Dental Caries

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Questions and Answers

What is the primary organic component found in dentin?

  • Amelogenin
  • Elastin
  • Hydroxyapatite
  • Collagen (correct)

According to the ICDAS classification, what is the defining characteristic of stage 6 caries?

  • Extensive cavity with visible dentin involvement (correct)
  • Localized enamel breakdown without visible dentin involvement
  • A distinct cavity with visible demineralization, limited to enamel
  • Initial enamel opacity visible only after air drying

What best describes the appearance of a tooth with an ICDAS score of 4?

  • Localized enamel breakdown with visible dentin involvement
  • A dark shadow visible from dentine, with or without enamel breakdown. The spot is white or brown when wet. (correct)
  • A white or brown spot visible only after air drying
  • No visible changes in enamel when wet or dry

What is the approximate pore volume of sound enamel?

<p>0.1% (B)</p> Signup and view all the answers

What is the approximate pore volume found in the translucent zone of enamel caries?

<p>1% (A)</p> Signup and view all the answers

In enamel caries, where does the initial destruction primarily occur?

<p>Translucent zone (A)</p> Signup and view all the answers

What is the pore volume in the dark zone of enamel caries?

<p>2-4% (D)</p> Signup and view all the answers

What best describes the dark zone of enamel caries?

<p>A thin layer below the body of the lesion with small porosities (C)</p> Signup and view all the answers

What is the typical pore volume of the body of the lesion in enamel caries?

<p>5-25% (B)</p> Signup and view all the answers

On conventional radiographs, which area of enamel caries is most likely to be visible?

<p>Body of the lesion (A)</p> Signup and view all the answers

Which zone of enamel caries constitutes the majority of the lesion's volume?

<p>Body of the lesion (C)</p> Signup and view all the answers

What is the approximate pore volume of the surface zone in enamel caries?

<p>Below 5% (D)</p> Signup and view all the answers

What are two alternative terms used to describe the enamel caries surface zone?

<p>Intact or pseudo-intact surface (B)</p> Signup and view all the answers

Histologically, what is the typical shape of an enamel caries lesion?

<p>Wedge (C)</p> Signup and view all the answers

What is the most likely cause of early-stage caries white spot lesions turning brown?

<p>Exogenous pigmentation (C)</p> Signup and view all the answers

What is often the first clinically detectable sign of caries development?

<p>White spots (C)</p> Signup and view all the answers

In early-stage enamel caries, where are microporosities generally located?

<p>At the prism boundaries (D)</p> Signup and view all the answers

According to the ICDAS, what criteria identifies a tooth with a score of 3?

<p>Localized enamel breakdown WITHOUT visible dentin (A)</p> Signup and view all the answers

According to the ICDAS, what signifies a score of 2?

<p>Distinct visual change in enamel visible on wet or dry tooth (A)</p> Signup and view all the answers

What constitutes an ICDAS score of 1?

<p>Initial stage caries, no evidence of lesion when tooth is wet, but visual signs on dry tooth (B)</p> Signup and view all the answers

Which factor primarily determines whether a patient is classified as having a 'high' caries risk during a Caries Risk Assessment (CRA)?

<p>Evidence of frequent consumption of fermentable carbohydrates, poor oral hygiene, and a history of multiple caries lesions. (C)</p> Signup and view all the answers

In caries risk assessment, why are saliva flow rate and buffering capacity considered important?

<p>They indicate the mouth's ability to neutralize acids produced by bacteria and clear food debris, affecting the caries process. (B)</p> Signup and view all the answers

What is the rationale behind using bitewing radiographs as a caries detection method?

<p>To detect interproximal caries, which are not easily visible during a clinical exam. (D)</p> Signup and view all the answers

Why is professional application of fluoride varnish considered an important preventive strategy for caries?

<p>It provides a high concentration of fluoride directly to the tooth surface, promoting remineralization and inhibiting demineralization. (B)</p> Signup and view all the answers

How do pit and fissure sealants prevent dental caries?

<p>By creating a physical barrier that prevents bacteria and food particles from accumulating in the pits and fissures. (B)</p> Signup and view all the answers

What is the primary goal of dietary modifications in the prevention of dental caries?

<p>To reduce the frequency and amount of fermentable carbohydrate consumption, thereby reducing acid production by oral bacteria. (C)</p> Signup and view all the answers

What is the mechanism of action of chlorhexidine mouthwash in preventing dental caries?

<p>It reduces the bacterial load in the oral cavity. (B)</p> Signup and view all the answers

What is the key principle behind minimally invasive dentistry in caries management?

<p>To preserve as much healthy tooth structure as possible during restorative procedures. (B)</p> Signup and view all the answers

In the context of caries management, what does 'caries control' refer to?

<p>Addressing all active caries lesions to prevent further progression. (A)</p> Signup and view all the answers

What is the primary advantage of using glass ionomer cement in restorative dentistry, particularly for patients with high caries risk?

<p>Its ability to release fluoride, which helps to prevent secondary caries. (A)</p> Signup and view all the answers

What is the main indication for endodontic treatment (root canal therapy) in the context of caries management?

