Caridology

What percentage of enamel is inorganic material?

96% - composed of calcium hydroxyapatite

What percentage of enamel is organic material?

1% - composed of amelogenin (a lace-like network)

How are enamel crystals organized?

Crystal oriented in a complex 3-D pattern

When does enamel formation begin?

In the late bell stage

What cells produce enamel?

Ameloblasts

What proteins are found in the enamel matrix?

Amelogenins and enamelins

What is the Tomes process?

Secretory processes of ameloblasts that deposit enamel in tightly packed masses of hydroxyapatite crystals (enamel rods)

What is the shape of enamel rods?

6-sided pyramidal shape creating a microscopic prism-shaped pattern

Are Tomes processes left behind in calcified tissue?

No, they are not left behind or embedded in the calcified tissue

Can enamel grow after formation?

No - enamel does not have vital cells and is incapable of tissue growth

What trace minerals are found in enamel?

Strontium, magnesium, lead, and fluoride

When does dentin formation begin?

In the late bell stage

What do odontoblasts produce?

Collagen fibers and a rich ground substance

How does dentin calcify?

By deposition of crystals of calcium salts (hydroxyapatite) into the matrix

What is left behind in dentinal tubules?

The odontoblastic process

Is dentin vital throughout life?

Yes - dentin is vital throughout the life of the tooth and cells continue to produce dentin when needed

What percentage of dentin is organic?

18%

What percentage of dentin is inorganic?

70%

What percentage of dentin is water?

12%

Where does dentin and enamel formation begin?

At the DEJ (dentin) at the cusp or incisal edge (enamel) of the tooth and continues apically

What is cariology?

The study of dental caries

Define dental caries

Biofilm mediated, diet modulated multifactorial disease of the hard tissues that results in demineralization of the tooth structure

What is the paradigm shift in cariology?

From an old restorative/surgical model to a new medical model focusing on prevention, risk assessment, and non-restorative therapies

What are the 5 essential elements for caries formation?

Bacteria, Diet/fermentable carbohydrate, Susceptible host/tooth surface, Saliva, Time

What factors influence host susceptibility to caries?

Individual's genetic constitution, Tooth anatomy (deep grooves and fissures), Tooth hard tissue quality, Salivary properties, Host immunity, Oral microbiome composition, Interactions between host genes and environmental factors (fluoride exposure)

What types of foods serve as substrate for caries?

Starchy, refined carbohydrates - chips, bread, crackers, pasta, candy

How do simple sugars contribute to caries?

They feed bacteria which produce acid

What bacteria is associated with early caries lesions?

Streptococcus mutans - secretes lactic acid

What other Streptococcus species causes caries?

Streptococcus sobrinus

What bacteria thrives in later stages of caries?

Lactobacilli - thrives in low pH

What is the normal pH range of saliva?

6.2 - 7.6 (average: 6.7)

What are the protective factors of saliva?

Lubricates oral tissues, Aids in removal of food, Salivary pellicle formation, Contains sodium bicarbonate (buffers acids), Initiates carbohydrate digestion, Possesses antibacterial properties, Serves as reservoir for calcium, phosphate, and fluoride

What are the main functions of saliva?

Maintenance of oral health, Tissue repair, Digestive functions, Lubrication in mastication, Food bolus formation and swallowing, Taste sensation, Initiates digestion, Articulation of speech

What is saliva composed of?

99% water, 1% small molecules, and non-glandular original components

What are the 3 major salivary glands?

Submandibular (65%), Parotid (20%), Sublingual (5%), Minor glands (10%)

What are the 3 major buffer systems in saliva?

Bicarbonate system (major), Phosphate system, Protein system

What is demineralization?

Loss of calcium and phosphate from the enamel surface when cariogenic bacteria use carbohydrates to produce acid and lower pH

What is the first visible clinical sign of demineralization?

White spot lesions

What is remineralization?

Natural repair process where calcium and phosphate use fluoride to rebuild crystalline subsurface

What type of crystals are formed during remineralization?

Fluorapatite crystals (more resistant to acid)

At what pH does enamel demineralization occur?

pH of 5.5 or lower

At what pH does dentin demineralization occur?

pH of 6.5-6.8 or lower

What are the steps in caries formation?

Intake of dietary sugars, Bacterial enzymatic activity, Fermentation on tooth surfaces, Organic acids formation, Low pH below critical pH 5.5, Demineralization & decalcification, Caries formation

What are protective factors against caries?

Saliva and components (calcium and phosphate), Fluoride, Antibacterial agents (xylitol)

What are pathologic factors for caries?

