Cariology 3rd discussion (Prelims)

98%
calcium phosphate
hydroxyapatite crystals

Percentage of the Enamel inorganic content?
What are the inorganic contents?

70-72%
calcium phosphate
hydroxyapatite crystals
8-10%

Percentage of the Dentin inorganic content?
What are the inorganic contents?
Percentage of water contents in the Dentin?

45-50%
hydroxyapatite crystals

Percentage of the Cementum inorganic content
What are the inorganic contents?

4%
proteins
amelogenins
water

Percentage of the Enamel organic materials
What are the organic materials?

20%
90% collagen type 1
10% gro

Percentage of the Dentin organic materials
What are the organic materials?

50-55%
water
collagen type 1

Percentage of the Cementum organic materials
What are the organic materials?

Hydorxyapatite crystals (Enamel prism/rods)
Interrod enamel
Enamel tufts
Enamel lamellae
Straie of retzius (incremental lines)

What are the basic structures of ENAMEL

Dentinal Tubules
Collagen fibers
Mineral crystals
Intertubular dentin

What are the basic structures of DENTIN

Mineral crystals
Collagen fibers
Cementocytes
Sharpey’s fiber

What are the basic structures of Cementum

Understanding the disease process
Correct treatment
Understanding the role of dental biofilm

Importance of knowing the histology of Caries Lesion

Dental Caries

It is an outcome or symptom of many metabolic events in biofilms

shape of the lesion

[?] REFLECTS where the biofilm has been allowed to grow and remain for prolonged periods of time.

prorgression
morphology

The [?] and [?] of the caries lesion vary depending on the site of origin and the conditions in the mouth.

single

There is no such thing as [?] tooth treatment

total patient assessment

Choice of treatment and the assessment of the prognosis of the dentition must be based on a [?]

Pits and Fissure surfaces
Smooth surface
Root surface

What are the clinical sites for caries intiation?

pits and fissures

Most susceptible sites

Smooth enamel surface

What clinical site shelter cariogenic biofilm

Change in structure
Change in Color

What are the changes/evidence that indicates caries

white spot

Earliest evidence of caries on the smooth enamel surface

remineralize
nucleating

Non-cavitated caries of enamel can still [?] and retain the original crystalline framework of the enamel rods and serve as [?] agents for remineralization

calcium
phosphate ions
crystalline

Non-cavitated caries of enamel
[?] and [?] from saliva can penetrate the enamel surface and precipitate on the highly reactive [?] surfaces of the enamel lesion

fluoride
phosphate
fluorapatite

Non-cavitated caries of enamel

Presence of trace amounts of [?] IONS during remineralization process greatly enhances the PRECIPITATION OF CALCIUM AND [?], resulting in the remineralized enamel becoming more resistant to subsequent caries attack because of the incorporation of the more acid-resistant [?].

discolored
brown
black
objectionable

Non-cavitated caries of enamel

Clinically, remineralized (arrested) lesions can be observed as intact but [?] usually [?] or [?] spots and It is not be restored unless they are esthetically [?].

subtle breakdown
probing
probing force

Cavitated enamel lesions can be initially detected as [?] of enamel surface and it is very sensitive to [?] and can easily be enlarged by using sharp explorers and excessive [?]

Translucent zone
Dark zone
Body of the lesion
Surface of the lesion

What are the zones of enamel caries?

Translucent zone

What is the advancing front of the caries, the innermost zone of enamel caries

1%

What is the pore volume of the translucent zone?

magnesium
carbonate ions
proteins

In the translucent zone of enamel caries there is a loss of [?] and [?] however no [?] loss

Dark zone

What is IMMEDIATELY ABOVE the translucent zone and appears dark?

2-4%

What is the pore volume of the dark zone?

6%

What is the % mineral loss of dark zone

Dark zone

What zone of enamel caries shows positive birefringence in polarized light?

slower

Dark zone
Wider zone indicates [?] advancing lesion

Body of the lesions

What occupies the major portion of the lesion and area of maximum demineralization in enamel caries

striae of retzius

Dark zone is the LARGEST ZONE which exhibits enhanced [?]

5% to 25%

What is the pore volume of body of lesion?

surface of the lesion
10

What zone of enamel caries has partial demineralization? [?]% mineral loss characterize by broadening of prism sheaths

20-100
active
inactive

Surface of the lesions has approximately [?] um thick and thinner in [?] lesion and thicker in [?] ones.

Microscopic tubules
Bacteria
Minerals

Dentin contains much less mineral and possesses [?] that provide a pathway for the ingress of [?] and egress of [?], so less resistance to acid attack.

laterally
DEJ

When the carious lesion has penetrated the dentin, it SPREADS [?] along the [?], undermining the enamel.

v shaped
dej
pulpally

Dentin Caries
The pattern of invasion is a ‘[?]’ in cross section with a wide base at the [?] and the apex directed [?].

tertiary dentin
reactionary dentin
reparative dentin

Topic: The Three (3) levels of Dentinal reaction to caries

1. Reaction to long-term, low-level acid demineralization associated with a slowly advancing lesion.

In slowly advancing caries, the vital pulp can repair demineralized dentin by remineralization which [?] is formed

What reacts to stimulus?

