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Dental Caries - A Presentation by Dr. J. O. Olaoye.


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Tooth decay, also known as dental caries or cavities, is a breakdown of teeth due to acids made by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating.

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Dental Caries - A Presentation by Dr. J. O. Olaoye.

  2. 2. Outline  INTRODUCTION  Aetiology  Pathophysiology  Signs and Symptoms  Diagnosis  Treatment
  3. 3. Introduction Dental caries simply means tooth decay.  It is infectious, slowly progressive, communicable.  The development is dynamic, resulting from interplay of four (4) principal factors.  Results from imbalance between demineralization and remineralization process.
  4. 4. Enamel is the hardest substance in the body and is composed of 96 % minerals and the remnant being organic substance.The enamel is rightly classified as acellular tissue.The mineral component is basically hydroxyapatite, this forms the hard tissue structure of the tooth.These minerals become soluble in acidic environment.
  5. 5. Normal Anatomy
  6. 6. Aetiology of Dental Caries
  7. 7. Aetiology For dental caries to occur there must be interplay of four main factors:  Susceptible tooth surface  Fermentable carbohydrate  Caries causing bacteria  Time Though the above factors must be present for
  8. 8. caries to occur, it is not definite that cavity must form.There are other determinant factors that influence the process…The shape of the teeth, level of oral hygiene and buffering capacity of the saliva.
  9. 9. Susceptible Tooth Surface  Some areas are rough naturally, for instance the pits and fissures. Other areas are made rough by :plaque and calculus formation, poorly cleansed areas, friction due to rough diet.  Certain diseases and disorders make teeth vulnerable to decay e.g. Amelogenesis imperfecta.  Gingival recession expose root surfaces to decay, decay is faster here due to absence of enamel.
  10. 10. Caries Causing Bacteria The oral cavity contains a wide range of microorganism but only few species of bacteria has been implicated in caries formation, e.g. Streptococcus mutans, Lactobacilli acidophilis, Actinomyces isreali.These bacteria has the ability to produce high level of lactic acid following the breakdown of
  11. 11. Dietary sugars.They are resistant to the effect of low ph.These bacteria collect around the teeth in a sticky creamy coloured mass called plaque which serves as biofilm.The pits and fissures provide high retention site.
  12. 12. Fermentable Carbohydrate  If left in contact, the aforementioned bacteria acts on fermentable carbohydrate (glucose, fructose and sucrose) and convert it acids (lactic acid) through a glycolytic process called fermentation.The acid formed causes demineralization with teeth.
  13. 13. If this is one time process over a long time, there is possibility of remineralization. But when the rate of demineralization is higher than remineralization, the amount of hard tissue component lost is high leading to disintegration of the organic component left behind thereby forming cavity.
  14. 14. Time  This has to do with frequency at which the teeth is exposed to cariogenic environment and the duration of exposure. After a refined carbohydrate rich meal, the bacteria in the mouth converts the fructose, sucrose and glucose into acids resulting in drop in pH.The higher the frequency, the higher the chances of caries formation.
  15. 15. Stephan Curve
  16. 16.  The curve shows sudden decrease in plaque pH following a glucose rinse, which returns to normal after 30-60 mins. Net demineralization occurs at below the critical pH of 5.5.This happens in reality after consumption of our usual soft drink and refined juice.
  17. 17. Other factors  Disease condition associated with reduced salivary flow, under this circumstance the buffering effect of saliva is lost. Examples include Sjogren syndrome, diabetes mellitus, sarcoidosis.  Medications, such as antihistamines and antidepressants can reduce salivary flow. Tetrahydrocannabinol found in cannabis impair salivary flow.
  18. 18. Pathophysilogy The bacteria in the saliva consumes refined carbohydrate, utilizing it for its energy needs, acid is produced. Acid produced causes demineralization of hard tissue structure of the teeth.When the rate of demineralization is faster than remineralization, the mineral content is lost, leading to crumbling of the remaining organic structure.
  19. 19. Enamel: The rate of progression here is slow. Enamel rods which are the basic unit of the enamel structure, run perpendicularly from the surface of the tooth to the dentine.The demineralization follows the direction of enamel rods,the different triangular patterns between pit and fissure and smooth-surface caries develop in the enamel because the orientation of enamel rods are different in the two areas of the tooth.
  20. 20. Dentine: Unlike enamel, the dentin reacts to the progression of dental caries. Presence of caries in dentine can initiate a process leading to formation of sclerotic and tertiary dentine.This is aimed at reducing the rate of progression and prevent the exposure of the pulp.
  21. 21. Sign and Symptoms The earliest sign of tooth decay is the appearance of chalky white spot on the surface of the tooth, indicating an area of demineralization. If the oral hygiene improves at this stage this spot will turn brown(shiny), the progression stops.Otherwise the demineralization will continue till cavity is formed.When once cavity is formed, there must be intervention.
  22. 22. When the cavity is restricted to the enamel, in about 98% of the cases the individual is not aware of the cavity. Enamel being acellular, nil sensation. As the caries progresses into the dentine the individual will experience different level of sensation on exposure to fluids and chewing.The pain becomes throbbing when the pulp is exposed.
  23. 23. Diagnosis Presentation is highly variable. Primary diagnosis is made using a good light source, dental mirror and explorer. Dental x-rays are used for less visible areas and to judge the extent of destruction. Large dental caries are visible to the naked eye. Visual and tactile inspection along with radiographs are used in diagnosing pit and fissure caries. Lasers can also be used.
  24. 24. Treatment (Restoration) No carious lesion NoTreatment Carious lesion Inactive lesion No treatment Active lesion Non cavitated lesion Non operative treatment Cavitated lesion Operative treatment Existing filling No defect No replacement Defective filling Ditching, over hang No replacement Fracture or food impaction Repair or replace filling Inactive lesion No treatment Active lesion Non cavitated lesion Non operative tx Cavitated lesion Repair or replace filling
  25. 25. Treatment  Root canal treatment  Extraction
  26. 26. REFERENCES  British Dental Journal 2013  Journal of American Dental Association 2010  Dental Caries Article by Prof. Dickson Ufomata 2000