This document provides an overview of dental caries including definitions, the caries process, etiological factors, prevention, classification, and types such as enamel caries, root caries, and early childhood caries. It defines dental caries as a localized pathological process involving softening of tooth structure from acid produced by bacteria. Key points covered include how the caries process starts with acid production leading to demineralization or remineralization, classification systems for cavity locations, and risk factors for root caries and early childhood caries.

1. Introduction
to Dentistry
DA101
Lecture Four
Dental
Caries
Dr. Somaia Hasan Dashti
2017
]
SDashti 2017

2. Lecture Outlines
• Dental Caries Definition
• Terminology
• Process of Dental Caries
• Etiological factors and Prevention
• Cavities Classification
• Enamel Caries
• Root Caries
• Early Childhood Caries
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3. Terminology Meaning
Acidogentic
Bacteria
Bacteria in dental biofilm capable of metabolizing fermentable
carbohydrates into acids
Buffer Substance that increase amount of acid or alkali necessary to
produce change in pH
Cariology Science and study of dental caries
Cavitation Process of formation cavity; final stage of dental caries
Cavity A hole, final stage in demineralization and breakdown of tooth
structure
Demineralization Major process in dental caries in which minerals (calcium,
phosphorus are dissolved from tooth structure by acid formed by
acidogentic bacteria (streptococcus mutans)
remineralization Healing process in which minerals redeposit in demineralized tooth
structure
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4. Definitions
• The world Health Organization (WHO) has defined
dental caries as a localized post eruptive,
pathological process of external origin involving
softening of the hard tooth tissue and proceeding to
the formation of a cavity
• It is a infectious disease that caused by acidogenic
bacteria with dissolution of enamel and dentin
(Coronal Caries) and Cementum and dentin (Root
Caries)
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5. • Arrested Caries occurs after remineralization
when caries process is halted
• Rampant Caries (Early Childhood Caries ECC) is
rapidly progressive caries occurring in many
teeth simultaneously (acute caries)
• Secondary caries (recurrent) which is carious
lesions at margins od and existing restoration
• Dental caries is a preventable Disease
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6. Caries Process
Food
Bacteria
(Streptococcus
Mutans)
Acid
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Acid Tooth
Dental
Caries

