DENTAL

CARIES

P re p a re d by:
Dr. S w a t i G o e l
D e n t a l Caries

progressive

initially subsurface
demineralization of teeth by
bacterial acid

one of the most common of all

diseases

major cause of loss of teeth

D e n t a l Caries

biological process of tooth decay with

mutifactorial etiology

microbial disease of calcified tissues

of teeth

characterized by demineralization of
inorganic portion

destruction of organic substance of

tooth
 Etiology of D e n t a l Caries
Possible interventions Possible interventions

Reduce intake of ariogenic sugars Reduce Strep. mutans

c articularly sucrose numbers by:
P Diet
Bacteria Reduction in sugar intake

Caries

Possible interventions
Susceptible Water + other types of
Time Surface Fluoridation
Possible interventions (Host)
Prevention during post-
Avoid frequent sucrose intake eruptive maturation
(snacking) Fissure sealing

Stimulate salivary flow Properly contured

+ sugar clearance restorations
Etiology of D e n t a l Caries

New Theories

(1) Acidogenic Theory

(2) Proteolytic Theory
(3) Proteolysis-chelation Theory
Old
NewTTheories
h e o r i e s (Exogenous
Theory)
(1) Acidogenic/Chemoparasitic Theory

1890

WD Miller

dental decay is a chemoparasitic process

consisting of 2 stages

• decalcification of enamel results in total

destruction
Old
NewTTheories
h e o r i e s (Exogenous
Theory)
(1) Acidogenic/Chemoparasitic
Theory

• decalcification of dentin as a
preliminary stage

followed by dissolution of softened

residue
Old
NewTTheories
h e o r i e s (Exogenous
Theory)
(1) Acidogenic/Chemoparasitic Theory

following factors cause decay:

• (1) Role of carbohydrates

• (2) Role of microorganisms
• (3) Role of acids
• (4) Role of dental plaque
Old T h(1)Acidogenic/
eories
Chemoparasitic Theory
(1) Role of carbohydrates

food substances act as substrate

for microorganisms of dental
plaque

various carbohydrates have been

examined for cariogenic potential
Old (1)Acidogenic/
Theories
Chemoparasitic
Theory
(1) Role of carbohydrates

cariogenicity of carbohydrate
varies with:

• (1) frequency of ingestion

• (2) physical form
• (3) chemical composition
• (4) route of administration
• (5) presence of other food
constituents
Old (1)Acidogenic/
Theories
Chemoparasitic
Theory
(1) Role of carbohydrates

• (1) frequency of ingestion

taken repeatedly in between

two major meals

provides constant supply of

carbohydrate to plaque
bacteria for fermentation + production of
acids
Old (1)Acidogenic/
Theories
Chemoparasitic
Theory
(1) Role of carbohydrates

• (2) physical form

sticky

solid carbohydrates
Old (1)Acidogenic/
Theories
Chemoparasitic
Theory
(1) Role of carbohydrates

• (3) chemical composition

in the form of glucose, sucrose

+ fructose due to low molecular
weight

rapidly diffuse into plaque

make themselves easily

available for fermentation by
plaque bacteria
 (1)Acidogenic/
Chemoparasitic
Theory
(1) Role of carbohydrates

• (4) Route of administration

oral intake of sticky food

 (1)Acidogenic/
Chemoparasitic
Theory
(1) Role of carbohydrates

• (5) Presence of other food

constituents

refined pure carbohydrates more caries

producing
 (1)Acidogenic/
Chemoparasitic
Theory
(2) Role of microorganisms

caused by acid resulting from action

of microorganisms
on carbohydrates
 (1)Acidogenic/
Chemoparasitic
Theory
(2) Role of microorganisms
Initiation of Dental Progression of Dental
Caries Caries
Streptococci Streptococcal species:
•S. mutans Streptoccal species in deep
•S. milleri dentinal caries and root caries
•S. mitior
•S. sanguis
•S. salivaris
Lactobacilli Lactobacilli in dentin
•L. acidophillus •L. acidophillus
•L. casei •L. casei
Actinomycoses Actinomycoses
•A. viscosus •A. Israeli
•A. naeslundii •A. odontolyticus
 (1)Acidogenic/
Chemoparasitic
Theory
(2) Role of microorganisms

