Professional Documents
Culture Documents
By
Dr:
Hanan eid gamal
Definition
Dental caries is a progressive,
largely irreversible bacterial
damage of the hard dental tissues
exposed to the oral environment,
characterized by demineralization
of the inorganic portion and
destruction of the organic
substances of the tooth”
Classification of Dental Caries
I. based on morphological site:
1. Pit and fissure caries
2. Smooth surface caries
3. Root caries
II. Based on rate of progression:
CHO Bacteria
Caries
Tooth
1- Tooth
1) Position of the tooth
2) Morphology or form of the tooth
3) Structure of the tooth
4) Fluorides
5) Genetic factors
Contributing Factors of Dental Caries
5) Genetic factors
• Hereditary has a minor influence on
resistance to caries.
• Increased incidence of caries in some
families may be due to:
1- Tooth shape or anatomy.
2- Common dietary habits in the family.
Contributing Factors of Dental Caries
2- Carbohydrates
1) Importance of carbohydrates
- When carbohydrates, proteins and fats
were examined for their cariogenic effect it
was found that carbohydrates are the only
food component that can cause caries
(why?)
- This is because carbohydrates can be
acted upon by the oral bacteria with the
production of acids.
Contributing Factors of Dental Caries
Type of Carbohydrate
Carbohydrates are of three types:
• Monosaccharides → (glucose and fructose)
• Disaccharides → (sucrose, lactose and
maltose)
• Polysaccharides → (glycogen and starch)
Contributing Factors of Dental Caries
• Sucrose, in particular, has been described
as the arch criminal of dental caries, this
may be due to:
• Sucrose is of low molecular weight and
can thus diffuse rapidly into plaque.
• Sucrose is rapidly broken down by plaque
bacteria.
• Cariogenic bacteria can synthesize
dextran faster from sucrose than from
other sugars.
Contributing Factors of Dental Caries
• Polysaccharides, on the other hand, are of
little importance in the etiology of dental
caries. This may be due to:
• Polysaccharides are of larger molecular
weight and hence can not diffuse
rapidly into dental plaque.
• Polysaccharides need the action of
salivary amylase before oral bacteria
can act upon them.
Contributing Factors of Dental Caries
Total Amount of Carbohydrate Intake
• Increased intake of fermentable
carbohydrates is followed by increased
caries activity.
• In communities where carbohydrates do
not constitute a major part of the diet
(Eskimos), caries is rare.
• In industrialized countries, (USA and
Europe), where readily fermentable
carbohydrates constitute a considerable
part of the diet, caries activity is severe.
Contributing Factors of Dental Caries
Frequency of Intake and Relation to
Meals
• Frequent intake of fermentable
carbohydrates between meals causes
increased caries activity.
Consistency and Texture of
Carbohydrates
• Sticky carbohydrates are highly cariogenic
because they are more attached to the teeth
thus remain accessible to oral bacteria for
longer periods of time.
Contributing Factors of Dental Caries
Refinement of Carbohydrates
• Refinement by definition is the treatment of
carbohydrates in order to make them whiter,
remove fibrous material and improve flavour.
• It is believed that refinement of carbohydrates
increases their cariogenicity due to:
• Increased concentration of the fermentable
fraction.
• Removal of the fibrous material.
• Increased adhesiveness of the carbohydrate.
Contributing Factors of Dental Caries
3- Microorganisms
1. Historical background
2. Miller's experiment
3. Orland's experiment
4. Types of bacteria involved in caries
5. Discussion of the role of some bacteria
• Lactobacilli
• Streptococci
Contributing Factors of Dental Caries
2. Miller's experiment
- Miller, in 1890, was the first to suggest that
caries might be caused by the action of
bacteria on fermentable carbohydrates with
the production of acids.
- Miller conducted an experiment in which he
suspended two sound teeth in two test tubes
containing saliva and carbohydrates. one of
the test tubes was subjected to boiling.
