Cariology Lecture 2

Where, specifically, do caries typically form?

Plaque stagnation areas; covered, overlapping areas

Where do caries typically form in younger people?

Pits and fissures

Where do caries typically form in older patients?

At interproximal surfaces and at the gingival margin

What is the first clinically visible sign of caries-affected enamel?

White spot lesion

The enamel is dissolving, more pores of the tooth are exposed

Classical caries zones

Surface zone

Body of the lesion

Dark zone

Translucent zone

When does dentin react to caries?

Before the demineralization process reaches the DEJ (dentin-enamel junction)

What is the first sign of dentin reaction to caries?

Tubular sclerosis

No bacteria can be found in the dentin as long as the enamel surface is macroscopically intact

What zones appear when caries reach the DEJ

Zone of demineralization

Dead tracts

Sclerotic zone

Normal, but affected dentin

Tertiary dentin

How do caries appear on x-rays?

Less dense, more transparent areas

How does the tooth add minerals to itself?

From the inside out

What happens when the dentin is exposed?

Tooth experiences sensitivities

What happens when the zone of penetration reached the pulp?

Irreversible pulpal inflammation

This happens when enzymes continue to destroy the dentin after the enamel surface has been broken down and plaque is persistently demineralizing

What parts of the tooth are more vulnerable to demineralization than the enamel?

Cementum and dentin

Why are older patients more susceptible to exposed root caries?

Gingival recession exposes more root surface

Lower salivary flow

Reduced oral hygiene capabilities

All hasten the caries process

What is erosion caused by?

NOT bacteria, but the direct dissolution of enamel and dentin die to acids

What are some factors that affect erosion?

Diet: acidic food and drinks

Stomach acids: acid reflux, vomitng

Environment: poor swimming pool maintenance, frequent exposure to acid vapors in industry

Medications: chewable vitamin C tablets

Brutish: Grinding while sleeping

Indirect factors affecting dental caries

Education

Socioeconomic status

Income

Genetics

Age

Dentist

Direct factors affecting dental caries

Host defense/immunity

Oral hygiene

Saliva

Fluoride/ca2+

What type of diet promotes the development of caries?

One rich in readily fermentable carbohydrates

How many tsp of sugar do Americans consume daily?

22.7

How many lbs of high fructose corn syrup do Americans consume yearly?

51

2 most carcinogenic dietary sugars

Sucrose

Glucose

2 least carcinogenic sugars

Sorbitol

Mannitol

What sugar is still carcinogenic, just not as much as sucrose and glucose?

Starch

What dietary sugar has been shown to be proactive against tooth decay?

Xylitol

How many grams of sugar is 1 tsp?

4

How many grams of sugar in a packet?

2.6

Is all water neutral?

No, some popular brands add acid for a fresher flavor

Some also make them more alkaline

Are all mouthwashes above the critical pH?

No

What drinks should you be drinking?

Fluoridated tap water

Alkaline water

Fruit and herb infused water, which contains much less sugar than fruit juices, is low calorie, and inexpensive

What should you avoid in your diet?

Retentive carbohydrates

What does xylitol gum do?

Increases salivary benefits after eating

What other food components may play a protective role?

Proteins

Fats

Preservatives