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An Update on Demineralization/Remineralization

Mark E. Jensen, MS, DDS, PhD; Robert V. Faller, BS

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  1. Dental caries became a matter of national concern in the:

    • 1930's

    • 1940's

    • 1950's

    • 1960's

  2. According to the most recent NIDR study (NHANES III), children between the ages of 5 and 17 are:

    • 80% caries free

    • 35% caries free

    • 42% caries free

    • 55% caries free

  3. The earliest clinical evidence of an enamel lesion of dental caries is ____________.

    • a white spot lesion

    • a roughened surface

    • an explorer "stick"

    • a darkened appearance

  4. Radiographically, an early lesion of enamel caries appears as:

    • A break in the outer layer of enamel

    • An opaque area

    • A demineralized zone beneath the intact surface layer

    • All of the above.

  5. Caries activity usually begins _______________.

    • at the outer-most surface of the enamel

    • along the rod margins below the outer tooth surface

    • mostly on smooth surfaces

    • within 1 to 2 microns of the outer tooth surface

  6. The elements that dissociate during demineralization are:

    • Fluorapatite

    • Calcium hydroxide and phosphorous

    • Calcium citrate and pyrophosphate

    • Calcium and phosphate

  7. A remineralized area of enamel is actually stronger than it was prior to acid attack.

    • True

    • False

  8. Which surfaces do not demineralize in the same manner?

    • Enamel

    • Pit and fissures

    • Primary teeth

    • None of the above. All surfaces are affected the same.

  9. A root surface can actually remineralize to a greater percentage than the original content of mineral.

    • True

    • False

  10. If the outer surface layer in coronal or root caries is intact, the demineralized area can remineralize.

    • True

    • False

  11. More than 1000 medications, including prescriptions for hypertension and depression, have been identified which cause reductions in salivary flow (hyposalivation).

    • True

    • False

  12. Although there are indications that pathologically lower salivary flow, as a consequence of Sjogren's syndrome or as an effect of head/neck radiation treatment or xerostomic medications, is associated with caries, there is no evidence that low normal salivary flow produces a similar outcome.

    • True

    • False

  13. Fluoride plays a key role in the remineralization process by:

    • Speeding up the remineralization process

    • Inhibiting demineralization at the crystal surfaces

    • Enhancing crystal growth

    • Enhancing the transformation through the mineral phases

    • All of the above.

    • None of the above.

  14. Duggal et al used a human intra-oral model to examine carbohydrate frequencies and the use of non-fluoride and fluoride toothpaste and found when a F-free toothpaste was used and carbohydrate frequency exceeded 3 times per day, significant demineralization occurred. When subjects used a fluoride-containing toothpaste, however, net demineralization was only seen when carbohydrate consumption exceeded _______________.

    • 3 times per day

    • 5 times per day

    • 10 times per day

    • 15 times per day

    • More than 19 times per day

  15. One published study on digital radiography reports a significantly improved accuracy of caries diagnosis while reducing observer variability.

    • True

    • False

  16. The process of evidence-based dentistry includes:

    • Following a strict protocol written only for dental patients

    • Consultation with an attorney

    • Incorporate the best scientific evidence (evidence that is critically appraised in systematic reviews) with clinical experience and their patients' preferences for treatment outcomes

    • A and B

    • A and C

    • All of the above.

  17. The "Cochrane Review" on fluoride toothpaste that indicated it is clearly efficacious in preventing caries included studies on more than ___________ children.

    • 1,200

    • 7,600

    • 10,500

    • 43,000

    • 100,000

  18. Leake in a review of 807 references on root caries stated that “Severity reaches over one lesion by age fifty, two lesions by age seventy, and just over ________ lesions for those seventy-five and older.

    • Four

    • Five

    • Three

    • Six

  19. The paradigm shift from a surgical model to a medical model for caries control as described by Steinberg includes:

    • Bacterial control

    • Reduction of risk levels for at-risk patients

    • Reversal of active sites by remineralization

    • Follow-up and maintenance

    • B and C

    • All of the above.

  20. There is some evidence that the use of topical fluoride or fluoride-containing bonding materials during orthodontic treatment reduces the occurrence and severity of white spot lesions, however there is little evidence as to which method or combination of methods to deliver the fluoride is the most effective.

    • True

    • False

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