Question 1

Each has the potential to initiate demineralization,except one.Which is the exception?

Accepted Answer

Casein,the principal protein in milk,as well as phosphorus and calcium are ingredients in cariogenic or even cariostatic foods,such as cheese and milk.Streptococcus mutans is a gram-positive,anaerobic,spherical bacterium that is widely implicated in initiation of dental caries.Other microorganisms,such as bacteria from other mutans streptococci and the Lactobacillus species are capable of initiating dental caries through their fermentation of carbohydrates.These organisms thrive in an acidic environment.

Question 2

The timing of an acidic food within a meal has little effect on cariogenicity.Cariogenic foods create less risk of enamel demineralization if followed by a noncariogenic or cariostatic food.

Accepted Answer

The first statement is false; the second is true.Timing and sequence within a meal are major factors affecting cariogenicity of an acidic food.An example for the dental hygienist to convey,drinking coffee with sugar after a meal lowers plaque pH (increased acid).Conversely,eating cheese after a fermentable carbohydrate within a meal prevents the decrease of plaque pH that would occur if this fermentable carbohydrate were eaten alone.The takeaway is the following advice: Consume fermentable carbohydrates within a meal,or eat a noncariogenic food last.

Question 3

Energy drinks cause each condition,except one.Which is the exception?

Accepted Answer

Although energy drinks might contain vitamins and minerals,the main ingredients are added sugars and stimulants such as caffeine.The consumption of energy drinks is not associated with slow heart rate (bradycardia)but is associated with a rapid heart rate (tachycardia).Energy drinks are also associated with insomnia,nervousness,headache,seizures,and cardiac arrest.The amount of caffeine varies widely among drinks,but can be as high as 500 mg caffeine per can,which is comparable to approximately 14 cans of caffeinated soda.

Question 4

Polysaccharides such as rice,potatoes,and corn (starches)are less cariogenic than monosaccharides because the physical and chemical properties of starches render complex carbohydrates less damaging to enamel.

Accepted Answer

Both the statement and the reason are correct and related.The unique physical and chemical properties of starches prevent starch from providing a readily available energy source for cariogenic microflora,and it is less likely to produce caries than other carbohydrates.In addition,hydrolysis and breakdown of starches occur after the food has left the mouth,minimizing oral acid production.

Question 5

Primary bacteria involved in initiation of dental caries are:

Accepted Answer

As a by-product of the metabolism of sucrose and glucose,bacteria produce acids that lower the pH,resulting in a more favorable environment for the development of cariogenic bacteria.Primary bacteria implicated in initiation of dental caries are those that ferment carbohydrates including Streptococcus mutans,Lactobacillus species,and other mutans streptococci.

Question 6

Salivary flow is stimulated the most by foods rich in:

Accepted Answer

Firm,fibrous food,such as raw fruits and vegetables,stimulates salivary flow.Other foods that stimulate flow include chewing gum,sour foods,and citrus fruits.An increase in the flow rate has a positive effect on resistance of teeth to dental caries.

Question 7

Which has the least effect on cariogenicity?

Accepted Answer

Of the factors influencing cariogenicity,the quantity of fermentable carbohydrate has the least effect on initiation of dental caries.The remaining factors are more relevant.To illustrate frequency,if a person eats a candy bar within a 5-minute period,the teeth will be exposed to a critical pH (acid)for approximately 40 minutes.Alternatively,if another person eats the same candy bar in 5 bites,but only takes a bit every hour,the total acid exposure would be approximately 200 minutes.

Question 8

Participants in the Vipeholm study who ate foods high in sugar between meals had a significantly higher decay rate than participants who consumed these foods at mealtime only.This result supports the concept that parents should refrain from giving between meal snacks to children.

Accepted Answer

The first statement is true; the second is false.Although the Vipeholm study concluded that consumption of sugary foods between meals is a major risk factor in dental caries,children need snacks to get all the nutrients they need.Dental hygienists can be helpful in providing lists of appropriate snacks that are low fat and do not promote tooth decay.Noncariogenic snacks include skim milk,low-fat cheese,yogurt,peanuts,popcorn,whole-grain bagels,seeds,pizza,and tacos.

Question 9

Although cheeses contain caries inhibitive casein,chewing hard cheeses increases caries potential because lactose is cariogenic.

Accepted Answer

The statement is not correct,but the reason is correct.Cheeses contain casein,the principal protein in milk.Together with phosphorus and calcium,casein has anticariogenic or even cariostatic properties.Despite the fact that milk and cheese contain cariogenic lactose (the least cariogenic of all saccharides),the cariostatic elements in these foods decrease the risk of dental caries.It has been demonstrated that chewing hard cheeses increases salivary flow,which reduces acidity and thus demineralization.

Question 10

Increasing low-fat milk intake as a saliva substitute can offer protection against caries for patients experiencing xerostomia because physical properties of milk are comparable to saliva.

Accepted Answer

Both the statement and the reason are correct and related.In addition to the physical properties of milk,MyPlate recommends using low-fat dairy products as snacks or at the end of a meal to benefit from their anticariogenic effects.However,the dental hygienist should encourage proper oral hygiene techniques to avoid complications associated with exposure to the lactose in milk,as seen in early childhood caries.Xerostomia is dryness of the oral tissues and is most frequently caused by medications and disease.This condition predisposes teeth to dental caries and has significant negative effects on gingival and periodontal health.

Question 11

Each is true regarding oral exposure to fermentable carbohydrates,except one.Which is the exception?

