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DENTALCARIES  Prepared by:       Dr. Rea Corpuz
Dental Caries progressive initially subsurface  demineralization of teeth  by bacterial acid one of the most common of ...
Dental Caries may be considered a  disease of modern  civilization since prehistoric man  rarely suffered from  this for...
Dental Caries biological process of tooth  decay with mutifactorial  etiology microbial disease of calcified  tissues of...
Etiology of Dental Caries generally agreed to be  complex problem complicated by many  indirect factors obscure the dir...
Etiology of Dental CariesPossible interventions                              Possible interventionsReduce intake of       ...
Etiology of Dental Caries PlaqueAcidogenic   Enzymes   Food   Acids   Tooth   Carious Bacteria                            ...
Etiology of Dental Caries Old Theories   Exogenous Theories     • (1) Legend of worm     • (2) Chemical Theory     • (3)...
Etiology of Dental Caries Old Theories   Endogenous Theories     • (1) Humoral Theory     • (2) Vital Theory
Etiology of Dental Caries New Theories   (1) Acidogenic Theory   (2) Proteolytic Theory   (3) Proteolysis-chelation Th...
Old Theories(Exogenous Theory) (1) Legend of Worm   5000 BC   ancient Sumerian text   obtained from Mesopotamian    ar...
Old Theories(Exogenous Theory) (2) Chemical Theory    1819    proposed by Parmly    unidentified chemical     agent   ...
Old Theories(Exogenous Theory) (2) Chemical Theory    stated that caries began     on enamel surface where     food putr...
Old Theories(Exogenous Theory) (3) Parasitic or Septic      Theory    1843    proposed by Erdl    filamentous parasite...
Old Theories(Endogenous Theory) (1) Humoral Theory   4 humors of body     • blood     • phelgm     • black bile     • ye...
Old Theories(Endogenous Theory) (2) Vital Theory    18 century    tooth decay originated     like bone gangrene, from  ...
New TheoriesOld Theories(Exogenous Theory) (1) Acidogenic/Chemoparasitic     Theory    1890    WD Miller    dental dec...
New TheoriesOld Theories(Exogenous Theory) (1) Acidogenic/Chemoparasitic     Theory      • decalcification of dentin     ...
New TheoriesOld Theories(Exogenous Theory) (1) Acidogenic/Chemoparasitic     Theory       following factors cause       ...
(1)Acidogenic/Old TheoriesChemoparasitic Theory (1) Role of carbohydrates    food substances act as     substrate for mi...
(1)Acidogenic/Old TheoriesChemoparasitic Theory (1) Role of carbohydrates    cariogenicity of carbohydrate     varies wi...
(1)Acidogenic/Old TheoriesChemoparasitic Theory (1) Role of carbohydrates      • (1) frequency of ingestion          tak...
(1)Acidogenic/Old TheoriesChemoparasitic Theory (1) Role of carbohydrates      • (2) physical form          sticky      ...
(1)Acidogenic/Old TheoriesChemoparasitic Theory (1) Role of carbohydrates      • (3) chemical composition          in th...
(1)Acidogenic/Chemoparasitic Theory (1) Role of carbohydrates      • (4) Route of administration          oral intake of...
(1)Acidogenic/Chemoparasitic Theory (1) Role of carbohydrates      • (5) Presence of other food           constituents   ...
(1)Acidogenic/Chemoparasitic Theory (2) Role of microorganisms    caused by acid resulting from     action of microorgan...
(1)Acidogenic/Chemoparasitic Theory (2) Role of microorganisms      Initiation of Dental   Progression of Dental      Car...
(1)Acidogenic/Chemoparasitic Theory (2) Role of microorganisms    S. mutans has been proved     for the initiation of ca...
(1)Acidogenic/Chemoparasitic Theory (3) Role of acids    play most important role     in pathogenesis of dental     cari...
(1)Acidogenic/Chemoparasitic Theory (4) Role of Dental Plaque    found on uncleaned tooth     surfaces    appear as ten...
