Dental Caries

Lec. 4
 Enamel caries
 Early enamel lesion:
• The early enamel lesion appears as white
spot.
• White spots are chalky white (opaque)
areas that appear only when the tooth is
dried or dehydrated.
• There is loss of minerals from the
subsurface layer results in loss of
translucency.
 How can white spot of incipient caries be
distinguished from developmental white spot of
hypo-calcifications?
 How can white spot of incipient caries be
distinguished from developmental white spot of
hypo-calcifications?
 Incipient caries will disappear visually when the
enamel is hydrated(wet).
 Hypocalcified enamel is unaffected by drying and
wetting.
 Enamel caries
 Early enamel lesion:
 The surface texture is unaltered and is undetectable
by tactile examination.
 A more advanced lesion can develop a rough surface
that is softer than the normal unaffected enamel.
 Care must be taken with examination with an
explorer to avoid causing cavitation in a non-
cavitated lesion.
 Enamel caries
Early enamel lesion:
 Incipient caries of Enamel can be reminerlized.
 Calcium and phosphate ions from saliva can then
penetrate the enamel surface and precipitate in the
subsurface enamel layer.
 Enamel caries
Early enamel lesion:
 the presence of trace amounts of fluoride ions
enhances the precipitation of calcium and
phosphate, resulting in formation of fluoroapatite
which is more resistant to subsequent caries attack.
 Enamel caries
Early enamel lesion:
 Remineralized(arrested) lesions can be observed
clinically as intact, but discolored, usually brown
or black spots .
 The change in color is due to trapped organic
debris and metallic ions within the enamel.
 Enamel caries
Early enamel lesion:
 These discolored remineralized arrested caries are
intact and more resistant to subsequent caries attack
than the adjacent unaffected enamel.
 They should not be restored unless they are
esthetically objectionable.
 Enamel caries
Early enamel lesion:
 Characteristics of an early enamel lesion:
1- Clinically appears as chalky white (opaque) areas.
2- The surface is intact but fragile that may damaged with
probing.
3- Increased porosity that can result in staining.
4- Thereis reduced density so it can be detected with
radiogragh or with transillumination.
5- It can be remineralized.
 Histologic zones of incipient enamel caries
lesion

(1) The translucent zone.

(2) The dark zone.
(3) The body of the lesion.
(4) The surface zone.
 (1)Translucent zone
 It is the deepest zone.
 There are pores or voids formed as a result of
demineralization.
 (2)Dark zone
 It is the next deepest zone.
 The size of the dark zone is probably an indication of the
amount of remineralization that has recently occurred.
 (3)Body of lesion
 The body of the lesion is the largest portion
of the incipient lesion.

 Bacteria may be present in this zone.
 (4)Surface zone
 This zone remains intact and heavily reminerlized.
 Ions for remineralization come either from oral cavity
or from re-precipitation of calcium and phosphate ions
diffusing outwards as deeper layers are demineralized.
 Eventually, this zone is demineralized by the time
caries penetrates dentin.
 Dentin Caries
 Demineralization extends to reach the dentinoenamel
junction.
 The dentinoenamel junction has the least resistance
to caries attack and allows rapid lateral spreading.
 Because of these characteristics, dentinal caries is V-
shaped in cross section with a wide base at the DEJ
and the apex directed towards the pulp.
 Dentin Caries
 Progression of caries in dentin is more rapid than in
enamel because:
1- Dentin contains much less mineral (less resistance to
acid) (critical PH of dentin is 6.2).
2- Dentin possesses microscopic tubules that provide a
pathway for the ingress (way in) of acids and egress
(way out) of mineral.
 Dentin Caries
 Non cavitated lesions can
progress to cavitated lesions,
which are:
 Obvious clinically and can
be enlarged by probing.
 Can become arrested but
require restoration.
 Dentin Caries
Histologic zones of dentinal caries
Three different zones have been described in
carious dentin.
 These zones are most clearly distinguished in
slowly advancing lesions.
 In rapidly progressing caries, the difference
between the zones becomes less distinct.
 Dental
• Zone 1:
plaque
Normal Dentin
(Hard Dentin) Zone 3
• The deepest area. Zone 2
• No bacteria.
Zone 1
• Dentinal tubules contain
odontoblastic processes
• Zone 2:
Affected Dentin
(Firm Dentin): Dental
• Also called inner carious plaque
dentine.
• A zone of demineralization. Zone 3
• Softer than normal dentin.
Zone 2
• Slight damage to
Zone 1
odontoblasts.
• Intact collagen.
• Zone 2:
Affected Dentin Dental
plaque
(Firm Dentin):
• Is capable of remineralisation
• Further classified into: Zone 3
a. Subtransparent dentin. Zone 2
b. Transparent dentin. Zone 1
c. Turbid dentin.
• Zone 3:
Infected dentine Dental
(Soft Dentin): plaque
• Also called outer carious
dentine. Zone 3
• The outermost zone. Zone 2
• A zone of bacterial Zone 1
invasion.
• Soft.
• Zone 3:
Infected dentine
(Soft Dentin): Dental
plaque
• Dentinal tubules are
distorted and filled with
bacteria. Zone 3
• Mineral seem to be absent. Zone 2
• Collagen is irreversibly Zone 1
damaged.
• This zone can’t undergo
remineralization.
 Carious dentine

Affected dentine Infected dentine

 In operative procedures:
 Infected, requires removal. And
 Affected, does not require removal.
CLINICAL TYPES OF DENTAL CARIES

 Pits and fissures  Chronic caries.

caries.  Arrested caries.
 Smooth surface caries.  Recurrent caries.
 Incipient caries.  Residual caries
 Rampant caries.  Root caries.
 Nursing bottles caries.  Radiation caries.
 Rampant Caries
 Acute type of caries.
 is a sign of:
• gross dietary inadequacy or
• a complete absence of oral hygiene practice, or
• systemic illness.
 Characterized by extensive and multiple cavitated and
active caries lesions in the same person.
Rampant Caries
 Nursing Bottles Caries

 Acute lesions affect children using nursing bottles for

longer duration.
 Common in the upper anterior teeth.
 Lower teeth remain unaffected as they are covered by
the tongue.
NURSING BOTTLES CARIES
 Arrested Caries

 Inactive caries.
 There is remineralization of demineralized lesion.
 It is hard , black or brown.
 Arrested caries require restoration when there is:
i. Cavitation.
ii. Un pleasant esthetic.
 Recurrent caries

Lesions that occur around defective restoration

margins.
 Thanks