Dental Caries

Definition

Caries is a disease resulting in the destruction of the hard structure of the teeth

Stages in the development of caries

1. 2. 3. 4.

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The enamel becomes decalcified A small white spot appear Discoloration becomes pronounced The tooth surface softens and deca penetrates through the enamel into the dentine Caries spreads laterall and in depth Cavitation occurs

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The lesion deepens$ and pulp becomes affected$ first reacting to stimuli %e.g.sweets$ temp.&$ then damaged and dead (acteria travels down the root canal$ out through the ape) causing abscesses
Hanadi Baeissa

*actors determining the incidence of caries

1.

2. a. b.

+icro organisms, Acid producing bacteria$ especiall if the produce e)tracellular pol saccharides$ will increase ris.ost factors, Decreased saliva secretion increase incidence (uffering power of saliva to raise p. decrease incidence
Hanadi Baeissa

c.

d.

The morpholog of the teeth, well spaced teeth decrease incidence$ while fissures / pits increase it. The composition of the teeth, certain trace elements decrease incidence %e.g. *$ +b and (&$ while others %e.g. Cu / +n& increase it
Hanadi Baeissa

3.

4.

Time, fre0uenc of consumption of carboh drates$ and length of time in the mouth are related to incidence. 1ood oral h giene can counter act this Substrates for acid production provided in diet

Caries as a disease of civili2ation

3vidence lin-s caries to civili2ation This is due mainl to changes in dietar habits$ e.g. increased carboh drates inta-e b 3s-imos and eating refined instead of natural forms of carboh drates b African tribes

*actors in unrefined food lead to decreased incidence of caries

1. 2. 3. 4. !.

Substances that decrease solubilit of calcium phosphate +ore ph tate /4or calcium Antibacterial substances Substances that inhibit aggregation of bacteria ,5 decrease pla0ue formation Absence of free sugar %most important&

Theories for the cause of caries

1.

2.

The proteol tic theor , presence of proteol tic bacteria lead to h drol sis of protein %collagen& leading to progression of caries The phospho protein theor , phospho protein phosphatse in pla0ue acts on phosphoproteins in enamel$ but this is not tested in humans

3.

The proteol sis5chelation theor , some products of bacterial action on enamel$ dentine$ saliva / food constituents form comple)es with calcium from pla0ue causing a decrease in the concentration re0uired to maintain saturation$ and leading to more solubilit

4.

The acid theor of caries, (acteria in saliva 6 carboh drate %sugar& lead to acid production dissolving appetite This the most li-el theor

3vidence
1. 2. 3.

4.

7n thic- pla0ue$ p. below critical point p. in carious cavities is lower Caries intensit correlates with acid production and count of acid producing bacteria 7n germ5free rats$ caries was produced b inoculation with acid producing organisms

,The importance of diffusion

Since caries is a penetrating lesion$ the inward diffusion of the acid must pla an important role in its development 3vidence shows that the concentration of unioni2ed lactic acid outside the enamel is more important than low p.

8nioni2ed acid diffuses more easil inward$ becomes diluted and ioni2ed$ allowing reaction with apatite to form free calcium and phosphate These ions diffuse outwards$ and ma precipitate as Ca.9:4$ e)plaining the apparentl intact outer la er of enamel over the cavit Therefore$ the critical p. ma not onl be the level at which the environment of enamel becomes unsaturated with apatite$ but it also ma be the p. at which sufficient conc. :f unioni2ed lactic acid e)ists to ensure inward diffusion

The bacteria responsible for caries

Two species were isolated from carious mouths and were suggested as causal organisms, Streptococcus mutants$ and ;actobacillus acidophilus or odontol ticus :ther filamentous bacteria producing lactic acid were isolated from caries lesions of the root surfaces. These bacteria$ the genus Actinom ces are of two species Actinom ces viscosus Actinom ces naeslundi $ both are found predominantl in the gingival region and cause< inaddition< severe periodontal disease

1. 2.

=elationship between lactobacilli and streptococcus mutans

streptococcus mutans alone can produce caries$ but the combination is more effective streptococcus mutans stop acid production at p. 4.3$ but lactobacilli continue to below p. 4 Therefore$ the >oint effect is more intense ;actobacilli seems to be involved in the initial attac-$ and is found at tha front of the lesion

;ocal effects in caries

Caries is locali2ed$ indicating the role of local conditions This might be partl due to differences in composition of pla0ue %bacterial and matri)& 3vidence also suggests that different t pes of bacteria cause caries at different sites %e.g. tetrac cline reduces smooth surface caries$ to a greater e)tent than pit and fissure caries

The role of diet in caries

1.

