in the mouth.
- Different types of sugar—intrinsic sugars are naturally occurring sugars in unprocessed foods, extrinsic sugars are not bound to a cellular structure. Examples include milk sugars, free sugars, and added sugars.
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Critical pH for enamel is 5.5, while critical pH for dentin is 6.5. These values trigger remineralization or demineralization processes. When pH drops below the critical level, demineralization occurs when tooth tissue loses minerals to saliva or plaque, and this process can reverse with healthy pH levels and saliva
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Time is critical for caries development. Regular acid attacks (due to frequent sugar intake) lead to more demineralization. Infrequent attacks allow for remineralization. The Stephan curve shows the fluctuations in mouth pH, which relates to the frequency and time of sugar intake. Short gaps between intake of cariogenic foods mean prolonged periods of low pH, which increases the occurrence of caries.
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Bacteria, such as lactobacillus and streptococcus mutans, thrive in low-pH environments.
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These bacteria are involved in demineralization, causing a further drop in pH, leading to continuous dental caries.
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The evidence of the aetiology of dental caries comes from various studies:
- 1954 study by Orland using germ-free rats confirmed the need for bacteria.
- 1952 Vipeholm study in a Swedish mental hospital revealed a correlation between sugar frequency and caries development.
- Tristan de Cunha study highlighted the influence of introducing fermentable carbohydrates on caries prevalence.
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Description
This quiz explores the aetiology of dental caries, focusing on the localized chemical processes and the four main contributing factors. It highlights the role of tooth surfaces, fermentation of carbohydrates, plaque bacteria, and time in the development of caries. Understanding these elements can provide insights into the prevention and management of dental health.
