Dental caries

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  • @Bapuji Maringanti sir, I cant speak about efficacy of fluoride,,,but as per I have studied, caries is multifactorial disease which wont comes only due to lack of oral hygiene or diet.......it would be my pleasure to communicate more with you,,,kindly send me your email id. dr.dkg07@gmail.com
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  • Dear Sarang and other students and teachers of dental healthcare: There is probably need to look afresh at other reasons for caries instead of being carried away by the existing. Fluoride is found to be of no help in Caries prevention. In your profession you often load with a heavy dose of F- need to be reconsidered. I (67+yrs) and my brother (72) eat sweets- rather eat jagggery/Gur before bed time- sleep without brusing or gARGLING. My mouth does not smell nor my teeth are bad. Almost No caries so far. Kindly consider. I am a retd Scientist Organic chemist working on fluorosis for the past one year.
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  • V.GOOD PRESENTATION.........FABULOUS......THANKS.......
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  • thanks
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Dental caries

  1. 1. DENTALCARIES Prepared by: Dr. Rea Corpuz
  2. 2. Dental Caries progressive initially subsurface demineralization of teeth by bacterial acid one of the most common of all diseases major cause of loss of teeth
  3. 3. Dental Caries may be considered a disease of modern civilization since prehistoric man rarely suffered from this form of tooth
  4. 4. Dental Caries 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
  5. 5. Etiology of Dental Caries generally agreed to be complex problem complicated by many indirect factors obscure the direct cause or causes
  6. 6. Etiology of Dental CariesPossible interventions Possible interventionsReduce intake of Reduce Strep. mutanscariogenic sugars numbers by:Particularly sucrose Diet Bacteria Reduction in sugar intake Active or passive Caries immunization Possible interventions Susceptible Water + other types of Time Surface FluoridationPossible interventions (Host) Prevention during post-Avoid frequent sucrose eruptive maturationintake (snacking) Fissure sealingStimulate salivary flow Properly contured+ sugar clearance restorations
  7. 7. Etiology of Dental Caries PlaqueAcidogenic Enzymes Food Acids Tooth Carious Bacteria Lesions
  8. 8. Etiology of Dental Caries Old Theories  Exogenous Theories • (1) Legend of worm • (2) Chemical Theory • (3) Parasitic or Septic Theory
  9. 9. Etiology of Dental Caries Old Theories  Endogenous Theories • (1) Humoral Theory • (2) Vital Theory
  10. 10. Etiology of Dental Caries New Theories  (1) Acidogenic Theory  (2) Proteolytic Theory  (3) Proteolysis-chelation Theory
  11. 11. Old Theories(Exogenous Theory) (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
  12. 12. Old Theories(Exogenous Theory) (2) Chemical Theory  1819  proposed by Parmly  unidentified chemical agent  responsible for caries
  13. 13. Old Theories(Exogenous Theory) (2) Chemical Theory  stated that caries began on enamel surface where food putrefied  acquired sufficient dissolving power to produce disease chemically
  14. 14. Old Theories(Exogenous Theory) (3) Parasitic or Septic Theory  1843  proposed by Erdl  filamentous parasite in plaque • he termed as “Denticolae” • responsible for dental caries
  15. 15. Old Theories(Endogenous Theory) (1) Humoral Theory  4 humors of body • blood • phelgm • black bile • yellow bile  any change in relative proportion of these elements causes disease
  16. 16. Old Theories(Endogenous Theory) (2) Vital Theory  18 century  tooth decay originated like bone gangrene, from within the tooth itself
  17. 17. New TheoriesOld Theories(Exogenous Theory) (1) Acidogenic/Chemoparasitic Theory  1890  WD Miller  dental decay is a chemoparasitic process consisting of 2 stages • decalcification of enamel  results in total destruction
  18. 18. New TheoriesOld Theories(Exogenous Theory) (1) Acidogenic/Chemoparasitic Theory • decalcification of dentin as a preliminary stage  followed by dissolution of softened residue
  19. 19. New TheoriesOld Theories(Exogenous Theory) (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
