The document discusses factors that influence dental caries, including the dental plaque biofilm, substrates like sugar exposure frequency, host factors like tooth structure and saliva, and time. It notes that the major bacteria involved are mutans streptococci like Streptococcus mutans and S. sobrinus. It also discusses caries detection methods, the caries process, preventing dental caries through approaches like improving plaque removal and diet, applying fluoride treatments and fissure sealants, and increasing recall frequencies for patients with caries activity. Early childhood caries has etiological factors like long periods of cariogenic substrate exposure, low salivary flow at night, parental caries history, and social stress.

1. by Dr. Zainab Mohammed Al-Tawili 1

2. Factors influencing dental caries
by Dr. Zainab Mohammed Al-Tawili 2
The multifactorial nature of
caries involves the Host,
Substrate, Bacteria and Time.

3. by Dr. Zainab Mohammed Al-Tawili 3
Scanning electron micrograph of dental plaque (×4555
magnification). This image shows the typical ‘corncob’
arrangement of streptococci held by an extracellular
polysaccharide matrix on a web of central filamentous
microorganisms.

4. Factors influencing dental caries
• Dental plaque biofilm:
◦ dental plaque is viewed as a dynamic biofilm, plaque maintains its own microenvironment & has actions that
influence oral health. Streptococcus mutans is still believed to be the most important bacterium in the
initiation & progress of this disease in combination with lactobacilli. Mutans streptococci (incl. S. mutans and
S. sobrinus) is the major group of bacteria involved in the initiation of enamel demineralization.
• Substrates:
◦ the frequency of exposure is the important factor.
• Host factors:
◦ the quality of tooth structure & the saliva are the major factors.
• Saliva:
◦ By removing substrate & buffering plaque acid, & has a critical role in remineralization it provides a
stabilized supersaturated solution of calcium and phosphate ions as well as fluoride ions from extrinsic
sources.
• Time:
◦ Thus the term ‘caries-free’ often used to describe a child with no visible decay is best changed to the term
‘caries-inactive’ to more accurately reflect this clinical reality.
by Dr. Zainab Mohammed Al-Tawili 4

5. The caries process
◦ Dental enamel demineralization is a chemical process. The dissolution of hydroxyapatite can be described simply:
• Caries detection:
◦ The current methods used commonly for caries detection are:
◦ Visual & tactile inspection.
◦ Radiography.
◦ Transillumination.
◦ Fluorescence.
◦ The recent commercial development of detection systems such as:
◦ Diagnodent™.
◦ QLF-D™.
◦ Canary™.
◦ Soprolife™ and CarieScan™ have the potential to increase the accuracy of detection of enamel and dentinal caries.
by Dr. Zainab Mohammed Al-Tawili 5

6. The caries process
• Approximal caries:
◦ The detection of approximal caries at an early stage is important in pediatric dentistry due
to the large proportional size of the pulp in deciduous teeth.
• Preventing dental caries:
◦ Instituting preventive programmes table:
by Dr. Zainab Mohammed Al-Tawili 6
No caries Early caries Active caries
Risk Low risk High risk Clinical/radiographic
enamel demineralization
Very high risk: New lesions at
each recall, including risk
behaviors
Question How to keep teeth caries
free?
How to decrease risk & heal
existing
Early lesions & prevent new
lesions?

7. by Dr. Zainab Mohammed Al-Tawili 7
No caries Early caries Active caries
Preventive plans
Plaque Check what the patient is
doing regarding oral
hygiene. Either reinforce
the behavior or improve
efficacy
Disclose; have patient remove
the disclosing agent & clean as
appropriate.
Advise flossing after brushing
with fluoridated Toothpaste
Disclose; have patient remove
the disclosing agent & clean as
appropriate
Advise flossing after brushing
with fluoridated toothpaste
Diet Reinforce good dietary
habits.
Check for recent changes
such as use of sports
drinks & give advice
Advise against frequent
fermentable carbohydrate intake.
Check for recent changes such as
sports diets
Check the dietary habits
Thoroughly with a 3-day diet
diary, including 1 weekend day.
Advise against frequent
fermentable carbohydrate
intake & check that the patient
can identify these

