Dental caries

When a tooth is attacked by a group of microbial strains it leads to Tooth Decay ( in simple). This ppt would help us to know about DENTAL CARIES.

1. VS
MIGHTY TOOTH
INVISIBLE STRAINS
GOOD MORNING!
Dr. Ram

2. DENTAL CARIES
- An irreversible microbial process….
Dr. Ram

3. •INTRODUCTION
•DEFINITION
•REMINERALISATION AND DEMINERALISATION
•CLASSIFICATION OF DENTAL CARIES
•ZONES OF ENAMEL CARIES
•ZONES OF DENTAL CARIES
•MICROBIOLOGY OF THE DENTAL CARIES
•THEORIES OF DENTAL CARIES
CONTENTS
I’M READY…
Dr. Ram

4. •IMMUNOLOGY OF DENTAL CARIES
•GENERAL CLINICAL FEATURES
•DIAGNOSIS
•CARIES ACTIVITY TESTS
•MANAGEMENT AND TREATMENT
•RECENT UPDATES
WHERE I’M I NOW?
Dr. Ram

5. • COMMON REASON FOR TOOTH LOSS.
•Disease of Civilization- Due to habits & Diet.
•TRANSMISSIBLE DISEASE.
•WINDOW OF INFECTION
MATERNAL CARIES LEVEL
DIETARY SUCROSE LEVELS
INTRODUCTION
Dr. Ram

6. Simple caries can …
? next
Dr. Ram

7. DEFINITION OF DENTAL CARIESDEFINITION OF DENTAL CARIES
MISTAKE??
Dr. Ram

8. •REMINERALISATION AND DEMINERALISATION OF DENTAL CARIES
PLAQUE FORMATION ( NATURAL , PHYSIOLOGICAL PROCESS)
BACTERIA----------CARBOHYDRATES---------SUCROSE----------PH-BELOW -5
DEMINERALISATION
REMINERALISATION
Saliva neutralizes the acid, ph increased and minerals may be gained.
Dr. Ram

9. Dr. Ram

10. The cumulative process of de and remineralisation leads to
net loss of minerals.
DENTAL CARIES
Dr. Ram

11. CLASSIFICATIO
N
OF DENTAL
CARIES
Dr. Ram

12. Dr. Ram

13. Dr. Ram

14. Dr. Ram

15. Dr. Ram

16. Dr. Ram

17. Pit & Fissure Caries
Bluish Discoloration
Dr. Ram

18. Proximal caries
Dr. Ram

19. CERVICAL CARIES
crescent shaped
Dr. Ram

20. Secondary / Recurrent Caries
Dr. Ram

21. ETIOLOGY OF DENTAL CARIESETIOLOGY OF DENTAL CARIES
Dr. Ram

22. Factors responsible for carbohydrates to be cariogenic
1.Physical nature- Sticky, solid carbohydrates, REFINED.
2. Chemical nature- glucose, galactose, sucrose, lactose &
starch.
3. Route of intake- tube/IV line don’t contribute to caries
4. Clearance rate-  salivation causes less caries & vice versa
5. Frequency of intake-  INTAKE,  caries incidence is
more
Dr. Ram

23. Other components of diet
Primitive man – unrefined, fibrous diet
which cleaned teeth automatically, caries’
incidence 
Modern man – soft diet with refined
sugars, caries’ incidence 
Dr. Ram

24. Fat & proteins taken with sugars
prevent attachment of
carbohydrates to tooth surface
Dr. Ram

25. PLAQUE
AND
MICROBIES
OF DENTAL CARIES
And their types
Dr. Ram

26. ACQUIRED PELLICLE
1
st
layer of glycoprotein deposited on teeth 30 mins after
brushing.
Doesn’t contain micro-orgs, but gets colonized with
bacteria-forming plaque.
Derived from saliva.
Dr. Ram

27. PLAQUE AND TYPES
–Is a white, tenacious substance/deposit on tooth
surface which contains glycoproteins derived from
saliva.
–Also contains, micro-orgs, desquamated epithelial
cells, Ca, Ph, etc
–Causes dental caries & periodontal disease
–Formed from structure called “acquired pellicle”
Dr. Ram

