Microscopic Feature of Dental Caries Smooth Enamel Surfaces

Three Cariogenic Bacteria  second most susceptible areas to caries

 Forms a triangular pattern or cone shaped lesion as it
1. Streptococcus Mutans
goes deeper.
 Initiator of dental caries  This situation favors the occurrence of caries or
 Called as Cariogenic streptococci periodontal disease.
 Habitat: Enamel
Pits and Fissures
2. Lactobacillus Acidophilus
 excellent mechanical shelter for organisms
 In an active carious process, there is a lot of
 In cross section microscopy, the gross appearance is
lactobacillus acidophilus there, but the caries initiator
truly needs Streptococcus mutans an inverted V or it is triangular in shape.
 Habitat: Dentin  In susceptible patients, sealing the pits and fissures
just after tooth eruption may be the most important
Snyder test event in their resistance to caries
 counting the number of lactobacillus acidophilus, the Root Surfaces
more you have it, the more you are prone to dental
caries.  Frequently harbor cariogenic biofilm.
3. Actinomyces  Root surfaces most often in old patient because
of niche availability and other factors sometimes
 These are usually associated with the dental caries. associated with senescent, such as decrease
 Habitat: Root Caries salivary flow and poor oral hygiene.
 Plaque and microorganism are essentially for the
Enamel
cause and progression of the lesion, mostly
 Seen as a chalky white spot on the tooth just adjacent actinomyces
to contact point.
Dentin
Four Different Zones:
• Initial (non infected) lesion in dentin forms beneath
1. Translucent zone enamel before any cavity has formed
2.Dark zone
• Once the bacteria penetrate to enamel, they spread
3. Body of Lesions laterally along DEJ and attack dentin over a wide
area
4.Surface Zone
• The infected lesion will course its way on the tubules
1. Translucent zone which provide an easy pathway to the bacteria
 Unrecognizable clinically & radiographically ,occurs
Zone 1: Normal Dentin
due to formation of submicroscopic pores at enamel
rod boundaries
 The deepest area, which has tubules with
2. Dark zone odontoblastic processes that are smooth and no
crystals that are present in the lumens.
 Lies superficial to translucent zone; called positive  No bacteria are present in the tubules
zone as it always present
 Stimulation of dentin produces a sharp pain
3. Body of Lesion
Zone 2: Affected dentin
 It forms bulk of the lesion and lies between relatively
unaffected surface zone and dark zone.  Also called inner carious dentin
 Zone of demineralization of intertubular dentin and
4. Surface Zone initial formation of fine crystals in the tubule lumen
at the advancing front
 This zone not only remains intact during the early
stages of attack by carries, but also remains more  Damage to the odontoblastic process is evident
heavily mineralized
3 Subzones:
1. Subtransparent dentin Saliva

2. Transparent dentin • Bathes the tooth surface

3. Turbid dentin • Vehicle for solubilizing and transporting media for

various substances
Zone 3: Infected dentin
• Cleansing Property
 Also called outer carious dentin
 The infected is the zone of bacterial invasion • Buffering Property
 The dentin in this zone does not self repair, it cannot
Diet
be rematerialized, and its removal is essential to
sound • Dental caries and fermentable carbohydrate
*successful restorative procedures and the prevention of • Sucrose is the most important factor in producing
spreading the infection* cariogenic biofilm and, ultimately, caries lesions.

Oral hygiene

• Proper tooth brushing and flossing

• Mechanical cleaning of teeth disrupts the biofilm and

leaves a clean enamel surface

MICROORGANISMS

• Lactobacillus acidophilus – dentin caries

• Streptococcus mutans – enamel caries

• Actinobacillus actinomycetemcomitans – root

caries
Etiology of Caries

 The word “caries” is derived from latin word

meaning “rot” or “decay”
 According to WORLD HEALTH ORGANIZATION
dental caries is a preventable disease of the
mineralized tissues of the teeth with a multi-
functional etiology related to the interaction over
time between tooth substance and certain
microorganisms and dietary carbohydrates
 Dental caries is a microbial disease of the calcified
tissues of the teeth characterized by demineralization
of the inorganic portion and destruction of the
organic substance of the tooth,

