CARIOLOGY

SHAFER (1993)

Define caries as irreversible ⎯ Microbial disease of hard calcified tissue of the tooth

Sturdevant’s Art and Science of Operative Dentistry 2012

Infectious, microbial disease of teeth that result in localized dissolution of calcified tissue

2017

Plaque(ON)/biofilm (NN) ⎯ Sugar driven ⎯ Multifactorial ⎯ Dynamic o Disease that results in the phasic demineralization and remineralization of dental hard tissues

2020

⎯ Biofilm mediated ⎯ Diet-modulated ⎯ Multifactorial ⎯ Dynamic ⎯ Noncommunicable o Disease resulting in net mineral loss of dental hard tissue.

▪ Dental Caries

⎯ Name of the disease.

▪ Cavitation of caries lesion

⎯ symptom of disease

▪ Incipient Lesion

⎯ or white spots ⎯ can be reversed or arrested

Ø  Tooth level

Ø  Person level

Ø  Community level

Caries is a complex disease prevention and management should be done at the :

Dental Caries

Multifactorial oral disease

Caused primarily by complex interaction of cariogenic oral flora with fermentable dietary carbohydrates on the tooth surface over time.

Greene Vardiman Black

Who is considered one of the founders of modern dentistry in the United States?

DENTAL PLAQUE

A term historically used to describe the gelatinous (soft, translucent, tenaciously adhering) mass of bacteria adhering to the tooth surface.

Biofilm

An aggregate of microorganisms in which cells adhere to each other and/ or to a solid substrate exposed to an aqueous surface

Polysacharides

Which substance produced by oral bacteria holds biofilms together

extracellular polysaccharides (EPS).

What is the gel-like matrix in dental biofilm mainly composed of

90%

What percentage of biofilm volume is comprised of a gel-like intermicrobial matrix

1. Formation of Pellicle

2. initial attachment

3. irreversible attachment

4. early maturation

5. late maturation

6. dispersion

Stages of BIOFILM Development

Streptococcus sanguinis

early colonizers of the teeth,normal inhabitants on the mouth

– Weak and reversible van der Waals forces.

What type of forces mediate the initial attachment of early colonizers?

van der Waals forces

(distance-dependent interaction between atoms or molecules

Materia alba

⎯ Soft accumulation of bacteria, salivary proteins , food debris and tissue cells. ⎯ Lacks the organized structure of dental plaque ⎯ Easily displaced with a water spray.

Calculus (tartar)

⎯ This is formed over time, if plaque isn't removed on a regular basis, minerals from your saliva are deposited into the plaque biofilm causing it to harden within 24 to 72 hours ⎯ Mineralized dental plaque - Or TARTAR, CALCULAR DEPOSITS

• Pathological factors

  • Protective factors

Factors influencing initiation and progression of caries (2017 definition)

• Tooth/Lesion level

• Person level

• Community level

Three levels of caries management

• Fluoride

• Sealants

• Salivary stimulation

Protective factors against caries

Acidogenic

→ produce acids

Aciduric

→ thrive in acidic environment

Willoughby Dayton Miller

The American dentist considered the first oral microbiologist who proposed the chemo-parasitic theory of caries.

Streptococcus mutans & Lactobacilli

The bacterial group primarily responsible for lactic acid production in caries.

• Demineralization

• The process by which enamel minerals dissolve when pH falls below 5.5.

Remineralization

The process where minerals are redeposited in enamel when pH rises above 5.5.

BUFFER

⎯ A solution (or substance) that has the ability to maintain pH and bring it back to its optimal value by addition or removal of hydrogen ions

▪ S. mutans (or MS) ▪ Lactobacilli

aciduric and acidogenic microorganisms:

SOLUBILITY

⎯ Is the measure of the concentration of dissolved solid in a saturated solution

UNDERSATURATED

⎯ When the solution contains less than the equilibrium concentration of dissolved solid

SUPERSATURATED

⎯ when the concentration of dissolved solid in solution is greater than at equilibrium

GV Black

organized 'Black's Classification of Caries Lesions' which is still in use today

Ecological Shift

What is the term for the process where the pH in dental plaque becomes acidic due to sugar metabolism by acidogenic bacteria?

subsurface lesion.

This is seen as a white spot lesion. The first clinical sign of incipient caries.

"disturbance in the mineral homeostasis"

More minerals in saliva will enter the plaque in an attempt to neutralize or buffer the acidic plaque. The entry of more minerals into the biofilm makes the saliva undersaturated(of minerals) compared to the minerals on the tooth surface. This is called

Demineralization

To restore the mineral levels of saliva, the hydroxyapatite of enamel will dissolve and release calcium and phosphates. This is called ?and this happens at a pH of <5.5 in the absence of flouride.

Remineralization

The mineral level in saliva is now higher compared to the mineral level in enamel. The higher levels in saliva will cause reprecipitation of minerals in enamel. This is called ??. This happens at a pH pf> 5.5

lactic acid and extracellular polysaccharide like glucan.

Acidogenic bacteria will metabolize sugar and produce

Black's Classification of Caries Lesions

GV Black organized

CLASS I

Occlusal of posterior teeth

or lingual pit near cingulum

in maxillary incisors

CLASS 2

Proximal

surfaces of

posterior teeth

CLASS 3

Interproximal surfaces

of anterior teeth without

Incisal edge involevement

CLASS 4

Interproximal surfaces

of anterior teeth with Incisal

edge involevement

CLASS V

Cervical third of

facial or lingual

surfaces of teeth

CLASS VI

affect the cusp tips of posterior teeth and the incisal edges of anterior teeth, often resulting from abrasion, erosion, or attrition.

