Dental caries is caused by bacteria in the mouth that feed on sugars and produce acids. The acids demineralize the enamel and dentin of the teeth. Two main bacteria, Streptococcus mutans and Lactobacillus, are responsible for initiating caries. If left untreated, dental caries can lead to pain, tooth loss, and infection. Factors that influence the development of caries include diet, microorganisms, host factors, genetics, and immunology. Clinical and radiographic exams are used to detect caries. Treatment involves removing decay and restoring teeth. Preventive methods focus on nutrition, oral hygiene, fluoride, dental sealants, and altering bacterial growth.

1. Dr. Mimosa Chatterjee
www.pediatricdentists.blogspot.com

2.  Dental caries is a microbial disease of the calcified
tissues of the teeth, characterised by demineralisation
of the inorganic portion & destruction of the organic
substance of the tooth.
 It is one of the most common infectious diseases
affecting the human race
 Two groups of bacteria are responsible for initiating
caries Streptococcus mutans and Lactobacillus. If left
untreated, the disease can lead to pain, tooth loss and
infection.
 Cariology is the study of dental caries.

7. 1) Dietary factor 2) Microorganisms
 Carbohydrates with types  acidogenic strptococcus
like mutans & Actinomycosis
monosaccharides, disacc  Aciduric-Lactobacilli
harides or poly  Other micoorganism
saccharides producing IgA1,proteases
 Amount consumed
 Form-refined or coarse Streptococcus mutants
 Nature-sticky or easily
cleared.
 Biochemical properties-
fermentable/non-
fermentable.

8. 3) Host Factor 4)Genetic Factors
 Morphology of teeth-Deep
fissures are prone to food 5)Immunological Factors
accumulation and development 6)Other factors
of caries.
 Intro-oral variations:-The caries
susceptible of teeth varies in the
following order:-Lower first
molar>Upper first molar>upper
& lower second molar>second
bicuspid>upper
incisors>cuspids
 Irregularities of arch
form:crowding ,malaligned
teeth favour development of
caries.
 Salivary-quantity,viscocity,flow
rate,composition,buffing
capacity etc

10. Pathogenesis of dental caries
1.Whenever carbohydrate is consumed, oral micro-organisms rapidly begin
fermentation producing organic acids like lactic acids , acetic acid & formic acid. this
leads to fall in pH of the oral fluids
2.these organic acids attack the tooth structure, resulting in loss of tooth minerals
specially calcium & phosphate ions, which leach out from hydroxyapatite. this
process is known as demineralization
3.After a period of 30 mins, due to salivary buffering by bicarbonate ions & ammonia
production from salivary proteins, there is am increase in pH of the oral fluids. the
acid is neutralised & the condition now favours precipitation of calcium & phosphate
ions in to tooth surface. this process is called as re mineralisation & is hastened if
fluoride is present in a small amount in either plaque fluid or saliva
4.the microorganism which is of primary concern in the pathology of dental caries is
Streptococcus mutants. it forms soluble, sticky extracellular polysaccharides which
help in further colonization & increases the contact of the acids which ultimately
leads to cavitation.
5.The balance between the caries causing & caries protective factors is very
delicate. it is only when repeated attacks of demineralisation occur that there is a net
loss of minerals from the tooth & caries result. the surface layer of enamel overlying
the lesion remains intact & the demineralisation occurs primarily sub surface
location. once this happens the process gradually extends deeper, involving enamel
& subsequently the dentin & pulp

12. First classification
 based on location of the  based on tissue involved:
lesion
 pit & fissure caries
1. enamel caries
• occlusal
2. dental caries
• buccal or lingual pit
3. cemental caries
 smooth surface caries-
• proximal
• buccal or lingual surface
 root caries

13.  based on virginity of the  based on progression of
lesion lesion:
 progressive caries-
• primary caries
• rapidly progressive like
• secondary caries
nursing caries &
radiation caries
• slowly progressive
 arrested caries

14. 2nd classification Mount GJ in 1997 classified dental
caries based on site and size
 Site:  Size:
 Site 1- include lesion on the pit &  Size 1( mild)- includes lesions which
fissure of the posterior teeth on have progressed just beyond
other surfaces, these include the remineralisation
buccal grooves on the mandibular  Size 2 ( moderate)- includes larger
molars, palatal grooves of the lesions with adequate tooth surface
maxilarry molars & erosion lesion to support the restoration.
on the incisal edges.
 Size 3(enlarged)-includes lesions in
 Site 2- includes lesions in the which the tooth structure and the
contact areas of posterior and restoration are susceptible to
anterior teeth. fracture.
 Site 3- includes lesions originating  Size 4 (severe)- includes lesions
in the gingival third of all teeth. which have destroyed a major
portion of the tooth structure.

