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112 Cards in this Set

  • Front
  • Back
2 functioins of drying tooth with air/water syringe
1. remove saliva that can obscure a lesion
2. dry a white spot lesion (demineralization)
What do bitewings detect?
interproximal, occllusal, recurrent carious lesions
How do lesions appear?
structure-shiny, matte, smooth, cavitated
cosistency-hard,soft tooth
color-white, yellow, brown
surfaces at risk for dental caries
occlusion fissure
initial evidence of cariess
white spot/lesion
surfaces affected by remineralization/demineralization
enamel pits
smooth surfaces
criteria for visual examination of caries
1. no change in enamel transluceny after drying
2. on wet surface opacity is slightly visible and distinctly visible after drying
3. opacity or discolaration is visible wo air drying
4. localized enamel demineralization in opaque or discolored enamel
5. cavitaion in enamel exposing the dentin
criteria for histologic examination of pit and fissure caries
1. no enamel demineralization
2. enamel demineralization limited to outer half of enamel
3. demineralization involving between half of enamel and outer third of dentin
4. demineralization involving middle third of dentin
5. demineralization involving pulpal thrid of dentin
most visible lesion
smooth surface lesions
what type of lesion is most likely to become arrested due to preventive treatment?
smooth surface lesion
what indicated smooth surface lesion activity?
1. white spot lesion chlose to gingival margin that has a matte apperance and plaque covered.
2. cavitated plaque covered lesions with/without exposed dentin. soft dentin indicated infected dentin and active lesions
arrested lesions
shiny white, brown
not plaque covered

cavitated lesions that may be dark brown in color with hard dentin and not plaque covered

maybe away from gingival margin
no lesion progression on radiograph.
lo caries risk following treatment
arrested lesions
where are interproximal lesion activities seen?
pt with hi caries risk
persistent gingival inflam.
Dental caries risk at age 50
by age 50, one half of population will have at least one surface of root caries
Initial phase of root caries
periodontal conditions
Phase II of root caries
Begins apical to cemento enamel junction

few clinical symptoms
Where are active root caries lesions
close to gingival margin and covered in plaque

soft or leatherly lesion
arrested lesion of root caries
distance from gingival margin and not covered in plaque

hard consistency as surrounding tooth

color of lesion not reliable
Class VI caries
carious lesions located on incisal edge of anterior teeth and cusp tips of posterior teeth
ddevice for detecting caries using laser fluorescence

laser is fixed wavelength. penetrated 1-2mm

teeth have flu. charactersistics that change w/caries. the laser measures the change in fluorescne qualitites of tooth
What is a necessary factor for a carious lesion?
What does biolfilm on tooth structure for a period of time with metabolic activity cause?
numerous minute flucturatins in pH at interface between tooth surface and biofilm
other causes of dental caries
ind. oral hygiene
medical issues
lack of knowledge
3 main causes of caries
is there a single cause of dental caries
no. different set of causes for diff people
where does demineralization/remineralization occur on ttoth?
at the interface between tooth surface and microbial biofilm deposits
What does removal of biofilm result in?
half of mineral loss of tooth and/or remineralizatin of tooth surface
factors that determine loss of mineral and rate
pH fluctuation
comp/thickness of biofilm
salivary secretion rate
fl ionc conc. in saliva
when is tooth fully mineralized?
when tooth erupts in oral cavity it is fully mineralized.

95% mineral and 5% water and org matrix
what does normal enamel consist of ?
hydroxyapatite crystals and is translucent
how are enamel crystals arranged?
in rods as a prism. each crystal is seperated by intercrystalline spaces filled with water and organic material. this forms a diffusiion of pathways called micropores
what is dentin composed of?
70% mineral and 20% organic

mineral portion is made of hydroxyapatite and small crystals

org matrix is composed of collagen in triple helix of 3 intertwinted pp chains
structural backbone of dentin
collagen, it hold together the apatite crystallites
How to detect caries in clinical exam.
need good visibiligy
bright op.

dry off teeth to remove debris and saliva fro better visual exam
passage of light through the tooth.
How is transillumination used for careis detection?
when tooth illuminated w/bright light, healthy area of enamel lets light come through, light does not pass throug carious lesoin. this is used mainly for anterior teeth
ways to detect caries
clincal exam
where does stain often occur with dental caries?
occlusal surfaces
pits and fissure
buccal and lingual grooves
when does demineralization occur?
when acids produced by cariogenic bacterial plaque diffuse into the microchannels in enamel surface and dissolve minerals in the tooth structrue
is early loss of mineral during demineralizaion visbile?
no not early stages
between enamel crystals
what happens to enamel as more mineral is lost?
it becomes porous. enamel looks white, chalky.
Marginal ridge overlying carious lesoin
initial appearance of demineralization
white spot appears with no breakthrough of enamel surface BUT over time the area turns darker due to food, bverages, tobacco
what does demineralizzation and destruction of hard tooth structure result in?
loss of tooth density in area of lesion. the decreased density allows for greater penetration of xray in carious lesion so lesion applears radiolucent on radiograph
what determine caries radioluceny on Xray?
extent and severity of destraction of tooth by carious process
IS caries always furthered advanced in clinic or on xray?
can a small, new carry be visualized on xray?
early demineralization does not affect tooth density so a radiolucency may not be seen until furter desturction
problem with pits in enamel
makes plaque removal difficult or impossible so prone to decay
places pit and fissure caries occurs
occlusal pit in premolars/molars

buccal and lingual grooves

lingual surfaces of maxillary incisors
What pathway do occlusal caries follow?
pathway of enamel rods and dentinal tubules. carious lesion starts small and enlarges as it progresses through the tooth
when do occlusal caries appear radiographically?
occlusal caries appar once the lesion has brached the dentin enamel junction. caries spreads out laterally under the DEJ and moves toward the pulp
what surface do caries begin in?
smooth surfaces where there is no pit, fissrue, or groove. where bacterial plaque collects like proximal surfaces and cervial areas of buccal and lingual surfaces of teeth
only way to see early interproximal caries
on xray
interproximal caries
carious lesions develop apically to contact point between ajacent teeth
How are advanced interproximal lesions identified clinically?
by discoloration of enamel in marginal ridge and by checking buccal and lingual surfaces with an explorer
incipient caries
caries less that half way through enamel
can incipient caries be stopped?
yes. remineralizaion of tooth can stop it. Use Fluoride, decrease sugar, improve oral hygeine
caries shapes
half moon
triange (chevron)
when does pt have caries symptoms?
when caries penetrate more than halfway towards the pulp tooth can be symptamatic to temp
Root surface caries
also called cervical, cemental or radicular caries.
root surface caries ae soft, progressive lesions of cementum and dentin
What are root surfaces subjected to?
chemical erosioin
abrasive action of brushing
when does incidence of rooth caries increase?
with age but not bc of age. usually due to gingival recession
What is necessary for root caries?
gingival recession
What is root caries related to?
periodonatal conditions that lead to gingival recession and associated w, xerostomia
recurrent caries
caries that develops at existing margins of restorations
best way to detect recurrent caries
explorer clinically
radiograph of recurrent caries
may be obscured or restorations may be superimposed over carious lesion
appearance of recurrent caries
check for discoloration of the enamel around the margins of the restoration.
prevention of recurrent caries
check for any space between enamel and restoration

check for any defects such as fracture in restoration
rampant caries
widespread rapid progressive destructtion type of caries
clinical feature of rampant caries
decay affecting most teeth

numerous smooth surface lesions

poor oral hygiene

high sugar intake
example of rampant caries
1.early childhood caries (BBTD)
caused by sleeping w/bottle with sugary liquid

