The document discusses dental caries, including its etiology and classifications. It provides details on: 1) Dental caries is a progressive, subsurface demineralization of teeth caused by bacterial acids that leads to tooth decay. 2) Old and new theories on the etiology of dental caries including the roles of carbohydrates, microorganisms, acids, and dental plaque in the acidogenic/chemoparasitic theory. 3) Classifications of dental caries including based on nature of attack, progression, surfaces involved, direction of attack, number of surfaces, GV Black classification, location, and tissues involved.

1. DENTAL
CARIES
Prepared by:
Dr. Rea Corpuz

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. Dental Caries
 may be considered a
disease of modern
civilization
 since prehistoric man
rarely suffered from
this form of tooth

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. Etiology of Dental Caries
 generally agreed to be
complex problem
 complicated by many
indirect factors
 obscure the direct cause
or causes

6. Etiology of Dental Caries
Possible interventions Possible interventions
Reduce intake of Reduce Strep. mutans
cariogenic 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 Fluoridation
Possible interventions (Host)
Prevention during post-
Avoid frequent sucrose eruptive maturation
intake (snacking) Fissure sealing
Stimulate salivary flow Properly contured
+ sugar clearance restorations

7. Etiology of Dental Caries
Plaque
Acidogenic Enzymes Food Acids Tooth Carious
Bacteria Lesions

8. Etiology of Dental Caries
 Old Theories
 Exogenous Theories
• (1) Legend of worm
• (2) Chemical Theory
• (3) Parasitic or Septic Theory

9. Etiology of Dental Caries
 Old Theories
 Endogenous Theories
• (1) Humoral Theory
• (2) Vital Theory

10. Etiology of Dental Caries
 New Theories
 (1) Acidogenic Theory
 (2) Proteolytic Theory
 (3) Proteolysis-chelation Theory

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. Old Theories
(Exogenous Theory)
 (2) Chemical Theory
 1819
 proposed by Parmly
 unidentified chemical
agent
 responsible for caries

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. 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. 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. Old Theories
(Endogenous Theory)
 (2) Vital Theory
 18 century
 tooth decay originated
like bone gangrene, from
within the tooth itself

17. New Theories
Old 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. New Theories
Old Theories
(Exogenous Theory)
 (1) Acidogenic/Chemoparasitic
Theory
• decalcification of dentin
as a preliminary stage
 followed by dissolution
of softened residue

19. New Theories
Old 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. (1)Acidogenic/
Old Theories
Chemoparasitic Theory
 (1) Role of carbohydrates
 food substances act as
substrate for microorganisms
of dental plaque
 various carbohydrates have
been examined for cariogenic
potential

21. (1)Acidogenic/
Old Theories
Chemoparasitic 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. (1)Acidogenic/
Old Theories
Chemoparasitic 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. (1)Acidogenic/
Old Theories
Chemoparasitic Theory
 (1) Role of carbohydrates
• (2) physical form
 sticky
 solid carbohydrates

24. (1)Acidogenic/
Old Theories
Chemoparasitic 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. (1)Acidogenic/
Chemoparasitic Theory
 (1) Role of carbohydrates
• (4) Route of administration
 oral intake of sticky
food

26. (1)Acidogenic/
Chemoparasitic Theory
 (1) Role of carbohydrates
• (5) Presence of other food
constituents
 refined pure carbohydrates
more caries producing

27. (1)Acidogenic/
Chemoparasitic Theory
 (2) Role of microorganisms
 caused by acid resulting from
action of microorganisms
on carbohydrates

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. (1)Acidogenic/
Chemoparasitic Theory
 (2) Role of microorganisms
 S. mutans has been proved
for the initiation of caries

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. (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. New Theories
Old 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. New Theories
Old 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. New Theories
Old 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. New Theories
Old 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. Classification
Old 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. Classification
Old Theories
 (6) GV Black Classification
based on treatment and
restoration design
 (7) Based on location of lesion
 (8) Based on tissue involved

38. (1) Nature of
Old Theories Attack
 Primary Caries
 incipient; initial
 first attack on tooth surface
 Secondary Caries
 recurrent
 occurs on margins or walls
of existing restorations

39. (2) Progression of Caries
Old Theories
 Acute
 rapidly invading process
 involves several teeth
 lesions are soft + light colored

40. (2) Progression of Caries
Old Theories
 Acute
 usually pulp is involved
at early stage
• Rampant caries
• Nursing bottle caries
• Radiation caries

