Plaque microorganisms - Which bacteria are implicated in dentinal caries?
Substrate - What type of sugars can be used as substrate by plaque bacteria? Which is the most cariogenic and what are they used for?
- Produce acids and dextrans
What three factors in relation to substrate increase caries risk?
Substrate - What can also lower the pH of the mouth further increasing the caries risk?
Carbonated drinks and fruit juices
_______ tooth enamel is _______ by _______ and _______ in the saliva in a process known as ________.
calcium and phosphate ions
Define Ion Exchange
The exchange of minerals between the enamel and saliva following periods of eating and drinking. Demineralised enamel is remineralised by a reservoir of calcium, phosphate and fluoride ions in saliva
Demineralisation is caused by ______ and _____
bacterial plaque and substrate
Remineralisation occurs by a combination of what four factors?
3. Fluoride ions present
4. natural protective factors
What are the eight steps of demin/remineralisation?
1. Consumption of a NMES
2. Reduction of pH in the oral cavity
3. Initial mineral loss from enamel surface
4. Demineralization of the enamel surface zone
5. Calcium and phosphate ions move down a concentration gradient from an area of high concentration (saliva) to an area of low concentration (enamel)
6. Calcium and phosphate ions exchanged from the saliva into the enamel, resulting in the remineralisation of enamel
7. Available fluoride ions in saliva (fluoride reservoir) bond with the calcium hydroxyapatite crystals of enamel
8. Formation of fluorapatite crystals
In what four ways can demineralisation be treated to stop it progressing?
1. Diet advice
3. Fluoride advice
3. Topical fluoride application
Time - Discuss the effect of time on caries risk
- Balance of repair vs destruction depends on the frequency of NMES intake
- 4x sugar exposures a day
- Easily modifiable
What is the Stephens Curve?
- Time vs pH
- The pH of the oral cavity drops quickly following consumption of NMES
- Frequent snacking results in the pH of the oral cavity being maintained below the critical point
- Destruction vs repair tipped in favour of destruction causing demineralisation of enamel
Susceptible tooth - What five factors can influence the susceptibility of the tooth?
1. position and structure
2. systemic fluoride
3. topical fluoride
Susceptible tooth - List 6 susceptible tooth surfaces.
1. pits and fissures
2. interproximal surfaces
3. cervical margins
4. exposed root surface
Susceptible tooth - How does systemic fluoride influence the tooth structure and how?
- Fluorapatite formation
- Reduced pits + fissures
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