Contributing Factors of Dental Caries
Gnotobiote rat
Contributing Factors of Dental Caries
4. Types of bacteria involved in caries:
A- Acidogenic bacteria
1) Lactobacilli: L. acidophilus, L. caesi
2) Streptococci: Viridance group which include:
St. mutans, St. sanguis, St. salivarius, St. mitis.
B- Proteolytic bacteria
1) Actinomyces 2) Clostridia
3) Pseudomonas
C- Chromogenic bacteria
Asprigillus niger
Characteristic features of cariogenic bacteria
Dextran Levan
- Glucose polymer - Fructose polymer
- Water insoluble - Water soluble
- Highly adhesive - Less adhesive
- Important in plaque - Act as a store of
formation and carbohydrates
adhesiveness
Contributing Factors of Dental Caries
Food debris.
Dental Plaque - Composition
Role of plaque matrix:
1- Act as a diffusion limiting membrane against
the escape of acids.
2- Act as a diffusion limiting membrane against
the entry of buffers from saliva , delaying their
neutralizing action .
3- Contribute to adhesiveness, bulk and
resistance to washing.
Mechanism of formation:
Stage I: deposition of the acquired
pellicle
At the beginning a structurless cell free
pellicle of salivary glycoprotein (Protein +
Carbohydrate) which is adsorbed on the
tooth surface (for about 3m). It is also not
usually visible to the naked eye and difficult
to be removed by normal tooth brushing.
Acquired pellicle acts as a substrate for
adherence, nutrition, growth and
colonization of plaque m.os.
Mechanism of formation:
Stage II: colonization of the acquired pellicle
Acquired pellicle becomes visible, when tooth
brushing stops for 12-24 hours and by
proliferated of heterogenous bacterial flora
occurs.
Adhesion of bacteria to the tooth surfaces is an
essential requirement. Attachment depends on
complex mechanism and again on bacterial
production of extracellular polysaccharides
such as glucans (dextran).
Colonization here is by aerobic streptococci .
Mechanism of formation:
Stage III: Maturation of the dental plaque
Proliferation of heterogeneous bacterial flora
leading to increase in the thickness of the
dental plaque, oxygen consumption in deeper
layers will cause anaerobic filamentous
microorganisms to colonize the plaque
The filamentous microorganisms grow in long
interlacing threads in which smaller bacilli and
cocci become entrapped.
Corn-Cob Appearance
This scanning
electromicrograph at
higher power shows
cocci attached to
filamentous organisms
to produce the corn-
cob arrangement
sometimes seen in
plaque
Corn-Cob Appearance
Macroscopic picture
Microscopic picture
1. Phase of Initiation
2. Phase of bacterial invasion
3. Phase of destruction
4. Phase of secondary enamel caries
Macroscopic Picture
The white
areas
represent the
earliest clinical
evidence of
caries.
Macroscopic Picture
The carious enamel lesions
are cone shaped.
• In pit and fissure lesions:
the base is towards the
dentino-enamel junction
and the apex towards the
surface
• In smooth surface lesions:
the base is towards the
surface and the apex
towards the dentino-
enamel junction
Microscopic picture
Microscopically enamel caries consists of four
phases and the first phase consists of four zones.
I- Phase of initiation
- Translucent zone
- Dark zone
- Body of the lesion
- Surface zone
II- Phase of bacterial invasion
III- Phase of destruction
IV- Phase of secondary enamel caries
Microscopic picture
I- Phase of initiation
• In this phase the enamel lesion is cone
shaped.
• The outer enamel surface is intact.
• Changes in this phase are not due to
bacterial invasion but due to the effect of
acids.
Caries Enamel –
Phase of Initiation
4
3
2 1
Phase of Initiation
1- Translucent Zone
· Lies at the advancing front of the
carious lesion.
· The appearance of this zone is due
to initial demineralization of the 4
enamel creating pores representing
3
about 1 -2 % of enamel volume.
· This zone appears translucent only
when seen with quinoline or Canada 2 1
balsam media which have the same
refractive index as that of enamel.
