NORMAL TOOTH
Definition
According to Sturdevants Dental caries is an
infectious microbiologic disease of the teeth that
results in localized dissolution and destruction of
the calcified tissues .
According to Shafers the microbial disease of
the calcified tissues of teeth, characterized by
demineralization of the inorganic portion and
destruction of organic substance of the tooth .
According to WHO caries is defined 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 .
CLASSIFICATION
On basis of occurrence as a new or on previously
attacked surface :
(1) Primary Caries-is the original carious lesion of
the tooth .
(2) Secondary Caries / Recurrent caries - occurs at
the junction of a restoration & under it
ON BASIS OF LOCATION
PIT &FISSURE CARIES
Form in the regions of pits and fissures usually
resulting from imperfect coalescence of the
developmental lobes.
Diagrammatically caries may be represented as
two cones ,base to base, with the apex of the enamel
cone at the point of origin and the apex of the dentin
cone directed toward the pulp.
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ON BASIS OF PROGRESSION OF
CARIES
Forward Caries is wherever caries cone in
enamel is larger or at least is the same size as
that in dentin
Backward Caries- when the spread of caries
along the DEJ exceeds the caries in contiguous
enamel ,caries extend into this enamel from the
junction and is termed backward caries
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CAVITATED
CARIES
(NONREVERSIBLE)
The
enamel surface is broken & usually the lesion has
advanced into dentin. Usually remineralisation is
not possible.
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G.V.BLACKS CLASSIFICATION
Class I cavities- All pit and fissure cavities i.e.cavities on
occlusal surface of premolars and molars,cavities on
occlusal two thirds of the facial and lingual surfaces of
molars,cavities on lingual surface of maxillary incisors.
Class II cavities- Cavities on the surface of proximal
surfaces of posterior teeth.
Class III cavities - On the proximal surfaces of anterior
teeth that do
not involve the incisal
angle.
Class IV cavities- On the proximal surfaces of anterior
teeth that do involve the incisal edge.
Class V cavities- On the gingival third of the facial or
lingual surfaces of all teeth.
Class VI cavities- On the incisal edge of anterior teeth or
occlusal cusp heights of posterior teeth.
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PREDOMINANT SPECIES
Enamel Caries - S Mutans
Dentin Caries - S Mutans &Lactobacillus
Root Caries
- Actinomyces species
.
Actinomyces odontologica,
Actinomyces naeslundii
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HOST
The two main host factors are:
(A) Saliva
(B) Tooth
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SALIVA
Saliva is the primary means by which the host
exerts control over its oral flora. The modifying
factors can be defined as ;
Composition
Quantity
Viscosity
Antibacterial Properties
Buffering Capacity of Saliva
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Composition
Inorganic
Calcium and phosphate contents present in saliva
are inversely related to caries.
Fluoride is also inversely related to caries.
Organic
Ammonia reduces plaque formation and
neutralize acid.
Urea gets hydrolyzed to ammonium carbonate by
urease, thus increases the neutralizing power of
the saliva.
Amylase/Ptyalin a substance responsible for the
degradation of starches.
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Quantity
Adults produce 1 to 1.5 L of saliva a
flushing effect of the salivary flow
microorganisms not adherent to an oral
Therefore, an inverse relationship
salivary flow rate and caries exist.
day. The
removes
surface.
between
Viscosity
High caries incidence is associated with thick
mucinous saliva. Viscosity of the saliva is due to
mucin content derived from the submandibular,
sublingual glands.
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Antibacterial Properties
Lysozyme - In the presence of sodium lauryl
sulfate , can lyse many cariogenic and non
cariogenic streptococci.
Lactoperoxidase
Immunoglobulins (mainly IgA)
Lactoferrin
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Buffering Capacity of
Saliva
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TOOTH
Tooth is one of the major modifying factors of the
carious process which can be described as:
Tooth Morphology
Tooth Composition
Tooth Position
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Tooth Morphology
Enamel
hypoplasia
predisposes
to
the
development of dental caries. More severe the
tooth is affected, the more extensive will be the
caries.
Presence of deep, narrow occlusal fissures or
buccal or lingual pits predisposes to the
development of caries. Such fissures tend to trap
food, bacteria and debris. Food impaction and
bacterial stagnation leads to caries.