41. (2) Progression of Caries
Old Theories
 Chronic
 lesions are long standing
 fewer in number

42. (3) Surfaces involved
Old Theories
 Pit and fissure
 Smooth surface caries

43. (4) Direction
Old 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. (4) Direction
Old Theories of caries
attack
 Backward Caries
 proceeds from DEJ towards
enamel surface
 also triangle shaped with
base at DEJ + apex towards
enamel surface

45. (5) Number of
Old Theories Surfaces
involved
 Simple
 only one surface is involved
by caries
 Compound
 2 surfaces are involved
 Complex
 more than 3 surfaces involved

46. (6) GV Black
Old Theories Classification
 Class I
 begin in pits, fissures +
defective grooves
 seen in occlusal surface
 occlusal two-thirds of molars
 lingual pits of incisors

47. (6) GV Black
Old Theories Classification
 Class II
 lesions seen on proximal
aspects of molars +
premolars

48. (6) GV Black
Old Theories Classification
 Class III
 lesions involving proximal
aspects of incisors
 do not involve or necessitate
removal of incisal edge

49. (6) GV Black
Old Theories Classification
 Class IV
 lesions involving proximal
aspects of incisors
 involve or require
removal of incisal edge

50. (6) GV Black
Old Theories Classification
 Class V
 lesions present on gingival
third of all teeth

51. (6) GV Black
Old Theories Classification
 Class VI
 lesions found on incisal
edges + cusp tips

52. (7) Location
Old Theoriesof the lesion
 Pit and Fissure caries
 Occlusal
 Buccal or lingual pit
 Smooth surface caries
 Proximal
 Buccal or Lingual surface
 Root caries

53. (8) Tissue involved
Old Theories
 Enamel Caries
 Dentinal Caries
 Cemental Caries

54. Classification
 Senile Caries
 caries associated with
aging
 almost exclusively seen on root
surface
 Residual Caries
 not removed during restorative
procedure

55. Clinical Features: Smooth
Surface 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. Clinical Features: Smooth
Surface Caries
 Interproximal Caries
 as caries penetrates
enamel, enamel surrounding
the lesion assumes bluish white
appearance
• usally apparent as laterally
spreading caries at DEJ

57. Clinical Features: Smooth
Surface Caries
 Interproximal Caries
 common for proximal
caries to extend both
bucally + lingually

58. Cervical, Buccal, Lingual or
Palatal Caries
 Clinical Features:
 usually extends from
area opposite gingival crest
occlusally to convexity
of tooth surface
 extends laterally towards
proximal surfaces

59. Cervical, Buccal, Lingual or
Palatal 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. Pit and Fissure Caries
 Clinical Features:
 appears brown or black
 feel slightly soft
 catch a fine explorer point

61. Pit and Fissure Caries
 Clinical Features:
 enamel bordering the pit
and fissure may appear
• opaque as it becomes
• bluish white undermined

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. 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. 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. 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. Recurrent Caries
 Clinical Features:
 restoration with poor
margins
• permitted leakage +
entrance of both bacteria +
substrate

67. Nursing Bottle
Caries
 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. Nursing Bottle
Caries
 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. Nursing Bottle
Caries
 Pathogenesis:
 carbohydrate containing
liquid provide an excellent
culture medium for
acidogenic microorganisms

70. Nursing Bottle
Caries
 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. Nursing Bottle
Caries
 Clinical Feature:
 carious process is so
severe that only root
stumps remain

72. Nursing Bottle
Caries
 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. Rampant Caries
 suddenly appearing
 widespread
 resulting in early involvement
of pulp

74. Rampant Caries
 Etiology:
 may be due to nutritional
deficiency
 malnutrition
 emotional disturbances

75. Rampant Caries
 Clinical Features:
 occurs in children with
poor dietary habits
 extensive inter-proximal
+ smooth surface caries

76. Rampant Caries
 Management:
 extensive dental care
 parent education

77. Arrested Caries
 Clinical Features:
 both deciduous + permanent
are affected
 large open cavities
 brown-stained polished
appearance + hard

78. Prevention/Management
of Dental Caries
 Restorative Treatment
 Tooth Brushing
 Mouth Rinsing
 Dental Floss
 Topical Fluoride Application (Pedo Patients)
 Pit and Fissure Sealants

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)