Dental Caries

Dental Caries
 Unique form of infection in which specific
bacteria accumalate on tooth surface
 Progressive bacterial damage to teeth exposed
to saliva
 Effect of caries is to break down enamel and
dentine by acid and proteolytic enzymes ,
opening a path for the bacteria to reach the
pulp
Aetiological Factors

Diet Bacteria

Caries

Time Susceptible
surface
 Types of Dental Caries

 Clinical  Acute ( rampant)

Classification  Chronic
 Pit and Fissure  Recurrent
 Smooth surface  Arrested
 Cemental
 In young – pit & fissure caries most
commonly seen in first molar ( first 3 yrs)
 Next highest susceptibility 2nd molar then 2nd
premolars
 Very high sugar content will promote smooth
surface caries esp. of interproximal area then
lingual and buccal surfaces of molars & pre
molars.
Pit and Fissure Caries
Smooth surface caries
Cemental caries
 Essential Requirements for the
development of dental caries
1. Cariogenic Bacteria
2. Bacterial Plaque
3. Stagnation areas
4. Fermentable bacterial substrate
5. Susceptible tooth surface
 A. Cariogenic Bacteria
1. Viridans Streptococci
 Streptooccus mutans
 Streptococcus sobrenus
 Streptococcus salivarius
 Sterptococcus mitior
 Streptococcus sanguis
2. Lactobacillus
Properties of Cariogenic Bacteria
 Acidogenic ( producing lactic acid from sucrose)
 Ability to produce pH low enough (<5)to decalcify tooth
substance.
 Survival ability and continued production of acid at low pH
 Possesses attachment mechanisms for firm adhesions to
smooth tooth surfaces
 Contributes to plaque formation
 Ability to produce adhesive insoluble plaque polysaccharides
(glucans)
 Glycogen storage ability for later acid production
 B. Bacterial Plaque (BIOFILM)
Definition
(Becomes visible 12 to 24 hours after brushing)

Adherent deposit forming on tooth surface consisting of

an organic matrix containing a dense concentration of
bacteria
 Plaque

Properties
 Living entity
 Resistant to antibiotic
 Resistant to immunological defences
 Concentrates and retains acid.
 Resists food friction
 Bacterial adhesion to tooth surface is essential
for colonisation
 Bacterial attachment to tooth
surface
 Role of glucans and glucosyl transferase
 Role of adhesion receptors ( proline rich
proteins ) from saliva
 Plaque formation stages
 Deposition of structureless cell free pellicle of
salivary glycoproteins
 Pellicle enhancement
 Bacterial action precipitating salivary protein
 Bacterial colonistaion within 24 hours
 S. sanguis, S. mutans
 Plaque buildup by bacterial polysaccharides
 Filamentous and other bacterial proliferation.
 Initial colonisation by
pioneer species
 Outgrowth,
microcolonies are
formed which spread
outwards and upwards
 Secondary colonisation
and multiplication
 Acid Production in Plaque
Stephan’s Curve
Diffusion of sucrose
rapidly into plaque with
consequent acid
production
 Maintenance of low plaque PH
 Rapid production of a high concentration of
acid within plaque, overcoming local buffering
 Escape of acid into the saliva is delayed by the
thickness diffusion limiting properties
 Limited entry of salivary buffers into the
plaque
 Continued acid production from the stored
sugars -polysaccharides
 C. Sucrose as Plaque Substrate &
its cariogenecity
 Disaccharide ( glucose and fructose)
 Forms 1/3 of the carbohydrate content in diet
 Promotes colonisation of teeth by S. Mutans
 Disaccharide bond contains enough energy to
react with bacterial enzymes- glucosyltransferase
to form extracellular dextran matrix
 Small molecule readily diffuse into plaque
 Rapidly metabolised by bacteria
 D. Susceptibility of teeth to
caries.
Teeth may be resistant to decay because of
developmental factors.
 Hereditary hypoplasia or hypocalcification

 Newly erupted teeth (hypomineralised)

 Effect of fluorides
 E. Saliva and Dental Caries
 Salivary components contribute to plaque
formation.
 Sucrose in saliva is taken up by plaque
 Buffering power of saliva limits pH drop
caused by acid from plaque.
 Related to rate of secretion
 High flow rate reduces caries activity
 Gross reduction enhances caries in cariogenic diet
 Salivary factors affecting plaque
contd….
 Inorganic components and enamel maturation
 Enzymatic activity( Salivary amylase)
 Antibacterial activity
 Immunological defences ( IgA )
 Effect of Fluorides
1. Incorporated into teeth during development
2. Water content 1 p.p.m or more declines
incidence of caries
3. In early lesions (after eruption) reduces
enamel solubility and promotes
remineralisation
4. In constant small supply reduces dental
caries.
FACTOR HIGH RISK LOW RISK
Amount of Large amount of plaque Few bacteria =
on the teeth, meaning "good" oral hygiene
plaque many bacteria that can
produce acids (low pH,
demineralization)

Type of bacteria Large proportion of Low proportion of

"cariogenic" types of "cariogenic" types
bacteria, resulting in
lower pH and sticky
plaque and also
prolonged acid
production
Type of diet High in carbohydrates, in Low sugar content;
particular sucrose; non- "sticky" type
"sticky" diet leading to
of diet
low pH longer time
FACTOR HIGH RISK LOW RISK

Frequency of High sugar frequency Low sugar

resulting in longer time
carbohydrates per day with low pH
frequency

Saliva secretion Reduced saliva flow Optimal, helps to

leading to prolonged wash out sugars and
sugar clearance time and
to a reduced amount of acids
other saliva protective
systems
Saliva buffer Low buffer capacity Optimal, time with
resulting in prolonged
capacity time with low pH
low pH shorter

Fluorides Absent: reduced Available: increased

remineralization
remineralization