Caries Diagnosis and Progression

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 1/18

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 2/18

It is an irreversible microbial disease of calcified tissue of teeth characterized bydemineralization of inorganic portion and

destruction of organic substance of the toothwhich often lead to cavitation.

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 3/18

According to location:a) pit and fissure

b) Smooth surface

c) Root surface

Acc. to structure of tooth:

a) Enamel

b) Dentine

c) Cementum

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 4/18

Onset and progression:

a) Acute

b) Chronic

c) Incipient

 Acc. To chronology:

a) Infancyb) Aldosencent

c) Adult

Acc. to senile:

a) Rampant

b) Arrested

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 5/18

 The Early Theories :

I. The legend of worm.

II. Endogenous theories

III. Chemical theory

IV. Parasitic theory

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 6/18

It states that caries is caused by ACIDproduced by microorganisms of the mouth.

Dental decay is a CHEMOPARASITIC PROCESSconsisting of two stages :

I. Decalcification of enamel and dentine (

preliminary stage ).II. Dissolution of the softened residue (

subsequent stage ).

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 7/18

 Acids resulting in primarydecalcification is produced byfermentation of starches and sugar

from the retaining centers of teeth.

 Significance of Miller’s observation

included three factors namely :1. Oral microorganisms.

2. Carbohydrate substrate.

3. Acid produced by themicroorganisms.

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 8/18

ZONES OF ENAMEL CARIES:

Zone 1:Translucent zone (TZ): First recognizable zone of the lesion. Advancing front of the lesion . Half the lesions demonstrate TZ ,not always

present.

TZ appears structure less. Pore volume -1% (compared to 0.1% sound enamel)

Zone 2: Dark zone:

Lies adjacent and superficial to the TZ . Positive zone. Shows positive birefringence (in contrast to sound

enamel)

Pore volume of 2%-4% (polarized light )

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 9/18

Presence of small pores,large molecules of quinolone are enable to penetrate.

Micropore system –gets filled with air and becomedark.

Medium like water may penetrate.

Zone 3:Body of lesion Between unaffected surface and dark zone.

Area of greatest demineralization .

Pore volume -5% in periphery and 25% in centre.

Water imbibition- positive birefringence compareto sound enamel.

Striae of retzius -prominent

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 10/18

Zone 4: surface zone

Quantitative studies –partial demineralization of 1-10%.

Pore volume –less than 5% of spaces.

Negative birefringence-water imbibition.

Positive birefringence-porous subsurface.

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 11/18

f

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 12/18

 Dentinal caries starts from DEJ andinvolves greater number of dentinaltubules.

It includes following stages namely :

1. Early dentinal changes.

2. Advanced dentinal changes.

3. Secondary dentine involved.

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 13/18

 Caries penetrate initial to dentine. Ground section shows TRANSPARENTappearance of tooth surface in

transmitted light. Reflected light shows SCLEROTICdentine, which will appear dark.

 Fatty degeneration of TOME’S fibers. 

PIONER bacteria in early stages of caries is seen.

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 14/18

 Here, decalcification of tubule wall,

liquefaction of foci is seen. Globular dentine also showsdecalcification.

Proteolytic enzyme produced bymicroorganisms cause furtherdestruction.

Lathery consistency of necrotic massis seen.

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 15/18

 Zone 1 : Zone of fatty degeneration of 

Tome’s process.  Zone 2 : Zone of dentinal sclerosis.

Zone 3 : Zone of decalcification of 

dentine. Zone 4 : Zone of bacterial invasion of decalcified but intact dentine.

Zone 5 : Zone of decomposeddentine.

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 16/18

 The caries involvement of secondarydentine is usually slower because thedentinal tubules are fewer in number

and more irregular in their course,thus delaying the penetration of theinvading microorganisms.

Occasionally, caries will spreadlaterally at the junction of the primaryand secondary dentine and produces aseparation of two layers.

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 17/18

7/28/2019 Caries Diagnosis and Progression

http://slidepdf.com/reader/full/caries-diagnosis-and-progression 18/18