New TheoriesOld Theories(Exogenous Theory) (2) Proteolytic Theory    proteolysis of the organic     components of tooth ...
New TheoriesOld Theories(Exogenous Theory) (2) Proteolytic Theory    proposed that enamel     lamellae or rod sheath    ...
New TheoriesOld Theories(Exogenous Theory) (3) Proteolysis Chelation Theory    suggests that caries is     caused by sim...
New TheoriesOld Theories(Exogenous Theory) (3) Proteolysis Chelation Theory    chelation      •removal of calcium by    ...
ClassificationOld Theories (1) Depending on nature of attack (2) Depending on progression of      caries (3) Depending ...
ClassificationOld Theories (6) GV Black Classification      based on treatment and      restoration design (7) Based on ...
(1) Nature ofOld Theories Attack Primary Caries   incipient; initial   first attack on tooth surface Secondary Caries ...
(2) Progression of CariesOld Theories Acute   rapidly invading process   involves several teeth   lesions are soft + l...
(2) Progression of CariesOld Theories Acute   usually pulp is involved    at early stage     • Rampant caries     • Nurs...
(2) Progression of CariesOld Theories Chronic   lesions are long standing   fewer in number
(3) Surfaces involvedOld Theories Pit and fissure Smooth surface caries
(4) DirectionOld Theories of caries   attack Forward Caries   proceeds from enamel     to dentin   lesion is triangle i...
(4) DirectionOld Theories of caries   attack Backward Caries   proceeds from DEJ towards    enamel surface   also trian...
(5) Number ofOld Theories Surfaces    involved Simple   only one surface is involved     by caries Compound   2 surfac...
(6) GV BlackOld Theories Classification Class I    begin in pits, fissures +     defective grooves    seen in occlusal ...
(6) GV BlackOld Theories Classification Class II    lesions seen on proximal     aspects of molars +     premolars
(6) GV BlackOld Theories Classification Class III    lesions involving proximal     aspects of incisors    do not invol...
(6) GV BlackOld Theories Classification Class IV    lesions involving proximal     aspects of incisors    involve or re...
(6) GV BlackOld Theories Classification Class V   lesions present on gingival     third of all teeth
(6) GV BlackOld Theories Classification Class VI    lesions found on incisal     edges + cusp tips
(7) LocationOld Theoriesof the lesion Pit and Fissure caries    Occlusal    Buccal or lingual pit Smooth surface carie...
(8) Tissue involvedOld Theories Enamel Caries Dentinal Caries Cemental Caries
Classification Senile Caries    caries associated with     aging    almost exclusively seen on root     surface Residu...
Clinical Features: SmoothSurface Caries Interproximal Caries    opaque chalky region     (white spot)    some cases yel...
Clinical Features: SmoothSurface Caries Interproximal Caries    as caries penetrates     enamel, enamel surrounding     ...
Clinical Features: SmoothSurface Caries Interproximal Caries    common for proximal     caries to extend both     bucall...
Cervical, Buccal, Lingual orPalatal Caries Clinical Features:    usually extends from     area opposite gingival crest  ...
Cervical, Buccal, Lingual orPalatal Caries Clinical Features:    usually occurs on cervical     area    typical cervica...
Pit and Fissure Caries Clinical Features:    appears brown or black    feel slightly soft    catch a fine explorer point
Pit and Fissure Caries Clinical Features:    enamel bordering the pit     and fissure may appear      • opaque         a...
Pit and Fissure Caries Clinical Features:    lateral spread of caries     at DEJ as well as     penetration into dentin ...
Root Caries  also known as cemental     caries  involves both dentin +     cementum        in number of people     exhi...
Root Caries Clinical Features:    slowly progressing     chronic lesion    usually found in mandibular     molar area +...
Recurrent Caries  occurs immediately adjacent   to restoration  may be caused by inadequate   extension of restoration ...
Recurrent Caries Clinical Features:    restoration with poor     margins      • permitted leakage +        entrance of b...
