Dental caries

1. DENTAL
CARIES
Prepared by:
Dr. Rea Corpuz

2.  progressive
 initially subsurface
demineralization of teeth
by bacterial acid
 one of the most common of
all diseases
 major cause of loss of teeth
Dental Caries

3.  may be considered a
disease of modern
civilization
 since prehistoric man
rarely suffered from
this form of tooth
Dental Caries

4.  biological process of tooth
decay with mutifactorial
etiology
 microbial disease of calcified
tissues of teeth
 characterized by demineralization
of inorganic portion
 destruction of organic substance
of tooth
Dental Caries

5.  generally agreed to be
complex problem
 complicated by many
indirect factors
 obscure the direct cause
or causes
Etiology of Dental Caries

6. 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

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

8.  Old Theories
 Exogenous Theories
• (1) Legend of worm
• (2) Chemical Theory
• (3) Parasitic or Septic Theory
Etiology of Dental Caries

9.  Old Theories
 Endogenous Theories
• (1) Humoral Theory
• (2) Vital Theory
Etiology of Dental Caries

10.  New Theories
 (1) Acidogenic Theory
 (2) Proteolytic Theory
 (3) Proteolysis-chelation Theory
Etiology of Dental Caries

11.  (1) Legend of Worm
 5000 BC
 ancient Sumerian text
 obtained from Mesopotamian
area
 caused by worm that drank
blood of teeth
 fed on roots of jaws
Old Theories
(Exogenous Theory)

12.  (2) Chemical Theory
 1819
 proposed by Parmly
 unidentified chemical
agent
 responsible for caries
Old Theories
(Exogenous Theory)

13.  (2) Chemical Theory
 stated that caries began
on enamel surface where
food putrefied
 acquired sufficient dissolving
power to produce disease
chemically
Old Theories
(Exogenous Theory)

14.  (3) Parasitic or Septic
Theory
 1843
 proposed by Erdl
 filamentous parasite in
plaque
• he termed as “Denticolae”
• responsible for dental caries
Old Theories
(Exogenous Theory)

15.  (1) Humoral Theory
 4 humors of body
• blood
• phelgm
• black bile
• yellow bile
 any change in relative
proportion of these elements
causes disease
Old Theories Old Theories
(Endogenous Theory)

16.  (2) Vital Theory
 18 century
 tooth decay originated
like bone gangrene, from
within the tooth itself
Old Theories Old Theories
(Endogenous Theory)

17.  (1) Acidogenic/Chemoparasitic
Theory
 1890
 WD Miller
 dental decay is a chemoparasitic
process consisting of 2 stages
• decalcification of enamel
 results in total
destruction
Old Theories New Theories
(Exogenous Theory)

18.  (1) Acidogenic/Chemoparasitic
Theory
• decalcification of dentin
as a preliminary stage
 followed by dissolution
of softened residue
Old Theories New Theories
(Exogenous Theory)

19.  (1) Acidogenic/Chemoparasitic
Theory
 following factors cause
decay:
• (1) Role of carbohydrates
• (2) Role of microorganisms
• (3) Role of acids
• (4) Role of dental plaque
Old Theories New Theories
(Exogenous Theory)

20.  (1) Role of carbohydrates
 food substances act as
substrate for microorganisms
of dental plaque
 various carbohydrates have
been examined for cariogenic
potential
Old Theories (1)Acidogenic/
Chemoparasitic Theory

21.  (1) Role of carbohydrates
 cariogenicity of carbohydrate
varies with:
• (1) frequency of ingestion
• (2) physical form
• (3) chemical composition
• (4) route of administration
• (5) presence of other food
constituents
Old Theories (1)Acidogenic/
Chemoparasitic Theory

22.  (1) Role of carbohydrates
• (1) frequency of ingestion
 taken repeatedly in
between two major
meals
 provides constant supply
of carbohydrate to plaque
bacteria for fermentation +
production of acids
Old Theories (1)Acidogenic/
Chemoparasitic Theory

23.  (1) Role of carbohydrates
• (2) physical form
 sticky
 solid carbohydrates
Old Theories (1)Acidogenic/
Chemoparasitic Theory

24.  (1) Role of carbohydrates
• (3) chemical composition
 in the form of glucose,
sucrose + fructose
due to low molecular weight
 rapidly diffuse into plaque
 make themselves easily
available for fermentation
by plaque bacteria

