1. DENTAL
CARIES
Prepared by:
Dr. Rea Corpuz

2. Dental Caries
 progressive
 initially subsurface
demineralization of teeth
by bacterial acid
 one of the most common of
all diseases
 major cause of loss of teeth

3. Dental Caries
 may be considered a
disease of modern
civilization
 since prehistoric man
rarely suffered from
this form of tooth

4. Dental Caries
 biological process of tooth
decay with mutifactorial
etiology
 microbial disease of calcified
tissues of teeth
 characterized by demineralization
of inorganic portion
 destruction of organic substance
of tooth

5. Etiology of Dental Caries
 generally agreed to be
complex problem
 complicated by many
indirect factors
 obscure the direct cause
or causes

6. Etiology of Dental Caries
Possible interventions Possible interventions
Reduce intake of Reduce Strep. mutans
cariogenic sugars numbers by:
Particularly sucrose
Diet Bacteria Reduction in sugar
intake
Active or passive
Caries immunization
Possible interventions
Susceptible Water + other types of
Time Surface Fluoridation
Possible interventions (Host)
Prevention during post-
Avoid frequent sucrose eruptive maturation
intake (snacking) Fissure sealing
Stimulate salivary flow Properly contured
+ sugar clearance restorations

7. Etiology of Dental Caries
Plaque
Acidogenic Enzymes Food Acids Tooth Carious
Bacteria Lesions

8. Etiology of Dental Caries
 Old Theories
 Exogenous Theories
• (1) Legend of worm
• (2) Chemical Theory
• (3) Parasitic or Septic Theory

9. Etiology of Dental Caries
 Old Theories
 Endogenous Theories
• (1) Humoral Theory
• (2) Vital Theory

10. Etiology of Dental Caries
 New Theories
 (1) Acidogenic Theory
 (2) Proteolytic Theory
 (3) Proteolysis-chelation Theory

11. Old Theories
(Exogenous Theory)
 (1) Legend of Worm
 5000 BC
 ancient Sumerian text
 obtained from Mesopotamian
area
 caused by worm that drank
blood of teeth
 fed on roots of jaws

12. Old Theories
(Exogenous Theory)
 (2) Chemical Theory
 1819
 proposed by Parmly
 unidentified chemical
agent
 responsible for caries

13. Old Theories
(Exogenous Theory)
 (2) Chemical Theory
 stated that caries began
on enamel surface where
food putrefied
 acquired sufficient dissolving
power to produce disease
chemically

14. Old Theories
(Exogenous Theory)
 (3) Parasitic or Septic
Theory
 1843
 proposed by Erdl
 filamentous parasite in
plaque
• he termed as “Denticolae”
• responsible for dental caries

15. Old Theories
(Endogenous Theory)
 (1) Humoral Theory
 4 humors of body
• blood
• phelgm
• black bile
• yellow bile
 any change in relative
proportion of these elements
causes disease

16. Old Theories
(Endogenous Theory)
 (2) Vital Theory
 18 century
 tooth decay originated
like bone gangrene, from
within the tooth itself

17. New Theories
Old Theories
(Exogenous Theory)
 (1) Acidogenic/Chemoparasitic
Theory
 1890
 WD Miller
 dental decay is a chemoparasitic
process consisting of 2 stages
• decalcification of enamel
 results in total
destruction

18. New Theories
Old Theories
(Exogenous Theory)
 (1) Acidogenic/Chemoparasitic
Theory
• decalcification of dentin
as a preliminary stage
 followed by dissolution
of softened residue

19. New Theories
Old Theories
(Exogenous Theory)
 (1) Acidogenic/Chemoparasitic
Theory
 following factors cause
decay:
• (1) Role of carbohydrates
• (2) Role of microorganisms
• (3) Role of acids
• (4) Role of dental plaque

20. (1)Acidogenic/
Old Theories
Chemoparasitic Theory
 (1) Role of carbohydrates
 food substances act as
substrate for microorganisms
of dental plaque
 various carbohydrates have
been examined for cariogenic
potential

21. (1)Acidogenic/
Old Theories
Chemoparasitic Theory
 (1) Role of carbohydrates
 cariogenicity of carbohydrate
varies with:
• (1) frequency of ingestion
• (2) physical form
• (3) chemical composition
• (4) route of administration
• (5) presence of other food
constituents

22. (1)Acidogenic/
Old Theories
Chemoparasitic Theory
 (1) Role of carbohydrates
• (1) frequency of ingestion
 taken repeatedly in
between two major
meals
 provides constant supply
of carbohydrate to plaque
bacteria for fermentation +
production of acids

23. (1)Acidogenic/
Old Theories
Chemoparasitic Theory
 (1) Role of carbohydrates
• (2) physical form
 sticky
 solid carbohydrates

24. (1)Acidogenic/
Old Theories
Chemoparasitic Theory
 (1) Role of carbohydrates
• (3) chemical composition
 in the form of glucose,
sucrose + fructose
due to low molecular weight
 rapidly diffuse into plaque
 make themselves easily
available for fermentation
by plaque bacteria