Nursing BottleCaries Etiology:    due to nursing bottle     containing milk or milk     formula, fruit juice or     swee...
Nursing BottleCaries Pathogenesis:    child is put on bed at     afternoon nap time or at night     with nursing bottle ...
Nursing BottleCaries Pathogenesis:    carbohydrate containing     liquid provide an excellent     culture medium for    ...
Nursing BottleCaries Clinical Feature:    prolonged feeding beyond     usual time may result in     early + rampant cari...
Nursing BottleCaries Clinical Feature:    carious process is so     severe that only root     stumps remain
Nursing BottleCaries Prevention:    parent should start brushing     the child teeth as soon     as they erupt in oral  ...
Rampant Caries suddenly appearing widespread resulting in early involvement  of pulp
Rampant Caries Etiology:    may be due to nutritional     deficiency    malnutrition    emotional disturbances
Rampant Caries Clinical Features:    occurs in children with     poor dietary habits    extensive inter-proximal     + ...
Rampant Caries Management:   extensive dental care   parent education
Arrested Caries Clinical Features:    both deciduous + permanent     are affected    large open cavities    brown-stai...
Prevention/Managementof Dental Caries Restorative Treatment Tooth Brushing Mouth Rinsing Dental Floss Topical Fluorid...
References: Books   Cawson, R.A: Cawson’s Essentials of Oral       Oral Pathology and Oral Medicine,       8th Edition  ...
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Dental caries

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Dental caries

  1. 1. DENTALCARIES Prepared by: Dr. Rea Corpuz
  2. 2. Dental Caries progressive initially subsurface demineralization of teeth by bacterial acid one of the most common of all diseases major cause of loss of teeth
  3. 3. Dental Caries may be considered a disease of modern civilization since prehistoric man rarely suffered from this form of tooth
  4. 4. Dental Caries biological process of tooth decay with mutifactorial etiology microbial disease of calcified tissues of teeth characterized by demineralization of inorganic portion destruction of organic substance of tooth
  5. 5. Etiology of Dental Caries generally agreed to be complex problem complicated by many indirect factors obscure the direct cause or causes
  6. 6. Etiology of Dental CariesPossible interventions Possible interventionsReduce intake of Reduce Strep. mutanscariogenic sugars numbers by:Particularly sucrose Diet Bacteria Reduction in sugar intake Active or passive Caries immunization Possible interventions Susceptible Water + other types of Time Surface FluoridationPossible interventions (Host) Prevention during post-Avoid frequent sucrose eruptive maturationintake (snacking) Fissure sealingStimulate salivary flow Properly contured+ sugar clearance restorations
  7. 7. Etiology of Dental Caries PlaqueAcidogenic Enzymes Food Acids Tooth Carious Bacteria Lesions
  8. 8. Etiology of Dental Caries Old Theories  Exogenous Theories • (1) Legend of worm • (2) Chemical Theory • (3) Parasitic or Septic Theory
  9. 9. Etiology of Dental Caries Old Theories  Endogenous Theories • (1) Humoral Theory • (2) Vital Theory
  10. 10. Etiology of Dental Caries New Theories  (1) Acidogenic Theory  (2) Proteolytic Theory  (3) Proteolysis-chelation Theory
  11. 11. Old Theories(Exogenous Theory) (1) Legend of Worm  5000 BC  ancient Sumerian text  obtained from Mesopotamian area  caused by worm that drank blood of teeth  fed on roots of jaws
  12. 12. Old Theories(Exogenous Theory) (2) Chemical Theory  1819  proposed by Parmly  unidentified chemical agent  responsible for caries
  13. 13. Old Theories(Exogenous Theory) (2) Chemical Theory  stated that caries began on enamel surface where food putrefied  acquired sufficient dissolving power to produce disease chemically
  14. 14. Old Theories(Exogenous Theory) (3) Parasitic or Septic Theory  1843  proposed by Erdl  filamentous parasite in plaque • he termed as “Denticolae” • responsible for dental caries
