A complete biochemistry of dental caries

1. {
OF DENTAL
CARIES
Presented By :
Gunjan Singh (29)
Shreya Singh (86)
Shristy Dubey (87)
Srishti Swaraj (92)
Srishti Verma (93)
Under The Guidance Of Dr. Alka Yadu

2. HOW DOES THE TOOTH
LOOK LIKE ?

4. WHAT ARE DENTAL CARIES ?

6. Cavities and tooth decay are
among the world's most common
health problems. They're
especially common in children,
teenagers and older adults. But
anyone who has teeth can get
cavities, including infants.
If cavities aren't treated, they get
larger and affect deeper layers of
your teeth. They can lead to a
severe toothache, infection and
tooth loss. Regular dental visits
and good brushing and flossing
habits are your best protection
against cavities and tooth decay.

7. STAGES OF TOOTH DECAY
Did you know there are five distinct stages of tooth
decay? And, that in the first stage of decay, you can
actually take steps to reverse the progression of the
disease? Indeed, it’s true. In the first stage of decay,
whether you’re a child or an adult, the application
of fluoride via fluoride treatments, your toothpaste
and even the local water supply can stop a cavity
from penetrating through the enamel and reaching
its second stage. Even the saliva in your mouth and
the foods you eat help to re-mineralize a tooth in
jeopardy. But that’s just the first stage! What about
the rest?

10. WHAT CAUSES DENTAL
CARIES ?

14. The development of carious lesion requires
the presence of the bacteria Streptococcus
mutans.
This is generally seen in the oral mucosa and
in dental plaque.
When there is a decrease in saliva flow, the
pH of the plaque drops, allowing the acid
tolerant bacteria like S. mutans to proliferate.
S. mutans forms dextran and causes a sticky
plaque, trapping bacteria, calcium and
phosphate ions.
Microbial Organisms Cause Caries

15. Sucrose is a low molecular weight
disaccharide that can be rapidly metabolized
by the plaque flora.
A sucrose high diet favours the growth of
bacteria that has an enzyme (a
glucosyltransferase), which transfers glucose
units from sucrose to the dextran polymer.
The bacteria in plaque metabolizes fructose from
the sucrose to lactate , and this acid causes a drop
in pH that dissolves the minerals in the teeth.
Sucrose and Caries

16. Even though sugars and poor oral hygiene
are major causes of caries.
In adults, chewing of tobacco and
exposure to lead, cadmium (metals that
can replace calcium) are implicated in the
genesis of caries.
Excess iodine is found to be able to
penetrate enamel, dental pulp and
periodontal tissues.
Other Causes Of Dental Caries

18. SIGNS AND SYMPTOMS OF
TOOTH DECAY

22. PREVENTIONS AND
TREATMENTS

23. Conc. of IgA in saliva ∝ 1/Dental Caries
Lysozyme, lactoperoxidase & lactoferrin in saliva
have a direct antibacterial action on plaque.
Salivary proteins could increase the thickness of the
acquired pellicle & help to retard the movement of Ca
& phosphate ion out of enamel.
The carbonic acid-bicarbonate buffering system,
ammonia & urea constituents of saliva act as
buffer.
Dry Mouth : Home for
Caries

25.  Intake of 2.4 microgram fluoride per day leads to
decrease in the incidence of dental caries.
 Several possible mechanisms are postulated, which
include:
a.) Effect on hard tissued to modulate mineralization,
demineralization and remineralization.
b.) Effect of cariogenic bacteria by altering their
metabolism.
c.) Effect on soft tissues to modify the development of
teeth.
Fluoride Rich Toothpaste is
Highly Recommended

27.  Arginine, a common amino
acid found in saliva is broken
down by oral plaque bacteria
to acid neutralizing base.
 Production of ammonia by oral
bacteria can positively
influence the balance between
remineralization and
demineralization of the tooth
and may help to prevent the
emergence of a cariogenic
microflora.
 Therefore, the capacity of oral
biofilms to generate alkali
appears to be a major caries
inhibiting factor.
Arginine

28.  Wolinsky et al. investigated the
inhibitory effects of aqueous
extracts from Neem (Azadirachta
indica) upon bacterial aggregation,
growth and adhesion to
hydroxyapatite and production of
insoluble glycan, which may
effect in vitro plaque formation.
 Neem dental care products
contains Neem leaf or bark
extract. Neem leaf is rich in
antioxidants and helps to boost
the immune response in gums
and tissues of the mouth. Neem
offers a good remedy for curing
mouth ulcers, tooth decay and
acts as a pain reliever in toothache
problems.
Neem

29.  Various components of green & black
tea have anticariogenic activity. These
include a direct bactericidal effect
against S.mutans & S.sobrinus,
prevention of bacterial adherence to
teeth, inhibition of glucosyl transferase ,
thus limiting the biosynthesis of sticky
glucan, inhibition of human and
bacterial amylases.
 Ferrazzano et al. concluded that the
anticariogenic effect against hemolytic
streptococci by polyphenols from
cocoa, coffee & tea suggest further
possible application of these beverages
in the prevention & pathogenesis of
dental caries.
Tea

30.  Cow’s milk contains lactose which is
the least cariogenic of all
monosaccharides & disaccharides.
 It also contains calcium phosphate
& casein which prevents
demineralization of enamel.
Antibacterial factors in milk may
interfere with the oral microbial
flora.
 Cheese contains casein
phosphopeptides (CPP) which make
it anticariogenic. So, a cube of
cheese consumed after a sugary
snack reduces demineralization. It
also stimulates the salivary flow.
Milk & Cheese

