Professional Documents
Culture Documents
Eruption
Mechanisms of tooth eruption are complex Teeth eventually appear in mouth through a combination of growth of supporting bone Elongation of tooth root and growth of pulp
Enamel Integrity
Tooth enamel structure may be damaged by trauma or acid demineralization Loss of the tooth mineral structure begins when enamel surface pH is below 5.7 to 5.5 Normal Neutral pH of the oral cavity is around 6
Equilibrium shifting of these factors towards demineralization results in enamel dissolution and hence caries formation Calcium and phosphate ( pH) as well as fluoride, can help remineralize affected areas if the process has not reached the cementoenamel junction
Tooth integrity exists when these processes occur without net loss of tooth mass Carious lesions results when the rate of demineralization exceeds the rate of remineralization over an extended time
Further facilitated by xerostomia xerostomia as the natural protection by saliva is absent Important to differentiate this type of erosion from the caries process Acid produced from plaque bacteria causes the enamel demineralization
Caries Process
Dental caries is a multifactorial disease Involves demineralization of the enamel and dentin Bacteria in dental plaque metabolize fermentable carbohydrates into organic acids Below the critical pH proteolytic enzymes break down the organic component
Food
Tooth
Caries
Time
Bacteria
Individual Susceptibility
Proteins from saliva adsorb to the cleaned tooth and form the acquired enamel pellicle
Proteinacious coating allows certain bacteria to start to colonize the tooth protein interactions between bacterial cell wall and pellicle Mature and thickened plaque contains many species of oral bacteria in extracellular matrix material More than 500 species of bacteria present in mouth
Small proportion of these are acidogenic bacteria that use dietary sugars as an energy source They produce acids and are associated with the caries development (not all acidogenic bacteria are cariogenic) In humans the two species of interest are Streptococcus mutans and Streptococcus sobrinus
S. mutans is the major pathogenic bacterial species involved in the caries process Studies show that 93% of children with detectable caries were positive for S. mutans The physiologic characteristics of the S. mutans that make them prime etiological agent in caries include their ability to:
S. mutans
1. Adhere to tooth surface 2. Produce abundant insoluble extracellular polysaccharides from sucrose 3. Rapidly produce lactic acid from a number of sugar substrates 4. Be tolerant to acid 5. Produce intracellular polysaccharide stores
Cariogenic bacteria metabolize sugars to produce energy required for their growth and reproduction The energy source may be exogenous or endogenous Metabolism of mono or di saccharides Once within the cell, glucose enters the Embden-Meyerhof glycolitic pathway
End result is production of Lactic acid and or other organic acids Presence of these acids in dental plaque fluid lowers its optimal pH The interface between tooth and plaque is no longer saturated with calcium and phosphate ions Demineralization starts taking place which may go beyond the dentinoenamel junction
pH
Acid decalcification progress Bacterial invasion of organic matrix Degradation by the process of proteolysis Carious lesions can occur where plaque can sufficiently colonize such as:
Pit and fissure caries (found mainly on the occlusal surfaces of posterior teeth, and in lingual pits of maxillary incisors)
Earliest clinically detectable stage of caries in the enamel is the incipient lesion Characterized by an opaque, white appearance At this stage the process is amenable to remineralization Further mineral loss result in enamel degradation and frank cavitation Only treatment option in most cases is the placement of restoration