8. by Dr. Zainab Mohammed Al-Tawili 8
No caries Early caries Active caries
Fluoride Check that it is being used
Appropriately especially
brushing with it twice per
day
Check that it is being used
appropriately Introduce weekly
Mouthwashes if appropriate for age
Consider high concentration
Fluoride varnish for demineralized
areas & other areas of risk
Provide supplementary ionic calcium
&
Phosphate via products like Tooth
Mousse/MI Paste
Check that it is being used
appropriately Introduce daily
Mouthwashes if appropriate for
age
Apply concentrated Fluoride
treatments such as gels or
varnishes
Provide supplementary Ionic
calcium & phosphate via
products like Tooth Mousse/MI
Paste
Fissure
sealants
Apply to deep retentive
fissures
Only or if patient requests
Apply to molars, especially those
Showing demineralization
Ensure all open lesions are
restored temporarily or
permanently
Apply fissure sealant to all molars
& premolars use GIC for semi
erupted teeth
Recall 12-monthly if there have
been two 6-month
periods of low caries
activity
6-monthly while there are signs of
caries activity or high risk remains
6-monthly or 3-monthly with
medically compromised or very
high-risk children

9. by Dr. Zainab Mohammed Al-Tawili 9
(A) (B)
(A) Hypomineralized and/or hypoplastic teeth will be predisposed to caries, particularly if
the enamel deficiencies are plaque retentive. If the enamel is completely absent and
dentine is exposed, then these teeth can deteriorate rapidly.
(B) Interproximal lesions that are cavitated and unable to be thoroughly cleaned do not
arrest.

10. by Dr. Zainab Mohammed Al-Tawili 10
It is important to note that risk can change. A child who
was previously free of caries has developed cervical
lesions during orthodontic treatment.

11. Early childhood caries
• Etiological factors of early childhood caries:
• Long periods of exposure to cariogenic substrate.
• Low salivary flow rate at night.
• Parental history of active and untreated caries – particularly in the mother.
• Parent(s) in situations of social stress.
by Dr. Zainab Mohammed Al-Tawili 11

12. by Dr. Zainab Mohammed Al-Tawili 12
Social aspects of night-waking and feeding:
General recommendations for infant feeding routines
Birth to 3 months Breast-feeding up to 10 times in 24 h or 6–8 formula bottles in 24 h.
3–6 months 3–4 hourly feeds, i.e. 6–8 breast-feeds or 5 formula bottles.
The early morning 2 a.m. feed is ceased & usually the infant will have only one feed
over night.
4–6 months 4–5 milk feeds. Taste & texture of solids may be introduced from 4 months,
although these recommendations may differ between countries.
6–12 months 4 milk feeds, last one prior to midnight. 3 major solids meals – breakfast, lunch &
dinner with
morning and afternoon snacks.
Over 12 months No milk feeds required after bedtime but may have a bedtime ritual of milk feed,
tooth cleaning, then a bedtime story in bed.

13. by Dr. Zainab Mohammed Al-Tawili 13
(A) ECC showing the characteristic pattern of decay. The upper anterior teeth & the molars are affected but
the lower anterior teeth are spared.
(B) A particularly rampant case of ECC where a pacifier had been dipped in honey (or any other cariogenic
agent). Both the upper & lower anterior teeth may be affected.

14. by Dr. Zainab Mohammed Al-Tawili 14
C. The first primary molars are carious due to a bottle habit at night. There is no interproximal decay (due
to open contact points) & the canines that have erupted later, are unaffected.
D. An abscess following pulp necrosis in carious upper incisors. Extraction is required & the abscess will
resolve following removal of the tooth & drainage of the pus. It is important to note that the teeth are
not fractured due to trauma, but are carious.

15. Reference:
by Dr. Zainab Mohammed Al-Tawili 15