25. (1)Acidogenic/
Chemoparasitic Theory
 (1) Role of carbohydrates
• (4) Route of administration
 oral intake of sticky
food

26. (1)Acidogenic/
Chemoparasitic Theory
 (1) Role of carbohydrates
• (5) Presence of other food
constituents
 refined pure carbohydrates
more caries producing

27. (1)Acidogenic/
Chemoparasitic Theory
 (2) Role of microorganisms
 caused by acid resulting from
action of microorganisms
on carbohydrates

28. (1)Acidogenic/
Chemoparasitic Theory
 (2) Role of microorganisms
Initiation of Dental Progression of Dental
Caries Caries
Streptococci Streptococcal species:
• S. mutans Streptoccal species in deep
• S. milleri dentinal caries and root
• S. mitior caries
• S. sanguis
• S. salivaris
Lactobacilli Lactobacilli in dentin
• L. acidophillus • L. acidophillus
• L. casei • L. casei
Actinomycoses Actinomycoses
• A. viscosus • A. Israeli
• A. naeslundii • A. odontolyticus

29. (1)Acidogenic/
Chemoparasitic Theory
 (2) Role of microorganisms
 S. mutans has been proved
for the initiation of caries

30. (1)Acidogenic/
Chemoparasitic Theory
 (3) Role of acids
 play most important role
in pathogenesis of dental
caries
 pH 5.5 is called critical pH
 below this pH demineralization
of tooth substance begins

31. (1)Acidogenic/
Chemoparasitic Theory
 (4) Role of Dental Plaque
 found on uncleaned tooth
surfaces
 appear as tenacious, thin
film
 may accumulate within 24-48
hours

32. New Theories
Old Theories
(Exogenous Theory)
 (2) Proteolytic Theory
 proteolysis of the organic
components of tooth
as an initial process
 than actual demineralization
+ dissolution of inorganic
substances

33. New Theories
Old Theories
(Exogenous Theory)
 (2) Proteolytic Theory
 proposed that enamel
lamellae or rod sheath
(proteins) may be lysed
 which means proteolysis
as first event in further
progression of bacterial
invasion + demineralization
carious lesions

34. New Theories
Old Theories
(Exogenous Theory)
 (3) Proteolysis Chelation Theory
 suggests that caries is
caused by simultaneous
events of proteolysis +
chelation
 proteolysis
• destruction of organic
portion of tooth by
proteolytic microorganisms

35. New Theories
Old Theories
(Exogenous Theory)
 (3) Proteolysis Chelation Theory
 chelation
•removal of calcium by
forming soluble chelates
 oral bacteria attack organic
component of enamel (proteolysis)
 breakdown products have chelating
ability and this dissolves tooth minerals

36. Classification
Old Theories
 (1) Depending on nature of attack
 (2) Depending on progression of
caries
 (3) Depending on surfaces involved
 (4) Based on direction of attack
 (5) Based on number of surfaces involved

37. Classification
Old Theories
 (6) GV Black Classification
based on treatment and
restoration design
 (7) Based on location of lesion
 (8) Based on tissue involved

38. (1) Nature of
Old Theories Attack
 Primary Caries
 incipient; initial
 first attack on tooth surface
 Secondary Caries
 recurrent
 occurs on margins or walls
of existing restorations

39. (2) Progression of Caries
Old Theories
 Acute
 rapidly invading process
 involves several teeth
 lesions are soft + light colored

40. (2) Progression of Caries
Old Theories
 Acute
 usually pulp is involved
at early stage
• Rampant caries
• Nursing bottle caries
• Radiation caries

41. (2) Progression of Caries
Old Theories
 Chronic
 lesions are long standing
 fewer in number

42. (3) Surfaces involved
Old Theories
 Pit and fissure
 Smooth surface caries

43. (4) Direction
Old Theories of caries
attack
 Forward Caries
 proceeds from enamel
to dentin
 lesion is triangle in shaped
with base of triangle at enamel
surface + apex towards
dentin
 in pits + fissures base is at DEJ
+ apex is in the pit

44. (4) Direction
Old Theories of caries
attack
 Backward Caries
 proceeds from DEJ towards
enamel surface
 also triangle shaped with
base at DEJ + apex towards
enamel surface

45. (5) Number of
Old Theories Surfaces
involved
 Simple
 only one surface is involved
by caries
 Compound
 2 surfaces are involved
 Complex
 more than 3 surfaces involved

46. (6) GV Black
Old Theories Classification
 Class I
 begin in pits, fissures +
defective grooves
 seen in occlusal surface
 occlusal two-thirds of molars
 lingual pits of incisors

47. (6) GV Black
Old Theories Classification
 Class II
 lesions seen on proximal
aspects of molars +
premolars

48. (6) GV Black
Old Theories Classification
 Class III
 lesions involving proximal
aspects of incisors
 do not involve or necessitate
removal of incisal edge

49. (6) GV Black
Old Theories Classification
 Class IV
 lesions involving proximal
aspects of incisors
 involve or require
removal of incisal edge

50. (6) GV Black
Old Theories Classification
 Class V
 lesions present on gingival
third of all teeth

51. (6) GV Black
Old Theories Classification
 Class VI
 lesions found on incisal
edges + cusp tips

