cariology

dental caries

an infectious microbiologic disease of the teeth that results in localized dissolution and destruction of calcified tissues

dental caries

ubiquitous process defined as the result of a localized chemical dissolution of the tooth surface caused by acid production by the biofilm exposed frequently to sugar

caries diagnosis

the clinical judgement integrating available information, including the detection and assessment of caries signs (lesions) to determine presence of the disease

caries activity

concept that reflects the mineral balance, in terms of net mineral loss, net mineral gain or stasis over time

active caries

implies caries initiation/progression

inactive caries

implies caries arrest/regression

prognosis of caries

expected course of dental caries

caries free

implies no detectable signs of dental caries

cavity free

implies no detected cavities in dentine

non-cavitated and or micro-cavitated carious lesions

thorough clinical examination of cavity free may reveal the presence of ?

caries care/management/control

actions taken to interfere with mineral loss at all stages of the caries disease

fluoride

non-operative treatments

restoration

operative treatments

caries prevention

• inhibition of caries initiation/primary prevention

• primary, together with secondary and tertiary

  prevention, comprising non-operative and operative treatments

cariogenic

substances or microorganism capable of promoting dental caries

candies, sweets, carbs

example of cariogenic

cariostatic

substances or procedures capable of arresting dental caries

fluoride, chlorhexidine

example of cariostatic

dental biofilm

a consortium of microorganisms that stick to a tooth surface

dental plaque

a clinical term used commonly when referring to the dental biofilm

caries lesion

clinical manifestation of caries disease

non-cavitated

initial lesion development, before cavitation occurs characterized by a change in color, glossiness or surface structure because of demineralization

cavitated

• denotes a loss of surface integrity

• refers to the total loss of enamel and exposure of the underlying dentin

• cavitation denotes the inability to biologically replace the loss of hard tissue

3000 to 5000 BC

when was the first year of dental cream introduced

1. powdered ashes

2. oxen hooves

3. burnt eggshells

4. pumice

5. myrrh

dental cream in 3000 - 5000 BC is made up of ?

1873

what year was the first commercially produced toothpaste launched and sold in a jar

1892

what is the year when dr. washington sheffield put toothpaste in a collapsable tube similar to the one we have today

1914

the year when fluoride is added to toothpaste

france and england

were major manufacturers of toothbrushes

second half of 19th century

regular tooth brushing was not a widespread practice until after ?

paleozoic fishes

history of dental caries: 570-250 million years

mesozoic herbivores dinosaurs

245 - 265 million years

prehominines of the eocene

60 - 25 million years

miocenic

25 - 5 million years

pliocenic

5 - 1.6 million years

pleistocenic animals

1.6 - 0.01 million years

5000 BC

a sumerian text from describes a “tooth worm” as the cause of caries

ancient chinese in 2500 BC

earliest theory was the “tooth worm theory”

460 - 357 BC ; hippocrates

_____ proclaimed that disease was due to natural causes and should be treated by means of human reason

…. and in what year?

350 BC ; aristotle

_______ observed figs and sweets caused tooth decay

…. and in what year?

12th century

when did caries is described as holes in the teeth or cavities

bronze and iron age

• low caries

• sugar cane in the western world in 11th century, increase in caries prevalence

…. what year?

middle ages

caries incidence increased and affected around 20% of the teeth in populations whose food was cooked and included carbohydrates

… what year?

pierre fauchard

known as the father of modern dentistry, was one of the first to proclaim the idea of caries and sugars

w.d. miller; 1890

he found that acid producing bacteria inhabits the mouth and acid dissolved tooth structures

w.d. miller with g.v. black and j.l. williams

researched plaque and basis for explanation of the etiology of caries

fernando e. rodrigez vargaz; 1921

he also found several strains of lactobacilli

killian clarke ; 1924

he found streptococcus mutans in london for which he believed that they were the cause of caries but remained unproven

keyes and fitzgerald ; 1950s

found the cause of caries only after experiments on hamsters

the legend of the worms 5000 BC

what theory?

• earliest reference to tooth decay from ancient sumerian text

• caries are caused by worms – cause of toothache

early studies

what theory?

• pierre fauchard was one of the first people to cite sugar as the possible cause of caries

• in 1890s W.D. miller – world's first oral microbiologist said he believed bacteria in the mouth could dissolve tooth structures

• miller and dental pioneers G.V. black and J.L. williams researched plaque and investigated the causes of dental caries

w.d. miller

world's first oral microbiologist

endogenous theory: humoral theory

what theory?

• the relative proportion of the 4 elemental fluid of the body determines the person’s physical and mental constitution

4 elemental fluids of the body:

1. blood

2. phlegm

3. black bile

4. yellow bile

which corresponds to 4 humors-sanguine, phlegmatic, melancholic, and choleric, respectively

• any imbalance in these humors causes disease including caries

1. blood

2. phlegm

3. black bile

4. yellow bile

humors:

1. sanguine

2. phlegmatic

3. melancholic

4. choleric

4 elemental fluids of the body? and humors that corresponds

endogenous theory: vital theory

what theory?

• was advanced towards the end of the 18th century which postulated that tooth decay originated like bone gangrene, from within the tooth itself

• physicians of the middle ages – teeth are the integral part of the body (celsus, galen)

1. hippocrates

2. celsus

3. galen

4. avicenna

people in VITAL THEORY

exogenous theory: chemical (acid) theory

what theory?

caries starts on the enamel surface, where food putrified and acquired sufficient dissolving power

1. nitric

2. citric

3. sulfuric

what are the acids formed by the decomposition of food in saliva?

parmley and robertson in 1819

people in CHEMICAL (ACID) THEORY

exogenous theory: parasitic (septic) theory

what theory?