S. mutans has been proved for the

initiation of caries
 (1)Acidogenic/
Chemoparasitic
Theory
(3) Role of acids

play most important role in

pathogenesis of dental caries

pH 5.5 is called critical pH

below this pH demineralization of

tooth substance begins
 (1)Acidogenic/
Chemoparasitic
Theory
(4) Role of Dental Plaque

found on uncleaned tooth surfaces

appear as tenacious, thin film

may accumulate within 24-48

hours
Old Theories
New Theories
(Exogenous Theory)
(2) Proteolytic Theory

proteolysis of the organic

components of tooth
as an initial process

than actual demineralization

+ dissolution of inorganic substances
Old Theories
New Theories
(Exogenous Theory)
(2) Proteolytic Theory

proposed that enamel lamellae

or rod sheath (proteins) may be
lysed

which means proteolysis as first

event in further progression of
bacterial
invasion + demineralization carious
lesions
Old Theories
New Theories
(Exogenous Theory)
(3) Proteolysis Chelation Theory

suggests that caries is caused by

simultaneous events of
proteolysis + chelation

proteolysis
• destruction of organic portion
of tooth by proteolytic
microorganisms
Old Theories
New Theories
(Exogenous Theory)
(3) Proteolysis Chelation Theory

chelation

• removal of calcium by forming soluble

chelates

oral bacteria attack organic component of

enamel (proteolysis)

breakdown products have chelating ability

and this dissolves tooth minerals
Old Theories
Classification

(1) Depending on nature of attack

(2) Depending on progression of caries

(3) Depending on surfaces involved

(4) Based on direction of attack

(5) Based on number of surfaces involved

Old Theories
Classification

(6) GV Black Classification

based on treatment and
restoration design

(7) Based on location of lesion

(8) Based on tissue involved

Old
(1)Theories
Nature of Attack
Primary Caries

incipient; initial

first attack on tooth surface

Secondary Caries

recurrent

occurs on margins or walls of

existing restorations
Old Theories
(2) Progression of Caries

Acute

rapidly invading process

involves several teeth

lesions are soft + light colored

Old Theories
(2) Progression of Caries

Acute

usually pulp is involved at

early stage

• Rampant caries
• Nursing bottle caries
• Radiation caries
Old
(2) PTrhoegorreisessi o n of Caries

Chronic

lesions are long standing

fewer in number
Old
(3)TShue ro frai ec se s i n v o l v e d

Pit and fissure

Smooth surface caries

Old T h e o r i eof
(4) Direction s caries attack

Forward Caries

proceeds from enamel to dentin

lesion is triangle in shaped with

base of triangle at enamel surface +
apex towards
dentin
Old T h e o r i eof
(4) Direction s caries attack

Backward Caries

proceeds from DEJ towards

enamel surface

also triangle shaped with base

at DEJ + apex towards enamel
surface
Old(5)
T hNumber
e o r i e s of Surfaces
involved
Simple

only one surface is involved by

caries

Compound

2 surfaces are involved

Complex

more than 3 surfaces involved

Old T h eB
(6) GV o rl ai ec sk Classification

Class I

begin in pits, fissures + defective

grooves

seen in occlusal surface

occlusal two-thirds of molars

lingual pits of incisors

Old T h eB
(6) GV o rl ai ec sk Classification

Class II

lesions seen on proximal aspects

of molars + premolars
Old T h eB
(6) GV o rl ai ec sk Classification

Class III

lesions involving proximal

aspects of incisors

do not involve or necessitate

removal of incisal edge
Old T h eB
(6) GV o rl ai ec sk Classification

Class IV

lesions involving proximal

aspects of incisors

involve or require removal of

incisal edge
Old T h eB
(6) GV o rl ai ec sk Classification

Class V

lesions present on gingival third of

all teeth
Old T h eB
(6) GV o rl ai ec sk Classification

Class VI

lesions found on incisal edges

+ cusp tips
Old
(7)TLhoecoartiio
e sn of t h e l e s i o n

Pit and Fissure caries

Occlusal
Buccal or lingual pit

Smooth surface caries

Proximal
Buccal or Lingual surface

Root caries
Old
(8) TTihs seuo er iiensv o l v e d

Enamel Caries

Dentinal Caries

Cemental Caries
Classification

Senile Caries

caries associated with aging

almost exclusively seen on root

surface

Residual Caries

not removed during restorative

procedure
Clinical Features: Smooth Surface
Caries
Interproximal Caries

opaque chalky region (white spot)

