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
 is an infectious, communicable
disease

causes destruction of teeth by

acid-forming bacteria found in
dental plaque (NIH, 2002)

is a DYNAMIC disease process

not a STATIC problem

before a cavity is formed, the

caries infection can be reversed
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 diet
s

dental
susceptibl
e
Bacteria plus food Demineralization
makes the saliva
very acidic within
5 minutes

Saliva is normal
30 minutes
Remineralization after eating

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 CARIES CONTROL

DENTAL
CARIES

Tooth Diet Bacteria Saliva

Age Frequency S. Mutans Flow rate

Morphology Sucrose Plaque Viscosity
Fluoride Acidic F&B Brushing Buffering
White spots Flossing
Restoration,3 yrs Restoration
Enamel lesion
Dentinal lesion
Pulpal lesion
Filling
Dental appliance
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
1. 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
 Dental Caries

Enamel Caries Dentin Caries Cementum Caries

(Root caries)

Smooth surface 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 WIDTH>DEPTH
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.
 SALIVA CHECK:
Flow
S.Mutans
Concistency check
pH Lactobacill
Buffer
SALIVA BACTERIA

OH
DIET
Care
Brushing Sugar vs Fiber
Fluor Snack
Rinsing Frequency
 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