Etiology of Dental Caries bBy Dr Qurat-Ul-Ain Assistant Professor Community Dentistry Department HBS Medical and Dental College , Islamabad

1. ETIOLOGY OF
DENTAL
CARIES
Dr Qurat-Ul-Ain
Assistant Professor
Community Dentistry Department
HBS Medical & Dental College,
Islamabad

2. LEARNING OBJECTIVE
• Dental caries
• Epidemiological triad
• Sugars and carbohydrates
• Human interventional study-
Vipeholm study

3. DENTAL CARIES

4. DENTAL CARIES
• It is define as progressive, irreversible
microbial disease of multifactorial nature
affecting the calcified tissues of the teeth
characterized by demineralization of
inorganic portion and destruction of
organic portion the tooth

5. DENTAL CARIES
• Dental caries is an infectious microbial
disease that begins as demineralization of
inorganic portion of tooth, followed by
destruction of organic portion, leading to
cavity formation

6. DENTAL CARIES

7. EPIDEMIOLOGICAL TRIAD

9. I- HOST FACTORS
• Tooth
(composition/morph
ology/ position)
• Saliva (viscosity)
• Gender
• Race
• Age
• Familial heredity
• Developmental
disturbance
• Economic status
• Related disease
• Oral hygiene habits

13. II- AGENT FACTORS
•MICROORGANISMS;
Streptococci (streptococcus mutans)
•CARIOGENIC PLAQUE

14. PROPERTIES OF CARIOGENIC PLAQUE
• High sucrose consumption
• Synthesize more
intracellular polysaccharides
• More lactic acid is formed
• Double extracellular
polysaccharide is produce
• Increased levels of
Streptococcus Mutans
• Decreased level of
Streptococcus Sanguis &
Actinomyces

15. III- ENVIRONMENTAL FACTORS
Environment of Oral cavity is affected by ;
• Diet ---------type of food and frequency of intake
“Vipeholm Study” ( CM Marya page # 308)
• Geographic variations --- increase in developing
countries and decreasing in developed countries
• Urbanization --- increase caries in urban populace
• Climate --- sunlight- decrease caries / rainfall increase
caries

16. CARIOGENICITY OF SUGARS
•Sugars are classified into INTRINSIC &
EXTRINSIC based on physical location of
sugar

18. CARIES PRODUCING NON MILK SUGARS
(NME OR ENEMY)
• Sucrose
• Glucose
• Maltose
• Fructose
• All above sugars are same cariogenic as starch but
SUCROSE was much more cariogenic
NME or enemy are harmful to teeth/ cariogenic sugars.
WHO recommended that,
1- no nutritional needs of these NME
2- consumption should be less than 10 % of total food
energy intake

19. CARBOHYDRATES & DENTAL
CARIES
• Dietary Carbohydrates
A.Sugars : dietary carb can divided into simple
sugars and complex carbohydrates e.g.,
starches
B. Starches : are major component of diet.
Cereal grains are often a primary source of
calories, proteins, minerals and vitamins

20. CARIES-PROMOTING ACTIVITY AND FOOD SOURCES OF CARBOHYDRATES AND
SWEETENERS 1 CARIES-PROMOTING ( SOURCE -PAGE 314 CM MARYA)

21. HUMAN INTERVENTIONAL STUDY
1. Vipeholm study (Gustafsson et al 1954)
2. Turku Sugar study (Scheinin & Makinen)
Alteration in diet was made intentionally in these studies
Frequency and form of carbohydrate

22. VIPEHOLM STUDY – IN
SWEDEN

23. VIPEHOLM STUDY
• Sample - 436 adult mental patients, 1 control group and six
main test groups
1. Sucrose group
2. Bread group
3. Chocolate group
4. Caramel group
5. 8- toffee group
6. 24- toffee group
• Duration – 5 years
• Intervention – the effect of liquid & sticky foods given at meal
times and between meals on caries was observed
•

24. CONCLUSION OF STUDY
1. Consumption of sugar even high levels, is
associated with only a small increase in caries
increment if the sugar taken with meal and none
between meal.
2. Increase sugar intake increases caries activity
3. Sugar intake both between meal and at meals is
associated with marked increase in caries increment
4. Risk of caries is greater when sugar consumed in
sticky form and prolong time of oral cleanliness

25. 5. The increase in caries activity varies widely from
person to person under uniform experimental
condition
6. Increase in caries activity disappears on the
withdrawal of sugar rich foods
7. Carious lesion occurred despite avoidance of
sugar.

26. ANY QUESTION?