Introduction to Dental Caries

(Lecture outlines)

Dr.Ghada Maghaireh BDS, MS

Certificate in Operative Dentistry
American Board in Operative Dentistry

Lecture Objectives
Definition of dental caries.
Primary causes of dental caries.
Caries in enamel.
Caries in dentin.

Dental Caries or "tooth decay".

Dental caries and periodontal diseases are the most common
chronic diseases in the world.

?What is Dental Caries

It is an infectious microbiologic disease of the teeth that result in localized
dissolution and destruction of the calcified tissues (enamel, dentin and
cementum).

Primary Causes of Dental Caries

Dental plaque
Dietary carbohydrates
Tooth (susceptible tooth surface)
Time

The Carious process

Bacteria in dental plaque.
Fermentable carbohydrates such as sugars (sucrose & glucose).
Production of acids causing the plaque pH to fall below 5.
Repeated fall in pH in time may result in the demineralization of susceptible
site on the tooth surface initiating the carious process.
Caries in Enamel

Enamel has high inorganic content (88% by volume).

Low organic content (2% by volume).
10% water.
Enamel consists of crystals of hydroxyapatite packed tightly together in orderly
arrangement.
Each crystal is separated from its neighbours by tiny intercrystalline spaces or
pores.
The spaces are filled with water and organic material.
When enamel is exposed to acids produced by dental plaque, minerals is
removed from the surface of the crystals which shrinks in size.
The intercrystalline spaces enlarge and the tissue become more porous.
At this stage the carious lesion can be detected clinically and called “White
“White
spot lesion“.
lesion“.

White spot Lesion

The earliest microscopic evidence of caries in enamel.
Best seen on dried tooth as a small, opaque, white area.
Some time the lesion may appear brown in color due to exogenous materials
absorbed into its porosities.
If the early enamel lesion progress, the intact surface breaks down (cavity
formation).

Microscopic Appearance of the White Spot Lesion on a smooth

Surface
Smooth surface = Proximal surfaces and Buccal surfaces of the teeth.
Usually cone shaped: The apex of the cone pointing toward the enamel-dentin
junction (DEJ).
The lesion takes this shape because it follows the direction of the enamel
prisms.
The lesion has been divided into 4 zones based on its histological
:appearance

Zone 1: The translucent zone

Not seen in all lesions.

Lies at the advancing front of the lesion.
More porous than sound enamel.
Pores has been created by the demineralization process.

Zone 2: The dark zone

Just superficial to the translucent zone.

More porous than the translucent zone.

Zone 3: The body of the lesion

The largest portion of the lesion.

Superficial to the dark zone.
Increase in porosity from the peripheries to the center.

Zone 4: The surface zone

Unaffected surface layer that cover the small lesion.

High degree of mineralization than subsurface enamel.
If the lesion progress the surface layer will be destroyed a cavity forms.

Light Microscope Appearance of Occlusal Caries

The lesion forms around the fissure walls.
As the lesion increases in size, it coalesces at the fissures.
The enamel lesion enlarges as it approaches the underlying dentin guided by
prism direction.
The lesion takes the shape of a cone with its base toward the enamel-dentin
junction.
Cavitation
If the lesion progress, the surface zone breaks down and a cavity forms.

Caries in Dentin
Dentin has less inorganic content(50% by volume) and more water (25%).
As caries reaches the enamel-dentin junction, caries spread laterally along
the junction.
Sound enamel appears to be undermined by the carious process in dentin.
Undermined enamel is brittle and can be fractured producing a large cavity.

Histological Appearance of the Lesion before Cavitation of the

Enamel
Dentinal tubules do not contain vital odontoblast process; they are called
“dead tracts”.
Theses tubules may contain gases, fluids, and degenerating cell remnants.

Histological Appearance of the Lesion after Cavitation of the Enamel

Once cavitation occurs, bacteria have direct access to dentin.

The body of the lesion in dentin can be divided into three structural
components:
1. Demeneralized dentin: At the advancing edge of the lesion, no bacteria.
2. Zone of penetration: dentin has become penetrated by bacteria.
3. Zone of destruction: zone of necrosis, destruction of the dentin substance.