DENTAL CARIES

Ms N Gordon
 Outcomes of the lecture
Students should:
•Know the factors involved in the caries process,
•Be able to describe the caries process,
•Describe how dental caries can be prevented
 DENTAL CARIES
• Dental caries is a common chronic infectious disease that
results from cariogenic bacteria, primarily Streptococcus
Mutans that adheres to the tooth structure, and which
metabolize sugars to produce acid that demineralizes
the tooth structure over a time period (Boyd et al., 2020)
• One of the most prevalent chronic diseases of people
worldwide,
• Common, preventable disease,
• People are susceptible throughout their lifetime,
• Dental caries is a major cause of tooth loss.
 Healthy Teeth
• As soon as the first tooth erupts, it is susceptible to
becoming carious.
• The first milk tooth erupts at about 6months of age,

The tooth enamel consists of a highly mineralized

substance called hydroxyapatite
 Terminology
Bacterial plaque is a sticky
biofilm that develops on teeth
in minutes of cleaning because
of organisms that naturally live
in the mouth

pH is a measure of acidity or
alkalinity. If the value is more
than 7, this indicates
alkalinity, and less than 7
indicates acidity.

Dental caries is tooth

decay or rotten teeth
 Dental Caries Formation
• The human mouth contains billions of bacteria from over 270
different species
• Bacteria adheres to tooth pellicle and contributes to plaque
formation.
• Streptococcus Mutans- main caries causing bacteria- requires
sugar for metabolism
• The sugar is metabolized into energy,
• Lactic acid is produced as a by-product.
• Lactic acid, can remove minerals from the tooth structure.
• Remember what an acidic pH is
What do we need for dental
caries to form?
FORMATION OF DENTAL
CARIES
 Stephan Curve
• Rinsing with 10% glucose solution-pH falls to around pH of 5
within 2-5 minutes- critical pH
• pH then slowly rises back to 6.5-7.0
• 5 is the critical pH where leaching of minerals from the
tooth structure occurs
 Stephan Curve
AETIOLOGY
8

• Four major factors involved in etiology:-

• Susceptible tooth surface (what make the tooth
6
susceptible?)
• Cariogenic bacteria (name the bacteria) Critical pH
Glucose
• Fermentable bacterial substrate (sugar)
pH

4
Xylitol
• Time (how does time influence dental caries?) Snacking
What2happens?
• Bacterial fermentation of dietary carbohydrates
releases acidic by-products
• These
0 acidic by-products causes localised destruction
of susceptible
1 5 9 13dental hard
17 21 25 tissues
29 33 37 41 45 49 53 57
Minutes
Stephan Curve (Stephan, 1940’s)
• Ste
 Demineralisation and
remineralisation process
 DENTAL CARIES- from
demineralisation to cavitation
Dental caries
https://youtu.be/n6mV6r67p4E?si=-CfTXBAVOpxyAN7x
 See-saw effect of the
demineralisation/
remineralisation process
Prevention of dental caries
 Prevention of dental caries-
plaque biofilm removal
Brushing and
flossing

• Brushing removes most plaque from the teeth

• Flossing removes plaque from between the teeth
• Fluoridated toothpaste increase tooth resistance to
demineralization.
Prevention of Dental Caries-
Diet
 Prevention of Dental Caries -
Fluoride
• Fluoride protects the tooth
• Fluoride is incorporated into the hydroxyapatite crystal
(of enamel) forming fluorapatite which has greater
resistance to demineralization
• Fluoride also acts on an enzyme (enolase) in the bacteria
which causes a slowing down of its (bacterial)
metabolism and subsequent acid production.
 Prevention of Dental Caries-
Fluoride
Fluoride is present in:
•Certain foodstuffs, fish,
Rooibos
•Toothpaste
•Mouthwashes
•Professionally applied fluoride
gels and varnishes
•Drops or tablets
•In some countries, in
fluoridated drinking water.
 Prevention of Dental
• Saliva can diminish the effect of the acids on the tooth
• Contains a buffer which neutralizes the acids
• Has a “washing’ action on the teeth
• Contains mineral ions
• Is anti-bacterial.
 Fissure sealants
• Fissure sealants are resin-based adhesives that are
applied to the grooves and fissures of the posterior
teeth
• A fissure sealant prevents bacteria and food particles
from becoming lodged in these fissures (where a
toothbrush can’t reach).

Caries
Essay: Sugar intake is more important than daily
brushing with fluoride toothpaste to prevent dental
caries. Discuss.
What does sugar intake mean?
•Consider the type of sugar (sticky, liquid-tells you how long the
sugar is in the mouth)
•Frequency of sugar intake (tells you how often the person is
exposed to a low pH)
What does daily brushing mean?
•What happens during the brushing process (biofilm removal)
•Does technique play a role in biofilm removal?
•Brushing once a day, twice a day? (does this make a difference?)
What does the use of fluoride toothpaste mean?
•What does fluoride do?
•Does it make a difference if brushing with a fluoride toothpaste
What are the other preventive factors that may play a role
 Think about caries prevention
• What are the factors implicated in the dental caries
process?
• What are the preventive factors in the dental caries
process?
• To what extent does/can the preventive factors prevent
dental caries?
• Under what conditions can dental caries be prevented?
Conclusion
• The lecture shows that there are risk factors that interact
to cause dental caries to develop.
• These risk factors are the tooth structure, bacteria, sugar
and time.
• There are also factors that contribute to caries prevention.
• Prevention of dental caries is therefore complex.
• In answering your essay, you are expected to demonstrate
that you understand how risk factors contribute to dental
caries formation and whether the modification of one risk
is more important than that the other in caries prevention.
Reference
• Boyd, L.D., Mallonee, L.F., Wyche, C.J. and Halaris, J.F., 2020.
Wilkins' Clinical practice of the dental hygienist. Jones &
Bartlett Learning.
• These animated videos provides an overview in a fun way
• https://youtu.be/n6mV6r67p4E

• Not a complete reference list

Acknowledgement
• Prof Barrie – contribution to the lecture material