10/30- guest lecture- introduction to cariology

caries can be gutted pits and can just look like white on the teeth

  • Fluorosis- not dental caries

  • Abrasion/erosion- not dental caries

Dental caries have a multifactorial cause, is a site-specific disease, and is a dynamic pprocess that is modified by protective factors

The caries process is known to be preventable and interruptible. The latter can be achieved by identifying demineralization lesions and _______________

In the present concept the emphasis is on a demineralization-cycle something


Terms

  • early (caries) lesion

  • nonvaitated lesion

  • white-spot lesion

  • established/moderate

  • more

Based on severity/extension

  • early (caries) lesion

  • cavitated (caries) lesion

  • cavitation

  • cavity

  • severe/extensive (caries lesion)

  • hole

Based on anatomical site

  • smooth surface caries lesion

    • Free smooth surface caries lesion

    • Approximal surface caries lesion

  • Occlusal surface caries lesion

  • Root surface caries lesion- root is exposed

Based on tissue involvement

  • enamel caries- lesion on the enamel

  • dentinal caries- if lesion is past the DEJ and reaches the dentin

Demineralization- mineral reaching out from a structure

Demineralization is NOT decalcification (when used to describe caries, use demineralization not decalcification)

Remineralization- the mineral once reaching out of structure is coming back? this is why we can help dental caries

Epidemiology of Dental Caries

  • Data are expressed using the DMFT index- each affected tooth (t) in the mouth and is scored as being either

    • (D) decayed cavitated

    • (M) Missing due to caries, or

    • (F) filled

  • If a tooth is both decayed and filled it is recorded as decayed

  • then the total is added for each pt. the max. is 32

, minimum number is 0? we don’t count third molars so range is 0-28


Enamel

  • 85vol% inorganic (hydroxyapatite)

  • 12vol% water

  • 3vol % protein

  • 95wt% inorganic (hydroxyapatite)

  • 4wt% water

  • 1wt% protein

Dentin

  • 55vol% inorganic

  • 20vol% water

  • 25vol % protein

  • 75wt% inorganic

  • 5wt% water

  • 20wt% protein

Saliva-

99.0% water

range of pH (6.2-7.6) 7.0 average

the amt of saliva that is produced in a healthy person per day; estimates range from 0.75 to 1.5 L a day

It is generally accepted that during sleep the amount drops to nearly zero????

inorganix salivary constituents

  • thiocyanate

  • calcium 5/8

  • a lot more

2 types of saliva

  • unstimulated saliva- this term is used to describe the saliva which can be collected by subjects who are awake but who are undergoing no apparent exogenous stimulation

    • normal > 0.25 somethin per min.

  • stimulated saliva-


  • Uniqueness of enamel caries

    • enamel can’t heal itself by a repair mechanism

    • enamel must rely on repair byy a physichemical process involving inorganic and organic constitutes from saliva

  • Dental caries is…

    • Multifactorial disease

      • (risk factors-it WILL most likely happen)4 factors

        • host factor-involve tooth, saliva, pellicle

        • diet

        • dental plaque (cariogenic bacteria)

        • time

      • (risk indicators- it CAN happen) Modern concept of dental caries

        • social

        • behavioral

        • psychological

    • Site-specific disease

    • dynamic process

Host factor

  • tooth

    • location'/morphology

      • areas of stagnation where plaque can accumulate undisturbed

    • Composition/ultrastructure

      • the less stable the crystals, the more soluble the enamel are

    • Posteruptive age

      • the caries susceptibility of the enamel surface is greatest immediately after eruption and tends to decrease with age

  • Saliva

    • loss of salivary function has been associated with rampant caries activity

      • saliva plays a major role in protecting the teeth against acid challenge

        • mechanical

Caries detection pt. 2

  • traditional/conventional methods

  • non=conventional/tech. based detection methods

  • similar appearance/ not dental caries

    • FLUOROSIS- too much fluoridel white areas on smooth surfaces and as white patches on occlusal surfaces, often close to fissures; but not extending into the fissure; more straight line and doesn’t associate with plaque accumulation area; aka snow-capping

      • can be-

        • bilateral

        • on multiple teeth

        • more straight across smooth surfaces

        • does not follow the gingival contour

        • shinier

        • diffuse

        • less opaque

    • EROSION-

    • ABRASION-pathological wearing away of dental hard tissue through abnormal mechanical processes involving foreign oblects or substances repeatedly introduced in the mouth and contacting the teeth;

    • ATTRITION- the physiological wearing away of dental hard tissue as result of tooth to tooth contact with no foreign substance intervening

    • ABFRACTION- the wedge shaped defects at the CEJ of a tooth caused by eccentrically applied occlusal forces leading to tooth flexure which results in microfracture of enamel and dentin

    • MOLAR INCISAL HYPOCALCIFICATION (MIH)- caused by hypomineralization (lack of mineralization of enamel) during its maturation phase, due to interruption to the function of ameloblasts. the cause is unknown; but only childhood illness, fever in particular, seems to be associated with MIH