  15. 15. Old Theories(Endogenous Theory) (1) Humoral Theory  4 humors of body • blood • phelgm • black bile • yellow bile  any change in relative proportion of these elements causes disease
  16. 16. Old Theories(Endogenous Theory) (2) Vital Theory  18 century  tooth decay originated like bone gangrene, from within the tooth itself
  17. 17. New TheoriesOld Theories(Exogenous Theory) (1) Acidogenic/Chemoparasitic Theory  1890  WD Miller  dental decay is a chemoparasitic process consisting of 2 stages • decalcification of enamel  results in total destruction
  18. 18. New TheoriesOld Theories(Exogenous Theory) (1) Acidogenic/Chemoparasitic Theory • decalcification of dentin as a preliminary stage  followed by dissolution of softened residue
  19. 19. New TheoriesOld Theories(Exogenous Theory) (1) Acidogenic/Chemoparasitic Theory  following factors cause decay: • (1) Role of carbohydrates • (2) Role of microorganisms • (3) Role of acids • (4) Role of dental plaque
  20. 20. (1)Acidogenic/Old TheoriesChemoparasitic Theory (1) Role of carbohydrates  food substances act as substrate for microorganisms of dental plaque  various carbohydrates have been examined for cariogenic potential
  21. 21. (1)Acidogenic/Old TheoriesChemoparasitic Theory (1) Role of carbohydrates  cariogenicity of carbohydrate varies with: • (1) frequency of ingestion • (2) physical form • (3) chemical composition • (4) route of administration • (5) presence of other food constituents
  22. 22. (1)Acidogenic/Old TheoriesChemoparasitic Theory (1) Role of carbohydrates • (1) frequency of ingestion  taken repeatedly in between two major meals  provides constant supply of carbohydrate to plaque bacteria for fermentation + production of acids
  23. 23. (1)Acidogenic/Old TheoriesChemoparasitic Theory (1) Role of carbohydrates • (2) physical form  sticky  solid carbohydrates
  24. 24. (1)Acidogenic/Old TheoriesChemoparasitic Theory (1) Role of carbohydrates • (3) chemical composition  in the form of glucose, sucrose + fructose due to low molecular weight  rapidly diffuse into plaque  make themselves easily available for fermentation by plaque bacteria
  25. 25. (1)Acidogenic/Chemoparasitic Theory (1) Role of carbohydrates • (4) Route of administration  oral intake of sticky food
  26. 26. (1)Acidogenic/Chemoparasitic Theory (1) Role of carbohydrates • (5) Presence of other food constituents  refined pure carbohydrates more caries producing
  27. 27. (1)Acidogenic/Chemoparasitic Theory (2) Role of microorganisms  caused by acid resulting from action of microorganisms on carbohydrates
  28. 28. (1)Acidogenic/Chemoparasitic Theory (2) Role of microorganisms Initiation of Dental Progression of Dental Caries Caries Streptococci Streptococcal species: • S. mutans Streptoccal species in deep • S. milleri dentinal caries and root • S. mitior caries • S. sanguis • S. salivaris Lactobacilli Lactobacilli in dentin • L. acidophillus • L. acidophillus • L. casei • L. casei Actinomycoses Actinomycoses • A. viscosus • A. Israeli • A. naeslundii • A. odontolyticus
  29. 29. (1)Acidogenic/Chemoparasitic Theory (2) Role of microorganisms  S. mutans has been proved for the initiation of caries
  30. 30. (1)Acidogenic/Chemoparasitic Theory (3) Role of acids  play most important role in pathogenesis of dental caries  pH 5.5 is called critical pH  below this pH demineralization of tooth substance begins
  31. 31. (1)Acidogenic/Chemoparasitic Theory (4) Role of Dental Plaque  found on uncleaned tooth surfaces  appear as tenacious, thin film  may accumulate within 24-48 hours
  32. 32. New TheoriesOld Theories(Exogenous Theory) (2) Proteolytic Theory  proteolysis of the organic components of tooth as an initial process  than actual demineralization + dissolution of inorganic substances
  33. 33. New TheoriesOld Theories(Exogenous Theory) (2) Proteolytic Theory  proposed that enamel lamellae or rod sheath (proteins) may be lysed  which means proteolysis as first event in further progression of bacterial invasion + demineralization carious lesions
