DENTAL CARIES

Read:
Chap 5
 Definition of Caries:
• An infectious microbiological disease
that results in localized dissolution
and destruction of the calcified
tissues of the teeth
Dental caries:
A constant balance between
demineralization and remineraliztion

acids Ca+P
5.5

http://en.wikipedia.org/wiki/Dental_caries
 I. Introduction
• 95% of US population affected (1987)
• 50% of children were caries-free (1987)
• Decline - fluoride, education
– 2002 CDC report:
• 42% ages 6-19 had caries
• 90% adults had caries
• 8% were edentulous
• Recently – increase in caries (economy?)
• 50% of children had caries by age 11
• 68% of 19 year olds have experienced caries
 Decay Process:
• Bacteria (mutans S.) + CHO matrix
= Bacterial plaque (acidic)

• Acidic plaque + Susceptible Tooth

+ Time = Dental Caries
 II. The Carious Lesions
• Pit and fissure lesions
• Smooth surface lesions
• Root surface lesions
• Recurrent lesions
A. Pit and Fissure Lesions
 A. Pit and Fissure Lesions
• Enamel: (triangle apex toward occlusal)
– Small site at origin
– Base widens towards DEJ

• Dentin:
(triangle apex towards pulp)
– Wide base at DEJ
– Apex of cone towards pulp
Progress of pit and fissure lesion:
 B. Smooth Surface
Lesions
• Enamel: ( -shape)
– Wide area of origin
– Apex towards DEJ

• Dentin: ( -shape)
– Wide base at DEJ
– Apex of cone towards pulp
Progress of a smooth surface lesion:
Smooth surface lesions:
 E0: no lesion
E1: outer 1/2 of enamel
E2: inner 1/2 of enamel
D1: outer 1/3 of dentin
D2: middle 1/3 of dentin
D3: inner 1/3 of dentin

Radiographic Classification
 C. Root Surface Lesions
• Begin directly on cementum/dentin
• Typically with recessed gingiva
• Pot-hole (saucer-shaped)
 D. Recurrent Lesions

Common causes:
- poor Oral Health Care
- sloppy dentistry
 Caries in Enamel
(Non-cavitated E1/E2):
• Zone 1(d): Translucent zone (deepest)
• Zone 2(c): Dark zone (remineralization)
• Zone 3(b): Body zone (demineralization)
• Zone 4(a): Surface zone (clinically intact)
 Caries into Dentin:
(D1, D2, D3 lesions)

• Invasion of bacteria into dentin

– Mutans S. facilitates (enamel)
– Lactobacillus propagates (dentin)
• Organic acids demineralize
dentin
• Collagen is degenerated/dissolved
infected dentin
• Loss of structural integrity (cavity)
 Types of Affected
Dentin:

• Sclerotic dentin
• Reparative dentin
 Sclerotic dentin
(sclerosis: hardening)

• Affected dentin (not infected)

• Deposition of crystalline minerals in
dentinal tubules
(hypermineralization)
• Function: occlude tubules
• Slow, long term irritation
• Hard, shiny, possibly
discolored
 Reparative dentin:
• Formation of tertiary dentin by
odontoblast-like cells (aka secondary
reparative dentin)
• Intermediate level
of irritation
• Between pulp tissue and
dentin (PDJunct)
 Review: Types of Dentin
• Primary dentin (initial formation
of tooth)
• Secondary dentin (next to pulp,lifelong)
– aka Physiologic secondary dentin
• Tertiary dentin (reaction to caries)
– aka Reparative secondary dentin
PSD

RSD
 Pulpal necrosis:
• Result of severe irritation
• Infection, death of pulp, abscess
 III. Detection of caries:
• Pit & fissure: Visual - dried tooth
with aid of magnifiers; explorer not
reliable (Summit JB, et al: Fund of Oper Dent)

• Proximal surfaces: radiographs

• Facial/lingual surfaces: visual, tactile
with spoon excavator or explorer
• Recurrent lesions: visual, tactile, &
radiographs
 Minimally Invasive Dentistry

The day is surely coming…when we will be

engaging in practicing preventive rather than
reparative dentistry
--GV Black, 1896
 Paradigm shift:
• Surgical model
• Medical model
– Prevention
– Re-mineralization
IV. Treatment options:

• When do we monitor only?

– Is the lesion a defect or carious?
– What is the history of the defect?
• When do we remineralize & monitor?
– MI paste, fluoride
– How frequently monitored?
• When do we treat surgically?
(drill and fill)
– What is the best material of choice?
 Surgical or Medical?

• E1, D2, and D3 lesions: tx options

self-evident
• E2 and early D1 lesions: gray area,
(patient’s caries risk factor)
Factors that affect
decision making:

• Patient s caries risk

– What s the history of past restorations?
– What s the OHC?
• Patient s level of responsibility
– Compliance with re-mineralization
– Routine follow-ups
To treat or not to treat…
 Prevention of Caries
• Daily oral hygiene
• Early detection of caries
(tx demineralized enamel)
• Fluoride application
• Sealants
• Healthy Diet
• Immunization
Sealants: most effective in pits and fissures
 Control of Non-cavitated
Lesions

• E1, E2, early D1

• Remineralization
– Fluoride application
– MI paste (Recaldent)
• Chewing xylitol gum
• Routine check-ups
 Control of Cavitated
Lesions
• Surgical removal of decay and weak
structures aka “the preparation”
• Restored with material of choice e.g.
amalgam, composite, glass ionomer
• Quality of your restorations is a
factor for long term health and
prevention of recurrent decay and
periodontitis
For Lab Today….
Meet back here at 1 p.m.
Today s Lab...
• Pick up dental issue from Dental
Supply
• Identify and organize instruments
Handpiece Lubrication
See you in lab!
Pick up your dental issue:
Line up in numerical order