Universitatea de Vest Vasile Goldis

Facultatea Medicina, Farmacie si Medicina Dentara

Specialitatea: Medicina Dentara
REFERAT EG!E"A
Anul ##, semestrul #
Student: Topciu Andreea $arina
Anul V# MD
Dental caries
Dental caries is t%e ma&or cause 'or loss o' teet% in c%ildren and adults( #t a)ects
t%e enamel sur'aces o' teet% in c%ildren and adults and t%e e*posed root sur'aces
o' t%e teet% o' t%e elderl+( Dental caries is t%e result o' t%e interaction o' t%e
,acteria on t%e toot% sur'ace, t%e dental pla-ue or oral ,io.lm, t%e diet and
speci.call+ 'ermenta,le car,o%+drate components o' t%e diet, /%ic% are
'ermented ,+ t%e pla-ue micro0ora to or1anic acids, and t%e teet% actin1
to1et%er over time( Dental caries /ill occur onl+ /%en t%e t%ree 'actors are
present to1et%er and /%en t%e+ act to1et%er over a su2cient period o' time(
#' t%e di)erent 'actors are considered individuall+, it is possi,le to o,tain a ,etter
understandin1 o' t%e nature o' t%eir interactions and %o/ t%ese interactions ma+
mani'est as a carious lesion and, eventuall+, i' not treated eit%er preventativel+
or /it% a restoration, as pain and ultimatel+ in t%e loss o' t%e toot%(
Dental pla-ue is a natural ,io.lm( T%e num,er o' di)erent ,acterial species in
dental pla-ue is not
3no/n, ,ut sop%isticated molecular ,iolo1+ studies %ave s%o/n t%at over 455
di)erent species ma+ ,e identi.ed6 man+ more %ave +et to ,e c%aracterised( T%e
ma&orit+ o' t%ese species %ave not ,een cultured in t%e la,orator+ usin1 t%e
current met%ods 'or ,acterial isolation( #t is also /ort%/%ile notin1 t%at t%ese
molecular approac%es %ave demonstrated t%at, 'or e*ample, Streptococcus
mutans, previousl+ reported onl+ to ,e isolated 'rom t%e oral cavit+ a'ter t%e
eruption o' t%e lateral incisors, is actuall+ present in t%e mout%, colonisin1 t%e
ton1ue, /it%in a 'e/ mont%s o' ,irt%( A ,io.lm is a communit+ o' microor1anisms
attac%ed to a solid sur'ace, /it% t%e ,acteria encapsulated in pol+mers derived
'rom t%e ,acteria and e*%i,itin1 speci.c ,io.lm c%aracteristics, includin1
increased resistance to antimicro,ials and ,iocides and t%e production o' novel
proteins( An appreciation o' t%is t+pe o' 1ro/t% %as led to attempts to develop
novel anti7pla-ue strate1ies, /%ic% tar1et t%e in%i,ition o' 'unction o' novel
,io.lm7speci.c proteins( Dental pla-ue is present on virtuall+ all toot% sur'aces
and %as a 1eneral structure /%ere,+ salivar+ and some ,acterial proteins are
initiall+ deposited on t%e enamel sur'ace to 'orm t%e pellicle and t%e pellicle t%en
a,sor,s 'urt%er ,acteria( T%e .rst ,acteria to ,ind to t%e toot% sur'ace, t%e
pioneer or1anisms, include Streptococcus oralis, Streptococcus san1uinius,
eisseria and 8aemop%ilus species and Actinom+ces naeslundii( T%ese ,acteria
are isolated 'rom cleaned toot% sur'aces /it%in 95 minutes o' cleanin1( Follo/in1
t%e ,indin1 o' t%ese ,acteria, ot%er or1anisms ,ind and eventuall+ pla-ue o' 'ull
t%ic3ness develops, partl+ ,ecause o' ,acterial ,indin1 ,ut primaril+ ,ecause o'
,acterial 1ro/t%( T%e ,indin1 o' ,acteria to t%e pellicle and to ot%er ,acteria is
mediated ,+ speci.c interactions in /%ic% onl+ certain ,acteria ,ind to
components o' t%e pellicle and onl+ certain ,acteria interact( :ne o' t%e ma&or
and most interactive o' all t%e ,acteria in dental pla-ue is Fuso,acterium
nucleatum /%ic% ,inds to man+ ot%er ,acteria6 it acts almost as a nucleus 'or
pla-ue 'ormation, cross7lin3in1 ot%er/ise non7interactin1 ,acterial species( T%e
composition o' dental pla-ue varies over time( #n supra1in1ival pla-ue t%e 0ora
,ecomes more anaero,ic, /it% pi1mented anaero,ic rods suc% as ;revotella and
Fuso,acterium species ,ecomin1 increasin1l+ a,undant as t%e pla-ue
accumulates and a1es, as it ,ecomes a clima* communit+( 8o/ever, in t%e sites
/%ere caries isinitiated, in t%e sta1nation sites t%e composition o' t%e pla-ue
re0ects t%e acidic environment o' t%ese sites( T%e or1anisms most li3el+ to ,e
isolated 'rom t%ese sta1nation sites are Streptococcus mutans and Streptococcus
so,rinus <mutans streptococci=, ot%er streptococci <S( oralis, S( intermedius and
S( an1inosus=, lacto,acilli, Actinom+ces and >i.do,acterium species( T%ese
or1anisms are Gram7positive, acido1enic <producin1 acid 'rom su1ars= and eac%
includes strains /%ic% are aciduric <a,le to survive in acidic environments=( At
t%ese sta1nation sites +easts, suc% as $andida al,icans, ma+ also ,e present as
