1. A susceptible tooth

2. Specific Plaque microflora

3. A specific diet (frequent consumption of sucrose or other fermentable carbohydrates)

4. Combination of these 3 elements for a sufficient period of time.

True or False

Caries takes place right after it is exposed to a susceptible tooth.

False

Only takes place when all factors are present!  If one factor is absent, caries will not occur!

• suceptible tooth
• specific plaque microflora (cariogenic bacteria),
• A specific diet (sucrose or other fermentable carbohydrates)
• and the combination of these for the right amount of time.

True or False

Caries can be prevented by removing or changing one of the factors that are involved.

1. Retentive sugar was more cariogenic than non-retentive.
2. Sugar consumption between meals is more cariogenic than at mealtime.
3. The FREQUENCY of sugar intake/day is more important in caries initiation than the amount of sugar consumed/day.
4. Sugar restriction can inhibit new caries formation in individuals who exibited active caries.

1.  Strep mutans

2. Strep sobrinus

True or False

Mutans streptococci (MS) are responsible for caries progression in the tooth and lactobacilli are responsible for caries initiation.

False

MS = Responsible for caries initiation

Lactobacilli = causes caries progression in the tooth

The key environmental factors leading to a cariogenic microflora are: ______?

1. A slightly acidic plaque environment pH (about 6.0, continuously).

2. Frequent exposure to dietary sugars (not other sugars)

Extracellular

Polysaccharide

(ECP)

True or False

Mutans streptococci (MS) are not indigenous and strongly acidogenic (acid-forming)

False

MS is strongly acidogenic

AND

it also IS indigenous

Cavitation

Lactobacilli (which are most aciduric - acid loving <3)

True or false

MS colonizes only hard tissue or surfaces  (tooth or appliance)

True

Mutans Streptococci

(MS)

Dietary sucrose

FROM MOM!

transmission to the infant occurs between 0-31 months

Dental Pits and Fissures (where they are protected from salivary buffers and the pH is slightly acidic)

*Other supra-gingival plaque retention sites (orthodontic brackets or partial dental clasps) may also serve as habitats.

Sub-gingival ecosystems

(pH is TOO ALKALINE)

(best grow in pH of about 6.0)

Lactobacilli (LB)

Lactobacilli (LB)

True or False

Lactobacilli initiates caries and MS is secondary.

False

MS initiates caries, LB is secondary.

(LB will continue the lesion into dentin but can NOT independantly initiate the disease - Needs MS)

Glucosyl-transferases (GT)

A disaccharide of glucose + fructose

Sucrose

the particular glucan that is made by MS and that is responsible for succession (increase in numbers) of MS in plaque.

Mutan

the protein adhesins that are attached to the cell wall of all MS.  These bind to any type of glucan and are not enzymatic.

Glucan

Binding

Sites

(GBS)

MS are more pathogenic than other streptococci because they are more ___________??

Acidogenic (species that produce acid)

Mutans streptococci (MS)

This is the main acid formed by MS

Lactic Acid

List characteristics of Chronic Gingivitis.

• Tissue is inflamed
• Color changes from pink to dark red
• Tissue becomes transparent/hyperemic (blood capillaries appear)
• Loss of stippling
• Gingiva bleeds when touched (probe, brushing...)
• Pseudo-pockets form (deepening of gingival crevice) but the gingival attachment apparatus is not disrupted so it is not a true pocket.  (Fibers still attached at CEJ)
• Usually not painful

this flows from the tissue through the sulcus into the oral cavity, removing bacteria and toxic substances.  Present in health AND in disease

Gingival

Crevice

Fluid

(GCF)

• Oxygen decreases
• Gram Negative anaerobic species increase (since o2 is down)
• Motile bacteria increases (spirochetes and vibriolike organisms) because they can swim to nutrients.
• GCF increases

(so there is an overall shift to predominantly Gram negative, anaerobic and motile species which are detrimental to tissue integrity)

a painful gingivitis that affects mainly young people and is associated with psychological stress.

Necrotizing

Ulcerative

Gingivitis

(NUG)

Purulent (associated with pus) whitish accumulations that cover affected lesions/tissue during NUG.  When they are removed, they reveal severe ulceration where interdental papilla used to be (becuase they are gone now...because of disease)

Pseudo-membrane

• Extremely painful to eat (esp salty and spicy), brush, and dentist manipulations.
• Interdental papilla totally wiped out to the connective tissue.
• Strong odor - foul, resembles necrosis and putrefaction. 
• Self-Limiting clears up on its own in about 2 weeks

Spirochetes

Treponema genus

the 2nd Trimester

Prevotella intermedia (Pi)

a gram negative anaerobic rod

Increased hormones

(progesterone and estradiol)

Puberty Gingivitis

• Highly inflammed marginal gingiva
• Sometimes painful
• doesn't always correlate with dental plaque levels.

• Oral malodor/bad breath
• Calculus
• Stains
• Materia alba
• Pocket formation/loss of attachment
• Bone loss/resorption

Periodontal pockets/

pocket formation

• Porphyromonas gingivalis (Pg) (most pathogenic of the three/the worst one)
• Treponema denticola
• Tannerella forsythia

• Tobacco smoking
• Physiological stress
• Diabetes
• High lipid diets
• Altered immunity
• Compromised health
• Medications

Calculus

Early Onset Periodontal Diseases

Aggressive Periodontics (AgP)/

Early Onset Periodontal Disease

Aggregatibacter

actinomycetemcomitans (Aa)

HIV related gingivitis and periodontitis

Retrograde

Periodontitis