  20. 20. (1)Acidogenic/Old TheoriesChemoparasitic Theory (1) Role of carbohydrates  food substances act as substrate for microorganisms of dental plaque  various carbohydrates have been examined for cariogenic potential
  21. 21. (1)Acidogenic/Old TheoriesChemoparasitic Theory (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
  22. 22. (1)Acidogenic/Old TheoriesChemoparasitic Theory (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
  23. 23. (1)Acidogenic/Old TheoriesChemoparasitic Theory (1) Role of carbohydrates • (2) physical form  sticky  solid carbohydrates
  24. 24. (1)Acidogenic/Old TheoriesChemoparasitic Theory (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
  25. 25. (1)Acidogenic/Chemoparasitic Theory (1) Role of carbohydrates • (4) Route of administration  oral intake of sticky food
  26. 26. (1)Acidogenic/Chemoparasitic Theory (1) Role of carbohydrates • (5) Presence of other food constituents  refined pure carbohydrates more caries producing
  27. 27. (1)Acidogenic/Chemoparasitic Theory (2) Role of microorganisms  caused by acid resulting from action of microorganisms on carbohydrates
  28. 28. (1)Acidogenic/Chemoparasitic Theory (2) Role of microorganisms Initiation of Dental Progression of Dental Caries Caries Streptococci Streptococcal species: • S. mutans Streptoccal species in deep • S. milleri dentinal caries and root • S. mitior caries • S. sanguis • S. salivaris Lactobacilli Lactobacilli in dentin • L. acidophillus • L. acidophillus • L. casei • L. casei Actinomycoses Actinomycoses • A. viscosus • A. Israeli • A. naeslundii • A. odontolyticus
  29. 29. (1)Acidogenic/Chemoparasitic Theory (2) Role of microorganisms  S. mutans has been proved for the initiation of caries
  30. 30. (1)Acidogenic/Chemoparasitic Theory (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
  31. 31. (1)Acidogenic/Chemoparasitic Theory (4) Role of Dental Plaque  found on uncleaned tooth surfaces  appear as tenacious, thin film  may accumulate within 24-48 hours
  32. 32. New TheoriesOld Theories(Exogenous Theory) (2) Proteolytic Theory  proteolysis of the organic components of tooth as an initial process  than actual demineralization + dissolution of inorganic substances
  33. 33. New TheoriesOld Theories(Exogenous Theory) (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
  34. 34. New TheoriesOld Theories(Exogenous Theory) (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
  35. 35. New TheoriesOld Theories(Exogenous Theory) (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
  36. 36. ClassificationOld Theories (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
  37. 37. ClassificationOld Theories (6) GV Black Classification based on treatment and restoration design (7) Based on location of lesion (8) Based on tissue involved
  38. 38. (1) Nature ofOld Theories Attack Primary Caries  incipient; initial  first attack on tooth surface Secondary Caries  recurrent  occurs on margins or walls of existing restorations
  39. 39. (2) Progression of CariesOld Theories Acute  rapidly invading process  involves several teeth  lesions are soft + light colored
  40. 40. (2) Progression of CariesOld Theories Acute  usually pulp is involved at early stage • Rampant caries • Nursing bottle caries • Radiation caries
  41. 41. (2) Progression of CariesOld Theories Chronic  lesions are long standing  fewer in number
  42. 42. (3) Surfaces involvedOld Theories Pit and fissure Smooth surface caries
  43. 43. (4) DirectionOld Theories of caries attack 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
  44. 44. (4) DirectionOld Theories of caries attack Backward Caries  proceeds from DEJ towards enamel surface  also triangle shaped with base at DEJ + apex towards enamel surface
  45. 45. (5) Number ofOld Theories Surfaces involved Simple  only one surface is involved by caries Compound  2 surfaces are involved Complex  more than 3 surfaces involved
  46. 46. (6) GV BlackOld Theories Classification Class I  begin in pits, fissures + defective grooves  seen in occlusal surface  occlusal two-thirds of molars  lingual pits of incisors
  47. 47. (6) GV BlackOld Theories Classification Class II  lesions seen on proximal aspects of molars + premolars
  48. 48. (6) GV BlackOld Theories Classification Class III  lesions involving proximal aspects of incisors  do not involve or necessitate removal of incisal edge
  49. 49. (6) GV BlackOld Theories Classification Class IV  lesions involving proximal aspects of incisors  involve or require removal of incisal edge
