02.dental caries

dental caries

1. Dental Caries 1

2. Definition Dental caries is defined as a microbiological disease of the hard structure of teeth, which results in localized demineralization of the inorganic portion and destruct on of the organic substances of the tooth . Cariology is a science which deals with the study of etiology, histopathology , epidemiology, diagnosis , prevent on and treatment of dental caries . 2

3. • Pits and fissures on occlusal surfaces of molars and premolar • Buccal pits of molars • Palatal pits of maxillary incisors • Enamel of the cervical margin of the tooth just coronal to the gingival margin • Proximal enamel smooth surfaces apical to the contact point • In teeth with gingival recession occurring because of periodontal disease • The margins of restorations predominantly which are defcient or overhanging • Tooth surfaces adjacent to dentures and bridges. SITES OF DENTAL CARIES 3

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5. Etiology of Dental Caries Diet Caries Bacteria Time Susceptible Surface (Host) Possible interventions Reduce intake of cariogenic sugars Particularly sucrose Possible interventions Avoid frequent sucrose intake (snacking) Stimulate salivary flow + sugar clearance Possible interventions Reduce Strep. mutans numbers by: Reduction in sugar intake Active or passive immunization Possible interventions Water + other types of Fluoridation Prevention during post-eruptive maturation Fissure sealing Properly contured restorations 5

6. Etiology of Dental Caries Plaque Acidogenic Bacteria Enzymes Food Acids Tooth Carious Lesions 6

7. THEORIES OF DENTAL CARIES Acidogenic theory Proteolytic theory Proteolysis- chelation theory . 7

8. Acidogenic Theory 1890 WD Miller dental decay is a chemoparasitic process consisting of 2 stages decalcification of enamel results in total destruction decalcification of dentin as a preliminary stage followed by dissolution of softened residue of enamel and dentine 8

9. F actors that causes decay: (1) Role of carbohydrates (2) Role of microorganisms (3) Role of acids (4) Role of dental plaque 9

10. Role of Carbohydrates Carbohydrates exert cariogenic effect which depends upon the following factors: Frequency of intake Chemical composition, for example, monosaccharides and disaccharides are more carious than polysaccharides Physical form like solid, sticky jelly like or liquid Time of contact of carbohydrate with the tooth Presence of other food components like presence of high fat or proteins makes carbohydrate less cariogenic . 10

11. Role of microorganisms caused by acid resulting from action of microorganisms on carbohydrates S. mutans has been proved for the initiation of caries 11 Initiation of Dental Caries Progression of Dental Caries Streptococci S. mutans S. milleri S. mitior S. sanguis S. salivaris Streptococcal species: Streptoccal species in deep dentinal caries and root caries Lactobacilli L. acidophillus L. casei Lactobacilli in dentin L. acidophillus L. casei Actinomycoses A. viscosus A. naeslundii Actinomycoses A. Israeli A. odontolyticus

12. Role of acids play most important role in pathogenesis of dental caries pH 5.5 is called critical pH Below this pH demineralization of tooth substance begins found on uncleaned tooth surfaces appear as tenacious, thin film may accumulate within 24-48 hours 12

13. Role of dental plaque Dental plaque also known as microbial plaque is important for beginning of caries because it provides the environment for bacteria to form acid, which causes demineralization of hard tissue of teeth . 13

14. Proteolytic Theory proteolysis of the organic components of tooth as an initial process than actual demineralization + dissolution of inorganic substances proposed that enamel lamellae or rod sheath (proteins) may be lysed which means proteolysis as first event in further progression of bacterial invasion + demineralization carious lesions 14

15. Proteolysis Chelation Theory suggests that caries is caused by simultaneous events of proteolysis + chelation Proteolysis destruction of organic portion of tooth by proteolytic microorganisms Chelation removal of calcium by forming soluble chelates oral bacteria attack organic component of enamel (proteolysis) breakdown products have chelating ability and this dissolves tooth minerals 15

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17. LOCAL FACTORS AFFECTING THE INCIDENCE OF CARIES • Tooth (Host) – Variation in morphology – Composition – Position. • Substrate (Environmental factors) – Saliva i . Composition ii. Quantity iii. pH iv. Viscosity v. Antibacterial factors. 17

18. • Diet i Physical factors ii. Local factors a. Carbohydrate content: Presence of refined cariogenic carbohydrate particles on the tooth surface b. Vitamin content c. Fluoride content. d. Fat content • Microorganisms: Most commonly seen microorganisms associated with caries are Streptococcus mutans and Lactobacillus . • Time period. 18