  34. 34. New TheoriesOld Theories(Exogenous Theory) (3) Proteolysis Chelation Theory  suggests that caries is caused by simultaneous events of proteolysis + chelation  proteolysis • destruction of organic portion of tooth by proteolytic microorganisms
  35. 35. New TheoriesOld Theories(Exogenous Theory) (3) Proteolysis Chelation Theory  chelation •removal of calcium by forming soluble chelates  oral bacteria attack organic component of enamel (proteolysis)  breakdown products have chelating ability and this dissolves tooth minerals
  36. 36. ClassificationOld Theories (1) Depending on nature of attack (2) Depending on progression of caries (3) Depending on surfaces involved (4) Based on direction of attack (5) Based on number of surfaces involved
  37. 37. ClassificationOld Theories (6) GV Black Classification based on treatment and restoration design (7) Based on location of lesion (8) Based on tissue involved
  38. 38. (1) Nature ofOld Theories Attack Primary Caries  incipient; initial  first attack on tooth surface Secondary Caries  recurrent  occurs on margins or walls of existing restorations
  39. 39. (2) Progression of CariesOld Theories Acute  rapidly invading process  involves several teeth  lesions are soft + light colored
  40. 40. (2) Progression of CariesOld Theories Acute  usually pulp is involved at early stage • Rampant caries • Nursing bottle caries • Radiation caries
  41. 41. (2) Progression of CariesOld Theories Chronic  lesions are long standing  fewer in number
  42. 42. (3) Surfaces involvedOld Theories Pit and fissure Smooth surface caries
  43. 43. (4) DirectionOld Theories of caries attack Forward Caries  proceeds from enamel to dentin  lesion is triangle in shaped with base of triangle at enamel surface + apex towards dentin  in pits + fissures base is at DEJ + apex is in the pit
  44. 44. (4) DirectionOld Theories of caries attack Backward Caries  proceeds from DEJ towards enamel surface  also triangle shaped with base at DEJ + apex towards enamel surface
  45. 45. (5) Number ofOld Theories Surfaces involved Simple  only one surface is involved by caries Compound  2 surfaces are involved Complex  more than 3 surfaces involved
  46. 46. (6) GV BlackOld Theories Classification Class I  begin in pits, fissures + defective grooves  seen in occlusal surface  occlusal two-thirds of molars  lingual pits of incisors
  47. 47. (6) GV BlackOld Theories Classification Class II  lesions seen on proximal aspects of molars + premolars
  48. 48. (6) GV BlackOld Theories Classification Class III  lesions involving proximal aspects of incisors  do not involve or necessitate removal of incisal edge
  49. 49. (6) GV BlackOld Theories Classification Class IV  lesions involving proximal aspects of incisors  involve or require removal of incisal edge
  50. 50. (6) GV BlackOld Theories Classification Class V  lesions present on gingival third of all teeth
  51. 51. (6) GV BlackOld Theories Classification Class VI  lesions found on incisal edges + cusp tips
  52. 52. (7) LocationOld Theoriesof the lesion Pit and Fissure caries  Occlusal  Buccal or lingual pit Smooth surface caries  Proximal  Buccal or Lingual surface Root caries
  53. 53. (8) Tissue involvedOld Theories Enamel Caries Dentinal Caries Cemental Caries
  54. 54. Classification Senile Caries  caries associated with aging  almost exclusively seen on root surface Residual Caries  not removed during restorative procedure
  55. 55. Clinical Features: SmoothSurface Caries Interproximal Caries  opaque chalky region (white spot)  some cases yellow or brown pigment area  spots are generally located on outer surface of enamel between contact point + height of free gingival margin
  56. 56. Clinical Features: SmoothSurface Caries Interproximal Caries  as caries penetrates enamel, enamel surrounding the lesion assumes bluish white appearance • usally apparent as laterally spreading caries at DEJ
