Caries Risk Assessment in Paediatric Dentistry

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Questions and Answers

What forms when fluoride is present during the remineralization process?

Amelogenin

Calcium phosphate

Hydroxyapatite

Fluorapatite (correct)

What is the critical pH at which demineralization of enamel begins to occur?

4.5

5.0

6.0

5.5 (correct)

What role does saliva play in oral health?

Acts as a buffer and provides calcium and phosphate ions (correct)

Decreases remineralization through acidity

Inhibits fluoride absorption

Increases plaque formation

Following consumption of a glucose solution, how long does it take for pH to return to baseline after a drop to 5.0?

30-40 minutes Signup and view all the answers

What is the reduction in caries for every additional 500 ppm F within the specified range?

6% Signup and view all the answers

Which group of patients is at an increased risk for caries due to reduced salivary flow?

Patients with xerostomia and head and neck radiation Signup and view all the answers

Which of the following statements correctly describes the relationship between fluoride concentration and caries reduction?

For 1000 ppm F to 2500 ppm F, each increase of 500 ppm F results in a 6% reduction in caries. Signup and view all the answers

What is the maximum fluoride concentration mentioned in the given range?

2500 ppm F Signup and view all the answers

If the fluoride level is increased from 1500 ppm F to 2000 ppm F, what can be expected?

A 6% reduction in caries Signup and view all the answers

What happens to caries when fluoride concentration is kept constant within the specified range?

Caries incidence remains the same Signup and view all the answers

Which scenarios are appropriate for the use of glass ionomer sealants?

Partially erupted teeth in children Signup and view all the answers

What is a notable characteristic of glass ionomer sealants compared to resin-based sealants?

They have lower retention rates. Signup and view all the answers

In which of the following situations would a glass ionomer sealant likely be the best choice?

A child with limited cooperation and a partially erupted tooth Signup and view all the answers

When is it appropriate to use glass ionomer sealants?

For temporary sealing in children Signup and view all the answers

Which of the following statements about glass ionomer sealants is false?

They are effective for all age groups. Signup and view all the answers

What is the safely tolerated dose of fluoride in mg/kg?

1 mg/kg Signup and view all the answers

Which food item is estimated to have the highest fluoride concentration?

Tea Signup and view all the answers

What is the critical period for maximum risk of dental fluorosis in permanent central incisors?

22–26 months of age Signup and view all the answers

What is a likely late symptom of acute fluoride toxicity?

Convulsions Signup and view all the answers

Which of the following is NOT a source of systemic fluoride?

Orthopedic implants Signup and view all the answers

Which dose is considered potentially lethal for fluoride consumption?

5 mg/kg Signup and view all the answers

What condition may develop due to chronic fluoride toxicity?

Skeletal fluorosis Signup and view all the answers

Which symptom is NOT typically associated with early fluoride toxicity?

Cardiac failure Signup and view all the answers

What is the primary consequence of early childhood caries?

Increased risk of new carious lesions Signup and view all the answers

Which dietary sugar is considered the most cariogenic?

Sucrose Signup and view all the answers

What factor contributes to the cariogenic potential of cooked starch mixed with sucrose?

Increased stickiness Signup and view all the answers

What characteristic of bacteria enables them to produce acid when carbohydrates are absent?

Intracellular carbohydrate storage Signup and view all the answers

Which of the following children is at higher risk for dental caries based on diet?

A child who frequently consumes fruit juices Signup and view all the answers

Study Notes

Prevalence of Caries in Kuwait

High prevalence of caries: 87% in 5-year-olds and 73.6% in 12-year-olds.

Consequences of Early Childhood Caries

Increased likelihood of new carious lesions in both primary and permanent teeth.
Leads to hospitalizations and emergency room visits due to dental issues.
Diminished quality of life related to oral health.
Associated with loss of school days for affected children.

Plaque Formation

Microorganisms make up 70% of dental plaque.
Cariogenic bacteria metabolize carbohydrates into acids, primarily lactic acid.
Bacteria can store carbohydrates both intracellularly and extracellularly.
Intracellular storage allows for continued acid production during periods without carbohydrate intake.

Dietary Factors

Sucrose is identified as the most cariogenic sugar.
Intrinsic sugars from fruits and vegetables are less cariogenic compared to extrinsic sugars (e.g., added sugars, fruit juices).
Cooked starch combined with sucrose (found in cakes and biscuits) increases cariogenic potential.
Sticky foods retain in the mouth longer, increasing caries risk.
Frequent snacking and prolonged breastfeeding or night bottle feeding contribute to caries development.

Tooth Factors

Tooth morphology influences caries risk: pits and fissures are more susceptible than smooth surfaces.
Defects in enamel and dentine, such as hypomineralization or amelogenesis imperfecta, increase risk.
Newly erupted teeth are more vulnerable to caries.

Role of Fluoride

Hydroxyapatite in teeth can be converted to fluorapatite through fluoride exposure during remineralization.
Fluorapatite is more resistant to acid attacks and has a critical pH of 3.5.

Saliva's Protective Role

Saliva acts as a buffer, neutralizing plaque pH post-eating and reducing demineralization time.
It provides calcium and phosphate ions essential for remineralization.
Reduced salivary flow (xerostomia, medications, radiation) increases caries risk.

Stephan’s Curve

Following glucose exposure, plaque pH drops from 7.0 to 5.0.
Enamel demineralization begins at a critical pH of 5.5.
pH typically returns to baseline within 30-40 minutes.

Fluoride Resistance and Sources

Fluoride concentration in toothpaste and supplements can significantly reduce caries by 6% for every additional 500 ppm.
Fluoride sources in food range from 0.85 to 7.09 ppm; commonly found in fish, spinach, tea, fortified milk, and salts.
Avoid fluoride supplements if drinking water fluoride levels exceed 0.6 ppm.

Fluoride Toxicity

Safely tolerated dose is 1 mg/kg, while potentially lethal dose starts at 5 mg/kg.
A certainly lethal dose ranges from 32-64 mg/kg, with survival unlikely at this level.

Symptoms of Fluoride Toxicity

Early signs include nausea, abdominal pain, vomiting, diarrhea, and hypersalivation.
Late symptoms can lead to severe consequences: convulsions (plasma calcium level drop), cardiac failure, or respiratory failure.

Chronic Fluoride Toxicity

Dental fluorosis manifests as demarcated opacities and hypoplastic enamel features.
Maximum risk period for permanent central incisors is a critical 4-month window between 22 to 26 months of age.
Skeletal fluorosis can be debilitating, causing fusion of intervertebral discs and ligaments.
Osteoporosis risk increases, particularly leading to hip fractures in elderly and post-menopausal women.

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Description

This quiz explores the prevalence of caries among children, particularly focusing on the statistics from Kuwait. Additionally, it examines the implications of early childhood caries and the role of plaque and cariogenic bacteria in dental health. Test your knowledge on paediatric dentistry practices and prevention strategies!