<p>When caries extends into the pulp, causing inflammation or infection. (D)</p> Signup and view all the answers

Why is understanding socioeconomic factors important in caries risk assessment?

<p>They can influence access to dental care, dietary habits, and oral hygiene practices, all of which affect caries risk. (A)</p> Signup and view all the answers

In caries management, recall appointments are essential. What is their primary purpose?

<p>To monitor caries risk, evaluate the effectiveness of preventive measures, and adjust treatment plans as needed. (C)</p> Signup and view all the answers

How does Xylitol contribute to caries prevention?

<p>It is a non-fermentable sugar substitute that reduces <em>Streptococcus mutans</em> levels by interfering with their metabolic processes. (D)</p> Signup and view all the answers

When is extraction considered as a treatment option for caries?

<p>When the tooth is unrestorable or poses a significant risk to overall health. (D)</p> Signup and view all the answers

What is the critical pH of Dentine

<p>6.5 (C)</p> Signup and view all the answers

What is the critical pH of Enamel?

<p>5.5 (B)</p> Signup and view all the answers

What is the critical pH of enamel with the presence of fluoride?

<p>4.5 (B)</p> Signup and view all the answers

What is the water content in dentine?

<p>10% (C)</p> Signup and view all the answers

What is the percentage of organic components in enamel?

<p>4% (B)</p> Signup and view all the answers

What is the percentage of Inorganic components in enamel?

<p>96% (A)</p> Signup and view all the answers

What is the percentage of organic components is dentine?

<p>20% (B)</p> Signup and view all the answers

What is the percentage of inorganic components in dentine?

<p>70% (D)</p> Signup and view all the answers

What is an extrinsic sugar?

<p>Sugar not bound within a cellular structure (A)</p> Signup and view all the answers

What is an intrinsic sugar?

<p>Natural occurring sugars within unprocessed food – the sugars are packed within the cell (B)</p> Signup and view all the answers

What are four types of sugars that can be metabolize by plaque bacteria?

<p>Sucrose, glucose, lactose, and fructose</p> Signup and view all the answers

What is the easiest type of sugar for oral bacteria to metabolize?

<p>Sucrose (A)</p> Signup and view all the answers

When sugar is metabolized by bacteria, what is produced?

<p>Lactic acid</p> Signup and view all the answers

What are the four key aetiological agents of caries?

<p>Time, susceptible to surface, fermentable, carbohydrates, plaque bacteria</p> Signup and view all the answers

Flashcards

What is caries?

A localized chemical dissolution of a susceptible tooth surface over time by bacteria.

What are the 4 agents of caries?

Time, susceptible tooth surface, fermentable carbohydrates, and plaque bacteria.

Most susceptible areas to caries?

Pits, fissures, smooth surfaces, proximal areas, margins, and overhangs.

Product of sugar metabolism by plaque?

Lactic acid

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Easiest sugar for oral bacteria to metabolize?

Sucrose

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Sugars metabolized by plaque bacteria?

Sucrose, glucose, lactose, fructose

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What are extrinsic sugars?

Sugars not bound within a cellular structure.

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What are intrinsic sugars?

Natural sugars in unprocessed foods.

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Categories of sugars?

Extrinsic and intrinsic

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Examples of extrinsic sugars?

Glucose and sucrose

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Critical pH of enamel?

5.5

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Critical pH of dentine?

6.5

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Resting pH of the mouth?

6.5-7

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What is a neutral pH?

7

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Mouth to neutralize after acid attack?

Approx. an hour

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What is irreversible pulpitis?

Irreversible inflammation/necrosis

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How to treat reversible pulpitis?

Restoration of the tooth

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First clinical signs of caries?

White spots

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Location of microporosities in early caries?

Prism boundaries

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What does ICDAS stand for?

International Caries Detection Assessment System

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Dental Caries

Multifactorial disease involving bacteria, fermentable carbs, and host factors, leading to tooth demineralization.

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Streptococcus mutans

Acidogenic and aciduric bacteria primarily responsible for dental caries.

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Fermentable Carbohydrates

Sucrose, fructose, and glucose metabolized by oral bacteria to produce acids.

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Host Factors (Caries)

Saliva, tooth structure and hygiene affecting caries development.

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Caries Risk Assessment (CRA)

Determining the likelihood of new caries or progression of existing lesions.

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CRA Factors

Saliva flow, bacterial counts, diet, hygiene, fluoride exposure, clinical exam, and socioeconomic factors.

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Saliva Measurements (CRA)

Evaluating saliva quantity and buffering capacity against acids.

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Caries Detection Methods

Visual inspection, radiographs, laser fluorescence (DIAGNOdent), QLF, and ECM.

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DIAGNOdent

Uses laser fluorescence to detect changes in tooth structure from caries.

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QLF (Quantitative Light-induced Fluorescence)

Measures enamel fluorescence to find demineralized, early lesions.

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Fluoride Therapy

Strengthening enamel and enhancing remineralization.