2.

Diet has two t pes of effects Dietar effects, local effects contributing to substrates for bacterial growth / direct interaction with teeth ?utritional effects, effects of assimilated food stuff

Dietar effects.1

There is evidence relating consumption of carboh drates %particularl sucrose& to caries

A5 7ndirect 3vidence for importance of dietar carboh drates in caries

1.

2.

3s-imos$ whose diet was formerl almost e)clusivel of fish$ meat and fat$ had a low incidence of dental caries while on their primitive diet The prevalence of dental caries in different countries parallels the e)tent of sugar consumption in those countries

3.

4.

7n man areas of 3urope where sucrose inta-e was severel restricted during @orld @ar 77$ caries incidence in children decreased dramaticall The stud of human biochemical genetics has also provided evidence that sucrose pla s a special role in caries. A rare en2 me deficienc involving a lac- of fructose575phosphate aldolase results in hereditar fructose intolerance. *oods containing fructose cause nausea$ vomiting$ tremors$ and convulsions in affected individuals. As sucrose is a glucose5fructose disaccharide$ it also produces these effects$ and is avoided b such pateints$ who are often found to be caries5 free or else have a ver low caries prevalence

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Amongst present5da children of pre5 school age there is a mar-ed correlation between caries e)perience and the e)tent of eating between main meals =ampant caries$ in which the anterior teeth ma be almost completel dissolved awa $ is found in babies who are given comforters filled with s rup or hone to suc- for prolonged periods of time

(5 9opulations on controlled diets

a&

The caries score %deca ed$ missing and filled teeth$ D+*T& was followed over ears for different groups given carboh drates sources of increasing degree of stic-iness compared to a control group given a diet low in carboh drates$ with the calories supplied b sugar normall $ replaced b margarine

Hanadi Baeissa

b&

A stud conducted at an orphanage$ indicated that refined carboh drates increase the caries score. @hile resident$ the children were given a diet that e)cluded refined carboh drates $ and had low caries score %D+*T&$ but this increased dramaticall after the left and changed their diet to include sugar and refined carboh drates

7nteraction between carboh drates / dental pla0ue

3pidemiological evidence / e)perimental studies indicated the following, 1. Carboh drate free diet thin pla0ue 2. 9resence of sucrose more pla0ue %gelatinous& 3. Sucrose is more cariogenic than glucose or fructose with respect to smooth surfaces

4. 3)tra cellular pol saccharides are produced b bacteria from sucrose this help in, a& Adherence to smooth surface b& =etain acid in close pro)imit to tooth surface c& Shield against buffering b saliva The above are less important in fissures

:ther dietar effects

Addition of Calcium sucrose phosphate %CaS9& caries Acidic drin- could dissolve enamel caries incidence *ibrous food reduce pla0ue formation $ therfore$ caries *oods that saliva flow caries e.g. salt foods *oods that p. / increase Ca content caries e.g. cheese

?utritional effects5 2
7. 77.

Aitamin D could lead to incidence of caries Some trace elements caries / some it

1. 2.

+inerals associated with increased caries include, Copper$ magnesium$ Se$ 2inc$ vanadium / lead +inerals associated with decreased caries include , *$ Sr$ ($ B$ nic-el$ +o$ ;i +echanism, suggestion 3ffect morpholog of teeth %rats& 3ffect cr stal structure / solubilit

Caries resistance
+an factors not strong b themselves combine to caries e.g. .ighl buffered saliva with high flow rate Ca$ 9$ .C:3 in saliva .igh *4C:3 of enamel The most important factor is the t pe of bacteria presence of antibodies to cariogenic bacteria might help to caries also

*inall the morpholog of teeth pla s a role ?ote, Cause of caries differs from person to another

=eminerali2ation
Carious lesions up to white spot stage can cease to develop and might disappear Caries progresses b alternate deminerali2ation$ when p. falls$ and partial reminerali2ation when the p. rises Saliva could reminerali2ation$ but * speeds process