DENTAL CARIES
Dr. SALEEM SHAIKH
7/1/2016
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What is Dental Caries
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DEFINITION OF CARIES
 “Irreversible
microbial disease of the
calcified tissue of teeth, characterized by
Demineralization of the inorganic portion
and destruction of the organic substance
of the tooth which often leads to
Cavitations”
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“Dental Caries is a process which occurs on any tooth
surface where Dental Plaque is allowed to develop
over a period of time”
PLAQUE
(In the presence of carbohydrate)
BACTERIA IN PLAQUE
(Metabolically active)
FERMENTS SUITABLE CARBOHYDRATE
PRODUCES ACID
(Plaque ph decreases)
DEMINERALIZATION
(Remineralised by saliva Ca + Po4 )
REMINERALIZATION
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FACTORS AFFECTING CARIES PREVALENCE

Race
– Blacks fewer prone to caries then whites

Age
– ***************

Gender
– Females >> males (permanent dentition)

>>
Familial
– Siblings of individuals with high caries susceptibility
are generally active
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Theories of caries formation


Legend of worms
Endogenous theory
Chemical Theory
Parasitic theory

Miller’s Chemico-Parasitic Theory, or Acidogenic Theory

Proteolytic theory

Proteolysis chelation theory


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Miller’s Chemico-Parasitic Theory /
Acidogenic Theory
W.D.MILLER


Caries is caused by acids produced by micro-organisms of mouth
The acids affects the primary Decalcification, derived from
Fermentation of Starch & Sugar
Significance of W.D.Miller’s Observation:
 Oral micro-organisms in production & proteolysis
 Carbohydrate substrate
 Acid which causes dissolution of tooth minerals
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CLASSIFICATION
 According to Morphology of anatomical site of lesion:
- Pit & Fissure caries
- Smooth surface caries
 Depending upon the dynamics with regard to the rate of caries
progression:
- Acute dental caries
- Chronic dental caries
 According to whether the lesion is a new one attacking a
previously intact surface:
- Primary (virgin) caries
- Secondary (recurrent) caries
 Based on Chronology:
- Infancy (soother / nursing bottle caries)
- Adolescent caries
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CLASSIFICATION CONTD…….
(1) According to Morphology of Anatomical Site:
 Pit & Fissure Caries
–Commonest
– Develops in the “occlusal surface of molars & pre molars”, in
the Buccal and Lingual surface of the molars and in the lingual
surface of the maxillary incisors
 Smooth Surface Caries:
– Caries that develop on the proximal surfaces of the teeth on
the gingival third of the buccal & lingual surface
– Generally preceded by the formation of microbial or dental
plaque
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CLASSIFICATION CONTD…….
(2) Classification Based on Severity and Rate of Progression:
 Acute Dental Caries
–Caries that runs a rapid clinical course and results in early pulp
involvement by the carious process
– Occurs frequently in children and young adults
 Chronic Dental Caries
–Progress slowly and tends to involve the pulp, much later than
acute caries
–Common in adults
–Dentin is deep brown in colour
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CLASSIFICATION CONTD…….
Recurrent Caries:
–Occurs in the immediate vicinity of restoration
–Due to inadequate extension of original restoration favoring
retention of dentin, or to poor adaptation of the filling material
to the cavity
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CLASSIFICATION CONTD…….
(3) Based on Chronology:
Nursing Bottle Caries
–Due to prolonged use of nursing bottle containing milk or milk
formula, fruit juice or sweetened water
–Prolonged breast-feeding
Adolescent Caries
–They are acute caries attacking in the latter period
–Seen in teeth and surfaces that are relatively immune to caries,
with a relatively small opening in enamel
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HISTOPATHOLOGY OF DENTAL CARIES

