Introduction to dental carries

Today we will talk about dental caries; what is dental caries? What is the
definition of dental caries, we will talk about the primary causes of dental
caries and finally the caries in dentin.

So... dental caries or tooth decay, ask yourself this Q. what’s the
difference between dental caries and tooth decay? We use “tooth decay”
when we are talking to another person like a patient, but in dentistry we
call it dental caries (dental from dentistry which means tooth and caries
means decay)

Dental caries as dental disease is the most common chronic disease in

the world, this disease affects the supporting tissue of the tooth so
“disease” refers to the infection that affects the supporting tissue of tooth,
that’s what we will talk about and it’s called dental caries.

The picture in the 3rd slide shows how the tooth looks like with decay (the
dark area), in the left picture there is occlusal caries (we will study this
when we will talk about calcification of the caries) we call it occlusal
because it related to the occlusal surface, we have in the right
picture smooth surface but not irregular or fissured… so we have two
parts of caries:

1. Occlusal caries

2. Smooth surface caries

Smooth surface caries can be in posterior teeth.

The definition of dental caries: it is an infectious microbiologic

disease of the teeth that results in localized dissolution and
destruction of the calcified tissue (enamel, dentin and
cementum). We said it is infectious so it’s caused by microorganisms it
means bacteria; we have another lecture that will talk about the bacteria
that cause dental carries so the result is dissolution and destruction of
tissue.

Some explanation:

The teeth are composed of what??

The teeth are composed of:

• Enamel is the outer layer of the teeth

• Dentin is the inner layer

• Cementum the layer that covers the pulp

dentine
• And inside we have the pulp (which is soft tissue)
 enam
el

Pulp

All of these layers of the teeth can be affected

by dental caries. cementu
m

Dental plaque is a layer that covers the tooth it is composed of

microorganism; protein... this layer has the bacteria which will act on
the dietary carbohydrate (sugar) that we eat. So the bacteria in the dental
plaque will act on the sugar to produce a pit that will attack the tooth
surface, of course this should have duration time to happen or to occur.

Again… we have dental plaque that covers the tooth surface & substrate
which means sugar that we eat & time &finally the teeth, missing one of
these rules will not lead to caries, so all these rules must work
together to produce dental caries

Time Suga
pluqu
re

Deca
y

Plaqu Tooth
e

The carious process…

Plaqu Susceptible Fermenta Acid

e host ble
carbohydr

Demineralizati
on

Now we are going to the definition of demineralization which means

loss of minerals from the tooth surface (Ca+2), we will talk about it
later when we talk about saliva & the PH of the saliva. But mainly acid
production makes PH Low (we will study this in oral physiology) but we
should know that saliva make less acidity in oral cavity. And this shows
that “time” has a very important role. Also “water” plays an important role
because it makes the oral cavity a less acidic environment so the acid
doesn't have enough time to cause demineralization.

Additional explanation:

Bacteri Sugar
a

Time

Fermentati
on

Acid

Demineralizati
on

Carie
s

Ca10 (PO4)6(OH)2 10Ca+2 + 6PO4-3 + 2OH

This is the clinical formula of hydroxyl appetite crystals which are the main
component of the mineral part of the tooth.

Caries in enamel:

Firstly take a look in oral anatomy, embryology and histology third edition,
page101 fig7.2 and imagine the composition of the teeth
Enamel consists of crystals of hydroxyl apatite packed together in orderly
arrangement between the crystals there is intercrystalline space and
these spaces are filled with water and organic material.

Microscopic enamel
structure

(The pic. is from the internet)

Take a look in oral anatomy, embryology and histology third edition, page
114, fig.7.45

The acid causes tooth pain & breakdown of crystals then demineralization.

The tooth Structure; enamel, dentin and cementum is composed of two

components:

• Organic (2%)

• Inorganic (88%)

The inorganic is mainly the protein & the organic is mainly the
collagen ???

Now... how caries occur in enamel?

1. When enamel is exposed to acids for long time

2. The crystals will start to dissolve

3. So the size of the crystals will decrease

4. The intercrystalline spaces increase in size

5. The caries start development

The 4th stage is the best stage for enamel to start the formation of dental
caries &it is called (white spot lesion) that means the 1st appearance
of caries in enamel is during that stage.

Why is it white?
Because it appears white in the tooth surface in earliest microscopic
evidence of caries in enamel (actually it seems brown in the slide picture
and that is because... Sometimes the color seems brown because of
absorption of materials from oral cavity, these materials (food, coffee…)
start to accumulate in the pores then the color appears brown.

And remember that in microscopic appearance of the white spot lesion on

smooth surface= proximal surfaces and buccal surface of the teeth

(Look to the slid pic.) “Microscopic appearance of the white spot lesion on
smooth surface”

There is dental enamel junction DEJ then line between the enamel and
dentin; it looks like a cone... the base towards the surface and the
apex towards the DEJ (see the difference between pic. A &B to
understand). The direction of the enamel prism is perpendicular on the
DEJ the caries will follow the direction of the enamel prism and because of
this the base will be towards the surface direction and the apex towards
the DEJ.

The 4 important zones

The white spot lesion in enamel has 4 zones, it is important to know the
zones because the cavitations depend on the stage of the zone

1. The 1st zone( the high arrow in the picture)

It is called the translucent zone, not seen in all lesions and the most
important is that pores have been created by demineralization process.

2. The 2nd zone (the low arrow in the picture)

It is called dark zone, it is superficial to the 1st one

3. The 3rd zone :The body of the lesion (B in the picture)

The largest portion of the lesion also it is superficial to the dark zone

4. The 4th zone: The surface zone

Higher degree of mineralization than subsurface enamel, unaffected

surface that covers the small lesion

(Read the characteristic from the slides because she didn’t mention
everything)

Open page 10 (slides) the 2nd slide "light microscope appearance…) (look
at the pic.)
The lesion forms around the fissure walls. As the lesion increase in
size, it coalesces at the fissure and as we mentioned the lesion takes the
cone shape, the base towards the DEJ

Slid 1 page 11...

This is a cross section of occlusial caries… look at the enamel, DEJ, dentin
& take a look at the fissure that causes a groove then it will develop to
caries

Cavitations: is breakdown of the surface zone and formation of a

cavity

Caries in dentin... Take a look in oral anatomy, embryology and histology

third edition, page128

The picture in the slide shows the tubules or the dead tracts, these
tubules do not contain vital odontoblast process, they may contain
gases, fluids, and degenerating cell remnant

Dentin less inorganic content (50%) and more water, it can be

producing large cavity….

End …End of lec :P

By: walaa waleed zetawee abu-baker