28. •Acidogenic bacteria-dental caries
•Proteolytic bacteria-periodontal disease
BACTERIA
Pioneer / primary bacteria – initiate caries
S.mutans (smooth surface caries)
Lactobacillus acidophilus (pit & fissure caries)
Actinomyces (root surface caries)
Invaders / secondary bacteria
Staphylococcus, VeillonellaeDr. Ram

29. •MICROBIOLOGY OF THE DENTAL CARIES
•STREPTOCOCCOUS
•ACTINOMYCES
•LACTOBACILLI
Dr. Ram

30. S.m, S.sang
Lacto.
Actinomyce.
Sm,
S salivaries
A.v
Acti. N
S.M
S.sang
LA. SP
ACT. SP
FILAMENTOUS
ROD SHAPED
Dr. Ram

31. S.MUTANS
•Most common, smooth surface caries producing org
Both acidogenic & aciduric.
•Attachment to tooth by Glucans dextrans synthesis from
dietary sucrose by polymerization.
•Synthesized by enzyme present in mutans’ cell wall – Glycosyl
transferase.( GT)
Dr. Ram

32. sucrose stored by mutans, released when required to
cause caries.
•Mutans  thickness of plaque – hampers diffusion of
salivary bi-carbonates into plaque,  risk of caries.
Dr. Ram

33. Stephan’s curve
Critical pH – 5.5
Resting pH in caries active ppl – 5.8
In caries immune ppl – 6.5
Graph showing behavior of pH in caries active & immune ppl,
after a 10% glucose rinse
SALIVA
IMMUNE
ACTIVE
CARBOHYDRATE DIET
Dr. Ram

34. SALIVA
Flow rate:  FR,  caries & vice versa
Buffering capacity:  BC,  caries & vice versa
Amount of salivary secretion: , then  caries
Dr. Ram

35. COMPONENTS OF SALIVA
•Bicarbonates (salivary buffers), diffuse into plaque,  acid
•Anti-bacterials like lactoferrin, lysosome, thiocynate, etc,
present in saliva.
•Ig A in saliva, prevents attachment of bacteria on tooth
surface Ions  Ca, P help in remineralization.
•Salivary urea & bicarbonate  rate of glycolysis I.e, glucose
metabolism is faster, so, contact time of teeth with
carbohydrates is reduced
Dr. Ram

36. THEORIES OF DENTAL CARIES
1)EARLY THEORIES: WORMS
2)ENDOGENOUS THEORY

-HUMORAL
-VITAL
-STAGNATION
3) EXOGENOUS THEORIES
-CHEMICAL THEORY
-PARASITIC/SEPTIC THEORY
-CHEMICO-PARASITIC THEORY ( MILLER’S/ ACIDOGENIC) THEORY
-PROTEOLYTIC THEOTY
-PROTEOLYTIC CHELATION THEORY
-COMBINED ACIDIOGENIC AND PROTEOLYTIC THEORY
Dr. Ram

37. OTHER THEORIES
-SULFATES THEORY
-COMPLEXING AND PHOSPHORYLATING THEORY
-SUCROSE CHELATING THEORY
-AUTOIMMUNE THEORY
-GENETIC THEORY
-CELLULOSE THEORY
-CARIES SURVILLENCE THEORY
Dr. Ram

38. •ACIDOGENIC THEORY
–Miller 1890, most accepted.
–“Acids formed due to the fermentation of dietary
carbohydrates by oral bacteria leads to progressive
decalcification of tooth structure with subsequent
disintegration of organic matrix”
–He isolated micro-orgs from his experiments & stated
that many were involved in the carious process.
TOOTH
PLAQUE
BACTERIA
SUGAR
ACIDS
TOOTH
DECAY
Dr. Ram

39. –4 important factors which can influence
process of tooth destruction in process of
dental caries
•Dietary carbohydrates, micro-organisms, acid,
plaque.
Dr. Ram