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21. Classification (1) Depending on nature of attack (2) Depending on progression of caries (3) Depending on surfaces involved (4) Based on direction of attack (5) Based on number of surfaces involved (6) GV Black Classification based on treatment and restoration design (7) Based on location of lesion (8) Based on tissue involved 21

22. Primary Caries incipient; initial first attack on tooth surface Secondary Caries recurrent occurs on margins or walls of existing restorations Old Theories Nature of Attack 22

23. Acute rapidly invading process involves several teeth lesions are soft + light colored Old Theories (2) Progression of Caries 23

24. Acute usually pulp is involved at early stage Rampant caries Nursing bottle caries Radiation caries Chronic lesions are long standing fewer in number lesions are long standing fewer in number Old Theories (2) Progression of Caries 24

25. Pit and fissure Smooth surface caries Old Theories (3) Surfaces involved 25

26. Forward Caries proceeds from enamel to dentin lesion is triangle in shaped with base of triangle at enamel surface + apex towards dentin in pits + fissures base is at DEJ + apex is in the pit Old Theories (4) Direction of caries attack 26

27. Backward Caries proceeds from DEJ towards enamel surface also triangle shaped with base at DEJ + apex towards enamel surface Old Theories (4) Direction of caries attack 27

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29. Simple only one surface is involved by caries Compound 2 surfaces are involved Complex more than 3 surfaces involved Old Theories (5) Number of Surfaces involved 29

30. Class I begin in pits, fissures + defective grooves seen in occlusal surface occlusal two-thirds of molars lingual pits of incisors Old Theories (6) GV Black Classification 30

31. Class II lesions seen on proximal aspects of molars + premolars Old Theories (6) GV Black Classification 31

32. Class III lesions involving proximal aspects of incisors do not involve or necessitate removal of incisal edge Old Theories (6) GV Black Classification 32

33. Class IV lesions involving proximal aspects of incisors involve or require removal of incisal edge Old Theories (6) GV Black Classification 33

34. Class V lesions present on gingival third of all teeth Old Theories (6) GV Black Classification 34

35. Class VI lesions found on incisal edges + cusp tips Old Theories (6) GV Black Classification 35

36. Pit and Fissure caries Occlusal Buccal or lingual pit Smooth surface caries Proximal Buccal or Lingual surface Root caries Old Theories (7) Location of the lesion 36

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38. Enamel Caries Dentinal Caries Cemental Caries Old Theories (8) Tissue involved 38

39. Senile Caries caries associated with aging almost exclusively seen on root surface Residual Caries not removed during restorative procedure Classification 39

40. Interproximal Caries opaque chalky region (white spot) some cases yellow or brown pigment area spots are generally located on outer surface of enamel between contact point + height of free gingival margin Clinical Features: Smooth Surface Caries 40

41. Interproximal Caries as caries penetrates enamel, enamel surrounding the lesion assumes bluish white appearance usally apparent as laterally spreading caries at DEJ Clinical Features: Smooth Surface Caries 41

42. Interproximal Caries common for proximal caries to extend both bucally + lingually Clinical Features: Smooth Surface Caries 42

43. Clinical Features: usually extends from area opposite gingival crest occlusally to convexity of tooth surface extends laterally towards proximal surfaces Cervical, Buccal , Lingual or Palatal Caries 43

44. Clinical Features: usually occurs on cervical area typical cervical lesion is a crescent shaped cavity beginning as slightly roughened chalky area gradually becomes excavated Cervical, Buccal , Lingual or Palatal Caries 44

45. Clinical Features: appears brown or black feel slightly soft catch a fine explorer point Pit and Fissure Caries 45

46. Clinical Features: enamel bordering the pit and fissure may appear opaque as it becomes bluish white undermined Pit and Fissure Caries 46

47. Clinical Features: lateral spread of caries at DEJ as well as penetration into dentin along dentinal tubules may be extensive without fracturing away overhanging enamel there may be large carious lesion with only a tiny point of opening Pit and Fissure Caries 47

48. Pit and Fissure Caries 48

49. also known as cemental caries involves both dentin + cementum in number of people exhibiting gingival recession with clinical exposure of cemental surface Root Caries 49

50. Clinical Features: slowly progressing chronic lesion usually found in mandibular molar area + premolar region gingival recession is associated with root surface caries Root Caries 50

51. occurs immediately adjacent to restoration may be caused by inadequate extension of restoration was not able to excavate or removed well original carious lesion Recurrent Caries 51

52. Clinical Features: restoration with poor margins permitted leakage + entrance of both bacteria + substrate Recurrent Caries 52