Old Theories (1)Acidogenic/
Chemoparasitic Theory

25.  (1) Role of carbohydrates
• (4) Route of administration
 oral intake of sticky
food
(1)Acidogenic/
Chemoparasitic Theory

26.  (1) Role of carbohydrates
• (5) Presence of other food
constituents
 refined pure carbohydrates
more caries producing
(1)Acidogenic/
Chemoparasitic Theory

27.  (2) Role of microorganisms
 caused by acid resulting from
action of microorganisms
on carbohydrates
(1)Acidogenic/
Chemoparasitic Theory

28.  (2) Role of microorganisms
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
(1)Acidogenic/
Chemoparasitic Theory

29.  (2) Role of microorganisms
 S. mutans has been proved
for the initiation of caries
(1)Acidogenic/
Chemoparasitic Theory

30.  (3) 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
(1)Acidogenic/
Chemoparasitic Theory

31.  (4) Role of Dental Plaque
 found on uncleaned tooth
surfaces
 appear as tenacious, thin
film
 may accumulate within 24-48
hours
(1)Acidogenic/
Chemoparasitic Theory

32.  (2) Proteolytic Theory
 proteolysis of the organic
components of tooth
as an initial process
 than actual demineralization
+ dissolution of inorganic
substances
Old Theories New Theories
(Exogenous Theory)

33.  (2) Proteolytic Theory
 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
Old Theories New Theories
(Exogenous Theory)

34.  (3) Proteolysis Chelation Theory
 suggests that caries is
caused by simultaneous
events of proteolysis +
chelation
 proteolysis
• destruction of organic
portion of tooth by
proteolytic microorganisms
Old Theories New Theories
(Exogenous Theory)

35.  (3) Proteolysis Chelation Theory
 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
Old Theories New Theories
(Exogenous Theory)

36.  (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
Old Theories Classification

37.  (6) GV Black Classification
based on treatment and
restoration design
 (7) Based on location of lesion
 (8) Based on tissue involved

Old Theories Classification

38.  Primary Caries
 incipient; initial
 first attack on tooth surface
 Secondary Caries
 recurrent
 occurs on margins or walls
of existing restorations

Old Theories (1) Nature of Attack

39.  Acute
 rapidly invading process
 involves several teeth
 lesions are soft + light colored

Old Theories (2) Progression of Caries

40.  Acute
 usually pulp is involved
at early stage
• Rampant caries
• Nursing bottle caries
• Radiation caries

Old Theories (2) Progression of Caries

41.  Chronic
 lesions are long standing
 fewer in number

Old Theories (2) Progression of Caries

42.  Pit and fissure
 Smooth surface caries

Old Theories (3) Surfaces involved

43.  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

44.  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

45.  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

46.  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

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

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

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

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

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

52.  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

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

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

55.  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

56.  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

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

58.  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

59.  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

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

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

62.  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

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

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

65.  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

66.  Clinical Features:
 restoration with poor
margins
• permitted leakage +
entrance of both bacteria +
substrate
Recurrent Caries

67.  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

68.  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

69.  Pathogenesis:
 carbohydrate containing
liquid provide an excellent
culture medium for
acidogenic microorganisms

Nursing Bottle
Caries

70.  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

71.  Clinical Feature:
 carious process is so
severe that only root
stumps remain

Nursing Bottle
Caries

72.  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

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

74.  Etiology:
 may be due to nutritional
deficiency
 malnutrition
 emotional disturbances
Rampant Caries

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

76.  Management:
 extensive dental care
 parent education
Rampant Caries

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

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

79. References:References:
 BooksBooks
 Cawson, R.A: Cawson’s Essentials of OralCawson, R.A: Cawson’s Essentials of Oral
Oral Pathology and Oral Medicine,Oral Pathology and Oral Medicine,
88
thth
Edition Edition
• (page 40)(page 40)
 Ghom, Ali & Mhaske, Shubhangi: Textbook of Ghom, Ali & Mhaske, Shubhangi: Textbook of
Oral PathologyOral Pathology
• (pages 401-419) (pages 401-419)
Shafer, et al: A textbook of Oral Pathology,Shafer, et al: A textbook of Oral Pathology,
33
rdrd
Edition Edition
• (pages 369,394, 407)(pages 369,394, 407)