This Tex

Father of resto - G.V. Black

Dental caries -  a pandemic disease that results in localized demineralization and destruction of the calcified tissues.

Plaque-bacteria feast on refined carbohydrates to metabolize the sugar (sucrose) and produce by product (lactic acid) to pH becomes acidic and de                                                                                                                                                                                                                                                                                                                                                                                                 mineralization will occur

l  Critical pH 5.5 enamel; 6.4-6.7 dentin

Tetralogy of dental caries

Ø  Diet/carbohydrates- High sucrose diet

Xylitol-sugar that prevents glucose from binding

Ø  Host- Tooth , lower 1^st molar susceptible

Ø  Time- frequency and duration (main)

Ø  Microorganism

            Streptococcus Mutans- most common cause

            - enamel caries

            - Target enamel rods/ prism

            Lactobacillus casei/acidophilus

            - dentin caries

            Targets dentinal tubules; faster spread of caries

            Actinomyces viscosus

            -Root/cemental caries

            -targets sharpeys fiber

            Strep. Salivarius

            - 1^st colonize plaque

            -plaque: food+saliva; formed 24-48hrs after toothbrushing.

TYPES OF CARIES

Enamel caries - longest time to progress

            Incipient caries (primary)- have not progressed farther than enamel; white spot; appears dry condition; can remineralize (saliva and fluoride)

            Frank caries- caries that have progressed into DEJ.

            Linear enamel caries(odontoblasia)- regin of the neonatal line of the maxillary anterior teeth.

Zones of carious enamel

1.      Translucent zone - deepest zone;nearest to DEJ

2.      Dark zone - Represent minerlization

3.      Body of lesion- Largest zone; represents demineralization

4.      Surface zone- outermost zone; unaffected by carious lesion

Dentinal caries - faster progression than enamel

            DEJ (most senstive); lateral spread

            -ebornatic caries (pimary dentin)

Zones of carious dentin

1. Normal dentin - no bacteria present in this deepest unaffected area;near to pulp.

2. Substransparent - dry&leathery texture; demineralization from acidogenesis

3. Transparent dentin- demineralization softened dentin; but no bacteria in tubules

            Affected dentin - zone 2 & 3

4. Turbid dentin- zone of bacterial invasion; presence of bacterial in tubules must be removed during preparation.

5. Infected dentin - outermost carious zone with numerous microorganisms; must be removed; soft, mushy texture.

Root surface caries- senile/cemented caries

            - destruction of cementum and radicular dentin and often asymptomatic and difficult to restore ; in geriatric patients

            -usually due to gingival resorption

Gold-best restorative material of choice for root surface caries.

Residual caries- infected or cavitated tooth structure remaining after attempted removal in a complete preparation.

            - tx. : indirect pulp capping (CaOH2); 3-4mos recall

Recurrent caries - “secondary caries”

            In faulty restoration (occlusal surface of composite restoration)

Rampant caries- (acute in children)

            -acute onset ; often associated w/pain; may be due to drug abuse, radiation, high sugar diets or decreased salivary conditions.

            -Rapidly progressing caries

Arrested caries- chronic

            -lesion that remineralized that appears hard, black or brown discoloration and asymptomatic.

            - no treatment, unless esthetic is needed.

Radiation caries - incisal edges and cuspal tips (class vi)

Pits and fissure caries- most common

-inverted v shape

Enamel:base of triangle towards DEJ; apex towards occlusal surface

Dentin: base  of triangle towards DEJ: apex towards pulp

DEJ: base-base relationship

Smooth surface caries

            Enamel: base of triangle towards outer surface; apex towards DEJ

            Dentin:  base of triangle towards DEJ; apex towards pulp

            DEJ: base to apex relationship

-proximal,facial and lingual surfaces

Visual examination - best technique for caries examination

Dextrans- adhesive used by microorganism to stick to the tooth

Saliva prevents caries by :

            -remineralization

            -acts as BUFFER for acids (bicarbonates- most important buffer)

            -Using proteins, enzymes and antibodies that kill microorganism (lysozyme, lactoferrin and lactoperoxidase)

            -washing away food

Reduced salivary flow will increase caries susceptibility

Flowy- ok; thick , ropey saliva - X

Spinnbarkeit- stretchy property of saliva

Sealant - preventive measure for pits and fissure

Fluoride application- preventive measure for smooth surface caries

DEJ- most sensitive part of tooth during tooth prep.

Between contact area and gingiva- most common site of proximal caries