DENTAL PLAQUE

Cannot be seen by the naked eye o but can often feel significant build-ups by running the tongue across the surface of the teeth due to its sticky properties.

DENTAL PLAQUE

More recently referred to as the dental biofilm or simply the biofilm, which is a more complete and accurate description

Plaque

- is an invisible layer of film made up of millions of bacteria and protein from saliva

BIOFILM

Provides the environment for bacteria to form acid

BIOFILM

Form via an ordered sequence of events resulting in a structurally and functionally organized,species-rich microbial film

salivary glycoprotein, phosphoproteins, and lipids

Composition of pellicle

“Streptococcus sanguinis”

form an initial attachment to the pellicle by weak and reversible van der Waals forces

Van der Waals forces

Which type of force allows early colonizers like Streptococcus sanguinis to make a weak and reversible initial attachment to the tooth pellicle?

Specific adhesion–receptor interaction

Organisms that were unable to attach to the pellicle begin to adhere to the first layer of colonizer with irreversible attachment via what process?

dispersin B

allow some bacteria to detach themselves from the biofilm

MATERIA ALBA

Lacks the organized structure of dental plaque

MATERIA ALBA

Easily displaced with a water spray

24 to 72 hours

How many hours does it take for minerals from saliva to harden dental plaque into calculus?

Theory

⎯ a system of ideas intended to explain something

⎯ hypothesis

⎯ assumption

⎯ proposition

synonyms: of theory

Etiology

⎯ the cause, set of causes, or manner of causation of a disease or condition

1. Non-specific Plaque Hypothesis

2. Specific Plaque Hypothesis

3. Ecological Plaque Hypothesis (1991)

Theories on Etiology of Dental Caries

Non-specific Plaque Hypothesis (NSPH)

Which plaque hypothesis, proposed by Loesche in 1976 and based on the works of Black (1884) and Miller (1890), states that all plaques are pathogenic and that caries result from the combined action of all oral organisms?

Loesche

• Who proposed the Non-specific Plaque Hypothesis in 1976?

Black and Miller

Which two researchers’ works (from 1884 and 1890) formed the basis of the Non-specific Plaque Hypothesis?

Willoughby Dayton Miller

Who is considered the first Oral Microbiologist?

1976

• In what year did Loesche propose the Non-specific Plaque Hypothesis?

1884

In what year did Black contribute work that later supported the Non-specific Plaque Hypothesis?

1890

In what year did Miller contribute research related to the Non-specific Plaque Hypothesis?

1970s

In what decade was the Specific Plaque Hypothesis proposed?

Specific Plaque Hypothesis

In the 1970s, culture-based techniques and microscopy allowed discrimination of specific bacterial species and opened the hunt for disease-related microorganisms. This led to which theory?

Ecological Plaque Hypothesis

In 1991, a change in the environment of the residential flora that gives pathogenicity to specific species and produces disease only at specific sites is explained by which hypothesis?

Non-specific Plaque Hypothesis

All plaques are pathogenic, and caries is the result of the combined action of all oral organisms. This describes which hypothesis?

Specific Plaque Hypothesis (SPH)

Caries is caused by infection with specific bacteria found in dental plaque.

Ecological Plaque Hypothesis (EPH)

Changes in the oral environment disturb the balance of bacteria, giving certain species the chance to cause disease at specific sites.

▪ Streptococcus oralis

▪ Streptococcus mitis

▪ Streptococcus sanguis

First to colonize biofilm are

30–60 minutes

How long after an acid attack can buffers in saliva increase the pH?

BUFFER

⎯ A solution (or substance) that has the ability to maintain pH and bring it back to its optimal value by addition or removal of hydrogen ions

MS (Mutans Streptococci) & Lactobacilli

Which bacteria produce lactic acid, extracellular polysaccharide (glucan), and intracellular polysaccharide that can be used for energy and contribute to the plaque matrix?

Crystal dissolution & precipitation

The processes underlying demineralization and remineralization in caries are?

intracellular polysaccharide

(can be used for energy production and converted to acid when sugars are not available)

Dissolution and crystal growth

are both surface- related processes

Saturated

When the rates of these processes are equal, the solid is in equilibrium with the solution and no net dissolution or crystal growth will occur. In this situation, the solution is said to be "_________" with respect to that particular solid.

Below 5.5

• At what pH do tooth minerals (hydroxyapatite) start to dissolve?

Crystal growth / remineralization

What happens when the oral fluids become supersaturated with calcium and phosphate?

> 4.5

At what pH in the presence of fluoride does re-precipitation of hydroxyapatite occur?

Elimination or modification of etiological factors (dietary, microbial) and/or by enhancing protective factors (fluoride, sealants and salivary stimulation)

The early stages of dental caries can be prevented, reversed or arrested, primarily through what?

▪ Phosphate ▪ Calcium

When pH goes up ▲ the oral fluids become supersaturated with

(fluoride, sealants and salivary stimulation).

protective factors

(dietary, microbial)

etiological factors

Cell-free protein-rich layer (pellicle)

What layer forms on enamel soon after brushing?