What layer of the dentin repair the dead dentin?

bacterial invasion of dentin
infected
degeneration
death

Topic: The Three (3) levels of Dentinal reaction to caries

2. Reaction to a moderate-intensity attack

In this reaction there is a [?] and [?] dentin contains a wide-variety of pathogenic materials or irritants, including high acid levels, bacteria and bacterial cellular debris causes the [?] and [?] of the odontoblast and their tubular extensions, and mild inflammation of the pulp

reparative dentin

Topic: The Three (3) levels of Dentinal reaction to caries

2. Reaction to a moderate-intensity attack

What do you call when the pulp produces replacement odontoblast and these cells produce [?] on the affected portion of the pulp chamber wall.

high acid levels
death

Topic: The Three (3) levels of Dentinal reaction to caries

3. Rapidly advancing caries

Bringing [?] overpowers the dentinal defenses and results in infection, abscess, and [?] of the pulp.

Normal dentin
Zone of scleorsis
Zone of decalcification without bacterial invasion
Zone of decalcification with bacterial invasion
Zone of decomposed dentin

What are the 5 zones of dentinal caries (innermost to outermost layer)

Normal dentin

Topic: Zones of Dentinal caries

What is known as zone of fatty degeneration and is the deepest area of the zone

smooth
no crystals

Topic: Zones of Dentinal caries

Normal dentin is the DEEPEST AREA of the zone where the tubules with odontoblastic processes are [?] and [?] are present in the lumens.

zone of sclerosis

Topic: Zones of Dentinal caries

What is knows as carious inner dentin?

intertubular
fine crystals
lumen

Topic: Zones of Dentinal caries

Zone of sclerosis has demineralization of the [?] dentin and initial formation of [?] in the tubule [?]

zone of sclerosis

Topic: Zones of Dentinal caries

In this zone there is a damage to the odontoblastic process; no bacteria found (subtransparent zone)

Zone of decalcification without bacterial invasion
translucent

Topic: Zones of Dentinal caries

This is an affected dentin and has no bacteria present ([?] zone) capable of self-repair provided the pulp remains vital.

normal
intertubular
large crystals

Topic: Zones of Dentinal caries

Zone of decalcification without bacterial invasion is softer than [?] dentin; there is further loss of minerals from [?] dentin, many [?] are present in the tubule lumen

Zone of decalcification with bacterial invasion

Topic: Zones of Dentinal caries

This is an infected dentin ‘turbid dentin’ and a Zone of bacterial invasion marked by widening and distortion of the dentinal tubules filled with bacteria. CANNOT REMINERALIZE,

Zone of decomposed dentin

Topic: Zones of Dentinal caries

What is known as the outer carious dentin and zone of destruction?

collagen
minerals
granular material

Topic: Zones of Dentinal caries

Zone of decomposed dentin consists of decomposed dentin teeming with bacteria; not recognizable dentin structure and [?] and [?] seem to be absent and Great number of bacteria are dispersed in this [?] and should be removed to prevent spreading the infection

Cementum caries

What is usually seen when there is gingival recession and poor oral hygiene

gingival recession

Cementum caries is usually seen where there is [?]

saucer
u-shaped
enamel covering

Clinically, cementum caries appears as [?] shaped cavities and [?] in cross section and progress rapidly because of the lack of [?].

actinomyces
sharpey’s fibers
dentinal

Topic: Cementum caries

The microorganisms involved in root caries are chiefly [?] and they appear to invade the cementum either along [?] or between bundles of fibers comparable to invasion along [?] tubules.

Active root caries
Arrested root caries lesion

What are the 2 clinical appearance of cemental caries?

laterally
bottom

Pits and fissure caries starts on the lateral walls of the fissures that eventually FLARE [?] AT THE [?] OF THE PIT.

v-shaped
dentin
outer enamel surface

Pits and fissure caries

The carious lesion follows the path of the enamel rods; hence a characteristic angular [?] LESION is formed with the base towards the [?] and the apex towards the [?].

Cariogenic biofilm attachment

Smooth surfaces caries present a LESS FAVORABLE SITE for [?].

gingiva
proximal

Smooth surface caries

Cariogenic biofilm attached itself usually near [?] or are under [?] contacts, which are protected sites for mechanical cleaning from the tongue, cheek movement and toothbrushing.

DEJ
v-shaped
dentin
Laterally
pulpally

Smooth surface caries is a broad area of origin and a conical, or pointed extension toward the [?] and has [?] pattern follows the direction of enamel rods and wide on enamel side tapering as it goes into the portion of the [?] then spreads rapidly [?] and [?]

inverted v shape
triangular
dej
enamel

Pits and fissure and smooth surface caries in ENAMEL

Pits and fissure on enamel is an [?] or [?] where the base is on the [?] and the apex towards [?]

triangular
v-shaped
enamel
dej

Pits and fissure and smooth surface caries in ENAMEL

Smooth surface caries on enamel is also [?] or [?] where the base is on the [?] and the apex is at the [?]

triangle
DEJ
pulp
base to base

Pits and fissure and smooth surface caries in DENTIN

Pit and fissure caries rapidly spreads at it reaches the DEJ. It is also in form of a [?] where the base is at the [?] and narrows to its apex toward the [?]. It has a [?] relationship with enamel caries

laterally
DEJ
pulp
apex to base

Pits and fissure and smooth surface caries in DENTIN

Smooth surface caries in the dentin likewise spreads [?] at the [?] and narrow down at it reaches the [?] It has an [?] relationship with enamel caries