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Lab 4

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Lab 4

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Lab. No. 4 DENTAL CARIES ‫ احالم طه‬.

‫د‬

DENTAL CARIES: is defined as irreversible multi-factorial disease of microbial origin


affecting the calcified tissues of the teeth in which the dietary carbohydrates are fermented
by bacteria forming an acid that causes demineralization of the inorganic part and
disintegration of the organic part of the tooth.

Theories of dental caries:


No universally accepted opinion of etiology of dental caries but there are 3 theories have
evolved:
(1) Acidogenic theory (chemico- parasitic theory).
(2) Proteolytic theory.
(3) Proteolysis-chelation theory.

1) Acidogenic theory (chemico- parasitic theory): Miller stated in 1887 that “Dental
decay is a chemico - parasitic process consisting of two stages:
First, decalcification of enamel and dentin (preliminary stage)
Second, dissolution of the softened residue (later stage)
The acid which affects the primary decalcification is derived from the fermentation of
starches and sugar lodged in the retaining centers of the teeth.
2) Proteolytic theory: In contrast to acidogenic theory, this theory postulated by Gottleib
et al, states that caries is essentially a proteolytic process and the organic or protein
elements like enamel lamellae, rod sheath etc are the initial pathway of invasion by
microorganisms.

3) The Proteolysis-Chelation theory (Schatz’s theory): This theory states that the
bacterial attack on the enamel, initiated by keratinolytic microorganisms, results in
breakdown of protein and other organic components of enamel, chiefly keratin. This
results in the formation of substances which may form soluble chelates with mineralized
component of tooth and thereby decalcify enamel at a neutral or even alkaline pH. This
theory states that initial attack of dental caries is on organic and inorganic portion of
enamel simultaneously.
Each of these theories fails to explain all ramifications of the disease, but all three agree on
the following: For dental caries there must be: (1) Host (2) Microflora (3) Substrate.

Composition of tooth
Enamel:-
- Inorganic : 96%
- Organic + water : 4%
Dentin:-
- Organic matter +water :35%
- Inorganic :65%
Cementum:-
- Inorganic : 45-50%
- Organic +water : 50- 55%
1
Classification of Caries:

A. According to number of surfaces involved:


1) Simple (1 surface involved).
2) Compound (2 surfaces involved).
3) Complex (more than 2 surfaces involved).

B. According to anatomic site:


1) Occlusal (pit-and-fissure) caries.
2) Smooth-surface caries (proximal and cervical caries).
3) Root caries.

C. According to histology:
1) Enamel caries.
2) Dentinal caries.
3) Cemental caries.

D.According to severity:
1) Incipient caries(Initial or primary): Carious lesion appears as a white opaque region
(white spot lesion).
2) Occult caries.
3) Cavitation caries: The enamel surface is broken (not intact) and the lesion has advanced
into enamel/dentin. No remineralization is possible at this stage.

E. According to onset:
1) Primary caries: is the original carious lesion of the tooth.
2) Secondary (recurrent) caries: Occurs at the interface of tooth and restorative
material.
3) Residual caries: is demineralized tissue left in place before a filling is placed.

F.According to the rapidity of the process:


1) Acute (rampant): Characterized by sudden, rapid destruction of teeth with early pulp
involvement affecting even relatively caries free surfaces like proximal and cervical
surfaces of mandibular teeth.
2) Chronic: That type of caries which progresses slowly and involves the pulp much later
than acute caries.

Nursing caries: - Acute caries occur in the primary teeth, 1 to 3 years old. Attributed to
the practice of putting the infant to bed with a bottle of sweetened drink. More prevalent
in low socioeconomic status population, where infants are being cared by little educated
mothers. Prevention based on education of parents.

2
G.According to chronology:
1) Early childhood caries.
2) Adolescent caries.
3) Senile caries.

ARRESTED CARIES: It is that caries which becomes static or stationary and does not
progress any further and could occur in both deciduous and permanent dentition.

Clinical Diagnosis Of Dental Caries:

By one or all of the following:


1) Visual changes in tooth surface texture or color.
2) Tactile sensation with explorer: exploration to detect any cavitation.
3) Radiographs.
4) Transillumination: in which light source directed through the tooth from the lingual
side.

CARIES SUSCEPTIBILITY OF INDIVIDUAL TEETH:

• Upper and lower first molar  95%

• Upper and lower second molar  75%

• Upper second bicuspid  45%

• Upper first bicuspid  35%

• Lower second bicuspid  35%

• Upper central and lateral incisor  30%

• Upper cuspids and lower first bicuspid  10%

• Lower central and lateral incisor  3%

• Lower cuspids  3%

• Caries susceptibility of individual tooth surface:

occlusal > mesial, distal > buccal > lingual

• Maxillary teeth more susceptible than mandibular teeth  relate to gravity and
saliva, with its buffering action, would tend to drain from upper teeth and collect
around lower teeth.

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