Dental Caries

Lec. 2
Etiology
Bacteria

Tooth CHO

Time
 Primary modifying Secondary modifying
factors factors
Tooth factor Socioeconomic status
Saliva
Education
Diet
Life style
Oral hygiene
Environment
Biofilm PH & composition
Age
Use of fluoride
Ethnic group
Immune system
Occupation
Genetic factors
 Etiology: Role of bacteria.
The etiologic agent of caries : bacteria
Dental plaque is a soft, translucent, and adherent material
accumulating on surface of teeth and composed almost
from bacteria and their byproducts.

It is also named: bacterial plaque or plaque biofilm.

 Etiology: Role of bacteria.

 Survival of microorganisms in the oral environment

depends on their ability to adhere to a surface.
 Free-floating organisms are cleared rapidly from the
mouth by salivary flow and frequent swallowing.
 Only a few specialized organisms, streptococci, are
able to adhere to oral surfaces such as the mucosa
and tooth structure.
 Etiology: Role of bacteria.

 These adherent bacteria have special receptors for

adhesion to the tooth surface and produce a sticky
matrix that allows them to cohere to each other.
 This adherence and coherence allow the bacteria to
colonize the tooth surface successfully.
 Etiology: Role of bacteria.

 When they are attached, they proliferate and spread

laterally to form a mat like covering over the tooth
surface.
 Further growth of bacteria produces a vertical growth
away from (external to) the tooth surface.
 Then other organisms, such as filamentous and spiral
bacteria, which otherwise are unable to adhere
directly to the tooth surface, can now adhere.
 Etiology: Role of bacteria.
Dental plaque consistency:
i. Bacteria which form 50-70%
ii. Inorganic ions such as fluorides,
phosphates and calcium .
Form The iii. Glycoprotiens
Plaque iv. Mucopolysaccharides
Matrix
 Etiology: Role of bacteria.

Cariogenic bacteria:

i. Strep coccus Mutans.

ii. Lactobacilli.
iii. Actinomyces.
 Etiology: Role of bacteria.
 Sreptococcus mutans are the main cariogenic
organisms because:

i. Adhere to enamel
ii. Transport sugars and convert them to acid
(acidogenic).
iii. Able to survive at low PH (acidouric).
iv. Produces bacterocin substances that kill other
competing bacteria.
 Etiology: Role of bacteria.

iv. Produce extracellular and intracellular

polysaccharides:
• Extracellular polysaccharide: contribute to the plaque
matrix.
• Intracellular polysaccharide: can be used for energy
production and converted to acid when sugars are not
available.
 Etiology: Role of bacteria.

• MS(mutans streptococci) and lactobacilli are

acidogenic and acidouric and they are the primary
organism associated with caries.
• Acids produced are: Lactic acid mainly and butyric
acid to some extent.
 Etiology: Role of CHO
• Fermentable carbohydrates are one of the most
important causes of dental caries.
• Sucrose is the most cariogenic type of sugar, than
glucose, fructose, and lactose.
• Increase in the intake of refined carbohydrates are
directly proportional in causing the dental caries
• (frequency of intake is more important than the
quantity).
• Cariogenicity of carbohydrates depend upon:
I. frequency of its ingestion.
II. physical form:
CHO in sticky, retentive foods are more cariogenic than those
in non sticky foods.
III. chemical composition:
Monosaccharides are more easily fermented than
polysaccharides.
IV. route of administration.
V. presence of other food components:
Meals high in fats, proteins or salt reduce the retentiveness of
CHO.
 Etiology: Role of CHO
• In 1944 Stephen demonstrated that consumption of
sugar cause a rapid drop in plaque pH, which favors
enamel demineralization.
Frequency of CHO intake:
• Increased frequency leads to increased periods of pH
reduction which causes an immediate drop of 2-4
points (Stephen curve) and demineralisation.
 Etiology: Role of CHO

• Recovery to normal resting pH takes from 20 min for

the normal patient to several hours for other patients
 Etiology: Role of CHO

• The degree of PH fall (or recover) depends on :

1. Salivary flow rate
2. The plaque thickness
3. The number and mix of plaque bacteria
4. The type of carbohydrates i.e. sticky food have
low clearance rate
 Tooth factor

Involves:
i. Composition of tooth.
ii. Morphologic characteristics.
iii. Position.

Composition of tooth:
 Composition of a tooth determines initiation and
rate of progression of caries.
 Tooth factor

Morphologic characteristics:
 Deep, narrow occlusal fissures or
buccal and lingual pits predispose to
caries as they tend to trap plaque.
 Tooth factor

Position:
 Malaligned, rotated or otherwise abnormally
situated teeth can be difficult to cleanse and are
likely to trap plaque.
Diet

i. Fermentable CHO.
ii. Acidic foods and drinks.
 Both play a major in dental caries.
 Saliva

• Saliva plays a major role in protecting the teeth

against acid.
• The saliva protect teeth from dental caries
through:
 Saliva
1- Bacterial clearance:
 This occurs through flushing mechanism. (mechanical way)
 After saliva is secreted, it remained in the mouth for short time
before being swallowed.
 While saliva in mouth, it lubricate soft tissues and teeth and
remove microorganisms that aren’t adherent to the tooth
surfaces.
 Amount of saliva secreted by an adult = 1-1.5 L/day.
 Saliva

2- Antibacterial activity:
 Saliva contain number of antibacterial agents
 They have a greater role against soft tissue infection than
against dental caries.
Saliva

3- Buffer capacity:
 Saliva contain 3 buffering systems:
i. biocarbonate
ii. Phosphate
iii. Proteins : as protein and urea.
 Buffering systems increase the pH.
Saliva

4- Remineralization:
 Saliva provide calcium and phosphate ions
that enhance remineralization.
 Saliva
5- formation of Pellicle:
Dental pellicle or acquired pellicle is a protein film that
forms on the surface enamel by selective binding of
glycoproteins from saliva.
 Saliva

Dental pellicle helps in high level of protection

against acid by:
i. Barrier of diffusion of acid into the tooth.
ii. Barrier to movement of dissolution products out
of the tooth.
 Saliva
 When the salivary flow is decreased (hyposalivation)
dry mouth: xerostomia
 Xero: dry Stoma: mouth
 Occurs as a result of:
i. Salivary glands diseases.
ii. Radiation.
iii. Medications.
It leads to increased incidence of dental caries.
 Primary modifying Secondary modifying
factors factors
Tooth factor Socioeconomic status
Saliva
Education
Diet
Life style
Oral hygiene
Environment
Biofilm PH & composition
Age
Use of fluoride
Ethnic group
Immune system
Occupation
Genetic factors
Thanks