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VS
MIGHTY TOOTH
INVISIBLE STRAINS
GOOD MORNING!Dr. Ram
DENTAL CARIES- An irreversible microbial process….
Dr. Ram
•INTRODUCTION
•DEFINITION
•REMINERALISATION AND DEMINERALISATION
•CLASSIFICATION OF DENTAL CARIES
•ZONES OF ENAMEL CARIES
•ZONES OF DENTAL CARIES
•MICROBIOLOGY OF THE DENTAL CARIES
•THEORIES OF DENTAL CARIES
CONTENTS
I’M READY…
Dr. Ram
•IMMUNOLOGY OF DENTAL CARIES
•GENERAL CLINICAL FEATURES
•DIAGNOSIS
•CARIES ACTIVITY TESTS
•MANAGEMENT AND TREATMENT
•RECENT UPDATES
WHERE I’M I NOW?
Dr. Ram
• COMMON REASON FOR TOOTH LOSS.
•Disease of Civilization- Due to habits & Diet.
•TRANSMISSIBLE DISEASE.
•WINDOW OF INFECTIONMATERNAL CARIES LEVEL
DIETARY SUCROSE LEVELS
INTRODUCTION
Dr. Ram
Simple caries can …
? nextDr. Ram
DEFINITION OF DENTAL CARIESDEFINITION OF DENTAL CARIES
MISTAKE?? Dr. Ram
•REMINERALISATION AND DEMINERALISATION OF DENTAL CARIES
PLAQUE FORMATION ( NATURAL , PHYSIOLOGICAL PROCESS)
BACTERIA----------CARBOHYDRATES---------SUCROSE----------PH-BELOW -5DEMINERALISATION
REMINERALISATION
Saliva neutralizes the acid, ph increased and minerals may be gained.
Dr. Ram
Dr. Ram
The cumulative process of de and remineralisation leads to net loss of minerals.
DENTAL CARIES
Dr. Ram
CLASSIFICATION
OF DENTAL CARIES
Dr. Ram
Dr. Ram
Dr. Ram
Dr. Ram
Dr. Ram
Dr. Ram
Pit & Fissure Caries
Bluish Discoloration
Dr. Ram
Proximal caries
Dr. Ram
CERVICAL CARIES
crescent shaped
Dr. Ram
Secondary / Recurrent Caries
Dr. Ram
ETIOLOGY OF DENTAL CARIESETIOLOGY OF DENTAL CARIES
Dr. Ram
Factors responsible for carbohydrates to be cariogenic
1.Physical nature- Sticky, solid carbohydrates, REFINED.
2. Chemical nature- glucose, galactose, sucrose, lactose &
starch.
3. Route of intake- tube/IV line don’t contribute to caries
4. Clearance rate- salivation causes less caries & vice versa
5. Frequency of intake- INTAKE, caries incidence is
more
Dr. Ram
Other components of diet
Primitive man – unrefined, fibrous diet which cleaned teeth automatically, caries’ incidence
Modern man – soft diet with refined sugars, caries’ incidence
Dr. Ram
Fat & proteins taken with sugars prevent attachment of
carbohydrates to tooth surface
Dr. Ram
PLAQUE AND
MICROBIES OF DENTAL CARIES
And their types
Dr. Ram
ACQUIRED PELLICLE
1st layer of glycoprotein deposited on teeth 30 mins after brushing.
Doesn’t contain micro-orgs, but gets colonized with bacteria-forming plaque.
Derived from saliva.
Dr. Ram
PLAQUE AND TYPES– Is a white, tenacious substance/deposit on tooth
surface which contains glycoproteins derived from saliva.
– Also contains, micro-orgs, desquamated epithelial cells, Ca, Ph, etc
– Causes dental caries & periodontal disease
– Formed from structure called “acquired pellicle”Dr. Ram
•Acidogenic bacteria-dental caries
•Proteolytic bacteria-periodontal disease
BACTERIA
Pioneer / primary bacteria – initiate caries
S.mutans (smooth surface caries)Lactobacillus acidophilus (pit & fissure caries)Actinomyces (root surface caries)
Invaders / secondary bacteria
Staphylococcus, VeillonellaeDr. Ram
•MICROBIOLOGY OF THE DENTAL CARIES
•STREPTOCOCCOUS
•ACTINOMYCES
•LACTOBACILLI
Dr. Ram
S.m, S.sangLacto.Actinomyce.
Sm, S salivaries
A. vActi. NS.MS.sang
LA. SPACT. SPFILAMENTOUS ROD SHAPED
Dr. Ram
S.MUTANS
•Most common, smooth surface caries producing orgBoth acidogenic & aciduric.
•Attachment to tooth by Glucans dextrans synthesis from dietary sucrose by polymerization.
•Synthesized by enzyme present in mutans’ cell wall – Glycosyl transferase.( GT)
Dr. Ram
sucrose stored by mutans, released when required to cause caries.
•Mutans thickness of plaque – hampers diffusion of salivary bi-carbonates into plaque, risk of caries.
Dr. Ram
Stephan’s curve
Critical pH – 5.5Resting pH in caries active ppl – 5.8In caries immune ppl – 6.5
Graph showing behavior of pH in caries active & immune ppl, after a 10% glucose rinse
SALIVA
IMMUNE
ACTIVE
CARBOHYDRATE DIET
Dr. Ram
SALIVAFlow rate: FR, caries & vice versa
Buffering capacity: BC, caries & vice versa
Amount of salivary secretion: , then caries
Dr. Ram
COMPONENTS OF SALIVA
•Bicarbonates (salivary buffers), diffuse into plaque, acid
•Anti-bacterials like lactoferrin, lysosome, thiocynate, etc, present in saliva.
•Ig A in saliva, prevents attachment of bacteria on tooth surface Ions Ca, P help in remineralization.