31.  Propolis is a natural beehive product
which has also shown antibacterial
activity against S.mutans & S.sobrinus
in vitro.
 Propolis extract when used as a
mouthwash exhibits an in vivo
antimicrobial activity against
S.mutans and might be used as an
alternative measure to prevent dental
caries.
 Topical applications of chemically
characterized propolis extracts have
also been shown to be highly
effective in reducing the incidence &
severity of smooth surface & sulcal
caries.
Propolis

32.  Patients who are at high risk for
dental caries are recommended
to chew xylitol gums for 5 to 30
minutes after eating of
snacking.
 Advantages of chewing xylitol
gum are :
a. Increases salivary flow.
b. Enhances mineralization.
c. Prevents S.mutans from
binding to sucrose.
d. Bacteriostatic (as they are non
fermentable).
Xylitol

33. 1. LASERS
Recent research has shown that Carbon dioxide lasers can be efficiently
absorbed by tooth minerals and rapidly transformed into heat to form a
ceramic like surface that is highly resistant to acid attack.
2. GENETICALLY MODIFIED ORGANISMS
Attempts are being made to create strains of S.mutans that lack lactate
dehydrogenase enzyme which is responsible for production of lactic acid. This
will prevent the development of caries.
Another attempt is to produce microorganisms capable of destroying S.mutans.
One such organism is Lactobacillus zeae.
3. GENETICALLY MODIFIED FOODS
Scientists have developed genetically modified fruits to protect us against
tooth decay. They interfere with the enzymatic pathways of S.mutans and
prevent their binding onto tooth surfaces.
4. POLYMERIC COATINGS
A new technology is under investigation to develop a thin polymeric coating
over tooth surfaces which would increase the resistance of tooth to dental
caries.
Advance Methods Of Caries
Prevention

35.  Root canal treatment is a treatment sequence for the
infected pulp of a tooth which results in the elimination of
infection and the protection of the decontaminated tooth
from future microbial invasion.
Root Canal Treatment

36.  Chemo mechanical caries removal is a non
invasive technique eliminating infected
dentin via a chemical agent.
 This process not only removes infected
tissues, it also preserves healthy dental
structure, avoiding pulp irritation and
patient discomfort.
 Restoration of cavities prepared by this
technique requires materials such as
composite resins or glass ionomer which
bind to the dentin surface rather than
materials such as amalgams which involve
cutting a cavity designed to mechanically
retain.
 It has following advantages over traditional
drilling :
• Less perception of pain, leads to less
discomfort to patients especially children.
• Removes only infected layer & leads to more
tissue preservation.
Chemomechanical Caries Removal

37.  Recently, ozone has been proposed as a
preventive mode for caries. Ozone
treatment has shown to eliminate bacteria
associated with caries; it can also lead to
lesion reversal.
 It is delivered to the tooth surface for 10-
40 seconds. The ozone delivery should be
followed by remineralization solutions
and fluoride rinses.
 How does it act ? : Carious enamel and
dentin is ozone permeable. Ozone
deactivates 99% of the bacteria. Acids
from bacteria are thus largely neutralized.
Reductant fluid neutralizes residual acid
and supplies fluorides and minerals. A
neutral medium enriched with minerals is
now available. Remineralization occurs
within 4-12 weeks.
Ozone Therapy

38. EPIDEMIOLOGY

39.  In present scenario, dental caries is a
major health problem in most
industrialized countries, affecting 60-90%
of school children and a vast majority of
adults.
 It is the most prevalent oral disease in
several Asian and Latin American
countries, while it appears to be less
common and less severe in most African
countries.
 The WHO records a Global DMFT of 1.61
for 12 year old in 2004, a reduction of
0.13 as compared to a DMFT of 1.74 in
the year 2001.
 Various studies conducted in different
countries at different time periods have
given evidence that a substantial
decrease in caries prevalence in the last
decade has been found among western
countries whereas in case of developing
and underdeveloped countries,
prevalence of caries seems to be
increasing.

40.  Toothpastes in India do not contain
fluoride.
 As India has few pockets rich in
Fluoride deposits, thus to avoid
Fluoride toxicity Indian government
has banned toothpastes rich in fluoride.
 Too much of fluoride in our body can
cause many problems like:
• Softening of the enamel making it
hypersensitive.
• Discoloured, scarred & brittle teeth.
• Causes toxicity, more in children.
• Becomes lethal overtime causing
damage to brain, skeletal and endocrine
system.
• Causes lower IQ levels in humans. Also
hampers neurological development in
children.
Did You Know ?

41. Toothpastes are just a saltified form of
mouthwash, all having almost same contents.
Even if we consider the traditional ways of
brushing such as usage of Neem twig or
brushing it with coal powder, constituents
were correct but the techniques used were
incorrect.
Thus all that matters is the technique of
brushing which can keep your teeth healthy.
Conclusion

43.  https://oralb.com/en-us/oral-health/conditions/cavities-tooth-
decay/what-are-dental-caries
 https://www.docsity.com/en/the-caries-process-dental-biochemistry-
lecture-notes/210824/
 https://www.slideshare.net/dream10f/lec-10-11-level-4de-
biochemistry-of-teeth-saliva-and-dental-caries
 https://www.slideshare.net/RawanShahien/saliva-and-caries
 https://en.wikipedia.org/wiki/Tooth_decay
 https://www.medicinenet.com/cavities/article.htm
 https://bedroomfurniture.club/search/bacteria-causes-tooth-
decay.html
 https://www.slideshare.net/sana_arman/prevention-of-dental-caries-
48890782
References