Enamel Caries

Dental Caries
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HISTOPATHOLOGY OF DENTAL CARIES
ENAMEL CARIES
4 ZONES ARE DISTINGUISHED--
(1)Translucent Zone
(2)Dark Zone
(3)Body of Lesion
(4)Surface Layer
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ENAMEL CARIES
(1)TRANSLUCENT ZONE
Deepest zone
Appears structure less when perfused with Quinoline solution
Slightly more porous then sound enamel
Pore volume of 1% ; 10 times greater than the sound enamel
(2)DARK ZONE
Next deepest zone
Dark Zone as it doesn’t transmit polarized light
Opaque
It has pore volume of 2-7%
Also known as “Positive Zone” as it shows positive
birefringence of sound enamel when examined with polarizing
microscope after inbibition with Quinoline
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ENAMEL CARIES
(3) BODY OF LESION
Area of greatest demineralization
Largest pore volume, varying from 5% at the periphery to
25% at the center of the intact lesion
Striae of Retizus are well marked
(4) SURFACE ZONE
Unaffected by caries attack
Has a lower pore volume than the body of the lesion (less
than 5%)
Shows negative birefringence
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DENTINAL CARIES
4 ZONES OF DENTINAL CARIES:
(1) Normal Dentin
(2) Sub-transparent Dentin
(3) Transparent Dentin
(4) Turbid Dentin
(5) Infected Dentin
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DENTINAL CARIES
(1) NORMAL DENTIN
Deepest area
Odontoblastic processes are smooth and no crystals are in
the lumens
The inter-tubercular dentin has normal cross-banded
collagen and normal dense apatite crystals
No bacteria are in the tubules
Stimulation of the dentin produces a sharp pain
(2) SUBTRANSPARENT DENTIN
It is the next layer
Zone of demineralization of intertubular dentin
Formation of crystals in the tubule lumen
No bacteria are found in the tubule
Stimulation of dentin produces pain
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DENTINAL CARIES
(3) TRANSPARENT DENTIN
Zone of carious dentin
Shows further loss of mineral from the intertubular dentin
Large crystals are seen in the lumen of dentinal tubules
(4) TURBID DENTIN
Zone of bacterial invasion
Widening & distortion of dentinal tubules: Millers foci of degeneration
Filled with bacteria: Pioneer bacteria.
Collagen are irreversibly denatured
(5) INFECTED DENTIN
Outermost zone
Composed of decomposed dentin
Contains bacteria
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CARIES PREVENTION
(1) FLOURIDE EXPOSURE
Increase resistance to caries
By fluoridated community water systems, tooth paste,
mouth wash, and professional topical applications
1ppm of fluoride is optimal for public water
(2) IMMUNAIZATION
For patients with high concentration of MS, agglutination
IgA may have an anticaries effect
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CARIES PREVENTION
(3) SALIVARY FUNCTIONING
Saliva stimulants such as gums, paraffin waxes, or saliva
substitutes, may also be prescribed for patients with
impaired salivary functioning
(4) ANTIMICIROBIAL AGENTS
“Chlorohexidine” – by enhancing remineralisation and
Decreasing microbial presence
“Penicillin” – because of its antibiotic property, which is the
ability of the product of an organism to inhibit the
normal biologic processes of other organisms
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CARIES PREVENTION
(5) DIET
By checking excessive and frequent intake of sucrose
which causes caries
Dietary counseling is done to identify sources of sucrose
in the diet and reduce the frequency of sucrose ingestion
(6) ORAL HYGIENE
Good oral hygiene as plaque free tooth surface do not decay
By dental flossing, tooth brushing and rinsing; best method
for prevention of caries
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ATLAS OF DENTAL CARIES
(1)Tooth surface without caries , (2)The first signs of demineralization,a
small “white spot” has been formed (initial caries, incipient caries).
(3)The enamel surface has broken down. A “lesion” with a soft floor is
formed, (4)A filling has been made, but demineralization has not
stopped and the lesion is surrounding the filling; sometimes called
“Secondary caries, (5)The demineralization proceeds and undermines
the tooth,
7/1/2016(6)The tooth has fracture!!
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