The molecules of the media will fill
these pores and thus the zone
appears translucent.
Phase of Initiation
2- Dark zone
· Lies superficial to the translucent
zone.
· The appearance of this zone is
due to further demineralization of 4
the enamel creating pores 3
representing from 2 - 4 % of
enamel volume. Some of these
pores are so small that they are 2 1
called micropores.
· Molecules of Canada balsam or
quinoline are too large that they
are unable to fill these micropores
thus this zone appears dark.
Phase of Initiation
Caries enamel
lesion
spreading
laterally along
dentino-enamel
junction,
affecting a
wider surface
area of dentine.
Phase of secondary enamel caries
More advanced
stage of caries.
Enamel lesion
spreading laterally
along dentino-
enamel junction,
producing
secondary
enamel caries
and affecting a
wider surface
area of dentine.
Pathology of Caries Dentine
Macroscopic picture
Microscopic picture
I- Initial uninfected lesions
II- Infected lesions
Pathology of Caries Dentine
Macroscopic Picture
• Pit and fissure lesions:
are conical in shape
with the base toward
the dentino-enamel
junction and a abroad
apex towards the pulp
chamber.
• Smooth surface lesions:
are also conical in shape
with the apex
approaching the pulp
further cervically.
Pathology of Caries Dentine
Microscopic Picture
I- Initial uninfected lesions
(before enamel cavitation)
1. Zone of reactionary or reparative
dentine formation (zone 1) irregular
2. Zone of sclerotic or translucent dentine
formation (zone 2)
3. Body of the lesion (zone 3) daed tracts
Pathology of Caries Dentine
Initial uninfected lesions - Animated
Pathology of Caries Dentine
Initial uninfected lesions
Pathology of Caries Dentine
Initial uninfected lesions
Ground section of an active
proximal lesion examined in
transmitted light. The
triangular enamel lesion
reaches the dentine-enamel
junction with demineralization
of the outer dentine (DZ) and
sclerotic reaction (TZ)
corresponding to the less
advanced peripheral parts of
the enamel lesion.
Pathology of Caries Dentine
Initial uninfected lesions
Caries
enamel Sclerotic
Dead tract Dentine
underneath
enamel caries,
surrounded and
underlaid by
translucent
dentine (slowly
progressing
caries).
Dead Tract Sclerotic Intact
Dentine surface
Pathology of Caries Dentine
II- Infected lesions
(after enamel cavitation)
1. Zone 1: Mild pulpal inflammation.
2. Zone 2: Reparative or reactionary dentine.
3. Zone 3: Sclerotic dentine.
4. Zone 4: Body of the lesion
a) Decalcified uninfected zone
b) Decalcified infected zone
c) Area of destruction
Pathology of Caries Dentine
Infected lesions
Pathology of Caries Dentine
The decalcified infected zone shows the
following:
• Pioneer bacteria: which are usually cocci.
• Beading: which is the lateral distension of the
soft dentinal tubules by the action of
proliferating bacteria.
• Liquefaction foci: coalescence of beads parallel
to the long axes of the dentinal tubules.
• Transverse clefts: liquefaction foci occurring
perpendicular to the direction of the dentinal
tubules.
Pathology of Caries Dentine
Decalcified infected zone
Dentine Caries – Diagrammatic
Invading bacteria
Beading
Liquefaction foci
Transverse clefts
Dentine Caries – beading
Beading Liquefaction
foci
Dentine Caries – Liquefaction Foci & Transverse
Clefts – Low Power
Transverse Liquefaction
cleft foci
Dentine Caries – Liquefaction Foci & Transverse Clefts
Dentine Caries – Liquefaction Foci
Liquefaction
foci
This frame
reveals infected
dentinal
tubules with
clefting
occurring in the
same direction
as the tubules.
Dentine Caries – Transverse clefts
Horizontal clefting is
typical of dentinal
caries. The process
of beading,
coalescence, and
clefting typifies
progression of
dental caries.