Definition, Etiology, PH, other caries definition, classifications, management with techniques.

1. DENTAL
CARIES &
MANAGEMENT
DR SYED HAROON BACHA

2. ❑ Definition:
 Dental Caries is defined as a multifactorial transmissible,
infectious oral disease caused primarily by the complex
interaction of cariogenic oral flora (biofilm) with
fermentable dietary carbohydrates on the tooth surface
over time.

3. ❑ DEMINERALIZATION AND REMINERALIZATION :
▪ Demineralization
(Pathological Factor):
Those factors favoring
demineralization of
tooth surface For
example: Plaque,
Calculus, Consuming
Carbohydrates, Bad
Oral Hygiene
Cause: Caries &
Periodontal Disease
▪ Remineralization
(Protective Factor):
Those factors favoring
remineralization of tooth
surface For
example: Tooth
Brushing, Fluoride Gels
and Fluoride Toothpaste,
Mouthwashes

4. ❑ ETIOLOGY OF DENTAL CARIES
TOOTH
HABITS
BIOFILM
DIET SALIVA
ORAL
HYGEIN

5. ❑ IN THE ABENCES OF PROTECTIVE
FACTORS
50%
10%
30%
10%
TOOTH (HOST)
BIOFILM
TIME
FERMENTABLE CARBOHYDRTES

6. ❑ CRITICAL BIOFILM PH:
▪ The cariogenic bacteria in the biofilm metabolize refined carbohydrates for energy
and produce organic acid by-products. These acids, if present in the biofilm
ecosystem for extended periods, can lower the PH in he biofilm to below a critical
level (5.5 for enamel & 6.2 for dentine

7. ▪ Smooth surface caries: Caries lesion on a smooth tooth surface
▪ Pits and fissure caries: Caries lesion on a pits & fissure area
▪ Coronal caries: caries lesion in any surface of the anatomic tooth
crown
▪ Root caries: Caries lesion on root surface
▪ Primary caries: Caries lesion not adjacent to an existing restoration
▪ Secondary caries (Recurrent caries): Caries lesion adjacent
to an existing restoration. A primary caries lesion was
restored but that the lesion reoccurred
▪ Rampant caries (baby bottle caries): The presence of extensive
and multiple cavitated and active caries lesions in the same person
▪ Residual caries: Caries lesion that was not completely excavated
prior to placing a restoration
▪ White spot lesion: Caries lesion that has not been cavitied

8. ❑ CLASSIFICATION OF G.V BLACK

9. ❑ CLASSIFICATION OF DENTAL CARIES
➢ According to location:
1)Pits & fissure caries
2)Smooth surface caries
3)Root caries
➢ According to direction:
1)Forward caries
2)Backward caries
➢ According to extent:
1)Incipient caries(reversible)
2)Cavitated caries(irreversible)
➢ According to rate:
1)Acute(rampant)
2)Chronic(slow)or(arrested
caries)
➢ According to histological
depth of penetration:
1)Enamel caries
ZONES OF ENAMEL CARIES:
1)Translucent zone 2)Dark zone 3)Body of
lesion 4)Surface zone
2)Dentine caries
1)Infected dentine
2)Affected dentine

10. ❑ Affected dentine:
Also called inner dentine, affected dentine is a zone of
demineralization of intertubular dentine and of initial formation of fine
crystals in the tubule lumen at the advancing front.
Damage to the odontoblast process is evident. Affected dentine
is softer than normal dentine & shows loss of mineral from intertubular
dentine & many large crystals in the lumen of the dentinal tubules.
Stimulation of affected dentine produce pain. Affected
dentine is capable for self repairing. This zone is capable for
remineralization.
❑ Infected dentine:
Also called outer dentine, this is the outermost carious layer, the
layer that the clinician would encounter first when opening a lesion. The
infected dentine is the zone of bacterial invasion & is marked by
widening & distortion of the dentinal tubules, which are filled with
bacteria. Little mineral is present, and the collagen in this zone is
irreversible denatured.
The dentine in this zone does not self-repair. This zone cannot be
remineralized.

11. ❑ CONVENTIONAL METHODS OF CARIES
DETECTION :
RADIOGRAPHY
PERIAPICAL
BITEWING
BIMOLAR
RADIOGRAPH
(USED IN VERY
YOUNG
CHILDRENS WHO
ARE NOT HAPPY
WITH INTRAORAL
PERIAPICAL
RADIOGRAPH)
▪ VISUAL-TACTILE METHOD
▪ CARIES DETECTION DYES
▪ FIBEROPTIC TRANSILLUMINATION
▪ ELECTRONIC CARIES MONITOR

12. ❑ MANAGEMENT OF DENTAL CARIES:
▪ PITS & FISSURE CARIES:
1)Pits & fissure sealants: Sealants should be
used primarily for the prevention of caries rather than for the
treatment of existing caries lesion. Only caries-free pits and fissures
or incipient lesions in enamel not extending to the DEJ currently
are recommended for treatment with pits & fissure sealants.
▪ MATERIAL EMPLOYED: (Pits & fissure sealants)
1)Light-activated UDMA (urethane dimethacrylate)
resin 2)Light-activated BIS GMA (bisphenol A-glycidyl
methacrylate) resin
▪ MECHANISM OF ACTION: 1)They eliminate the
geometry that harbors bacteria and to prevent nutrients
reaching bacteria in the base of the pit or fissure
2)The principal feature of a
sealant required for success is adequate retention. The
sealant blocks bacterial accumulation occurring in otherwise
non self-cleansing locations.

13. ISOLATION OF TOOTH (USE RUBBER
DAM,COTTON ROLLS OR ISOLITES)
THE AREA IS CLEANED WITH A SLURRY
OF PUMICE ON A BRISTLE BRUSH
THE TOOTH SURFACE IS DRIED, AND
ETCHED WITH 37% PHOSPHORIC ACID
GEL FOR 15-30 SECONDS
❑ CLINICAL TECHINQUE:
THE SEALANT MATERIAL IS THEN APPLIED
WITH AN APPLICATOR OR SMALL HAND
INSTRMENT
THE SEALANT IS LIGHTE-ACTIVATED FOR 15
SECONDS
THE OCCLUSION IS EVALUATED BY USING
ARTICULATING PAPER

14. ❑COMPOSITE
RESTORATION:
REMOVE CARIOUS LESION WITH THE
HELP OF HAND PIECE (ROUND BUR)
CLEAN THE CAVITY AND THEN
APPLY ETCHANT GEL PHOSPHORIC
ACID 37% FOR 15 SEC ON THE
TOOTH SURFACE
RINSE THE ETCHANT OFF
THOROUGHLY AND BLOT DRY THE
SUBSTRATE
APPLICATION OF PRIMER AND
ADHESIVE (SINGLE BOTTLE) ON THE
SUBSTRATE (BONDING AGENT)
THEN LIGHT CURE
❑ AMALGAM
RESTORATION:
AMALGAM
RESTORATI
ON MORE
DETAIL IN
AMALGAM
CHAPTER

15. THANK YOU