 In ancient humans, caries was usually located at the

CEJ or cementum, whereas in modern man grooves Clinical Feature of Dental Caries
and fissures are the most common sites of decay.
Smoooth Surface Caries
Factors of Caries
 Interproximal Caries
• Salivary flow
 opaque chalky region (white spot)
• Diet
 some cases yellow or brown pigment area
• Oral hygiene
  Spots are generally located on outer surface of
enamel between contact point + height of free
gingival margin
 Interproximal Caries
 As caries penetrates, enamel surrounding the lesion
assumes bluish white appearance
• Usually apparent as laterally spreading caries at DEJ
 Common for proximal caries to extend both buccally
and lingually
Location: Cervical, Bucccal, Lingual or Palatal Caries
 Usually extend from area opposite gingival crest
occlusally to convexity of tooth surface
 Extends laterally towards proximal surfaces
 Usually occurs on cervical area
 Typical cervical lesion is a crescent shaped cavity
beginning as slightly roughened chalky area
 Gradually becomes excavated
PiT AND FiSSURE CARiES
 Appears brown or black
 feel slightly soft
 Catch a fine explorer point
 Enamel bordering the pit and fissure may appear:
1. Opaque
2. Bluish white
 Lateral spread of caries at DEJ as well as penetration
into dentin along dentinal tubules may be extensive
 There may be large carious lesion with only a tiny
point of opening
Root Caries
 Also known as cemental caries
 Involves both dentin + cementum
 CLINICAL FEATURES:
 Slowly progressing chronic lesion
 Usually founds in mandibular molar area + premolar
region
 Gingival recession is associated with root surface
caries
Recurrent Caries
 Occurs immediately adjacent to restoration
 May be caused by inadequate extension of restoration
 Was not able to excavate or removed well original
carious lesion
CLINICAL FEATURES:
 Restoration with poor margins
 Permitted leakage + bacteria + substrate
Nursing Bottle Caries
 Prolonged feeding beyond usual time may result in
early + rampant caries
 Early carious involvement of maxillary + mandibular
1st permanent molars, mandibular canine
 Carious process is so severe that only root stumps
remain
Rampant Caries
 Occurs in children with poor dietary habits
 Extensive inter-proximal + smooth surface caries
Arrested Caries
 Both deciduous + permanent are affected
 Large open cavities
 Brown-stained polished appearance + hard
ICDAS (International Caries Detection and Assessment
System) - A simple, logical, evidence-based system for
detection and classification caries in dental education, clinical
practice, dental research and dental public health
Diagnostic Aids
1) ) Visual tactile method
- Detection of white spot, discoloration/frank
cavitations
- Without aids, usually unreliable
- Makes use of temporary elective tooth separation
2) Radiography
- can penetrate even the deep areas with ill defined
borders
3) Caries detecting dyes
- Observation can be qualitative or quantitative
- Dyes should be: Safe for intraoral use, stain the
tissues that are diseased, should be easily
removed.
- Not often used because it can stain the dentin and
the demineralized organic matrix
 4) Fiber optic transillumination Lesion Initiation
- Uses light transmission
- Demineralized dental hard tissues scatter and A) Primary Caries
absorb light more than sound tissue - The lesion constitutes the initial attack on the
- For enamel and dentin caries detection on tooth surface
occlusal, proximal and smooth surfaces of B) Secondary Caries
anterior and posterior, carious lesions appear - Recurrent caries
darker compared to sound tissue - Associated with microleakage on margins of
5) Digital imaging fiber optic transillumination tooth restorations
- Uses same principles as foti
Extent
- White light is delivered through an optical fiber
via a handpiece channeling the image back to a A) Incipient Caries
digital camera - Subsurface demineralization but with intact
6) Electronic caries monitor enamel surface
- has been developed as clinical diagnostic aids in - Reversible, remineralizable
the detection and quantification of - White, opaque lesion on
occlusal carious lesions. As the tooth - smooth surfaces (white spot lesion)
demineralizes in caries process, the loss of - Usual after orthodontic treatment
mineral leads to increased porosity in the tooth B) Hidden Caries
structure - Not readily seen
- Porosity - having minute spaces or holes through - Found radiographically below apparently sound
which liquid or air may pass. Not retentive or occlusal surface
secure. C) Cavitated Lesion
- Presence of cavity
NOTE:
- Presence of visual breakdown on the tooth
 Use of explorer is not advocated because: surface

• Sharp tips physically damage small lesions with Number of tooth surfaces involved
intact surfaces
- Simple - 1
• Probing can cause fracture and cavitation of incipient - Compound - 2
lesion. - Complex – 3 or more surfaces

Rate of Progression Mount and Hume Classification

A) Acute Caries Site 1

 Rapidly progressing
- G.V. Black’s Class I
 Involves large number of teeth - Pits and fissures
 Light colored (white – light brown)
 caseous consistency (cheesy) Site 2
 Often associated with tooth sensitivity and pulp
exposure - Contact areas of all teeth, Black’s Class II,
B) Chronic Caries III, IV
 Slow progressing and long standing lesions affecting
Site 3
fewer number of teeth
 Dark and leathery - Gingival margin, Black’s class V that extends to
C) Arrested Caries root surface
 Caries that has become static showing no tendency
for further progression Size1(Minimal)
 Sclerotic dentin (harder, dark brown)
- With lesion
 More resistant to further caries attack
 No need to be removed - Beyond remineralization (tooth can heal itself)

- Minimal dentinal spread

 • Size 2 (Moderate)

- Larger lesion

- Sufficient tooth structure to support the

restoration

- Moderate involvement of dentin

• Size 3 (Enlarged)

- More extensive lesion

- Restoration will take main occlusal load

• Size 4 (Extensive)

- Serious loss of tooth structure

- Loss of cusp or incisal edge

ICDAS

1. Code 0 - Sound tooth structure. No caries change

after drying (5sec)
2. Code 1 - First visual change in enamel: Opacity or
discoloration (white or brown). is visible at the
entrance to the pit or fissure seen after prolonged air
drying
3. Code 2 - Clear visual change in enamel visible when
wet. Lesion is visible even if not dried.
4. Code 3 - Localized enamel breakdown without
dentin involvement. Seen when wet and after
prolonged drying
5. Code 4 - With underlying shadow from dentin
With or without localized enamel breakdown
6. Code 5 - Distinct cavity with visible dentin. Frank
cavitation involving less than half of a tooth surface
7. Code 6 - Extensive distinct cavity (more than half the
tooth surface) with visible dentin