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Cariology-The Susceptible Tooth 9
Cariology-The Susceptible Tooth 9
Cariology-The Susceptible Tooth 9
COLLEGE OF DENTISTRY
Protective factors
• Saliva flow and components
• Remineralization (F, Ca,
PO4)
• Antibacterials
• Good oral hygiene
History factor Risk increasing observation
Age Childhood
Gender Women are at slightly greater risk
Fluoride exposure No fluoride in water supply
Smoking Risk increases with amount
Alcohol smoked
General health Risk increases with amount
consumed
Medication Chronic illnesses, delibitation
decrease
ability to give self-care
Medications that reduce salivary
Clinical Risk increasing findings
examination
General appearance Appears sick, obese, or malnourished
Mental or physical Unable or unwilling to comply with
disability dietary and OHI
Mucosal membranes Dry, red and glossy mucosa suggests
decreased salivary flow
Active carious lesions Cavitation and softening of enamel
and dentin, circumferential chalky
opacity at gingival margins
Plaque High plaque scores
Gingiva Puffy, swollen, inflamed, bleeds easily
Existing restorations Indicate past high caries rate; poor
quality indicates increased habitat for
cariogenic organisms
0 1 2 3
Sound tooth
surface Distinct visual
DESC No caries change in Loc. Enamel
Visual change in
change, enamel, seen breakdown
RIPTI hypoplasia
anamel after
wihen wet, with no dentin
drying
ON Wear, erosion white, or shadow
Non-caries colored
phenomena
Sealant Sealant or
/ minimally
Resto Sealant optional Sealant optional Sealant optional invasive
(LOW- restoration
RISK) needed
Sealant Sealant or
/ minimally
Sealant Sealant
Resto Sealant optional invasive
0 4 5 6
Extensive distin
dark shadow from Distict cavity, visible
cavity with dent
dentin, with or dentin, frank
DESCRIPTION cavity is deep an
without localized cavitation (<1/2 of
wide involving m
enamel breakdown tooth surface)
than ½ of the to
Sealant/
Minimally invasive Minimally invasive Minimally invasi
Resto restoration restoration restoration
(LOW-RISK)
Functions:
- Protects enamel
- Reduces friction between teeth
- Provides matrix for remineralization
1. Pellicle (1 µm thick) covers all oral surfaces
within 30 minutes to 1 hour after brushing
2. It becomes colonized by bacteria within 12-24
hours.
3. High sucrose diet or frequent ingestion of
sucrose - favors colonization of acidogenic
bacteria and exclusion of non-cariogenic bacteria
(e.g., S. sanguis, S. mitis)
4. Special receptors make it easy for acidogenic
bacteria to adhere and extracellular matrix
facilitates cohesion
5. Metabolism of sucrose results in acid production –
lactic acid from sucrose.
6. Plaque pH below 5.5 – period of demineralization
7. Plaque pH above 5.5 – period of remineralization
The gelatinous nature of the plaque limits outward
diffusion of metabolic products and thus serve to
prolong the retention of acids.
STIMULATED Interpretation of results
SALIVA
Sample colony forming
units for mi of saliva
Lactobacilli >10 5 HIGH RISK – high counts
suggest there already exxixt
cariogenic plaque and good
potential to infect other sites
by overcoming colonizaation
resistance
b. Secondary succession
Newborns:
Mouth is sterile at birth
Rapidly colonized by skin bacteria and S. salivarius
Transient organisms may be noted
Major changes in the species composition of the oral
cavity occur with the eruption of teeth because
Two types of succession:
a. Primary succession
b. Secondary succession
process of plaque regrowth after the tooth surface is
cleaned
similar plaque will reform on the teeth after
prophylaxis if there is no other change in the oral
environmental conditions.
Adults:
general composition of a well-established oral flora
remains relatively stable if there are no major
changes in the health of the host
remineraliza
tion
pH
0 0 10 20 30 40 50 60
5.5
Between meals sugar
Base of pits and fissures
Smooth enamel surfaces that shelter plaque
- areas cervical to the contact areas
- distal surface of most posterior tooth
- areas cervical to the heights of
contour on the facial and lingual
Root surfaces
Base of pits and fissures
High prevalence of all dental caries.
Provides excellent mechanical shelter for
organism.
Smooth enamel surfaces that shelter plaque
areas cervical to the contact areas
- distal surface of most posterior tooth
- areas cervical to the heights of
contour on the facial and lingual
These are the areas also protected physically
and are relatively free from the effects of mastication of
food, tongue movement and salivary flow.
Root surfaces
Proximal root surfac near cervical line is often unaffected by
the action of hygienic procedure susch as flossing reuently
harbor caries-producing plaque.