•Salivary urea & bicarbonate rate of glycolysis I.e, glucose metabolism is faster, so, contact time of teeth with carbohydrates is reduced
Dr. Ram
THEORIES OF DENTAL CARIES
1) EARLY THEORIES: WORMS
2) ENDOGENOUS THEORY
- HUMORAL- VITAL- STAGNATION
3) EXOGENOUS THEORIES
-CHEMICAL THEORY-PARASITIC/SEPTIC THEORY-CHEMICO-PARASITIC THEORY ( MILLER’S/ ACIDOGENIC) THEORY-PROTEOLYTIC THEOTY-PROTEOLYTIC CHELATION THEORY-COMBINED ACIDIOGENIC AND PROTEOLYTIC THEORY
Dr. Ram
OTHER THEORIES-SULFATES THEORY
-COMPLEXING AND PHOSPHORYLATING THEORY
-SUCROSE CHELATING THEORY
-AUTOIMMUNE THEORY
-GENETIC THEORY
-CELLULOSE THEORY
-CARIES SURVILLENCE THEORY
Dr. Ram
• ACIDOGENIC THEORY– Miller 1890, most accepted.
– “Acids formed due to the fermentation of dietary carbohydrates by oral bacteria leads to progressive decalcification of tooth structure with subsequent disintegration of organic matrix”
– He isolated micro-orgs from his experiments & stated that many were involved in the carious process.
TOOTH
PLAQUE
BACTERIA
SUGAR
ACIDS
TOOTH DECAY
Dr. Ram
– 4 important factors which can influence process of tooth destruction in process of dental caries
• Dietary carbohydrates, micro-organisms, acid, plaque.
Dr. Ram
Dr. Ram
PELLICLE FORMATION
COLONIZATION OF S. MUTANS AFTER 0-4 HRS
4-24 HRS MANY MICROBIAL COLONIES ARE FORMED WITH IN IT.
PLAQUE FORMATION
S.MUTANTS DOMINATION
CONVERSION OF CARBOHYDRATES INTO SUGARS ( SUCROSE)
RELEASE OF ACID (LACTIC ACID )Dr. Ram
• LIMITATIONS
– Did not explain sub-surface demineralization
– Failed to justify rampant caries
– Did not explain caries in impacted tooth
Dr. Ram
Proteolytic theory
• “ Formation of DC is essentially a proteolytic process. Bacteria present produce hydrolytic substances/enzymes & cause proteolysis leading to dissolution of organic substances”
• His view micro-orgs don’t cause decalcification but dissolution of organic substances present in the tooth. Micro orgs entered enamel through enamel lamellae & caused dissolution.
Dr. Ram
• Limitations – The carious lesion couldn’t be reproduced in vitro by
the proteolytic mechanism.
– Proteolytic bacteria are very uncommon in the oral
cavity.
– This theory cant explain the role of sucrose, pH and
fluoride in DC
Dr. Ram
Proteolytic Chelation theory
• Chelate formation- citrate, lactate
• During DC, proteolytic breakdown of organic portion of enamel matrix takes place first.
• Following this, chelating agent is formed by combination of proteolytic breakdown products, acquired pellicle, food debris, etc.– Ex of chelating agent: citrate, lactate, etc
Dr. Ram
•Even this theory failed to explain about sugar
or acid production
Dr. Ram
Autoimmune theory
• Few odontoblast cells at specific sites within pulp of specific teeth are damaged by autoimmune mechanism
• Due to this the defense capacity & integrity of of enamel and dentin in those specific areas are compromised and act as potential sites for caries development in future
Dr. Ram
DENTAL CARIES
•ZONES OF ENAMEL CARIES
•ZONES OF DENTAL CARIES
Dr. Ram
•ZONES OF ENAMEL CARIES
E
NA
ME
L
-ZONE- 1
-ZONE-2
-ZONE-4
-ZONE-5
TRANSLUCENT ZONE
DARK ZONE
BODY OF THE LESION
SURFACE ZONEDr. Ram
ENAMEL CARIES ( PIT AND FISSURE)
1
23
4
.
Inner most zoneAdvancing end
Birefringence – polarised light
Max demineralised area
40 microns thickness
Dr. Ram
SMOOTH SURFACE CARIESDr. Ram
Dr. Ram
Dr. Ram
•ZONES OF DENTINAL CARIES
Enamel
DEJ
Dentin
E-D- ACIDS- DEMINERALIZATION
ZONE-1- Fatty degeneration (T D F)
ZONE-2- Dentinal sclerosis
ZONE-3- Demineralization
ZONE-4- Bacterial invasion/ Turbid Dentin
ZONE-5- Decomposed dentin
Dr. Ram
DECALCIFIED STRUCTURE OF DENTAL CARIES
5
4
3DEMINERLIZED ZONE (WITHOUT BACTERIAL INVASION)
ROSARY BEAD APPEARENCE
Dr. Ram
Liquefaction Foci-Dentinal caries
Dr. Ram
ZONE-2- DENTINAL SCLEROSIS
ZONE- 1- (F D T D F)
•ADVANCING END NEAR PULPAL SURFACE
•DEPOSITION OF FAT GLOBULES AT THE ODONTOBLASTIC PROCESS
ZONE-1- Fatty degeneration (T D F)
ZONE-2- Dentinal sclerosis
ZONE-3- Demineralization
ZONE-4- Bacterial invasion
ZONE-5- Decomposed dentin
Dr. Ram
Dr. Ram
Expansion & Fusion Of Tubules-Liquefaction Foci
Dr. Ram
Transverse Clefts
Dr. Ram
Caries in Dentinal Tubules
Dr. Ram
Dr. Ram
Bacteria wins the battle!
Thank you!Dr. Ram