Dr. Mimosa Chatterjeewww.pediatricdentists.blogspot.com
Dental caries is a microbial disease of the calcified tissues of the teeth, characterised by demineralisation of the inorganic portion & destruction of the organic substance of the tooth. It is one of the most common infectious diseases affecting the human race Two groups of bacteria are responsible for initiating caries Streptococcus mutans and Lactobacillus. If left untreated, the disease can lead to pain, tooth loss and infection. Cariology is the study of dental caries.
1) Dietary factor 2) Microorganisms Carbohydrates with types acidogenic strptococcus like mutans & Actinomycosis monosaccharides, disacc Aciduric-Lactobacilli harides or poly Other micoorganism saccharides producing IgA1,proteases Amount consumed Form-refined or coarse Streptococcus mutants Nature-sticky or easily cleared. Biochemical properties- fermentable/non- fermentable.
3) Host Factor 4)Genetic Factors Morphology of teeth-Deep fissures are prone to food 5)Immunological Factors accumulation and development 6)Other factors of caries. Intro-oral variations:-The caries susceptible of teeth varies in the following order:-Lower first molar>Upper first molar>upper & lower second molar>second bicuspid>upper incisors>cuspids Irregularities of arch form:crowding ,malaligned teeth favour development of caries. Salivary-quantity,viscocity,flow rate,composition,buffing capacity etc
Pathogenesis of dental caries1.Whenever carbohydrate is consumed, oral micro-organisms rapidly beginfermentation producing organic acids like lactic acids , acetic acid & formic acid. thisleads to fall in pH of the oral fluids2.these organic acids attack the tooth structure, resulting in loss of tooth mineralsspecially calcium & phosphate ions, which leach out from hydroxyapatite. thisprocess is known as demineralization3.After a period of 30 mins, due to salivary buffering by bicarbonate ions & ammoniaproduction from salivary proteins, there is am increase in pH of the oral fluids. theacid is neutralised & the condition now favours precipitation of calcium & phosphateions in to tooth surface. this process is called as re mineralisation & is hastened iffluoride is present in a small amount in either plaque fluid or saliva4.the microorganism which is of primary concern in the pathology of dental caries isStreptococcus mutants. it forms soluble, sticky extracellular polysaccharides whichhelp in further colonization & increases the contact of the acids which ultimatelyleads to cavitation.5.The balance between the caries causing & caries protective factors is verydelicate. it is only when repeated attacks of demineralisation occur that there is a netloss of minerals from the tooth & caries result. the surface layer of enamel overlyingthe lesion remains intact & the demineralisation occurs primarily sub surfacelocation. once this happens the process gradually extends deeper, involving enamel& subsequently the dentin & pulp
First classification based on location of the based on tissue involved: lesion pit & fissure caries 1. enamel caries• occlusal 2. dental caries• buccal or lingual pit 3. cemental caries smooth surface caries-• proximal• buccal or lingual surface root caries
based on virginity of the based on progression of lesion lesion: progressive caries-• primary caries • rapidly progressive like• secondary caries nursing caries & radiation caries • slowly progressive arrested caries
2nd classification Mount GJ in 1997 classified dental caries based on site and size Site: Size: Site 1- include lesion on the pit & Size 1( mild)- includes lesions which fissure of the posterior teeth on have progressed just beyond other surfaces, these include the remineralisation buccal grooves on the mandibular Size 2 ( moderate)- includes larger molars, palatal grooves of the lesions with adequate tooth surface maxilarry molars & erosion lesion to support the restoration. on the incisal edges. Size 3(enlarged)-includes lesions in Site 2- includes lesions in the which the tooth structure and the contact areas of posterior and restoration are susceptible to anterior teeth. fracture. Site 3- includes lesions originating Size 4 (severe)- includes lesions in the gingival third of all teeth. which have destroyed a major portion of the tooth structure.
Clinical method Use of sharp explorer- if slight pull is required to remove the explorer from the tooth surface. i.e if there is a catch then the surface is counted as being decayed Use of mirror & probe- this is the most common method A mirror & blunt probe visual examination
Radiographic method Bite wing radiography is used. Dental radiographs, produced when X-rays are passed through the jaw and picked up on film or digital sensor, may show dental caries before it is otherwise Radiograph showing visible, particularly in the case of dental caries caries on interproximal (between the teeth) surfaces. Large dental caries are often apparent to the naked eye, but smaller lesions can be difficult to identify
Advanced caries diagnostic method Fiberoptic transillumination-a shadow visible in dentin has been suggested as the criteria. It does not detect small lesions. it does not detect small lesions Digital Fiberoptic transillumination-this is relatively new methodology.Illumination is delivered on the tooth surface by means of fiberoptic which acts as a light source. the resultant change in light distribution is captured by the camera & is sent to the computer for analysis
Electrical conductance measurement-Theory behind this is that sound surface should possess limited or no conductivity, where as carious or deminralized enamel should have a measurable conductivity that will increase with increasing demineralization. Indicator: Green- no caries Yellow-enamel caries Orange-dentin caries Red-pulpal involvement Visible luminescent spectroscopy-The visible emission spectra for decayed & non decayed regions of teeth differ. Quasi monochromic light from a tungsten source dispersed with a grating monochromatic is focused on the teeth & emission spectra are recorded & analysed.
disclosing dye-disclosing dyes have been recommended for Various dyes such as silver nitrate, methyl red & alizarin stains have been used to detect carious sites by change of colour.se as an adjunct when diagnosing smaller carious lesions in pits and fissures of teeth Laser Fluorescence Xeroradiography Ultrasound Laser Luminance Optical caries monitor Endoscopic method of caries detection Magnetic resonance micro-imagery
Control of all active lesions Initial treatment of all active lesions. Gross excavation of all carious lesions followed by systemic manner of restoring a tooth to normal contour
Nutritional measures for caries control Diet high in fat, low in carbohydrate & practically free from sugar have low caries activity. In a study, when refined sugar was added to the diet in the form of a mealtime supplement there was little or no caries activity Phosphates diet causes significant reduction in incidence of caries.
Tooth Brushingtooth brush removes gross amount of fooddebris & plaque material. Mouth Rinsingit helps in loosening food debris from theteeth. Dental flossit helps to remove plaque from an areagingival to the contact areas on proximalsurfaces of teeth, an area impossible to reachwith toothbrush DetergentFibrous food prevents lodging of food andact as detergent pit & fissure sealants
1)Substances which alter the tooth structure or tooth surface Fluorine The cariostatic activity of fluoride involves several different mechanisms. The ingestion of fluoride results in its incorporation into the dentin & enamel of unerupted teeth. This makes the teeth more resistant to acid attack after eruption into oral cavity. Ingested fluoride is secreted in to saliva, although present in low concentration in saliva, the fluoride is accumulated in plaque where it decreases microbial acid production & enhances the remineralisation of the underlying enamel. Fluride from saliva is also incorporated in to the enamel of newly erupted teeth, thereby enhancing the enamel calcification Bis-biguanides chlorhexidine & alexidine are potential anti caries agent as they are anti plaque agent
Zinc chloride & potassium ferrocynide it effectively impregnate the enamel & seal off caries invasion pathway Silver nitrate Silver plugs the enamel by either the organic invasion pathways such as enamel lamellae or the inorganic portion to form a less soluble combination2)Substances which interfere with carbohydrate degradation throughenzymatic alteration vitamin k sarcoside3)Substances which interfere with bacterial growth & metabolism Urea & ammonium compounds chlorophyll Nitrofurans penicillin