16.  Clinical method
 Use of sharp explorer- if slight
pull is required to remove the
explorer from the tooth surface.
i.e if there is a catch then the
surface is counted as being
decayed
 Use of mirror & probe- this is the
most common method
 A mirror & blunt probe visual
examination

17.  Radiographic method
 Bite wing radiography is used. Dental
radiographs, produced when X-rays
are passed through the jaw and picked
up on film or digital sensor, may show
dental caries before it is otherwise Radiograph showing
visible, particularly in the case of dental caries
caries on interproximal (between the
teeth) surfaces. Large dental caries are
often apparent to the naked eye, but
smaller lesions can be difficult to
identify

18. Advanced caries diagnostic method
 Fiberoptic transillumination-a shadow visible in
dentin has been suggested as the criteria. It does not
detect small lesions.
it does not detect small lesions
 Digital Fiberoptic transillumination-this is relatively
new methodology.Illumination is delivered on the
tooth surface by means of fiberoptic which acts as a
light source. the resultant change in light distribution
is captured by the camera & is sent to the computer for
analysis

19.  Electrical conductance measurement-Theory behind this is
that sound surface should possess limited or no
conductivity, where as carious or deminralized enamel
should have a measurable conductivity that will increase
with increasing demineralization.
Indicator:
Green- no caries
Yellow-enamel caries
Orange-dentin caries
Red-pulpal involvement
 Visible luminescent spectroscopy-The visible emission
spectra for decayed & non decayed regions of teeth differ.
Quasi monochromic light from a tungsten source dispersed
with a grating monochromatic is focused on the teeth &
emission spectra are recorded & analysed.

20.  disclosing dye-disclosing dyes have been
recommended for Various dyes such as silver nitrate,
methyl red & alizarin stains have been used to detect
carious sites by change of colour.se as an adjunct when
diagnosing smaller carious lesions in pits and fissures
of teeth
 Laser Fluorescence
 Xeroradiography
 Ultrasound
 Laser Luminance
 Optical caries monitor
 Endoscopic method of caries detection
 Magnetic resonance micro-imagery

22. Control of all active lesions
 Initial treatment of all active lesions.
 Gross excavation of all carious lesions followed by
systemic manner of restoring a tooth to normal
contour

23. Nutritional measures for caries control
 Diet high in fat, low in carbohydrate & practically free
from sugar have low caries activity.
 In a study, when refined sugar was added to the diet
in the form of a mealtime supplement there was little
or no caries activity
 Phosphates diet causes significant reduction in
incidence of caries.

24.  Tooth Brushing
tooth brush removes gross amount of food
debris & plaque material.
 Mouth Rinsing
it helps in loosening food debris from the
teeth.
 Dental floss
it helps to remove plaque from an area
gingival to the contact areas on proximal
surfaces of teeth, an area impossible to reach
with toothbrush
 Detergent
Fibrous food prevents lodging of food and
act as detergent
 pit & fissure sealants

25. 1)Substances which alter the tooth structure or tooth surface
 Fluorine
The cariostatic activity of fluoride involves several different mechanisms.
The ingestion of fluoride results in its incorporation into the dentin &
enamel of unerupted teeth. This makes the teeth more resistant to acid
attack after eruption into oral cavity.
Ingested fluoride is secreted in to saliva, although present in low
concentration in saliva, the fluoride is accumulated in plaque where it
decreases microbial acid production & enhances the remineralisation of the
underlying enamel. Fluride from saliva is also incorporated in to the enamel
of newly erupted teeth, thereby enhancing the enamel calcification
 Bis-biguanides
chlorhexidine & alexidine are potential anti caries agent as they are
anti plaque agent

26.  Zinc chloride & potassium ferrocynide
it effectively impregnate the enamel & seal off caries invasion pathway
 Silver nitrate
Silver plugs the enamel by either the organic invasion pathways such as
enamel lamellae or the inorganic portion to form a less soluble combination
2)Substances which interfere with carbohydrate degradation through
enzymatic alteration
 vitamin k
 sarcoside
3)Substances which interfere with bacterial growth & metabolism
 Urea & ammonium compounds
 chlorophyll
 Nitrofurans
 penicillin

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