t%e+ are also acido1enic and aciduric( Veillonella species, /%ic% are Gram7
ne1ative cocci, are also isolated, as t%is 1enus %as t%e a,ilit+ to use lactic acid
produced 'rom t%ese ot%er species to 1enerate ener1+ 'or 1ro/t%( Alt%ou1% it %as
lon1 ,een 3no/n t%at ,acteria are present on t%e teet% it /as not until t%e ?@A5s
t%at it /as proven t%at /it%out ,acteria t%ere /as no toot% deca+( :nl+ in recent
+ears %as it ,ecome clear t%at t%e identi.cation o' t%e causative micro,iolo1ical
a1ents o' toot% deca+ remains elusive( !acto,acilli /ere re1arded as t%e main
micro,iolo1ical a1ent o' toot% deca+ 'or man+ +ears until t%e ?@B5s, as t%e+
/ere, and still are, isolated in 1reat num,ers 'rom active carious lesions(
8o/ever, a de.nitive lon1itudinal stud+ clearl+ demonstrated t%at lacto,acilli
colonised lesions a'ter t%eir 'ormation and t%at t%e+ /ere not prevalent in dental
pla-ue durin1 t%e period o' lesion 'ormation Since lacto,acilli proli'erate in acidic
environments, t%e+ are 1ood indicators o' t%e amount o' su1ar t%at patients
consume( Monitorin1 t%e levels o' t%ese ,acteria in saliva is a 1ood /a+ o'
esta,lis%in1 /%et%er patients are 'ollo/in1 dietar+ advice and usin1 ade-uate
oral %+1iene measures( T%e studies /%ic% esta,lis%ed once and 'or all t%at
,acteria /ere essential 'or t%e initiation o' toot% deca+ /ere carried out in t%e
earl+ ?@A5s usin1 1erm7'ree <1noto,iotic= rats( #n t%ese studies, rats /ere orall+
inoculated /it% sin1le strains o' ,acteria isolated 'rom t%e 'aeces o' rats 'ed
sucrose7ric% diets and /it% toot% deca+( :nl+ rats inoculated /it% ,acteria and
'ed sucrose in t%e diets developed toot% deca+( 8o/ever, not all ,acterial isolates
/ere capa,le o' 'ormin1 carious lesions( #n addition, ,acteria, includin1
Streptococcus salivarius and Enterococcus spp(, /%ic% are not normall+ isolated
in lar1e num,ers 'rom dental pla-ue, also caused caries in rats( From t%ese
studies Streptococcus mutans, isolated man+ +ears previousl+, appeared to ,e
t%e most cario1enic o' all t%e species tested, /%ile ot%er commensal ,acteria,
e(1( streptococci and Actinom+ces, /ere less cario1enic( Some strains o'
Streptococcus oralis and milleri71roup streptococci produced levels o' caries t%at
approac%ed t%ose 'ound /it% Streptococcus mutans and Streptococcus so,rinus(
8o/ever, all strains o' mutans streptococci produced %i1% levels o' caries /%ile
onl+ a 'e/ o' t%e man+ ot%er species, especiall+ ot%er species o' streptococci, did
so( #t is no/ apparent t%at t%ese non7mutans streptococci are %etero1eneous
<di)erent= /it% respect to t%eir a,ilit+ to cause caries and t%at t%is is re0ected in
t%e ran1e o' acido1enic and aciduric properties o' t%ese or1anisms compared to
t%e relativel+ %omo1eneous <similar= properties o' t%e mutans streptococci( #t /as
'or t%ese reasons t%at 'or man+ +ears, mutans streptococci /ere re1arded as t%e
,acteria associated /it% t%e initiation o' dental caries and t%e levels o' t%ese
or1anisms /ere used to assess caries ris3( $onse-uentl+, considera,le researc%
/as underta3en to esta,lis% /%et%er Streptococcus mutans /as t%e cause o'
caries in %umans( Despite de.nitive evidence t%at t%is /as t%e case, a num,er o'
investi1ations /ere underta3en attemptin1 to develop novel treatments to
eradicate S( mutans 'rom t%e oral cavit+ as a means o' in%i,itin1 caries
'ormation( T%e met%ods /%ic% %ave ,een investi1ated include:
Vaccine development(
;assive immunisation /it% t%e direct application o' anti7S( mutans anti,odies
directl+ on t%e toot% sur'ace(
Replacement t%erapies in /%ic% less cario1enic ,acteria are introduced into t%e
mout% to eradicate t%e more cario1enic S( mutans strains(
Some o' t%ese approac%es /or3 in la,orator+ animal models, and some eradicate
S( mutans 'or s%ort periods 'rom t%e %uman oral cavit+, ,ut none %as +et ,een
s%o/n to ,e e)ective at reducin1 t%e incidence o' dental caries in %umans( T%e
reasons 'or t%e lac3 o' success are still ,ein1 determined( #t is, %o/ever, /ell
esta,lis%ed t%at t%ere is a clear association ,et/een t%e num,ers and
concentrations o' S( mutans in pla-ue andCor saliva and t%e dental caries status
o' populations, and to a lesser e*tent to t%e caries status o' an individual( #t is
also 3no/n t%at dental caries occurs in t%e a,sence o' S( Mutans and individuals
/it% %i1% levels o' S( mutans do not necessaril+ %ave to %ave caries(