Mini Lecture

23 February 2012

is a microbial disease of the calcified

tissues of teeth, characterized by
demineralization of inorganic portion

and destruction of organic substance of

tooth

DEFINITION
is

a disease of microbial origin in

which the dietary carbohydrates are
fermented (glukosiltransferase
glukan) by the bacteria forming an
acid which causes the
demineralization of the inorganic part
and disintegration of the organic part
of the tooth

 Bacterial-induced tooth
demineralization or cavitation
from imbalance between
risk factors and
protective factors over time
Harris and Christen ( Primary Preventive Dentistry, 1995),
Larsen and Bruun (Clinical Cariology, 1994)

Keyes Diagram
microorganism

carie
s

dental
susceptibl
e

diet

Bacteria plus food

makes the saliva
very acidic within
5 minutes

Demineralizati
on

Remineralizatio
n

Saliva is normal
30 minutes
after eating

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CARIES CONTROL

DENTAL
CARIES
Tooth

Diet

Age
Frequency
Morphology
Sucrose
Fluoride
Acidic F&B
White spots
Restoration,3 yrs
Enamel lesion
Dentinal lesion
Pulpal lesion
Filling
Dental appliance

Bacteria

Saliva

S. Mutans
Flow rate
Plaque
Viscosity
Brushing
Buffering
Flossing
Restoration

Remineralization

Demineralization

Cavity

Infrequent or inadequate tooth cleaning

Frequent meals and snacks
Large amount of decay causing bacteria
Deficient fluoride in saliva

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The Acidogenic Theory

The Proteolytic Theory
Proteolysis Chelation Theory

Remineralization:

Demineralization:

Its clinical correlation

 GV

BLACK classification of caries:

class I , II , III , IV , V and VI
Rampant caries
Recurrent caries
Arrested caries
Root or cemental caries
Baby bottle caries

Pit-and-fissure caries
develop initially in the
fissures of the teeth, but
can spread into the dentine
2. Smooth-surface caries
are most common on
interdental surfaces, but
can occur on any smooth
surface of the tooth
3. Root caries attack the
cementum and dentine,
which becomes exposed as
gums recede
1.

Dental Caries

Enamel Caries

Smooth surface caries

Dentin Caries

Cementum Caries
(Root caries)

Pit and fissure caries

Primary Caries: lesions on unrestored

tooth surface
Secondary (recurrent) caries: lesions
that developed adjacent to a filling.
Residual caries: demineralized tissue
that has been left behind before a filling
is placed

Active caries lesion:

progressive carious lesion
White spot caries: the first sign of a caries
lesion on enamel that can be detected with
the naked eye. Also known as initial or
incipient caries.

DX

ACTIVE

INACTIVE

COLOR

LIGHT

DARK

CONSISTENCY

MUSHY

FIRM

MOISTURE

WET

DRY

SYMPTOM

SENSITIVE

NONE

SHAPE

DEPTH>WIDT
H

WIDTH>DEPT
H

Translucent
zone
Dark zone
Body of the
lesion
Surface
zone

 lesion that may

have formed
years previously
and then
stopped further
progression

 multiple

active carious lesions occurring in

the same patient

frequently

involves surfaces of teeth that

do not usually experience dental caries eg,

bottle or nursing caries, baby caries,
radiation caries, or drug-induced caries.

 Goal

elimination of source of
cariogenic organisms by removal of
caries from all deep lesions and
placement of temporary restorations
early in the treatment
This is very important in effecting
reversal of the active caries process

 Cavity

preparation is done quickly

without definitive cavity preparation
Undermined enamel be left to aid in
retention of these treatment
restorations, especially if
restoratives are used that bond to
tooth structure.

Pulpal

response to the
restorative treatment can be
observed and endodontic
treatment instituted if
necessary before planning
definitive restoration.

The

restoration protects the

pulp against further insult and
promotes healing of the lesion
by remineralization of affected
dentin and stimulation of
reparative dentin.

1. CaOH :
- bacteriocidal
- stimulates reparative dentin
2.Reinforced Zinc Oxide-eugenol
- reducing pain and sensitivity
- bacteriocidal to organisms deep in the
cavity
- seals margins for several
months,preventing ingress of nutrients to
the organisms
- fair strength

 GI :
bonds to tooth structure for improved

retention
release fluoride reduces organisms
and promotes remineralization
good marginal seal
fair strength
esthetically pleasing

Amalgam
has excellent strength
maintains occlusal and
proximal relationships
fair marginal seal,
best for long term temporary

 All infected dentin is excavated with

large round burs and excavators

being careful not to expose the pulp
basic fuchsin effectively identifies
infected dentin.
A small amount of firm caries
(affected dentin) is left over sites of
potential exposure.

 Calcium hydroxide liner

- placed in the deepest areas
- high pH of the CaOH will neutralize

acid kill bacteria and stimulate

formation of restorative dentin.
The rein-forced ZOE/ GI/ Amalgam
restoration is placed

 After

6-8 weeks
- entire restoration removed
- any remaining caries is removed
- definitive restoration is planned