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Types of Fissures
1. V type wide at the top and gradually narrowing
towards the bottom (34%)
2. U type almost the same width from top to
bottom (14%)
3. I type an extremely narrow slit (19%)
4. IK type- hourglass extremely narrow slit
associated with a higher space at the bottom
(26%)
5.Inverted Y type bifurcating at the bottom
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Tooth Composition
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DIET
The main dietary factors effecting carious process
are:
Type of Carbohydrate
Physical Nature of Carbohydrate
Frequency of Consumption
Other Dietary Factors
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Caries Diagnosis
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Visual Examination:
under clean and dry conditions using good illumination
n Brownish discoloration of pits and fissures
n Opacity beneath pits and fissures or marginal
ridges
n Frank cavitation of the tooth surface.
Problem: discoloration of the pits & fissures may be
mistaken for the presence of caries.
Magnifying lens: enhances Visual examination
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Disadvantages:
1. May transmit cariogenic bacteria from one site to another.
2.May produce irreversible traumatic defects in potentially
remineralizable enamel.
3.May not be able to add any information to the visual
examination.
4.Mechanical binding of an explorer tip in a fissure may not
be because of caries but because of other causes like:
a.
Shape of the fissure.
b.
Sharpness of an explorer.
c.
Force of application.
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Conventional Radiographs:
presents a 2-D picture of a 3-D object.
intraoral periapical
bitewing radiographs
(bitewing radiographs have more diagnostic
value)
Advantages:
Non-invasive method
Disclose sites inaccessible to other diagnostic
methods
Permanent record for monitoring progress or
arrest of the carious lesion.
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5.
6.
7.
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caries
Cervical Burnout
Cervical burnout is an apparent radiolucency found just
below the CE junction on the root due to anatomical
variation (concave root formation posteriorly) or a gap
between the enamel and bone covering the root
(anteriorly).
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bone level
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RADIOVISIOGRAPHY
Introduced in 1989 in dentistry.
Principle- Digital, filmless technique that is based on
image acquisition from CCD(Charged Coupled Device).
CCD- semiconductor made of metal oxides coated with
x-ray sensitive phosphorus, is electrically connected to
the computer.
The Digital Image Receptor(DIR) is placed in the mouth.
Once the image has been captured by the CCD, it can
be stored in the computer memory for processing &
viewing.
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initially
designed
for
proximal
caries
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DIGITAL FIBREOPTIC
TRANS ILLUMINATION
The
receptor
with
photocells converts photon
energy to electrical energy
transmitted to a video
processor-converted
into
colour value and displayed
on video monitor.
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QUANTITATIVE LASER
FLUORESCENCE (QLF)
LF method measures the fluorescence of the tooth that is
induced after light irradiation to discriminate between
carious and sound enamel.
Uses laser light at/near 488 nm to quantify tooth
demineralization.
To quantify the mineral loss, the device was improvised
with a CCD camera and computerization.
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DIAGNODENT
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Why??
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CARIES PREVENTION
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Should aim
To asses the caries risk
To increase tooth resistance
To modify diet
To combat the microbial agent
To deliver anticaries measures to the
public
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Anti Caries
Campaign
SERVICE
S
ON
Individua Diet,
l
Checkups
SECONDA
RY
PREVENTI
EARLY
ON
DIAGNOSIS
C
& PROMPT
PROTEC TREATMEN
TIO-N
T
TERTIARY
PREVENTION
DISABILI REHABILI
TY
TAT-ION
LIMITATI
ON
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LEVELS
PRIMARY
OF
PREVENTION
PREVENTI
PREVENT HEALTH
ON
IVE
PROMOTI SPECIFI
Oral
Self
Utilization Utilization
hygiene, examination of
of
Fluorides utilization of services
services
services
Screening
provision of
dental
services
Provision
of dental
services
Provision
of dental
services
Dental
Education, Topical
professio plaque
applicati
nal
control
on
program,
fluorides,
Examn,
prompt
treatment,
preventive
Complex RPD/FPD
restorativ implants
e tt,
pulpotom
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Dentist
Prophylaxis [ scaling and root planing]
Pit and fissure sealants
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Conclusion
Changes in caries patterns in developed countries will
dramatically affect the nature of operative dentistry
practiced in the near future
Little is known about the caries risk in adults, particularly
with regard to root caries, except that the risk increases
with age. It is expected that the prevalence of root caries
will increase over the next several decades.
The emphasis should be on understanding and
controlling the carious process rather than spending
huge amounts of money to correct the disability arising
out of dental caries.
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Kauffman
THANK YOU
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