Acid-producing bacteria (strep mutans and lactobacilli), Consumption of fermentable carbohydrates (frequency), Reduced salivary flow

What is the difference between frequency and quantity regarding diet?

Frequency: how often (affects oral cavity) - example: 1 can soda all day long; Quantity: how much (affects waistline) - example: 3 cans soda at mealtimes

What are key tools for caries detection?

Good lighting, magnification, and clean, dry tooth surface; Visual inspection (avoiding sharp explorers on early lesions); Bitewing radiographs for interproximal caries

What are caries detection methods?

Visual inspection (mirror, explorer, air), Tactile inspection (shepherd's hook explorer, ball tipped probe, pigtail explorer), Radiographic detection (BWX), Emerging technologies (AI, fiber optics, fluorescence, LED, lasers)

Who developed the classification system for caries?

G.V. Black in the late 1800s

What is Class I caries?

Cavities in pits or fissures - occlusal surfaces of posterior teeth, lingual pits of maxillary anteriors, buccal pits of mandibular molars, lingual pits of maxillary molars

What is Class II caries?

Involves proximal surfaces of posterior teeth (could be 1, 2, 3 or more surfaces - MO, DO, MOD, MOL, MOB)

What is Class III caries?

Proximal surfaces of anterior teeth that does NOT involve the incisal edge

What is Class IV caries?

Involves both the proximal AND incisal edge of anterior teeth

What is Class V caries?

Involves the cervical region (facial or lingual) typically at the gingival margin on anterior or posterior teeth

What is Class VI caries?

Cusp tip caries of posterior teeth or incisal edge of anterior teeth

What does ICDAS stand for?

International Caries Detection and Assessment System

What is ICDAS Code 0?

Sound - no evidence of caries

What is ICDAS Code 1?

Distinct first visual change - a change in enamel color when surface is dry, but tooth looks sound when wet

What is ICDAS Code 2?

Distinct visual change - a lesion seen when tooth is wet

What is ICDAS Code 3?

Localized enamel breakdown - a physical hole in enamel without visible dentin exposure

What is ICDAS Code 4?

Underlying dark shadow - a dark shadow from dentin shows through enamel

What is ICDAS Code 5?

Distinct cavitation - a cavity that exposes visible dentin

What is ICDAS Code 6?

Extensive cavitation - a cavity that involves half or more of the tooth surface

What is incipient caries radiographically?

Less than 1/2 through enamel

What is moderate caries radiographically?

1/2 through enamel but not to DEJ

What is advanced caries radiographically?

Through DEJ, less than 1/2 way to pulp

What is severe caries radiographically?

Through DEJ, more than 1/2 way to pulp

What is pit and fissure caries?

Caused by incomplete closure of enamel plates

What is smooth surface caries?

Caused by incomplete removal of biofilm

What is primary caries?

Initial/virgin caries; may be incipient

What is recurrent caries?

Caries adjacent to existing restoration

What is arrested caries?

Lesion that does not change or progress

What is rampant caries?

Rapidly spreading caries; typically 10+ new lesions yearly (seen in early childhood, adolescent, xerostomia-induced)

What are characteristics of root caries?

Rapidly progressive, shallow, spreads laterally

What causes root caries?

Recession and xerostomia

Who is typically affected by root caries?

Older adults with recession, Lower socioeconomic status, Tobacco users, History of root caries, Gingival recession, Poor biofilm control, Higher levels of S. mutans and lactobacilli

What is fluoride varnish?

A highly effective, professionally applied topical treatment

What is Silver Diamine Fluoride (SDF)?

A minimally invasive treatment for arresting caries lesions, particularly in difficult-to-treat populations

What are dental sealants?

Protective coatings for pits and fissures of molars to prevent decay

How does xylitol help prevent caries?

It inhibits bacterial growth (found in gums, mints)

What is the hygienist's core responsibility in caries management?

Acting as a health coach to empower patients

What should dietary counseling focus on?

Reducing the frequency of sugar intake, not just the quantity; explaining the role of acidic foods and drinks

What should oral hygiene instruction include?

Personalized instructions on brushing and interdental cleaning

demonstrating proper techniques and recommending appropriate products

What is the hygienist's role in team-based caries management?

Collaboration: Working with dentist to implement comprehensive care plan,

Communication: Clearly documenting and communicating patient risk and intervention success, Monitoring: Regularly reassessing patient risk and status of caries lesions,

Empowerment: Motivating patients to take ownership of oral health through education and support.