Accepted Answer

Longer exposure to fermentable carbohydrates increases acid exposure to teeth.The result is an increased risk of demineralization and a corresponding decreased opportunity for remineralization.The Stephan curve,which demonstrates pH changes after rinsing with a sugar solution,provides an excellent aid for dental hygienists to illustrate the destructive effects of fermentable carbohydrates.Inherent to such discussions should be the effects of physical form,intake frequency,retentiveness of the food,and oral hygiene interventions.

Question 12

Which is the least significant factor influencing development of dental caries?

Accepted Answer

Gender is an insignificant host factor; food selection,dietary patterns,oral hygiene habits,genetics,race or ethnicity,age,and income are factors that determine susceptibility to caries.An adequate supply of saliva provides protection against dental caries in numerous ways.Particularly important to the prevention of dental caries is the flow of saliva.An adequate flow enables rapid transport of foods from the mouth.Saliva also acts as a buffer by neutralizing oral acids.

Question 13

Xylitol-containing chewing gums reduce caries rates by inhibiting microbial growth.The dental hygienist should recommend antacids and cough drops as salivary substitutes because they have anticariogenic properties.

Accepted Answer

The first statement is true; the second is false.Xylitol,a sugar alcohol,is classified as anticariogenic because the oral flora does not contain enzymes to ferment it.Chewing gums,mints,and candies containing xylitol inhibit enamel demineralization.This inhibitory effect is enhanced by increased salivary flow,increased oral clearance,and greater buffering capabilities.The dental hygienist should caution patients to limit the use of medications that contain fermentable carbohydrates,including antacids and cough drops.

Question 14

Each has cariostatic properties,except one.Which is the exception?

Accepted Answer

Some food components can provide a protection to teeth be decreasing demineralization,enhancing the remineralization process,or increasing salivary flow,even in the presence of a fermentable carbohydrate.Eggs,cheese,seafood,meat,nuts,seeds,margarine,and oils are examples of potentially cariostatic foods.Alternatively,processed foods such as instant oatmeal,are often more fermentable than their nonprocessed counterparts because of partial hydrolysis or diminution of particle size.Dental hygienists can help parents understand that when starches and simple carbohydrates are combined (as in pastries or sugar-coated cereals),their potential to produce caries is equal to or greater than that of sucrose.

Question 15

Which food selection has the most fermentable carbohydrate?

Accepted Answer

The major sources of added sugars,in descending order,are sugar-sweetened beverages such as sodas or fruit drinks,grain desserts (cookies and cakes),dairy desserts (ice cream),candy,and cold cereals.The average daily consumption from added sugars among 2 to18 year olds is 365 kcal.

Question 16

Cariogenic snacks before bedtime are advised if they are within 2 hours of a meal because salivary flow is reduced when sleeping and clearance of plaque acids is limited.

Accepted Answer

The statement is not correct,but the reason is correct.Cariogenic snacks before bedtime should be omitted or followed by careful oral hygiene.Dental hygienists should help parents understand the effects of reduced salivary flow during sleep and the accompanying reduction in the clearance of plaque acids.Highly pertinent,uninterrupted acid production for 2 hours can be harmful.Beneficial information for the hygienist to convey includes preventive strategies to reduce cariogenicity.Recall that casein in milk and cheeses inhibits demineralization,as do mints and gums containing the sugar alcohol xylitol.

Question 17

Tooth surfaces have remineralization potential because the plaque biofilms in saliva provide a buffering action.

Accepted Answer

The statement is correct,but the reason is not correct.Tooth surfaces (enamel and cementum)have the restorative ability of remineralization because saliva is saturated with calcium,phosphate,and fluoride ions.Note that plaque biofilms are not present in healthy saliva,nor do plaque biofilms neutralize saliva.Conversely,plaque biofilms are highly acidic; as a result,they lower salivary pH.Note that plaque biofilm has the unique ability to form a local barrier on enamel and can interfere with demineralization.However,acids produced in plaque biofilm have harmful properties offsetting any benefit of this barrier effect.

Question 18

An excellent snack for dental hygienists to recommend is raisins.The pH of diet and regular soft drinks,bottled teas,and sports drink ranges from 2.5 to 3.5.

Accepted Answer

The first statement is false; the second is true.A sticky and retentive carbohydrate such as raisins remains in contact with the enamel surface for a longer period than sweetened fluids.This comparison provides an example of the impact of oral clearance of fermentable carbohydrate and the resultant longer exposure of the teeth to acid attack.Again,dental hygienists should understand and be able to convey the multiple factors involved in initiation of dental caries and be well versed in providing oral hygiene strategies to address caries prevention.

Question 19

As the frequency of fermentable carbohydrate intake increases,which event occurs?

Accepted Answer

As the frequency of fermentable carbohydrate intake increases,the pH level decreases.The lower pH is more acidic,which diminishes both the buffering capacity and antimicrobial elements (immunoglobulin A)of saliva.Natural sugars,such as honey and molasses,have cariogenic capabilities similar to sucrose.

Question 20

The physical form of pretzels,a crunchy snack,makes them less cariogenic than a chewy food,such as caramels because pretzels have a faster oral clearance time.

Accepted Answer

Neither the statement nor the reason is correct.Although pretzels have less sugar than caramels,the chewy nature of caramel stimulates salivary flow because additional mastication is required to clear caramel from the mouth.This important mechanism results in less retention and damage as compared with dry,sticky foods such as pretzels.This supports the concept that retention and oral clearance time have more impact on cariogenicity than does the quantity of sugar.

Quiz 18: Nutritional Aspects of Dental Caries: Causes, Prevention, and Treatment