Mini Lecture23 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

• Bacterial-induced tooth demineralization or cavitation from imbalance between

risk factors andprotective factors over timeHarris and Christen ( Primary Preventive Dentistry, 1995), Larsen and Bruun (Clinical Cariology, 1994) 

Keyes Diagram

microorganism

caries

dental susceptibl

e

diet

Demineralization

Remineralization

Bacteria plus foodmakes the salivavery acidic within

5 minutes

Saliva is normal30 minutesafter eating

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DENTAL CARIES

CARIES CONTROL

DietTooth SalivaBacteria

• Flow rate• Viscosity• Buffering

•S. Mutans• Plaque•Brushing•Flossing• Restoration

•Frequency•Sucrose• Acidic F&B

• Age• Morphology• Fluoride• White spots• Restoration,3 yrs• Enamel lesion• Dentinal lesion• Pulpal lesion•Filling•Dental appliance

Remineralization Demineralization

• Infrequent or inadequate tooth cleaning• Frequent meals and snacks• Large amount of decay causing bacteria• Deficient fluoride in saliva

Cavity

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The Acidogenic TheoryThe Proteolytic Theory

Proteolysis Chelation Theory

Demineralization:

Remineralization:

Its clinical correlation

GV BLACK classification of caries: class I , II , III , IV , V and VIRampant caries Recurrent cariesArrested cariesRoot or cemental cariesBaby 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 CariesDental Caries

Enamel CariesEnamel Caries Dentin CariesDentin Caries Cementum CariesCementum Caries(Root caries)(Root caries)

Smooth surface caries Pit and fissure caries

Primary Caries: lesions on unrestored tooth surfaceSecondary (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.

DXDX ACTIVEACTIVE INACTIVEINACTIVE

COLORCOLOR LIGHTLIGHT DARKDARK

CONSISTENCYCONSISTENCY MUSHYMUSHY FIRMFIRM

MOISTUREMOISTURE WETWET DRYDRY

SYMPTOMSYMPTOM SENSITIVESENSITIVE NONENONE

SHAPESHAPE DEPTH>WIDTDEPTH>WIDTHH

WIDTH>DEPTWIDTH>DEPTHH

. 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.

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 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 insult and promotes healing of the lesion promotes healing of the lesion by remineralization of affected dentin and stimulation of reparative dentin.

1. CaOH : - bacteriocidal - stimulates reparative dentin2.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