some cases yellow or brown

pigment area

spots are generally located on

outer surface of enamel between
contact point + height of free
gingival margin
Clinical Features: Smooth Surface
Caries
Interproximal Caries

as caries penetrates
enamel, enamel surrounding the lesion
assumes bluish white appearance

• usally apparent as laterally

spreading caries at DEJ
 Cervical, Buccal, Lingual or
Palatal Caries
Clinical Features:

usually extends from

area opposite gingival crest
occlusally to convexity
of tooth surface

extends laterally towards

proximal surfaces
 Cervical, Buccal, Lingual or
Palatal Caries
Clinical Features:

usually occurs on cervical area

typical cervical lesion is a

crescent shaped cavity beginning
as slightly roughened chalky
area

gradually becomes excavated

P i t a n d F i s s u r e Caries

Clinical Features:

appears brown or black

feel slightly soft

catch a fine explorer point

 Pit and Fissure Caries

Clinical Features:

enamel bordering the pit and

fissure may appear

• opaque as it becomes
• bluish white undermined
Pit and Fissure Caries

Clinical Features:

lateral spread of caries at DEJ as well

as penetration into dentin along
dentinal tubules may be extensive

without fracturing away overhanging

enamel

there may be large carious lesion

with only a tiny point of opening
Root Caries

also known as cemental

caries

involves both dentin +

cementum

in number of people
exhibiting gingival recession
with clinical exposure of
cemental surface
Root Caries

Clinical Features:

slowly progressing chronic lesion

usually found in mandibular molar

area + premolar region

gingival recession is associated

with root surface caries
Recurrent Caries

occurs immediately adjacent to

restoration

may be caused by inadequate

extension of restoration

was not able to excavate or

removed well original carious
lesion
Recurrent Caries

Clinical Features:

restoration with poor margins

• permitted leakage + entrance

of both bacteria + substrate
Nursing Bottle
Caries
Etiology:

due to nursing bottle

containing milk or milk
formula, fruit juice or
sweetened water

sometimes it occurs due to

sugar or honey-sweetened
pacifier
Nursing Bottle
Caries
Pathogenesis:

child is put on bed at afternoon

nap time or at night with nursing
bottle containing milk or a sugar
containing beverage

milk or sweetened liquid becomes

pooled around maxillary anterior
teeth
 Nursing Bottle
Caries

Clinical Feature:

early carious involvement of

maxillary anterior, maxillary +
mandibular 1st permanent molars,
mandibular canines
 Nursing Bottle
Caries
Clinical Feature:

carious process is so severe

that only root stumps remain
 Nursing Bottle
Caries
Prevention:

parent should start brushing the

child teeth as soon
as they erupt in oral cavity

discontinue bottle feeding as

soon as child can drink from a
cup, at approximately
12-15 months of age
Rampant Caries

suddenly appearing

widespread

resulting in early involvement of

pulp
Rampant Caries

Etiology:

may be due to nutritional

deficiency

malnutrition

emotional disturbances
Rampant Caries

Clinical Features:

occurs in children with

poor dietary habits

extensive inter-proximal
+ smooth surface caries
Rampant Caries

Management:

extensive dental care

parent education
Arrested Caries

Clinical Features:

both deciduous + permanent are

affected

large open cavities

brown-stained polished
appearance + hard
Prevention/Managemen
t of Dental Caries

Restorative Treatment

Tooth Brushing

Mouth Rinsing

Dental Floss

Topical Fluoride Application (Pedo Patients)

Pit and Fissure Sealants