Chapter two

dental caries
 caries
Definition:
Bacteria-initiated ,
irreversible slowly progressive decay of dental
hard tissues.
 caries
Etiology:

Four Factors theory :

1 Micro-organism
2) mutans streptococci
3) Lactobacilli
4) Actinomyces
 caries
Cariogenic properties

1 they are able to produce acid rapidly from

fermentable carbohydrates.
2 They thrive under acid conditions .
3 They are able to adhere to the tooth surface.
 caries
2. Substrate
1) Refined carbohydrates such as sucrose
provide a suitable substrate on which the
cariogenic micro-organisms act to produce
the acids that lead to dissolution of the hard
dental tissues.
2) Caries experience is influenced by the
quantity, quality and especially frequency
of consumption of the refined carbohydrate.
The role of dietary carbohydrate

• Nutrition ----- systemic dietary effects

• Diet ------ local dietary effects

 caries

Epidemiological studies show a strong correlation

between caries development and sugar consumption.

Sucrose------called the arch-criminal in dental

caries

Sorbitol and xylitol -----sugar substitutes used

in sugar-free chewing-gums
3. Host and Susceptible teeth caries
• It was a clinical experience that not all
individuals with poor oral hygiene and
frequent sugar consumption develop caries.
• In the laboratory, extracted teeth exposed to
the same acidic buffer challenge certainly do
not develop artificatial caries-like lesions to
the same degree within a short period of time.
• Tooth morphology: susceptible sites
• Environment of the tooth:
»Saliva
»fluoride
•Saliva under normal conditions, the tooth is
continually bathed in saliva. It is capable of
remineralizing the early carious lesion because
it is supersaturated with Ca and P. when
salivary buffering capacity has been lost, a low
Ph environment is encouraged and persists
longer.
• Fluoride particular interest was the
discovery of the association between fluoride
concentration in water supplies and prevalence
of dental caries in children.
 caries

4. Time
All the factors should be present for
sufficiently long time for the caries
process to be initiated.
 caries

microorganisms

The four circle

diagrammatically
Host represent the
& substrate
tooth parameters involved in
the carious process. All
four factors must be
time
acting concurrently
(overlapping of the
circles) for caries to
occur.
 caries
Other factors
• Age
• Sex
• Geography
• Race
• Economics status
• Nutrition
• Health status
 caries
•Dental plaque
definition: A product of microbial colonization
and metabolism.
An adherent deposits of bacteria and their
products, which is not mineralized and forms on
all teeth, denture restorations’ surfaces. It is not an
accident accumulation of bacteria but develops in
a sequence of steps.
Harmful effect : Caries, periodontal disease,
other oral hygiene problems
 caries
The carious process
a pathological process of localized destruction of
calcified tooth tissues by acids produced by
organisms. Etiologically caries is considered a multi-
factorial disease, which involves interplay between the
host (saliva and teeth) micro organisms (streptococcus
mutans), and the substrate (dietary carbohydrate
sucrose), with the production of Lactic acid. Dental
plaque (Bio-film) serves as the medium for caries
development.
 caries

sugar

bacteria Decalcification of
inorganic material
PH 5.5
acid
Decomposition of
organic material
 caries
category
According to the degree:

Shallow caries (enamel /dentin, cement)

Moderate caries (dentin)
Deep caries (adjacent to pulp)
According to location :
pit or fissure caries
smooth surface caries

According to the rapidity :

acute caries
chronic caries
arrested caries
 caries
Clinical symptom
category symptom
Shallow caries no symptom
Moderate caries irritative pain
(chemical , temperature)

Deep caries irritative pain

(mechanical, chemical , temperature)
 caries
Clinical sign
•Changes of color , morphology and
texture
Color : yellow , brown, black
Morphology : substantial loss, cavity
Texture : soft
 caries

• occurrence area
Pits and fissures of molars and premolars

Proximal surfaces
Buccal and labial surfaces near gingival line
 caries

Disadvantage:
•Pulp and periapical disease
•Masticatory problems
•Esthetic problems
Caries in Pit or Fissure Surfaces
Caries in smooth enamel surfaces
 caries
therapy
• Principles
To remove decayed hard tissues and restore
the treated tooth to its proper form and
masticatory function.

• Include
Non-operative therapy
Operative therapy (restorative therapy)
 caries
•Non-operative therapy

1. Drugs (fluoride)
2. Re-mineralization (fluoride again)
3. Pit and fissure sealant
• operative therapy caries

Filling materials
Amalgam : mechanically retentive formation (loss of much
more healthy tooth tissue); release of mercury; bad sealing
of marginal gap; esthetic problem
Composite resin: adhesive retention (loss of less healthy
tooth tissue); good sealing of marginal gap esthetic
appearance
Glass ionomer cements: adhesive retention (loss of less
healthy tooth tissue); good sealing of marginal gap; esthetic
appearance; release of fluoride (less recurrent caries and
new caries)
 caries
Classification of decay cavity
G.V. Black classification
I. Class I These cavities occur in grooves, pits and
fissures, and can therefore be found in occlusal pits
and fissures of molars and premolars, in grooves on
buccal and lingual occlusal two-thirds of molars, as
well as in lingual pits of incisors and canines.
II. Class II These occur on approximal surfaces of
molars and premolars
III. Class III These occur on approximal surfaces of
incisors and canines, but do not involve the incisal
angle
 caries

IV. Class IV These occur on approximal surfaces of

incisors and canines and involve the incisal
angle.
V Class V These occur on the facial or lingual
surfaces of the cervical one-third of all teeth
VI Cavities which occur on the incisal edge of
anterior teeth or cusp tips of posterior teeth are
sometimes classified as Class VI , but such
cavities are rare and were not included in the
original classification by G.V. Black.
• The first step in restoring a
tooth is to determine the extent
of decay. We do this with an x-
ray. To the left, you see a large
area of decay in the bottom
tooth, second from the right.
The bright areas in the teeth
are all old amalgam fillings.
The decay is seen as the dark
area to the left of the amalgam
in that tooth. The dark area in
the center of the teeth are
where the nerves are located.
You can see that the decay has
gotten very close to the nerve .
• This picture shows
what the tooth looks
like before it is
restored. The hole to
the back of the tooth,
just behind the
amalgam is apparent to
the naked eye. The X-
ray above shows the
actual extent of the
decay.
• The tooth is prepared
with a high speed
handpiece removing all
the old fillings, and all
the decayed areas in
the tooth.
• After the tooth is completely
clean, all the holes are filled
with light cured composite,
and the tooth is carved to
resemble the form it had
before the decay occurred.
This tooth looks wonderful
now, but it is important to
remember that the original
decay was very close to the
nerve, and it is not possible
to guarantee that the nerve
will not become inflamed
and start to swell causing a
toothache later
Dental / mouth mirror
Dental explorer / probe
Dental tweezers: