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

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