2.Radiation caries following head/ neck radiation
prevention of early childhood caries
demand breast feeding at night

oralhygiene begins when teeth erupt by wiping teeth
treatment of early childhood caries
stainless steel crowns if teeth restorable
radiation caries
rampant caries followin head/neck radiation bc salivary gld atrophy and get xerostomia.
how is radiation caries characterized?
progression of cervial and smooth suface caries of most teeth
arrested caries
incipint or more advanced caries may be arrested if change in oral environ. that slows down carious process. Incipint caries can remain dormant for a long time or even be reversed with remineralization
how do arrested caries appear?
shiny white lesion

same hardness as surrounding tooth

no plaque covering it
describe arrested caries of occlusal lesions that become static
look like white/ brown spot with shiny surface

not plaque covered
demineralization is stopped or reversed and dull apperance now looks shiny
sign of inactive caries of arrested caries
how does remineralizatin occur?
same microchannels that allow acid to diffuse into the enamel and dssolve tooth minerals can also allow Calcium, phosphate, and fluoride to diffuse back into the tooth.
what neutralizes acid by raising pH?
neutral pH befor eating
at what pH does root surface demineralization occur
what does amount of demineralization depend on?
frequency and length of time the aid is in contact with the tooth
Function of saliva
neutralize acid

provides the calcium and phosphate molecules to diffuse back into the tooth
common agent used to prevent and reverse dental caries
what is largely responsible for decrease of caries in past two decades?
amound of fluoride needed to get benefical effect
v. little

.04-.08 ppm
3 ways fluoride inhibits cariuous process
1. inhibit plaque bacteria
2. inhibit demineralization
3. enhance remineralization by creating a caries reistant surface called a fluroapatite
chlorhexidine gluconate mouthrinses
peridex, periogard. they are chemotherapeutic agents

absorbed on tooth suface, dental plaque, and oral mucosa. reduces plaque

use 2x a day for 14 days
nonacidogenic, noncariogenic sugar substitute with caries inhibitor effects. sweetener used in food products such as gum. it is noncaloric and has sweetness like sugar
how does xylitol work?
it has unfavorable environ. by causing streptococcus mutans to become less adherent to plaque
Class I caries
cavities in pits/fissure
-occlusal of premolars/molars
-facial/lingual side of molar
-lingula side of max. incisor

examine by direct or indirect viion, exporer, radiographs NOT used
Class II
cavities in proximal surfaces of premolars and molars.

detect by:
early caries-xray only
moderate caries not broken through from proximal to occlusal look at color change and translucency, exploration.
extensive caries involving occlusal use direct vision
Class III
cavities in proximal surfaces of incisiors and canines that do no involve the incisal angele
detection of Class III caries
early caries by xray or transillumination

moderater caries not broken through lingual or facial look at colr change, exporation, xray

extensive caries use direct vision
Class IV
caviteis in proximal surfaces of incisors or canine the involve incisal angel

use visual or transilluminatin to detect
Class V
cavities in cervial 1/3 of factial or linual surface

to detcet use: direct vision with dry surface, exploration for demineralization, sensitivity
Class VI
cavities on incisal edges of anterior teeth and cusp tips of posterior teeth

to detect us direct visual bc areas maybe discolored
when was dentistry established as a scientific discipline?
100 yrs ago
Miller and Black
wrote texts about path and caries. accurately describes process and cause of dental caries.
term Black used to describe dental plaque
geainoid plaques

now referred to as Biofilm
streptococcus mutans
gram + aerobic non motile bateria made in acids.

streptococcus sobrins
streptococcus sanguis
gram + non motil rods gros under anaerobic conditions and acid
% of tooth enamel that is mineralized
composed of ydroxyapatite crystals containing calcium and phosphate
% of tooth dentin that is mineralized
what does saliva contain to minimize drops in pH
electrolytes and organic molecules
what does saliva contain?
electrolytes/org mol.

Na HCO3 and P to buffer

salivary protein helps raise pH to neutral levels