  50. 50. (6) GV BlackOld Theories Classification Class V  lesions present on gingival third of all teeth
  51. 51. (6) GV BlackOld Theories Classification Class VI  lesions found on incisal edges + cusp tips
  52. 52. (7) LocationOld Theoriesof the lesion Pit and Fissure caries  Occlusal  Buccal or lingual pit Smooth surface caries  Proximal  Buccal or Lingual surface Root caries
  53. 53. (8) Tissue involvedOld Theories Enamel Caries Dentinal Caries Cemental Caries
  54. 54. Classification Senile Caries  caries associated with aging  almost exclusively seen on root surface Residual Caries  not removed during restorative procedure
  55. 55. Clinical Features: SmoothSurface Caries 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
  56. 56. Clinical Features: SmoothSurface Caries Interproximal Caries  as caries penetrates enamel, enamel surrounding the lesion assumes bluish white appearance • usally apparent as laterally spreading caries at DEJ
  57. 57. Clinical Features: SmoothSurface Caries Interproximal Caries  common for proximal caries to extend both bucally + lingually
  58. 58. Cervical, Buccal, Lingual orPalatal Caries Clinical Features:  usually extends from area opposite gingival crest occlusally to convexity of tooth surface  extends laterally towards proximal surfaces
  59. 59. Cervical, Buccal, Lingual orPalatal Caries Clinical Features:  usually occurs on cervical area  typical cervical lesion is a crescent shaped cavity beginning as slightly roughened chalky area  gradually becomes excavated
  60. 60. Pit and Fissure Caries Clinical Features:  appears brown or black  feel slightly soft  catch a fine explorer point
  61. 61. Pit and Fissure Caries Clinical Features:  enamel bordering the pit and fissure may appear • opaque as it becomes • bluish white undermined
  62. 62. Pit and Fissure Caries 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
  63. 63. Root Caries  also known as cemental caries  involves both dentin + cementum  in number of people exhibiting gingival recession with clinical exposure of cemental surface
  64. 64. Root Caries Clinical Features:  slowly progressing chronic lesion  usually found in mandibular molar area + premolar region  gingival recession is associated with root surface caries
  65. 65. Recurrent Caries  occurs immediately adjacent to restoration  may be caused by inadequate extension of restoration  was not able to excavate or removed well original carious lesion
  66. 66. Recurrent Caries Clinical Features:  restoration with poor margins • permitted leakage + entrance of both bacteria + substrate
  67. 67. Nursing BottleCaries 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
  68. 68. Nursing BottleCaries 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
  69. 69. Nursing BottleCaries Pathogenesis:  carbohydrate containing liquid provide an excellent culture medium for acidogenic microorganisms
  70. 70. Nursing BottleCaries Clinical Feature:  prolonged feeding beyond usual time may result in early + rampant caries  early carious involvement of maxillary anterior, maxillary + mandibular 1st permanent molars, mandibular canines
  71. 71. Nursing BottleCaries Clinical Feature:  carious process is so severe that only root stumps remain
  72. 72. Nursing BottleCaries 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
  73. 73. Rampant Caries suddenly appearing widespread resulting in early involvement of pulp
  74. 74. Rampant Caries Etiology:  may be due to nutritional deficiency  malnutrition  emotional disturbances
  75. 75. Rampant Caries Clinical Features:  occurs in children with poor dietary habits  extensive inter-proximal + smooth surface caries
  76. 76. Rampant Caries Management:  extensive dental care  parent education
  77. 77. Arrested Caries Clinical Features:  both deciduous + permanent are affected  large open cavities  brown-stained polished appearance + hard
  78. 78. Prevention/Managementof Dental Caries Restorative Treatment Tooth Brushing Mouth Rinsing Dental Floss Topical Fluoride Application (Pedo Patients) Pit and Fissure Sealants
  79. 79. References: Books  Cawson, R.A: Cawson’s Essentials of Oral Oral Pathology and Oral Medicine, 8th Edition • (page 40)  Ghom, Ali & Mhaske, Shubhangi: Textbook of Oral Pathology • (pages 401-419) Shafer, et al: A textbook of Oral Pathology, 3rd Edition • (pages 369,394, 407)

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