52. (7) Location
Old Theoriesof the lesion
 Pit and Fissure caries
 Occlusal
 Buccal or lingual pit
 Smooth surface caries
 Proximal
 Buccal or Lingual surface
 Root caries

53. (8) Tissue involved
Old Theories
 Enamel Caries
 Dentinal Caries
 Cemental Caries

54. Classification
 Senile Caries
 caries associated with
aging
 almost exclusively seen on root
surface
 Residual Caries
 not removed during restorative
procedure

55. Clinical Features: Smooth
Surface Caries
 Interproximal Caries
 opaque chalky region
(white spot)
 some cases yellow or brown
pigment area
 spots are generally located on
outer surface of enamel
between contact point + height
of free gingival margin

56. Clinical Features: Smooth
Surface Caries
 Interproximal Caries
 as caries penetrates
enamel, enamel surrounding
the lesion assumes bluish white
appearance
• usally apparent as laterally
spreading caries at DEJ

57. Clinical Features: Smooth
Surface Caries
 Interproximal Caries
 common for proximal
caries to extend both
bucally + lingually

58. Cervical, Buccal, Lingual or
Palatal Caries
 Clinical Features:
 usually extends from
area opposite gingival crest
occlusally to convexity
of tooth surface
 extends laterally towards
proximal surfaces

59. Cervical, Buccal, Lingual or
Palatal Caries
 Clinical Features:
 usually occurs on cervical
area
 typical cervical lesion is a
crescent shaped cavity
beginning as slightly
roughened chalky area
 gradually becomes excavated

60. Pit and Fissure Caries
 Clinical Features:
 appears brown or black
 feel slightly soft
 catch a fine explorer point

61. Pit and Fissure Caries
 Clinical Features:
 enamel bordering the pit
and fissure may appear
• opaque as it becomes
• bluish white undermined

62. Pit and Fissure Caries
 Clinical Features:
 lateral spread of caries
at DEJ as well as
penetration into dentin
along dentinal tubules
may be extensive
 without fracturing away
overhanging enamel
 there may be large carious lesion
with only a tiny point of opening

63. Root Caries
 also known as cemental
caries
 involves both dentin +
cementum
 in number of people
exhibiting gingival recession
with clinical exposure of
cemental surface

64. Root Caries
 Clinical Features:
 slowly progressing
chronic lesion
 usually found in mandibular
molar area + premolar
region
 gingival recession is associated
with root surface caries

65. Recurrent Caries
 occurs immediately adjacent
to restoration
 may be caused by inadequate
extension of restoration
 was not able to excavate or
removed well original
carious lesion

66. Recurrent Caries
 Clinical Features:
 restoration with poor
margins
• permitted leakage +
entrance of both bacteria +
substrate

67. Nursing Bottle
Caries
 Etiology:
 due to nursing bottle
containing milk or milk
formula, fruit juice or
sweetened water
 sometimes it occurs due to
sugar or honey-sweetened
pacifier

68. Nursing Bottle
Caries
 Pathogenesis:
 child is put on bed at
afternoon nap time or at night
with nursing bottle containing
milk or a sugar containing
beverage
 milk or sweetened liquid
becomes pooled around
maxillary anterior teeth

69. Nursing Bottle
Caries
 Pathogenesis:
 carbohydrate containing
liquid provide an excellent
culture medium for
acidogenic microorganisms

70. Nursing Bottle
Caries
 Clinical Feature:
 prolonged feeding beyond
usual time may result in
early + rampant caries
 early carious involvement
of maxillary anterior,
maxillary + mandibular 1st
permanent molars,
mandibular canines

71. Nursing Bottle
Caries
 Clinical Feature:
 carious process is so
severe that only root
stumps remain

72. Nursing Bottle
Caries
 Prevention:
 parent should start brushing
the child teeth as soon
as they erupt in oral
cavity
 discontinue bottle feeding as
soon as child can drink from
a cup, at approximately
12-15 months of age

73. Rampant Caries
 suddenly appearing
 widespread
 resulting in early involvement
of pulp

74. Rampant Caries
 Etiology:
 may be due to nutritional
deficiency
 malnutrition
 emotional disturbances

75. Rampant Caries
 Clinical Features:
 occurs in children with
poor dietary habits
 extensive inter-proximal
+ smooth surface caries

76. Rampant Caries
 Management:
 extensive dental care
 parent education

77. Arrested Caries
 Clinical Features:
 both deciduous + permanent
are affected
 large open cavities
 brown-stained polished
appearance + hard

78. Prevention/Management
of Dental Caries
 Restorative Treatment
 Tooth Brushing
 Mouth Rinsing
 Dental Floss
 Topical Fluoride Application (Pedo Patients)
 Pit and Fissure Sealants

79. References:
 Books
 Cawson, R.A: Cawson’s Essentials of Oral
Oral Pathology and Oral Medicine,
8th Edition
• (page 40)
 Ghom, Ali & Mhaske, Shubhangi: Textbook of
Oral Pathology
• (pages 401-419)
Shafer, et al: A textbook of Oral Pathology,
3rd Edition
• (pages 369,394, 407)