DENTAL CARIES

Causative factors: tooth, bacteria, carbohydrates and time

CLASSIFICATION AND MORPHOLOGY OF DENTAL CARIES

DENTAL CARIES – dissolution and destruction/demineralization of hard structures of tooth/inorganic

portion of tooth.

DENTAL PLAQUE – soft, sticky film that builds up on tooth surface and contains millions of bacteria

MATERIA ALBA – white cheese like accumulation of food debris, microorganisms, desquamated
epithelial cells, and blood cells deposited around the teeth at the gumline.

DIFFERENCE OF DENTAL PLAQUE TO MATERIA ALBA:

• Dental plaque are just microorganisms, film

• Materia alba are tinga

BIOFILM – collective of one or more types of microorganisms that can grow on many different surfaces
(when you pass through your teeth with your tongue, biofilms is formed)

MATERIA ALBA DENTAL PLAQUE CALCULUS / CALCULAR

White cheese like accumulation
A soft accumulation of salivary
proteins, bacteria,
desquamated epithelial cells,
food debris
Lacks an organized structure
Easily displaced with a water
spray
If not removed, it will become
caries
DEPOSITS
Resilient clear to yellow grayish Hard deposit that forms by
substance mineralization of dental plaque
Composed of bacteria in a Generally covered by a layer of
matrix of salivary glycoproteins unmineralized dental plaque
& extracellular polysaccharides
Considered to be a biofilm
Impossible to remove by rinsing
or water spray
When it becomes hard, calcular
deposits form
DETECTION OF CARIES

• Visual examination
• Exploration – tactile examination – explorer
• Radiographic exam
• Use of floss
• Separate teeth using wedge
• Transillumination (periapical, occlusal, bitewings)

CLASSIFICATION OF DENTAL CARIES:

A. According to location and occurrence

• Primary caries – ORIGINAL CARIOUS LESION; pits and fissures (occlusal and buccal surface
of molars and premolars, lingual of maxillary lateral incisors; smooth surface caries
(proximal: mesial and distal surface, labial surface of incisors and premolars);
• Secondary / recurrent caries – OCCURS AROUND MARGINS OF RESTORATIONS (Why is it
called secondary caries: because it is found at the margins of the restoration because it’s
no longer first time, a recurrence was occured)
• Root / senile caries – OCCURS ON THE EXPOSED ROOT SURFACE (why is it called senile?
Because it is commonly found in old patients from the recession of the gingiva; another
cause is because of the periodontitis / gingivitis)
• Residual Caries – CARIES THAT ARE LEFT BEHIND DURING CAVITY PREPARATION
B. According to extent (kung gano na kalala)
• Incipient caries – 1st EVIDENCE OF CARIES; SURFACE APPEARS OPAQUE WHITE WHEN DRY
(How to detect incipient caries: by using tactile examination using an explorer, if bumaon,
then it’s caries, if it’s smooth then there’s a problem with fluoride a.k.a. fluorosis; it can be
seen as a chalky white appearance. This is due of the demineralization of enamel)
• Cavitated caries – ENAMEL SURFACE IS BROKEN & LESION HAS ADVANCED INTO DENTIN
(the tooth has a cavity)

DESCRIPTION INCIPIENT CAVITATED

Extent Limited to enamel Enamel, dentin, pulp
Presence of cavitation No Yes
Demineralization Reversible Irreversible
Remineralization Yes (with the use of tooth No
mousse)
Treatment Conservative Cavity preparation &
restoration

FLUOROSIS VS. INCIPIENT CARIES

• FLUOROSIS – there is no discontinuity of the enamel

• INCIPIENT CARIES -there would be catch
 C. According to speed of progression
• Acute / rampant caries – MULTIPLE, SOFT, LIGHT-COLORED / SLIGHTLY STAINED LESIONS
(this type of caries progress rapidly; upon tactile examination: when passed by the explorer,
it’s an acute caries when it’s soft and cheesy [babaon yung explorer sa caries]; in terms of
cheesy, with the use of the spoon-shaped excavator, when you can scoop it out it is an acute
caries; it is all over in the oral cavity, marami ang acute / rampant caries)
• Chronic / slow caries – FEW IN NUMBER, MORE DARK-COLORED, FAIRLY HARD LESION
(darkly stained or dark brown colored; it progresses slowly, matagal bago maging cavitated)
• Arrested caries – BROWN-BLACK, HARD & SMOOTH, PROGRESS HAS CEASED (these are
caries that are ceased to progress, meaning it stopped in progressing; when run through an
explorer, there would be no catch, it’s already smooth and the lesions are hard)

CATEGORY SPEED OF PROGRESSION CLINICAL FEATURES

Acute - Rampant - Many
- Rapid - Soft-to-touch
- Light-colored (why? Because
the acute caries is rapidly
occurring, it doesn’t have much
time to progress anymore)
Chronic Slow - Few
- Fairly hard
- Darkly stained
Arrested No progression - Few
- Hard
- Dark brown to black (Why?
Matagal nang nandon and it
ceased already that it became
black)

NON-CARIOUS DEFECTS TERMINOLOGY

1. ABRASION – interaction between the tooth and other materials (caused by:faulty
toothbrushing, getting picked abruptly by toothpick); Tooth surface that is lost due to
physiologic, pathologic or chemicomechanical actions

2. ATTRITION – defect of tooth structure wherein there’s a tooth-to-tooth contact (caused by:
bruxism – grinding of teeth); Tooth surface that is lost due to physiologic, pathologic or
chemicomechanical actions
3. EROSION -dissolutions of hard tooth tissue because of chemical or acidic substance (caused by:
sour and acidic food); Tooth surface that is lost due to physiologic, pathologic or
chemicomechanical actions

4. TOOTH FRACTURES – caused by: trauma; can have different categories depending on tooth
structures that is affected by depth and extend (it can be only on the crown or all the way to the
root)

5. AMELOGENESIS IMPERFECTA – defective tooth structures; hereditary defective enamel in form

or in structure (it didn’t fully develop or it supra developed)

6. DENTINOGENESIS IMPERFECTA – defective tooth structures; the enamel is normal however the
dentin has a defect on the dentin on the dentin structures or formation
7. NON-HEREDITARY ENAMEL HYPOPLASIA – defective tooth structures; there is a disruption on
the ameloblastic formation