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Pit and Fissure Sealants

Applying resin to occlusal pits and fissures to prevent bacteria and food accumulation.

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Dietary Modifications (Caries)

Reducing the intake of sucrose, fructose and glucose to help prevent caries.

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Strict Oral Hygiene

Removing plaque and bacteria through brushing and interdental cleaning.

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Caries Management

Assessing risk, detecting/preventing lesions, and caries treatment.

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Non-Invasive Caries Strategies

Prioritizing fluoride, diet changes, and hygiene for early lesions.

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Minimally Invasive Dentistry

Preserving healthy tooth structure during restorative procedures.

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Atraumatic Restorative Treatment (ART)

Removing soft dentin with hand instruments and restoring with glass ionomer.

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Restorative Materials

Amalgam, composite resin, glass ionomer, inlays/onlays, and crowns.

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Dental Amalgam

Durable, cost-effective, but less esthetic filling material.

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Study Notes

  • Dental caries

Six Zones of Dentine Caries

  • Zone of destruction
  • Zone of penetration
  • Zone of demineralisation
  • Translucent dentine
  • Tertiary dentine
  • Normal dentine

Organic Material in Dentine

  • Collagen

ICDAS Stage 6

  • An extensive cavity with visible extension into dentine is present.

ICDAS Score 5

  • Extensive stage caries are present with a distinct cavity, visible dentine, and visible demineralization.

ICDAS Score 4

  • There is a dark shadow from dentine, with or without enamel breakdown, and a white or brown spot when wet.

Pore Volume of Sound Enamel

  • 0.1%

Pore Volume of the Translucent Zone of Enamel Caries

  • 1%

Initial Area of Destruction in Enamel Caries

  • Translucent zone

Pore Volume of the Dark Zone in Enamel Caries

  • 2-4%

Dark Zone of Enamel Caries

  • A thin layer below the body of the lesion with small porosities appears dark microscopically.

Pore Volume of the Body of the Lesion in Caries

  • 5-25%

Area of Enamel Caries Visible on Conventional Radiographs

  • The body of the lesion

Zone of Enamel Caries that Makes Up the Majority of the Lesion

  • The body of the lesion

Pore Volume of the Surface Zone of Enamel Caries

  • Below 5%

Other Names for the Enamel Caries Surface Zone

  • Intact surface
  • Pseudo-intact surface

Shape of an Enamel Caries Lesion Histologically

  • Wedge

Early Stage Caries White Spot Lesions Turning Brown

  • Exogenous pigmentation

First Clinical Signs of Caries

  • White spots

Microporosities in Early Stage Caries in Enamel

  • Located in prism boundaries

ICDAS Score 3

  • Moderate stage caries with localized enamel breakdown but without visible dentine

ICDAS Score 2

  • A distinct visual change in enamel is visible when wet and dry.

ICDAS Score 1

  • Initial stage caries with no evidence when the tooth is wet, but first visual signs on dry tooth (white/brown)

ICDAS Score 0

  • Sound tooth with no evidence of caries when wet or dry

ICDAS Acronym

  • International Caries Detection and Assessment System

Irreversible Pulpitis

  • Irreversible inflammation or necrosis of the pulp

Treatment for Reversible Pulpitis

  • Restoration of the tooth

Symptoms of Reversible Pulpitis

  • Short, sharp pain that doesn't keep the patient awake, is not constant, and reacts to cold, hot, or sweet stimuli

Reversible Pulpitis

  • Inflammation of the superficial pulp that can be resolved via restoration of hard tissue

Consequences of Caries

  • Aesthetics issues
  • Sensitivity
  • Pain
  • Loss of tooth

Time for the Mouth to Neutralize After an Acid Attack

  • Approximately an hour

Resting pH of the Mouth

  • 6.5-7

Neutral pH

  • 7

Critical pH of Dentine

  • 6.5

Critical pH of Enamel

  • 5.5

Examples of Extrinsic Sugars

  • Glucose
  • Sucrose

Extrinsic Sugars

  • Sugars not bound within a cellular structure, e.g., sucrose and glucose

Intrinsic Sugars

  • Natural occurring sugars within unprocessed foods, packaged within the cell

Categories of Sugars

  • Intrinsic sugars
  • Extrinsic sugars

Types of Sugars Metabolized by Plaque Bacteria

  • Sucrose
  • Glucose
  • Lactose
  • Fructose

Easiest Type of Sugar for Oral Bacteria to Metabolize

  • Sucrose

Product of Sugar Metabolism by Plaque Bacteria

  • Lactic acid

Tooth Areas Susceptible to Caries

  • Pits and fissures
  • Smooth surfaces
  • Proximal areas
  • Margins and overhangs

Definition of Caries

  • Localized chemical dissolution of a susceptible tooth surface over time due to fermentable carbohydrates' action on bacteria in plaque biofilm

Key Etiological Agents of Caries

  • Time
  • Susceptible tooth surface
  • Fermentable carbohydrates
  • Plaque bacteria

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