Introduction to Cariology

This course is designed to review the biological basis for concepts and treatment procedures of dental caries as an ———

infectious disease

It will review information on the ———, ———, ———, and ——— of dental caries along with the ——— and ———-

initiation, progression, treatment, prevention

therapeutic and restorative implications

Dental caries is defined as:

bacterial infection caused by specific bacteria

reversible multifactorial process of tooth demineralization and remineralization

bacterial infection caused by specific bacteria; reversible multifactorial process of tooth demineralization and remineralization

Dental caries

First point is that dental caries is a ——-

bacterial infection caused by specific bacteria

He postulated that dental caries is a specific and treatable bacterial infection due to mutans streptococcus (ms) and in later stages to lactobacillus

1976 Loesch

Two main bacteria/organisms that cause dental caries

Mutans streptococcus and lactobacillus

Since that time there has been extensive evidence in the literature using animal models that caries is a ———, ———, ———

communicable, transmissible, infectious bacteria infection

What model was used in early times as evidence that caries is communicable, transmissible, infectious bacterial infection?

Animal models

primary responsible source and it is transmitted from other human

Mutans streptococcus

acid producing organisms (not acid loving)

acidogenic organisms

source or reservoir

person, animal, soil

transferred directly (from ppt)

person, insects

transferred indirectly (from ppt)

water, air, soil

oral main reservoir of microorganisms

Tooth

microorganisms can be transferred in two ways:

directly and indirectly

transfer agent of dental caries in mouth/ indirectly

Saliva

How is caries transferred directly in mouth

from tooth to tooth

The oral cavity is suitable for bacterial growth because it is:

warm, dark, moist

Multiplication of organisms

Colonization

These two are dependent upon sugar intake and other local factors

Colonization and bacterial multiplication

Indication that the colonization has begun and disease process has begun in dental caries

demineralization of the tooth surface

Pathogens must survive the transfer and successfully establish within the host. In dental caries, ——-

will take several attempts and only at specified time periods

For an infectious disease to occur, it must have a source or reservoir (person, animal, soil). In dental caries, the source may be, ———-

Mother who transfers the infection to the infant

Potential microorganism may be transferred directly (by people, insects) or indirectly (through water, air, soil). In dental caries the transfer agent is through ——-

saliva of the mother to the infant

The ——- will determine if there is a manifestation of the disease (demineralization)

Host response

Manifestation of the disease in mouth

Demineralization

In dental caries, the carrier would usually be the ——

Mother

The second point is that caries is a ——-

reversible, multifactorial process of demineralization and remineralization

describes the status of the carious process (demin/remin) on an individual tooth surface

Caries activity

An active lesion is progressing toward cavitation

Demineralization

An inactive lesion is not progressing or is healing

Remineralization

Describes the status of the whole patient and can be defined as the likelihood of the patient getting a new cavitation

Caries risk

Assessment of dental caries risk and caries activity must involve the following: Host risk factors:

Medical History

Dental Caries Status

Fluoride Use

Salivary Assessment

Diet Assessment

Bacterial Assessment

Tooth Surface Activity Assessment

The focus of this course will be upon

biological basis for the treatment of dental caries as an infectious disease process and resulting implications

Enamel is made of ——

Hydroxyapatite crystals

When fluoride is added to the enamel, its hydroxyapatite will become ——

Fluorapatite crystals

Adding fluoride to drinking water

Fluoridation

Applying fluoride directly to teeth

Fluoridization

Previous restorative philosophies and preventive strategies:

• Early identification of tooth surface w/ cavitated lesion/caries

• Use early operative intervention

• Caries prevention

Caries prevention has also been applied in the form of:

• Use of oral hygiene

• Use of fluoride

• Pit and fissures sealants

• Diet Counseling

• Prevention of extension

Sequella of Previous Preventive Strategies

• Fails to address the cariogenic bacteria

• Fails to treat the initial lesion

• Applied broadly and equally to all patients creating over-treatment

• Repair of damage produced by the disease w/o identification of the causative agent

U.S. tradition was to restore dental caries when it reaches the ——

D.E. junction or slighty into dentin

U.S tradition was considered as ——— internationally

Radical treatment

It has been recommend that a restoration should be placed only after penetration of ———

60% into dentin