: Cariology

the lesion, etiology prevention

and control

Dental caries and periodontal

disease probably the most
common chronic diseases in the
.world
 Definitions of caries and
plaque

Dental caries is an infectious

microbiological disease of the
teeth that result in localized
dissolution and destruction of the
calcified tissues which produce
cavity
Dental plaque :

A gelatinous mass of bacteria

adhering to the tooth surface . The
total metabolic activity of plaque is
responsible for production of
either caries or periodontal
disease .
These adherent bacteria have special
receptors for adhesion to the tooth
surface and also produce a sticky
matrix that allows them to cohere to
each other. Once they are attached,
these pioneering organisms
. proliferate and spread
There are three different sites in
tooth where cariogenic plaque
may originate :

a) Pit and fissures

b) Smooth surface of crown
.c) Root surface
Theory of caries: there are three main
theories that explain the process.
1) Acidogenic Theory <Miller> :- In
accordance of this theory dental caries
is caused by microbial enzymatic
action on ingested carbohydrates, This
theory the most popular and widely
.accepted
Proteolysis theory. )2

It claims that certain enzymes leave

the inorganic portion without matrix
support to be washed away, and
.forming cavity
Proteolytic chelation. )3

This claims that secretion or metabolic

products of microorganisms, have the
ability to Chelate Ca from tooth
structure leaving the organic matrix to
be disintegrated. These theory fail to
explain the process of caries and it's
.ramifications
For the caries process to be occur there *
must be :
1) Host [ tooth ]
2) Parasites [ Dental plaque ]
3) Medium [ Carbohydrates ]
* The host encompasses :
. The tooth
. Salivary factors
. Age
. Muscular activity
. Group susceptibility
Pathophysiology of Caries
Caries causes damage by
demineralization and dissolution of
tooth structure, resulting in:

a) A highly localized drop in the PH at

the plaque tooth interface

. b)Tooth demineralization
The local PH drop occurs as the result of
plaque metabolism, but only plaque
communities with high concentration of
MS and lactobacilli can produce a
sufficiently low PH to cause
demineralization of teeth.
A single exposure of sucrose solution to a
cariogenic plaque results in rapid
.metabolism and produces organic acids
The organic acids (Lactic acid) dissociate to
lower the local PH. single events of lowered
PH are not sufficient to produce significant
changes in the mineral components of the
teeth surface. However, many episodes of
long- duration demineralization, occurring
over long periods of time, will produce the
.characteristic lesions of caries
At lower PH, such as 3.0 or 4.0 the surface of
enamel is etched and roughened.
At a PH 5.0 the surface remains intact while
the subsurface mineral is lost. This initial
carious lesion limited to the enamel is
INCIPIENT CARIES and is characterized by
virtually intact surface, but a porous
subsurface .
The intact surface and subsurface porosity are
responsible for the clinical characteristics of
.incipient lesion
Lesion: Smooth intact surface that became
chalky white opacities when dried. When the
porous body of an incipient lesion is hydrated,
the lesion is not detectable clinically because
the porous area remains translucent. But
drying of the tooth with a stream of air
removes the subsurface water, Leaving air-
filled voids that render the area opaque and
white. Incipient lesion may be reversed by
.remineralization
When fluoride ion is a part of the
remineralization process, the enamel will
not only be restored to soundness but also
will have increased resistance to caries
attacks .
In advanced carious lesion of dentin, if the
lesion is progressing slowly there will be a
zone of sclerotic dentin, adjacent the
penetration of toxins and acids. There are
four zones to term dentin either infected or
. affected
In dentin under the microscope we reveal four .
zones
1) Translucent Zone : which is sclerotic and calcified.
It is the defense reaction of the pulp.
2) Demineralization zone
This zone lost Ca salt, but it is bacteria free.
3) Zone of penetration : Contain bacteria, which is
confined to dentinal tubule, and in this zone
demineralization of intertubular dentin take place.
4) Zone of distruction
 Caries Prevention

Dentist Patient

1- Periodic cleaing of the teeth 1.elimination of foods

2- Fluoride application . ingested between
3- use of sealant on caries meals
susceptible areas 2.Tooth brushing
4- Education and motivation after meals to remove
plaque.
3.A good, and
balanced nutrition.
4- support a good oral
hygiene