40. Dr. Ram

41. PELLICLE FORMATION
COLONIZATION OF S. MUTANS AFTER 0-4 HRS
4-24 HRS MANY MICROBIAL COLONIES ARE FORMED WITH IN IT.
PLAQUE FORMATION
S.MUTANTS DOMINATION
CONVERSION OF CARBOHYDRATES INTO SUGARS ( SUCROSE)
RELEASE OF ACID (LACTIC ACID )Dr. Ram

42. •LIMITATIONS
–Did not explain sub-surface demineralization
–Failed to justify rampant caries
–Did not explain caries in impacted tooth
Dr. Ram

43. Proteolytic theory
•“ Formation of DC is essentially a proteolytic
process. Bacteria present produce hydrolytic
substances/enzymes & cause proteolysis leading
to dissolution of organic substances”
•His view micro-orgs don’t cause decalcification
but dissolution of organic substances present in
the tooth. Micro orgs entered enamel through
enamel lamellae & caused dissolution.
Dr. Ram

44. •Limitations
–The carious lesion couldn’t be reproduced in vitro by
the proteolytic mechanism.
–Proteolytic bacteria are very uncommon in the oral
cavity.
–This theory cant explain the role of sucrose, pH and
fluoride in DC
Dr. Ram

45. Proteolytic Chelation theory
•Chelate formation- citrate, lactate
•During DC, proteolytic breakdown of organic
portion of enamel matrix takes place first.
•Following this, chelating agent is formed by
combination of proteolytic breakdown products,
acquired pellicle, food debris, etc.
–Ex of chelating agent: citrate, lactate, etc
Dr. Ram

46. •Even this theory failed to explain about sugar
or acid production
Dr. Ram

47. Autoimmune theory
•Few odontoblast cells at specific sites within pulp
of specific teeth are damaged by autoimmune
mechanism
•Due to this the defense capacity & integrity of of
enamel and dentin in those specific areas are
compromised and act as potential sites for caries
development in future
Dr. Ram

48. DENTAL CARIES
•ZONES OF ENAMEL CARIES
•ZONES OF DENTAL CARIES
Dr. Ram

49. •ZONES OF ENAMEL CARIES
E
N
A
M
E
L
-ZONE- 1
-ZONE-2
-ZONE-4
-ZONE-5
TRANSLUCENT ZONE
DARK ZONE
BODY OF THE LESION
SURFACE ZONE
Dr. Ram

50. ENAMEL CARIES ( PIT AND FISSURE)
1
2
3
4
.
Inner most zone
Advancing end
Birefringence –
polarised light
Max demineralised
area
40 microns
thickness
Dr. Ram

51. SMOOTH SURFACE CARIES
Dr. Ram

52. Dr. Ram

53. Dr. Ram

54. •ZONES OF DENTINAL CARIES
Enamel
DEJ
Dentin
E-D- ACIDS- DEMINERALIZATION
ZONE-1- Fatty degeneration (T D F)
ZONE-2- Dentinal sclerosis
ZONE-3- Demineralization
ZONE-4- Bacterial invasion/ Turbid Dentin
ZONE-5- Decomposed dentin
Dr. Ram

55. DECALCIFIED STRUCTURE OF DENTAL CARIES
5
4
3
DEMINERLIZED ZONE
(WITHOUT BACTERIAL INVASION)
ROSARY BEAD APPEARENCE
Dr. Ram

56. Liquefaction Foci-Dentinal caries
Dr. Ram

57. ZONE-2- DENTINAL SCLEROSIS
ZONE- 1- (F D T D F)
•ADVANCING END NEAR PULPAL SURFACE
•DEPOSITION OF FAT GLOBULES AT THE ODONTOBLASTIC PROCESS
ZONE-1- Fatty degeneration (T D F)
ZONE-2- Dentinal sclerosis
ZONE-3- Demineralization
ZONE-4- Bacterial invasion
ZONE-5- Decomposed dentin
Dr. Ram

58. Dr. Ram

59. Expansion & Fusion Of Tubules-
Liquefaction Foci
Dr. Ram

60. Transverse Clefts
Dr. Ram

61. Caries in Dentinal Tubules
Dr. Ram

62. Dr. Ram

63. Bacteria wins the battle!
Thank you!
Dr. Ram