3. The Caries Process
Caries is a multifactorial bacterial infection
involving a process of demineralization and
remineralization
4. The Caries Process
The progress of caries depends on the
balance of demineralization and
remineralization.
A lesions develops when the caries balance
shifts toward demineralization
7. Natural Remineralization
Remineralization occurs when the pH rises
and calcium and phosphate from the saliva,
and fluoride, enter and repair the subsurface
lesion. The resulting layer is more resistant to
dissolution than the original content
8. Natural Remineralization
The higher the level of acid and the longer it is
present at the tooth surface, the more difficult
it is for saliva to buffer the area and for
remineralization to succeed
11. Detection of early caries
Visual Examination
A white spot lesion that becomes visible only
after thorough air drying indicate that
demineralization will be less than halfway
through enamel.
A white spot lesion visible on wet surface
indicates that demineralization is over
halfway through enamel, possibly extending
into dentin.
12. Detection of early caries
Tactile Examination
G.V. Black 1924;
[A sharp explorer should be used with some
pressure and if a very slight pull is required to
remove it, the pit should be marked for
restoration even if there are no signs of
decay]
13. Detection of early caries
Tactile Examination
Explorer has been advocated for many
decades as important method to detect
caries, but research has shown this is to be
unwise practice
Summitt 1996
14. Detection of early caries
Tactile Examination
The explorer can damage white spot lesion by
breaking the relatively intact surface zone.
Ekstrand 1987
15. Detection of early caries
Tactile Examination
Graham Mount 2000;
[It is recommended that a blunt explorer
be used, only if necessary. The probe
must be used very lightly on the side
rather than the point. To test the
firmness and texture of tooth surface.]
16. Detection of early caries
Radiographic Examination
Bitewing radiographs are used to detect
proximal and occlusal caries
Enamel lesions will not be visible on
occlusal surface in a radiograph, but it
can be visible on proximal surface.
17. Detection of early caries
Caries Detecting Dyes [CDD]
Caries Detecting Dyes are
used for detection of occlusal
caries
18. Detection of early caries
Laser Fluorescence [LF]
Diode laser beam is directed
to the tooth then the reflected
fluorescent light is measured
in a numeric value
19. Detection of early caries
Digital Imaging Fibero-Optic Transillumination
[DIFOTI]
High intensity white light is
directed towards teeth through
handpiece and images are
captured and stored in computer.
Incipient caries appear as darker
areas in the resultant images.
20. Detection of early caries
Quantitative Light-induced Fluorescence [QLF]
Teeth are illuminated with high
intensity blue light and images
are captured and stored on the
computer. Caries lesions are
shown as dark lesion
21. Principles of Minimal Intervention
Dentistry [MI] FDI, 2000
1- Control the disease through reduction of
cariogenic flora
2- Remineralize early lesions
3- Perform minimal intervention surgical
procedures
3- Repair rather than replace, defective
restorations
24. ANTICARIOGENIC ACTIONS OF MILK
Due to protein buffers, calcium and
phosphate (1940s)
Due to casein (Reynolds 1987)
Due to Casein Phosphopeptides (CPP)
(Reynolds 1997)
25. Casein phosphopeptide-amorphous
calcium phosphate (CPP-ACP)
A combination of casein phosphopeptides
(CPP) and amorphous calcium phosphate
(ACP) was manufactured. The casein is
derived from cow’s milk
33. Casein phosphopeptide-amorphous
calcium phosphate (CPP-ACP)
Clinical uses
1- Prevention and treatment of dental caries
2- Prevention and treatment of dental erosion
3- Prevention and treatment of cervical tooth
sensitivity
34. Clinical indications of CPP-ACP
Patients at increased risk for
caries:
1- Xerostomia
2- patients wearing fixed
appliances
3- patients practicing poor oral
hygiene
35. Clinical indications of CPP-ACP
patients with intermittent
vomiting
Patients with cervical tooth
sensitivity
