DEN 204 Unit 2

Dental Caries

• Infectious, progressive, multifactorial disease of the hard dental structures characterized by decalcification, proteolysis, and microbial infection destroying the hard structures

• Multifactorial disease initiated by acid-producing bacteria: flora, and host substrate

• Main cause of tooth loss before age 35

• * The only infectious disease that destroys tissue in the absence of inflammation *

Scope

• Civilized: More processed foods, softer foods, & increase caries

• Primitive diet: More whole foods

DMF Index (Decayed/Missing/Filled Teeth)

• Indication of the dental health of a population

Incidence (Increasing in third world and the elderly in USA)

• Why?

  • 3rd world: Access to processed foods

  • Elderly: Polypharmacy, too many drugs

Populations most susceptible

• Children: 1st erupted teeth, not a lot of fluoride, longer-term w/enamel = stronger, learning to brush teeth

• Low SES individuals: Can’t afford, No access, No insurance, Not main priority

• Elderly (root exposure/xerostomia): Brushing habits, common occurrence but not a given, Loss of vertical dimension

• Persons with mental/physical disabilities: Caregiver undereducated

• Persons who have had radiation to the head/neck: Hurts the parotid gland (loss of saliva)

• Female vs Male: female with hormones, men with perio

Factors affecting incidence (often/occurrence)

• Diet (Fermentable carbs, consistency, frequency): Sugars & cooked starches

• Tooth (Fluoride content, morphology, alignment): Enamel solubility is good Fl = Low solubility, how much Fluoride? Smooth?, Pits & Fissures

• Saliva (Quality, Quantity, Medications, Composition, Antibodies, pH, Ptyalin, Minerals): Less = bad

• Oral Hygiene: Good, Fair, Poor

• Age (Young & Old): two major groups

• Systemic diseases (Sjogrens syndorme, diabetes): Fluid secreting parts, decreased immune system

Teeth commonly affected

• Molars: pits & fissures

• Maxillary: Less saliva

• Least affected: Mandibular anterior teeth, Smooth, small, & more saliva

Surfaces most commonly affected

• 50% occlusal: Grooves

• Mesial more than distal proximals: Easier to get toothbrush there, How you remove plaque

• Buccal more than lingual: Buccal is drier, less saliva

Multifactorial nature

• Flora: Microbes, Bacteria from plaque

• Host: Susceptible tooth

• Substrate: Diet, Fermentable Carbs

Microbes

• *Streptococcus Mutans: Main initiator, VERY acidogenic ( Bacteria that can live in acid), Needs Oxygen (enamel Caries)

• Functional anaerobes: Pit & fissure caries, root caries & dentinal caries

• Properties: Acidogenic- acid-producing

Aciduric

• Able to live in low pH

Proteolytic

• Capabile of breaking down protein

Anaerobic

• Capable of functioning in a low oxygen environment

Theories

• Acidogenic: bacterial acid decalcifies enamel first, THEN protein

  • Miller’s Chemioparasitic Theory

• Proteolytic: Protein broken first, Then enamel decalcified

Mineralization/demineralization/remineralization

• Fl/Ca/Ph

Pathogenesis

• “white spot” lesion: Acid has started destroying the underlying structure

• Cavitation: a break in the tooth

• To see caries on a radiograph, 40-60% of the tissue is demineralized

• Sclerotic dentin: Transparent dentin, Translucent dentin, Reactive dentin, Dentinal sclerosis, “plug”

  • Beneath carious lesion at the end of dentinal tubules closest to enamel

• Secondary dentin: Reparative dentin, irregular dentin, tertiary dentin produced by the pulp, located at the pulp surface of dentinal tubules

*Lesion Appearance*

• Follows enamel rods configuration, spreads laterally at DEJ, then follows dentinal tubules Configuration