Dental caries is an infectious microbial disease of the tooth that results in localized destruction and dissolution of calcified tissues. Dental caries is one of the most prevalent chronic diseases of people worldwide; individuals are susceptible to this disease throughout their lifetime.

1. PRESENTED BY:
DR. ANUBHUTI
BDS,MDS
Department of Conservative
Dentistry & Endodontics
DENTAL INSTITUTE
RIMS

2. DENTAL
CARIES
PART – 1
For undergraduates

3. INTRODUCTION
DEFINITION
ETIOLOGY HISTOGENESIS OF DENTAL CARIES
HISTOPATHOLOGY OF DENTAL CARIES

5. Dental caries is
commonly known
as tooth decay.

6. In the minds of the lay person, and
surprisingly even within dentistry,
dental caries is often thought of as
holes in the teeth rather than an
entire disease process.
(Dental caries: a dynamic disease process ,JDB Featherstone ,Australian Dental Journal 2008; 53: 286–291)

7. Dental caries is one of the most
prevalent chronic diseases of
people worldwide; individuals
are susceptible to this disease
throughout their lifetime.
(Dental caries, dr. Robert L Selwitz Volume 369, No. 9555, p51–59, 6 January 2007)

8. DEFINITION
Dental caries is an
infectious microbial
disease of the tooth that
results in localized
destruction and
dissolution of calcified
tissues.
8
Sturduvent (5th edition)

9. Theories Chemicoplastic theory
(Miller w.D.1980)
Proteolytic theory
(Bodeker C.F.1948)
Chelation theory
( shatz A etal 1957)
9
‘See-saw’
mechanism

10. 10
Demineralization
Remineralization

11. 11

12. Etiology of
dental caries
Primary
factors
Modifying
factors
12

13. Dental
caries
Host
Microflora
Time
Diet
Textbook of operative dentiistry -vimal sikri pg no 71

14. HOST
Host factor
Susceptible
tooth
Morphology &
Position
Chemical
Nature
Saliva
Composition pH
Antibacterila
properties
Quantity &
Viscosity
Textbook of operative dentiistry -vimal sikri pg no 71

15. TOOTHMorphology & Position in the arch
Deep Pits & fissure make the tooth
susceptible to caries because of food
impaction & bacterial stagnation.
Occlusal surfaces are more prone
to caries .
Textbook of operative dentiistry -vimal sikri pg no 71

16. Irregularities in the arch
form
Crowding & overlapping
Partially impacted 3rd molars
Bucally & lingually placed
teeth
Textbook of operative dentiistry -vimal sikri pg no 71

17. MOST SUSCEPTIBLE TOOTH
Mandibular
first molar
Maxillary 1st
molar
Mandibular
& maxillary
2nd molar
Textbook of operative dentiistry -vimal sikri pg no 71

18. TOOTHChemical Nature
Surface enamel is more caries
resistant than the subsurface level
Textbook of operative dentiistry -vimal sikri pg no 71

19. SALIVAComposition
Caries immune persons exhibit
greater ammonia content in
saliva.
Textbook of operative dentiistry -vimal sikri pg no 72

20. SALIVApH
Below this value, the inorganic material of the
tooth may dissolve.
Under normal conditions the critical pH is 5.5
pH at which any particular saliva ceases to be
saturated with calcium & phosphorus is referred to
as ‘critical pH’
Textbook of operative dentiistry -vimal sikri pg no 72

21. 0 1475.5
“Critical pH”Acid AlkalineNeutral
Demineralization Remineralization
Teeth loose minerals when
mouth chemistry becomes acidic
Teeth gains minerals when mouth
chemistry is neutral or slightly alkaline

22. 0 1475.5
Acid Alkaline
Enamel dissolves
below pH 5.5 Dentin dissolves
below pH 6.5

23. SALIVANormal pH of resting
saliva is 6-7.
A ‘buffer’ is a component
that tends to maintain a
constant pH
A fall in buffer capacity of
saliva leads to increase in
caries in incidence .
Textbook of operative dentiistry -vimal sikri pg no 72

24. SALIVAAntibacterial properties
Lysozyme ,an
antibacterial agent
present in saliva can
inhibit airborne &
waterborne
Salivary peroxide is also
considered antibacterial
Textbook of operative dentiistry -vimal sikri pg no 72

25. SALIVAQuantity & viscosity
Human beings suffering from decreased flow of
saliva or lack of salivary secretions (xerostomia)
experience increased rate of dental caries.
(Sjogren’s syndrome)
Caries susceptibility increases in patients
following radiation therapy of oral cavity.
Certain drugs influence salivary flow.
Textbook of operative dentiistry -vimal sikri pg no 72

26. PLAQUE
The acid dissolves the tooth enamel
A sticky film full of Bacteria that convert
sugar starch in the remaining food into Acid
DENTAL PLAQUE

27. MICROFLORA
It has been proved that
caries is a bacterial
infection.
Textbook of operative dentiistry -vimal sikri pg no 72

28. It has been established that
all acid producing organisms
are not cariogenic .
The role of microorganism
varies at different sites as
follow :
Textbook of operative dentiistry -vimal sikri pg no 72