53. Etiology: due to nursing bottle containing milk or milk formula, fruit juice or sweetened water sometimes it occurs due to sugar or honey-sweetened pacifier Nursing Bottle Caries 53

54. Pathogenesis: child is put on bed at afternoon nap time or at night with nursing bottle containing milk or a sugar containing beverage milk or sweetened liquid becomes pooled around maxillary anterior teeth Nursing Bottle Caries 54

55. Pathogenesis: carbohydrate containing liquid provide an excellent culture medium for acidogenic microorganisms Nursing Bottle Caries 55

56. Clinical Feature: prolonged feeding beyond usual time may result in early + rampant caries early carious involvement of maxillary anterior, maxillary + mandibular 1 st permanent molars, mandibular canines Nursing Bottle Caries 56

57. Clinical Feature: carious process is so severe that only root stumps remain Nursing Bottle Caries 57

58. Prevention: parent should start brushing the child teeth as soon as they erupt in oral cavity discontinue bottle feeding as soon as child can drink from a cup, at approximately 12-15 months of age Nursing Bottle Caries 58

59. suddenly appearing widespread resulting in early involvement of pulp Rampant Caries 59

60. Etiology: may be due to nutritional deficiency malnutrition emotional disturbances Rampant Caries 60

61. Clinical Features: occurs in children with poor dietary habits extensive inter-proximal + smooth surface caries Rampant Caries 61

62. Management: extensive dental care parent education Rampant Caries 62

63. Clinical Features: both deciduous + permanent are affected large open cavities brown-stained polished appearance + hard Arrested Caries 63

64. Zones in Enamel Caries Zone 1 : Translucent zone – Represent the advancing front of the lesion – Ten times more porous than sound enamel – Not always present. 64

65. Zone 2 : Dark zone – It lies adjacent and superficial to the translucent zone – Usually present and thus referred as positive zone – Called dark zone because it does not transmit polarized light – Formed due to demineralization. 65

66. Zone 3 : Body of the lesion – Largest portion of the incipient caries – Found between the surface and the dark zone – It is the area of greatest demineralization making it more porous. 66

67. Zone 4: Surface zone – This is zone is not or least affected by caries – Greater resistance probably due to greater degree of mineralization and greater fluoride concentration – It is less than 5 percent porous – Its radiopacity is comparable to adjacent enamel. 67

68. Zones of Dentinal Caries Zone 1 : Normal dentin – Zone of fatty degeneration of Tome’s fibers – Formed by degeneration of the odontoblastic process – Otherwise dentin is normal and produces sharp pain on stimulation. 68

69. Zone 2 : Zone of dentinal sclerosis – Intertubular dentin is demineralized – Dentinal sclerosis, i.e. deposition of calcium salts in dentinal tubules takes place – Damage to the odontoblastic zone process is apparent – There are no bacteria in this zone. Hence, this zone is capable of remineralization . 69

70. Zone 3 : Zone of decalcif cation of dentin – Further demineralization of intertubular dentin lead to softer dentin. 70

71. Zone 4 : Zone of bacterial invasion – Widening and distortion of the dentinal tubules which are f lled with bacteria – Dentin is not self-repairable, because of less mineral content and irreversibly denatured collagen – This is zone should be removed during tooth preparation. 71

72. Zone 5 : Zone of decomposed dentin due to acids and enzymes – Outermost zone – Consists of decomposed dentin filled with bacteria – It must be removed during tooth preparation. 72

73. Restorative Treatment Tooth Brushing Mouth Rinsing Dental Floss Topical Fluoride Application (Pedo Patients) Pit and Fissure Sealants Prevention/Management of Dental Caries 73

74. DIFFERENT WAYS FOR CARIES PREVENTION Chemical Method • Fluoride: Fluoride alters the tooth surface or/and tooth structure to increase resistance to demineralization and prevent dental caries. Fluorides are used in the following forms: a. Fluoridation of water supplies b. Topical application of fluoride i . Sodium fluoride ( NaF ) ii. Stannous fluoride (SnF2) iii. Acidulated fluorido -phosphate iv. Prophylactic paste v. Fluoride dentifrices vi. Fluoride mouthwashes or rinses. • Chlorhexidine • Zinc chloride • Caries vaccine • Vitamin K. 74

75. Dietary Method Caries can be prevented by the restriction of intake of refined carbohydrate. Sucrose is most cariogenic carbohydrate, hence its use in food should be restricted. Mechanical Methods • Tooth brushing • Dental floss • Mouth rinsing • Pit and fissure sealants 75