1. Has a comparatively rapid progression
2.It is often asymptomatic
3.Closer to the pulp
4.It is more difficult to restore.
Base of pits and fissures
Smooth enamel surfaces that shelter plaque
- areas cervical to the contact areas
- distal surface of most posterior tooth
- areas cervical to the heights of
contour on the facial and lingual
Root surfaces
The Oral Mucosa is populated by organism with receptors
specialized for attachment to the surface of epithelium.
Dark Zone
Translucent Zone
The movement of ions through carious enamel can result in acid dissolution of
the underlying dentin before actual cavitations of the enamel surface.
1. Incipient smooth surface lesion
This lesion are usually observed on the facial and lingual surface of the tooth.
White spots are chalky white, opaque areas that are reversed only when the
tooth surface is dessicated (dried)
SURFACE SURFACE
HYDRATED DESSICATED
TEXTURE HARDNESS
Noncavitated
Transluscent Opaque Smooth Softened
caries
Opaque, Opaque,
Inactive caries Roughened hard
dark dark
Compare thickness of
enamel below base of pit
3 levels of dentinal reaction to caries can be recognized
Turbid Zone
Transparent dentin
Subtransparent
dentin
Normal dentin
ZONE 1 NORMAL DENTIN
Has a tubule with odontoblastics rocesses that are smooth and no crystals in
the line.
There are no bacteria in the tubules
ZONE 2 SUB TRANSPARENT DENTIN
Zone of demineralized (by acid from caries) of the intertubular dentin and
initial formation of very fine crystals in the tubules and lumen at the advancing
prone.
Damage to the odontoblastic process is ended, however no bacteria are founf
in this zone.
ZONE 3 TRANSPARENT DENTIN
Zone of carious dentin that is softer than normal dentin.
Shows further loss of mineral from intertubular dentin and many large crystals
in the lower of dentinal tubules
ZONE 4 TURBID DENTIN
Zones of bacterial invasion marked by widening and distortion of dentinal
tubules w/c filled with bacteria.
Dentin in this zone will not self repair.
ZONE 5 INFECTED DENTIN
Outermost zone of infected dentin
Decomposed dentin that is teeming with bacteria.
No recognizable structure to dentin, seems to be absent of collagen and
mineral.
It recognized clinically, as a wet, mushy, easily removable mass.
This is structure less/ granular in histologic appearance and contain masses of
bacteria.
Sensitivity Presence of Capacity to
to stimuli bacteria remineralize
Zone 1, IZ
- + -
Zone 2, TZ
- + -
Zone 3, TrD
+ - +
Zone 4, STrD
+ - +
Zone 5, ND
+ - +
Infected dentin = Zones 1 and 2
- significantly discolored
- can be removed by
excavators
- stained with caries detector
- needs to be removed
unless judged to be within
0.5 mm of pulp
Affected dentin = Zones 3 and 4
- not significantly
discolored
- feels hard already
- capable of remineralization
Acute (Rampant) Caries- Soft, light- colored lesion
Chronic (Slowly progressing) Caries- Fairly hard or
leathery texture and highly discolored
Arrested Caries- Hard, shiny, smooth surface with
brown-black discoloration
Active lesion
In enamel, it has a dull, white, opaque
appearance. In dentin, a soft, yellowish or light to
dark brown discolorations of the demineralized
tissues prevail.
Arrested lesion
Varied appearance, ranging from a shiny,
white, opaque or discolored spot in the enamel to a
hard, dark dentinal surface exposed to the oral
environment
If mineralization occurs after cavitations , the remaining exposed
surface becomes harder and softer and often becomes dark
brown/ black in color –termed as ARRESTED CARIES
Type of caries according to extent
Incipient or reversible
Cavitated or irreversible
The time for progression from incipient caries to clinical caries on smooth
surface is estimated to be 18 mos.
Peak rates for the incidence of new lesion occurs 3 years after the erruption of
the tooth.
Both for oral hygiene and frequent exposure to sucrose containing food can
produce incipients (white spot lesion)– first clinical evidence of
demineralization as little as 3 weeks.
Primary caries lesions
Lesions found in intact tooth surfaces
Secondary caries lesions (Recurrent caries)
Lesions found adjacent to restorations
Remaining caries lesions
Caries lesion left behind in the preparation or at the enamel margin of
a preparation when a restoration is placed
2. Arrested Caries ( mineralized
lesion)
P Dentin Enamel
u
l
p
Substantially reduce sucrose from diet
Eliminate sucrose from between meal snacks
Rationale: Reduce number, duration and intensity
of acid attacks.
Reduce selection pressure for MS