Susceptible host

Tameyra Stefani Al-Suhairy · 44問 · 1年前

通報

問題一覧

Factors needed cares initiation 4

Flora bacteria in plaque, Diet, Susceptible surface, Time

Base of pits and fissures

populated by organism with receptors specialized for attachment to the surface of epithelium.

Oral Mucosa

plaque at the dorsum of the tongue.

Streptococcus Salivarius

dominated the teeth normally have plaque community.

Sanguis and S.Mitis

Health History Factors Associated with Increased Caries Risk 6

Age, Fluoride exposure, Smoking, Alcohol, General health, Medication

due to aversion to sweet foods

Hereditary fructose intolerance

due to prolonged antibiotic therapy

Primary immunodeficiency

due to high salivary pH

Chronic renal failure

due to high salivary

Congenital chloride diarrhea

due to delayed or retarded eruption with consequently increased time for enamel maturation before exposure to the oral environment

Growth hormone deficiency

Possibly related to delayed eruption & inter-dental spacing.

Down syndrome

Due to inter-dental spacing.

Turner syndrome

alteration in the enamel and an increased caries incidence.

Epidermolysis bullosa

Gross carious teeth are seen

Rapp-Hodgkin ectodermal dysplasia

gross carious tooth is one of the clinical features

Focal dermal hypoplasia:

The marked caries results from poor dental care resulting from a small mouth opening, misalignment of the teeth & mental retardation

Rubinstein-Taybi syndrome

Increased susceptibility to caries has been found

Klinefelter syndrome

present in the oral cavity of almost all individuals.

Mutans streptococci (MS)

also known as dry mouth,is dryness in the mouth, which may be associated with a change in the composition of saliva, or reduced salivary flow.

Xerostomia

process of neutralizing any added acid (H+ ions) or base (OH- ions) to maintain the moderate pH, making them a weaker acid or base.

Buffering

5 BUFFERING SYSTEMS

Bicarbonate, phosphate, proteins, sialin, urea

3 minerals

Calcium, Phosphate, Fluoride

(a proline-rich peptide) stabilizes Ca and PO4 ions and prevents excessive deposition of the ions to teeth

Statherin

Enhances post-eruption maturation of teeth Remineralizes demineralized tooth structures

Minerals

substances is facilitated by the flushing action of saliva

Oral clearance

Lubrication

mucins

5 Antimicrobial

Ig, peroxidases, lysozyme, lactoferrins, histatins

Digestion

amylase and lipase

produces abundant quantities of watery saliva

Parasympathetic stimulation

produces more viscous saliva.

sympathetic stimulatio

normal daily secretion of saliva

0.5 - 1.5 liters.

whole unstimulated saliva flow rate is approximately

0.3-0.4 ml / min

Morphologic and Structural Characteristics of Teeth that Increase Tooth Susceptibility to Dental caries

Aberrant anatomic and morphologic configurations, Rough tooth surface, Tooth surfaces that are non-self cleansing

3 Smooth enamel surfaces that shelter plaque

areas cervical to the contact areas, distal surface of most posterior tooth, areas cervical to the heights of contour on the facial and lingual

areas are protected physically and are relatively free from the effects of mastication, tongue movement, and salivary flow.

Smooth enamel surfaces

In 17 th and 18 th century,there emerged a concept that teeth are destroyed by acids formed in the oral cavity by fermentation of food particles around the teeth

Chemical Theory

Microorganisms were associated with the carious process

Parasitic theory

was the first well known scientist and investigator of dental caries and published his results in 1882.

WD miller

Acidogenic theory

Proteolytic theory

Importance of Saliva in the maintenance of normal flora (4)

Bacterial clearance, Direct Antibacterial Activity, Buffer, Demineralization

brownish discoloration of enamel term

Mottled enamel

Excessive fluoride exposure (10 PPM/ more) results in

Fluorosis

Substantially reduce sucrose from diet Eliminate sucrose from between meal snacks

Limit substrate

Rationale: Reduce number, duration and intensity of acid attacks. Reduce selection pressure for MS

Limit substrate

Goal of diet counseling is to identify source of sucrose in the diet and reduce the intake of these foods

Limit substrate

Bactericidal mouth rinses (chlorhexidine) • Topical fluoride treatments • Antibiotic treatment (vancomycin, tetracycline, polymyxin B)

Modify Microflora

Rationale: Eliminate MS from mouth

Modify Microflora

least resistance to caries attach and allows rapid lateral spreading once caries has penetrated the enamel.

DEJ

Often painful or hypersensitive - soft, wet and light yellow - demineralization penetrates deep into dentin

Rapidly progressing lesions

- commonly without clinical symptoms - hard, dry, and dark brown - very similar clinical appearance as arrested caries lesions

Slowly progressing lesions

change in color is presumambly due to trapped organic debris and mettalic ions with the enamel.

Arrested Caries ( mineralized lesion)

Clinically observed as intact, but discolored usually brown or black spots.

Arrested Caries ( mineralized lesion)

Caries lesion left behind in the preparation or at the enamel margin of a preparation when a restoration is placed

Remaining caries lesions

Lesions found adjacent to restorations

Secondary caries lesions (Recurrent caries)

Lesions found in intact tooth surfaces

Primary caries lesions

Type of caries according to extent 2

Incipient or reversible, Cavitated or irreversible

mineralization occurs after cavitations , the remaining exposed surface becomes harder and softer and often becomes dark brown/ black in color

Arrested caries

In enamel, it has a dull, white, opaque appearance. In dentin, a soft, yellowish or light to dark brown discolorations of the demineralized tissues prevail.

Active lesion

Varied appearance, ranging from a shiny, white, opaque or discolored spot in the enamel to a hard, dark dentinal surface exposed to the oral environment

Arrested lesion

Soft, light- colored lesion

Acute (Rampant) Caries

Fairly hard or leathery texture and highly discolored

Chronic (Slowly progressing) Caries

Hard, shiny, smooth surface with brown- black discoloration

Arrested Caries

Zones 3 and 4 - not significantly discolored - feels hard already - capable of remineralization

Affected dentin

Zones 1 and 2 - significantly discolored - can be removed by excavators - stained with caries detector - needs to be removed unless judged to be within 0.5 mm of pulp

Infected dentin

NORMAL DENTIN Has a tubule with odontoblastics rocesses that are smooth and no crystals in the line. no bacteria in the tubules

Zone 1

SUB TRANSPARENT DENTIN Zone of demineralized (by acid from caries) of the intertubular dentin and initial formation of very fine crystals in the tubules and lumen at the advancing prone. Damage to the odontoblastic process is ended, however no bacteria are founf in this zone.

Zone 2

TRANSPARENT DENTIN Zone of carious dentin that is softer than normal dentin. Shows further loss of mineral from intertubular dentin and many large crystals in the lower of dentinal tubules

Zone 3

TURBID DENTIN Zones of bacterial invasion marked by widening and distortion of dentinal tubules w/c filled with bacteria. Dentin in this zone will not self repair.

Zone 4

INFECTED DENTIN Outermost zone of infected dentin Decomposed dentin that is teeming with bacteria. No recognizable structure to dentin, seems to be absent of collagen and mineral.

Zone 5

• It recognized clinically, as a wet, mushy, easily removable mass. • This is structure less/ granular in histologic appearance and contain masses of bacteria.

Necrotic dentin

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