29. 29
Microflora
Occlusal caries
Streptococcus
mutans
Cemental
caries
Actinomyces
viscosus
Deep dentinal
caries
Lactobacilli
Textbook of operative dentiistry -vimal sikri pg no 72

30. DIET
Frequent snacking between meals promotes
caries

31. Physical nature DIET
It indirectly affects caries
Diet of primitive man
consisted of raw food
Led to attrition & help in cleansing the debris;
less incidence of caries
Textbook of operative dentiistry -vimal sikri pg no 73

32. Modern diet
Refined foods & soft
drinks
Led to collection of debris; predisposing to
more of caries
Textbook of operative dentiistry -vimal sikri pg no 73

33. Chemical nature
Nutrients present in meals have definite role in
caries progress
Carbohydrate is accepted as one of the most
important factor
Textbook of operative dentiistry -vimal sikri pg no 73

34. 34
Caries activity is
higher when sugar
is administrated in
sticky form
When sugar given in
solution form, is much
less capable of producing
caries than the same
amount of sugar
incorporated in food
Textbook of operative dentiistry -vimal sikri pg no 73

35. TIME
After intake of meals or snacks containing sugars,
the bacteria in the mouth metabolize them
resulting in production of acids as by products.
which decreases pH and lead to dissolution of
inorganic content

36. It takes around
two hours to
return the pH to
normal
Remineralise
the tooth surface
through the
buffering
capacity of saliva

37. 37
Modifyingfactors
Systemic health
Sex
Hereditary
Race
Geographic
environment
occupation

38. HISTOPATHOLOGY
OF CARIES
Progression of
caries in enamel
Progression of
caries in dentin

39. Progression
of caries in
enamel
Incipient
enamel caries
White spot
Hypocalcified
enamel
Cavity
formation
Bacterial
invasion
39

40. Enamel is highly mineralized
and forms an effective
barrier to bacterial attack.

41. INCIPIENT
ENAMEL CARIES
Incipient enamel caries appears
clinically as ‘white spot’
If the plaque is removed and the
enamel surface is dried
Early enamel carious lesions are
covered with dental plaque.
Clinical operative dentistry principles & practice Ramyya raghu pg no 58

42. CAVITY
FORMATION
If enamel lesion is
allowed to progress,
demineralization
becomes more
predominant.
This causes break in
enamel surface thus
producing a cavity
Clinical operative dentistry principles & practice Ramyya raghu pg no 58

43. BACTERIAL INVASION
Once a cavity
forms
Bacteria gain
entry into the
enamel surface &
Progress deeper
into the tooth
Clinical operative dentistry principles & practice Ramyya raghu pg no 58

44. ZONES OF
ENAMEL CARIES

45. 45

46. 46
It’s the largest portion of
enamel caries .Its poorly
mineralized
It lies deeper to the body
of the lesion & it
represents some
remineralization
It’s the deepest zone
which represents the
advancing front of the
enamel caries.
Its translucent due to
demineralization which
creates a structure less
appearance of the enamel .
Outermost zone is
relatively unaffected by
attack.
Its well mineralized
Clinical operative dentistry principles & practice Ramyya raghu pg no 58

47. ZONES OF
DENTINAL CARIES

48. Due to the structural
difference between enamel
& dentin, the progression of
caries is different in dentin
It has less mineral content &
microscopic tubules which
provide a pathway for the spread
of caries .
Thus Caries spread more rapidly
in dentin.
48
Clinical operative dentistry principles & practice Ramyya raghu pg no 58

49. Dentinoenamel
junction is least
resistant to caries
attack
It allows lateral spread
of caries
It’s a V-shaped in cross
section with a wide base
at the DEJ & apex
pointing pulpally
Clinical operative dentistry principles & practice Ramyya raghu pg no 59

50. 50
1.Normal dentin
2.Subtransparent dentin
3.Transparent dentine
4.Turbid dentine
5.Infected dentin
Clinical operative dentistry principles & practice Ramyya raghu pg no 59

51. 51
1.Normal dentin
2.Subtransparent dentin
3.Transparent dentine
4.Turbid dentine
5.Infected dentin
Affected dentin
Infected dentin

52. Define dental caries .Explain the etiology of dental caries.
Discuss the histopathology of dental caries.
Give the various classification of dental caries.
Discuss the various methods of diagnosing caries.
Explain the preventive measures for dental caries .
52

53. Role of saliva in dental caries
Role of diet in dental caries
Traditional methods of caries diagnosis
Bitewing radiographs.
Transillumination.
Topical fluroides.
Histopathology of enamel caries .
Histopathology of dental caries .
53

55. 1. Art & science of operative dentistry 5th edition
2. Sturdevent ‘s Art & science of operative dentistry south
asian edition
3. Clinical operative dentistry principles & practice
Ramyya raghu
4. Textbook of operative dentiistry -vimal sikri
5. Dental caries: a dynamic disease process ,JDB
Featherstone ,Australian Dental Journal 2008; 53:
286–291
6. Dental caries, dr. Robert L Selwitz Volume 369, No.
9555, p51–59, 6 January 2007
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