DENTAL CARIES - WHAT IS THAT?

DENTAL CARIES IS AN INFECTIOUS MICROBIOLOGIC DISEASE OF THE TEETH THAT RESULTS IN LOCALIZED DISSOLUTION & DESTRUCTION OF THE CALCIFIED TISSUES.

CAUSATIVE FACTORS RESPONSIBLE FOR THE DEVELOPMENT OF DENTAL CARIES CAN BE DIVIDED INTO TWO MAIN GROUPS:
1.

Essential factors
a. b. c. d.

2.

Modifying factors
a.

Bacteria Diet Tooth Time

b. c. d. e.

f.

Geographic environment Systemic health Race and sex Heredity Tooth structure characteristics Saliva

Race and sex

Heredity

Systemic health

bacteria

tooth

Tooth structure characteristics

caries
Saliva

Geographic environment

diet

time

DEVELOPMENT OF DENTAL CARIES DEPENDS ON FOUR INTERRELATED ESSENTIAL FACTORS: 1. teeth 2. bacteria 3. diet (fermentable carbohydrates; acidic foods and drinks) 4. time

1. TEETH (HOST)

Primary host factor but its composition, morphological characteristics, and locations influence the caries process

I. COMPOSITION

Caries susceptibility of a tooth is inversely proportional to its fluorine, calcium and tin contents.

II. MORPHOLOGICAL CHARACTERISTICS

The areas on the tooth surface where the food can stagnate are considered non self-cleansable such as
a. b. c.

d. e.

pits and fissures contact areas area of near approach gingival embrasures facial or lingual surfaces apical to the

Conversely, the areas on the tooth surface where the food is moving continuously are considered selfcleansable. The following areas on the tooth are relatively self-cleansable:
a. b. c. d.

e.

f.

tips of cusps crest of marginal and crossing ridges all inclined planes of cusps and ridges occlusal, incisal, facial and lingual embrasures facial or lingual surfaces incisal or occlusal to the height of contour with the exception of pits if present axial angles of teeth.

III. LOCATIONS

The closer the posterior teeth to the ramus (vertical portion of the mandible), the greater is the probability of food accumulation there, with concomitant greater difficulty in cleansing them. Therefore, they will be more susceptible to decay.

BACTERIA

Dental plaque - a gelatinous mass of bacteria adhering to the tooth surface Plaque is formed primarily of microorganisms.

Two principal groups of bacteria implicated in dental caries: 1. mutans streptococci S. mutans & S. sobrinus 2. lactobacilli Mutans Streptococci & lactobacilli acidogenic & aciduric bacteria Mutans Streptoccoci are strongly associated with the onset of caries Lactobacilli are associated with active progression of cavitated lesions

Acidogenic acid-producing Aciduric acid-tolerant Cariogenic organism that cause caries Cariogenicity potential degree to which a tooth is like to become carious

DIET
Three principal changes identified with the shift from low to high caries experience: First, protective factors are deleted from food materials during harvesting, processing, storage and/or preparation Second, cariogenic factors are added to food materials such as sucrose, fructose, lactose and glucose Third, the frequency of meals, usually three, with between meal snacks

Carbohydrates are known to be the most cariogenic of all food materials Sucrose is the most detrimental, followed by fructose, lactose, galactose and glucose When considering the relationship of the diet and dental decay, the following factors need to be considered: 1. Frequency of consumption. The more frequently one eats or drinks the greater potential for acid production and the greater the likelihood of the development of decay. 2. Consistency of Foods. Some foods are cleared more rapidly from the mouth than others. Foods that stay around the mouth longer have more decay causing potential. Acidic foods and drinks cause the oral environment to become acidic. When acidic foods are consumed frequently, they have the potential to dissolve tooth structures.

TIME

The time it takes for teeth to decay varies and is influenced by many factors such as:
a. b. c.

areas affected on the teeth position of teeth in the mouth the length of time the teeth have been in the mouth and individual differences.

A KNOWN SEQUENCE OF EVENTS FOLLOWS THE ORAL INTAKE OF SUGAR BY A CARIES SUSCEPTIBLE PERSON:

Food taken into the mouth is retained in the area of the plaque; The acidogenic bacteria of the plaque reduce the sugars to acids; The acids in the plaque are in contact with the tooth surface to which the plaque is attached; And since tooth enamel is soluble in acid, the enamel beneath the plaque is slightly dissolved. THIS IS THE BEGINNING OF A CARIES LESION

5 6

1. A tooth surface without caries. 2. The first signs of demineralization, a small "white spot" has been formed (initial caries, incipient caries). 3. The enamel surface has broken down. 4. A filling has been made, but as can be seen, the demineralization has not been stopped and the lesion is surrounding the filling. 5. The demineralization proceeds and undermines the tooth. 6. The tooth has fractured - an effect of a process which could have been stopped at an early stage