• dubos (1954) postulated that microorganisms can have toxic and destructive effects on tissues

• early microscopic observation of scrapings from teeth and of the carious lesions by antoni

• van leeuwenhoek (1632 – 1732) indicated that microorganisms were associated with the carious process

• erdl described filamentous organisms in the membrane removed from teeth

• ficinus (1847) attributed dental caries to “DENTICOLAE” for decay related microorganisms

ficinus in 1847

he attributed dental caries to “DENTICOLAE” for decay related microorganisms

denticolae

ficinus attributed dental caries to ? for decay related microorganisms

1. decalcifation of tissues

2. dissolution of softened residue

dental decay is a chemico-parasitic process consists of two stages:

1. acids produced from microorganisms of the mouth

2. acids derived from the fermentation of starch and sugar lodged in the retaining center of the teeth

the blend of two previous theories in chemico-parasitic theory

1. did not explain sub-surface demineralization

2. failed to justify rampant caries

3. did not explain caries in impacted tooth

4. phenomenon of arrested caries if not explained

5. smooth surface caries is not accounted in this theory

limitations of chemico-parasitic theory

exogenous theory: proteolytic theory

what theory?

• proposed that organic and protein elements were the initial pathway of invasion by microorganisms

• gottlieb (1944) stated that instead of decalcification of inorganic part, the initial action was due to the proteolytic enzymes attacking the lamellae, rod sheaths, tufts and walls of tubules (i.e. organic component)
  

1. enamel

2. enamel rod sheath

3. enamel lamellae

pathways for microorganism invasion through:

1. no sufficient evidence to the claim that the initial attack on enamel is proteolytic

2. in experimental studies caries occurs even in the absence of proteolytic microorganisms

drawbacks of PROTEOLYTIC THEORY

exogenous theory: proteolysis-chelation theory

what theory?

• simultaneous microbial degradation of the organic components (hence, proteolysis) and the dissolution of the minerals of the tooth by chelation

• chelate results from combining an inorganic metal ion with at least two electron-rich functional groups in a single organic molecule

• it considers dental caries to be bacterial destruction where the initial attack is essentially on the organic components of enamel

• the breakdown products of this organic matter have chelating properties and thereby dissolve the minerals in enamel

exogenous theory: sucrose-chelation theory

what theory?

• eggers-luna (1967) proposed that sucrose itself can cause dissolution of enamel by forming an ionized calcium saccharate

• calcium saccharates and calcium complexing intermediates requires inorganic phosphate which is subsequently removed from the enamel by phosphorylating enzymes

ionized calcium saccharate

eggers-luna proposed that sucrose itself can cause dissolution of enamel by forming an ?

streptococcus mutans ; 1924

clark isolated streptococci from human carious lesion, and named ?

… and in what year?

keyes ; 1960

? showed that “caries-free” hamsters develop dental caries only when caged together with “caries-active” hamsters – infectious and transmissible

…and in what year?

mutans streptococci (MS)

the bacteria previously referred to as S. mutans are seven distinct species now called ?

mutans streptococci (MS)

are the principal etiological agents of dental caries

acidogenic theory (chemico-parasitic theory)

the most widely accepted theory to date

HOST

MICROBIAL FLORA

SUBSTRATE

TIME

dental caries is a multifactorial disease with interplay of factors: factors of caries formation

microflora

• show selectively on the tooth surface they prefer

• streptococcus mutans play a vital role

• lactic acid formers which easily colonize on tooth surface

dental plaque

adherent deposit of bacteria and their products which form on all tooth surface

1. protection of bacteria

2. trapping nutrients

3. favorable conditions of diff bacterial species

4. exchange of genetic material of diff species

microorganism in biofilm show 4 distinct characteristics to survive under difficult situations:

STRUCTURE and COMPOSITION

MORPHOLOGIC CHARACTERISTICS

POSITION

tooth factors

1. fluoride

2. disturbances in formation or calcification of dental tissues

tooth factors: structure and composition

presence of deep, narrow occlusal fissures or buccal or lingual pits

tooth factors: morphologic characteristics of tooth

MISALIGNED

OUT OF POSITION

ROTATED

tooth factors: position

1. mand and max first molars

2. mand and max second molars

most susceptible permanent teeth to caries

mand canines and incisors

least likely to develop lesions

surface of teeth prone to decay

saliva factor and components

saliva

important natural defense mechanism against dissolution of teeth

1. fluoride

2. calcium

3. phosphate

composition of saliva

5.5 pH or lower

pH of saliva

dental caries salivary gland aplasia

lack in salivary flow-more prone to ??

1. thick and ropy

2. watery

viscosity of saliva

lysosome (n-acetylmuramide glycanohydrolassae)

can lyse many cariogenic and noncariogenic streptococci

salivary peroxidase system

inactivates many bacterial enzymes of the glycotic pathway and inhibit their growth by preventing cells from accumulating lysine and glutamic acid for essential growth

1. drugs can cause xerostomia

2. diuretics, beta blockers, tricyclic antidepressants

3. antihistamine, anticonvulsants, and antipsychotics, oral morphine

4. greater likelihood of taking these drugs as patients age which explains the correlations of xerostomia with age

5. radiotherapy

medication and treatment that affects salivary flow

1. physical factors (quality of diet)

2. nature of carbohydrate content

3. local factors (carbs, vitamin, fluoride content)

diet and nutritional factors

vitamin a (deficiency)

has definite effects on developing teeth - vitamin

vitamin d

necessary for the normal development of the teeth, malformation, particularly enamel hypoplasia - vitamin

disturbance to calcium and phosphorus

during tooth development may lead to enamel hypoplasia and defects in dentin - vitamin