THEORIES OF DENTAL

CARIES
 THEORIES OF DENTAL
CARIES

The Acidogenic theory

The Proteolytic theory
Proteolysis chelation theory
 ACIDOGENIC THEORY
 W.D Miller was the first well known scientist
and investigator of dental caries and
published his results in 1882.
 According to him dental decay is a chemo-
parasitic process
 It is a two-stage process where there is
decalcification of the enamel which also
results in the destruction of the dentin. in
the second stage there is dissolution of the
softened residue of the enamel and dentin.
ACIDOGENIC THEORY

 In the first stage destruction is done

by the acid attack whereas the
dissolution of the residue is carried by
the proteolytic action of the bacteria
 This whole process is supported by the
presence of carbohydrates,
microorganisms and dental plaque
PROTEOLYTIC
THEORY
PROTEOLYTIC THEORY

The evidence given by the acidogenic

theory was considerable but it was not
conclusive, and alternative explanation
was given in the form of proteolytic
theory.
 Workers like “Heider, Bodecker
(1878)and Abbott (1879) contributed
considerably to this theory
PROTEOLYTIC THEORY
 There has been evidence that the organic
portion of the tooth plays an important role
in the development of dental caries
 The are some enamel structure which are
made of the organic material such as
enamel lamellae and enamel rods
 These structure prove to be the pathways
for the advancing microorganisms.
PROTEOLYTIC THEORY
 It has been established that enamel contains 0.56
% of organic matter of which 0.18% is keratin and
0.17 % is a soluble protein
 Microorganisms invade the enamel lamellae and the
acid produced by the bacteria causes damage to
the organic pathways in advance
 There is production of the yellowish pigment by the
proteolytic bacteria and the presence of this
pigment is only possible in the presence of dietary
carbohydrates.
PROTEOLYSIS
CHELATION
THEORY
 PROTEOLYSIS
CHELATION THEORY
Some of the minor flaws of the
acidogenic and the proteolytic theory
were addressed in the proteolysis
chelation theory.
 This theory was put forward by Schatz
and his co-workers .
 PROTEOLYSIS
CHELATION THEORY
CHELATION
It is a process in which there is
complexing of the metal ions to form
complex substance through
coordinate covalent bond which
results in:
poorly dissociated /or
weakly ionized compound
 PROTEOLYSIS
CHELATION THEORY
 Chelation is independent of the pH of the
medium.
 The bacteria’s attack on the surface of the
enamel is initiated by keratinolytic
microorganisms this result in the breakdown
of the protein chiefly keratin and results in
the formation of soluble chelates which
decalcify enamel even at neutral pH
 Mucopolysaccarides may also act as
secondary chelators.
Hypothesis of the Etiology
of Dental Caries
As discussed by Loesche studying
periodontal disease
 Nonspecific plaque hypothesis- all
plaque is pathogenic
 Specific plaque hypothesis- recognizes
plaque as pathogenic only when signs
of associated disease are present
The goal of therapy is to suppress the
cariogenic plaques and to replace
them with pathogen-free plaques
which can be achieved by mechanical
debridement and chemical agents.
 Dental caries
Its clinical correlation
 TYPES OF DENTAL
CARIES
 G.V. Black’s classification of caries
class I , II , III , IV , V and VI
 Rampant caries
 Recurrent caries
 Arrested caries
 Root or cemental caries
 Baby bottle caries
Pits and fissure caries
 Pit and Fissure caries

 Caries found on the occlusal surfaces

of molars and premolars, lingual
surfaces of maxillary anteriors, and
buccal and lingual 2/3rds of molars.
Proximal caries
 Proximal Caries

 G.V. Black’s Class II - Caries found on

proximal smooth surfaces of posterior
teeth found gingival to the contact
area but occlusal to the gingival
margins
 and Mount and Hume’s Site 2- on
proximal surfaces of all teeth
Cervical caries
 Cervical Caries

 G. V. Black’s Class V- found on the

cervical 3rd of all teeth
 Mount and Hume’s Site 3- found
around the cervical areas including the
root portion
Rampant caries
 Rampant Caries
 Also termed as Acute caries refers to
disease that is rapidly damaging the
tooth, usually in the form of many soft,
light-colored (less time for extrinsic
pigmentation) lesions in the mouth and
is infectious.
Recurrent caries
 Recurrent Caries
 Also termed Secondary Caries –
occurs at the junction of a restoration
and the tooth and may progress under
the restoration. This usually indicates
that microleakage is present, along with
other conditions conducive to caries.
Arrested caries
 Arrested Caries

 Also termed Chronic Caries develops

at a slow rate or it might be arrested
after several active phases. The lesion
is discolored and fairly hard. An
arrested dentinal lesion typically is
“open”, dark, and hard and this dentin
is termed sclerotic or eburnated
dentin.
Root or cemental caries
 Root or Cemental Caries
 May occur on the tooth root that has
been exposed to the oral environment
and habitually covered with plaque;
often are prevalent in older patients;
more rapid than other forms of caries
and should be detected and treated
early.
Nursing bottle caries
 Nursing bottle caries
 Occurs when sweetened liquids or
those with natural sugars, cling to an
infant’s teeth for long periods of time.
Bacteria in the mouth thrive on this
sugar and produce acids that attack the
teeth.