  57. 57. Clinical Features: SmoothSurface Caries Interproximal Caries  common for proximal caries to extend both bucally + lingually
  58. 58. Cervical, Buccal, Lingual orPalatal Caries Clinical Features:  usually extends from area opposite gingival crest occlusally to convexity of tooth surface  extends laterally towards proximal surfaces
  59. 59. Cervical, Buccal, Lingual orPalatal Caries Clinical Features:  usually occurs on cervical area  typical cervical lesion is a crescent shaped cavity beginning as slightly roughened chalky area  gradually becomes excavated
  60. 60. Pit and Fissure Caries Clinical Features:  appears brown or black  feel slightly soft  catch a fine explorer point
  61. 61. Pit and Fissure Caries Clinical Features:  enamel bordering the pit and fissure may appear • opaque as it becomes • bluish white undermined
  62. 62. Pit and Fissure Caries Clinical Features:  lateral spread of caries at DEJ as well as penetration into dentin along dentinal tubules may be extensive  without fracturing away overhanging enamel  there may be large carious lesion with only a tiny point of opening
  63. 63. Root Caries  also known as cemental caries  involves both dentin + cementum  in number of people exhibiting gingival recession with clinical exposure of cemental surface
  64. 64. Root Caries Clinical Features:  slowly progressing chronic lesion  usually found in mandibular molar area + premolar region  gingival recession is associated with root surface caries
  65. 65. Recurrent Caries  occurs immediately adjacent to restoration  may be caused by inadequate extension of restoration  was not able to excavate or removed well original carious lesion
  66. 66. Recurrent Caries Clinical Features:  restoration with poor margins • permitted leakage + entrance of both bacteria + substrate
  67. 67. Nursing BottleCaries Etiology:  due to nursing bottle containing milk or milk formula, fruit juice or sweetened water  sometimes it occurs due to sugar or honey-sweetened pacifier
  68. 68. Nursing BottleCaries Pathogenesis:  child is put on bed at afternoon nap time or at night with nursing bottle containing milk or a sugar containing beverage  milk or sweetened liquid becomes pooled around maxillary anterior teeth
  69. 69. Nursing BottleCaries Pathogenesis:  carbohydrate containing liquid provide an excellent culture medium for acidogenic microorganisms
  70. 70. Nursing BottleCaries Clinical Feature:  prolonged feeding beyond usual time may result in early + rampant caries  early carious involvement of maxillary anterior, maxillary + mandibular 1st permanent molars, mandibular canines
  71. 71. Nursing BottleCaries Clinical Feature:  carious process is so severe that only root stumps remain
  72. 72. Nursing BottleCaries Prevention:  parent should start brushing the child teeth as soon as they erupt in oral cavity  discontinue bottle feeding as soon as child can drink from a cup, at approximately 12-15 months of age
  73. 73. Rampant Caries suddenly appearing widespread resulting in early involvement of pulp
  74. 74. Rampant Caries Etiology:  may be due to nutritional deficiency  malnutrition  emotional disturbances
  75. 75. Rampant Caries Clinical Features:  occurs in children with poor dietary habits  extensive inter-proximal + smooth surface caries
  76. 76. Rampant Caries Management:  extensive dental care  parent education
  77. 77. Arrested Caries Clinical Features:  both deciduous + permanent are affected  large open cavities  brown-stained polished appearance + hard
  78. 78. Prevention/Managementof Dental Caries Restorative Treatment Tooth Brushing Mouth Rinsing Dental Floss Topical Fluoride Application (Pedo Patients) Pit and Fissure Sealants
  79. 79. References: Books  Cawson, R.A: Cawson’s Essentials of Oral Oral Pathology and Oral Medicine, 8th Edition • (page 40)  Ghom, Ali & Mhaske, Shubhangi: Textbook of Oral Pathology • (pages 401-419) Shafer, et al: A textbook of Oral Pathology, 3rd Edition • (pages 369,394, 407)

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