7. Carbohyd-
rates0
(Sucrose)
Drop in PH
due to acid
formation
Within 15
minutes
Demineralization
No buffering or
demineralization
Dental
Caries
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8. • Dental caries starts at
the external surface of
tooth and progresses
toward the pulp
• The process in enamel
is called
demineralization of the
hard tissue following
the pattern of enamel
rods
• Once it reaches
dentine, it spreads
laterally following the
dentinal tubules
toward the pulp.
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9. Main Etiological factors
• Cariogenic food that produces acid : frequency , type vs.
length of time
• Starchy food (potato, crackers) , sticky candy , fat-rich
chocolate ect… (Sucrose)
• Low PH (less than 7)
• Bacteria mainly (Streptococcus Mutants)
• Susceptible tooth with low resistance ( low fluoride level)
• Bad oral hygiene
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10. • Prevention of Dental Caries:
• Fluoride is essential mineral for dental caries
prevention that inhibit demineralization and
enhances remineralization
• Reduce the frequency of cariogenic food (
fermentable carbohydrate)
• Reduce sticky soft food that cling to tooth and
gingiva and encourage food debris
accumulation
• Proper home oral hygiene care
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11. Factors to teach the
patients about Dental Caries
• All ages are susceptible
• On tooth surface , constant demineralization and
remineralization is going on
• Basic caries process starts with acidogentic bacteria
in dental biofilm acting to metabolize fermentable
carbohydrates ingested by patient
• Acids are formed that act to demineralize enamel,
dentine, Cementum, and or dentine that lead to
cavity formation
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12. Dental Caries
Classification
• Dr. G.V. Black developed a standard method
for caries classification according to surfaces
of tooth
• Each class is represented by a Roman numeral
• Those categories used in carious lesions, cavity
preparation , and finished restorations
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13. Caries Location Appearance
Class I
Cavities in pits and fissures
a. Occlusal surfaces od premolars
and molars
b. Faisal and lingual surfaces of
molars
c. Lingual surfaces of maxillary
incisors
Class II
Cavities in proximal surfaces of
premolars and molars
Class III
Cavities in proximal surfaces of
incisors and canines that do not
involve incisal angle
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14. Caries Location Appearance
Class IV
Cavities in proximal surfaces of incisors
and canines that involve incisal angle
Class V
Cavities in cervical 1/3 of facial or lingual
surfaces (not pit and fissure)
Class VI
Cavities on incisal edges of anterior teeth
and cusp tips of posterior teeth
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15. Nomenclature by surface
• Simple Cavity: involves one tooth surface
• Example : Occlusal cavity
• Compound Cavity: Involves two tooth surfaces
• Example: mesio-occlusal cavity (M-O Cavity)
• Complex Cavity: Involves more than two tooth
surfaces
• Example: mesio-Occlusal-distal (M-O-D)
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16. Enamel Caries
Steps in cavity formation
• A. Phase I: Incipient Lesion
• 1. Subsurface Demineralization: Acid passes
through enamel pores(microchannels)
• 2. Visualization: area is not clinically visible as a
thin layer of enamel still remain over the surface
• 3. First clinical evidence appears as a white spot
with no breakthrough enamel but with time it may
becomes brown
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17. • 4. Remineralization: Application of fluorides
from mouthwash , dentifrice, fluoridated
drinking water
• B Phase II: Untreated Incipient Lesion
• 1. Breakdown of enamel over demineralized
area (white spot)
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18. • 2. Progression of
carious lesion : follows
general direction of
enamel rods
• 3. Spread of carious
Lesion: Spreads at
dentinoenamel
junction; continuous
along the dentinal
tubules
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19. Types if Dentinal Caries
• A. Pit and Fissure:
Examples:
Occlusal pits of molars
and premolars
Buccal groove of a
mandibular molar
• B. Smooth Surfaces:
Caries begins in smooth
surface where there is no
pit or groove
Example: proximal tooth
surface ( difficult to clean
area)
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20. Early Childhood Caries (ECC)
• ECC or Baby bottle tooth decay is a form of
rampant caries found in very young children
who routinely have been given nursing bottle
when going to sleep or prolong breast –
feeding
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21. Predisposing Factors
• Nursing bottle with sweetened milk of
sweetened fluids with sucrose
• Pacifier dipped of filled with sweet agent such
as honey
• Prolonged at –will breast feeding
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22. Early Childhood Caries
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23. • Effects:
• Maxillary anterior
teeth and primary
molars are first to be
affected
• As baby falls asleep ,
pools of sweet liquid
can collect about the
teeth, while the
nipples covers
mandibular anterior.
• Recognition
• Children must be seen for
examination no later than 6 months
after eruption of first tooth
• Demineralization may be noted
along cervical third of maxillary
anterior teeth.
• At later stages , lesions appear as
dark brown and crown may be
destroyed which will cause pain and
discomfort to the child beside
major psychological effects.
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24. Root Caries
• Is soft , progressive lesion of Cementum and
dentin that involves bacterial infection and
invasion, it is called cemental caries , cervical
caries, or radical caries
• The incidence increases with age due to
gingival recession and not due to aging
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25. Risk Factors of Rood Caries
• Periodontal infection
• Presence of bacteria
• Poor oral hygiene
• Diet: frequent use of
cariogenic food
• Low fluoride exposure:
• No community
fluoridation
• Low use of local FL2
• Xerostomia due to
medications, radiation
therapy or salivary
gland dysfunction
• History of dental caries
• Prosthetic devices;
poor bacterial biofilm
removal
• Tobacco use
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26. SDashti 2017

27. Activates
• Visit your local COOP or any supermarket and
find out about the ingredients and fluorides
concentration in the following products:
• 1. Different brand of mineral water
• 2. Mouth washes
• 3. Toothpastes or dentifrice
• 4. Any other nutrients that contains fluorides
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