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Anita Rosa
Caries Etiology
A CAVITY occurs if the Demineralization "wins" over the Remineralization over time
Understanding the process
Demineralization
Acid
pH Low of
production Hydroxyapatite
Understanding the process
What is Hydroxyapatite?
Tooth Microstructure - Enamel
• Rods are made up of bundles of hydroxyapatite
(Ca10(PO4)6(OH)2) crystals, which are composed
of calcium and phosphate (95% inorganic, 5%
organic)
Tooth Microstructures - Dentin
• Dentin is also composed of hydroxyapatite,
(70% inorganic, 30% organic) and has tubules
running through it
Equilibrium at normal pH
Saliva is supersaturated with respect to enamel
Saliva
Ca+statherin Ca+aPRP
[Ca] [PO4] [Ca] [PO4]
Enamel
Ca10(PO4)6OH2
Demineralization
Dietary CHO + biofilm = lactic acid; diffusion into enamel = local pH drop
Saliva [Ca]
Ca+statherin Ca+aPRP
[PO4]
[Ca] [PO4] [Ca] [PO4] exit to
saliva
CHO CHO CHO [H+]
[H+]
[H+]
Enamel
[H+] Enamel
[H+] solubility
increases
Ca10(PO4)6OH2
Remineralization
Saliva flow clears CHO; salivary HCO3 returns pH to normal
Saliva
[Ca]
statherin Ca+aPRP
[PO4] [HCO3] CHO
move into [Ca] [PO4] [Ca] [PO4]
enamel [HCO3] [HCO3] CHO
Enamel
Enamel
becomes
less
soluble Ca10(PO4)6OH2
Alternating cycles of de/re-min
• Break even - sound enamel or arrested caries
• Net loss
– Subsurface demineralization
– New caries
– Progression of old lesions
http://www.uiowa.edu/~ocrdent/crown%20model.htm
Streptococcus Sobrinus
Lactobacillus
S. mutans structures
Glucans
• Tooth adherence
• Promotes aggregation
• Biofilm accumulation
• Retention of bacterial nutrients
• Some antibodies prevent GTF function and are
protective.
What is the role of saliva?
Role of Saliva in Caries
• Lubrication
• Also called Liquid Enamel because of high mineral
content
• Cleansing Action
• Buffering Capacity
• AntibacterialActionbyLysozyme,Lactoperoxidase,hemopr
otein enzyme (Prevents bacterial colonization)
• Reservoir of Calcium and Phosphate
• Most prominent antibody in saliva IGA.
• Proteins like statherin protects hydroxyapetite crystals.
Role of Saliva in Caries
If salivary function is reduced for any reason, such as from illness or medications or
due to radiation therapy, the teeth are at increased risk for decay.
What is the correlation between diet
and dental caries?
Fermentable carbohydrate intake
• The frequency of eating cause caries rather
than total quantity of fermentable
carbohydrate
• Why??
Fermentable carbohydrate intake
Questions…
• Have u ever heard about fluorapatite?
• What is it?
Meet the fluorapatite
Fluoride effect on remineralization
and demineralization of enamel
Promote remineralization1
F-
4
Extension of caries lesion into dentine
5 Possible
Extension of caries into pulp formation of
apical abscess
1. Collins WJN, et al. A Handbook for Dental Hygienists. 3rd edition. Oxford: Wright, 1992.
2. Clarkson BH, et al. Caries Res 1991;25:166-173.
sub-surface enamel lesion
Frank cavitation
http://www.dent.umich.edu/research/loeschelabs
DENTAL CARIES
-It is triangular in shape with the apex facing the surface of tooth and the
-it produces greater cavitation than the smooth surface caries and there is
2. Smooth Surface
Caries
Spread of the Carious Lesions
http://www.st-andrews.ac.uk/~amc/research/medical.htm
• Cavitation
• Demineralization + proteolysis
• Bacteria move down tubules
• Pulpal involvement
• Major damage if unchecked
http://www.dent.umich.edu/research/loeschelabs
CARIES OF ENAMEL
Smooth surface Caries:
Due to plaque formation on enamel. The earliest manifestation of incipient
caries (early caries) of enamel is usually seen beneath dental plaque as areas
of decalcification (white spots).
The first change seen histologically is the loss of inter-rod substance of
enamel with increased prominence of the rods.
-this is followed by the loss of mucopolysaccharides in the organic substance.
-presence of transverse striations of the enamel rods,
- accentuated incremental lines of Retzius
as it goes deeper, the caries forms a triangular pattern or cone shaped lesion
with the apex towards DEJ and base towards the tooth surface. Finally there
is loss of enamel structure, which gets roughened due to demineralization,
and disintegration of enamel prisms.
Carious
lesion
Dentin reaction
to caries
The zones seen before complete disintegration of enamel are:
Zone 1: Translucent zone,
-lies at the advancing front of the lesion,
-slightly more porous than sound enamel,
-it is not always present
Zone 2: Dark zone,
-this zone is usually present and referred
to as positive zone
-formed due to demineralization.
Zone 3: Body of the lesion,
-found between the surface and the dark zone,
-it is the area of greatest demineralization,
Zone 4: Surface zone,
-relatively unaffected area,
-greater resistance probably due to greater degree of mineralization and
greater F concentration.
CARIES OF DENTIN
Begins with the natural spread of the process along the DEJ and rapid
involvement of the dentinal tubules. The dentinal tubules act as tracts leading to
the pulp (path for micro-organisms).
Early Dentinal Changes:
-initial penetration of the dentin by caries dentinal sclerosis,
-calcification of dentinal tubules and sealing off from further penetration by
micro-organisms,
-more prominent in slow chronic caries.
Dentinal
sclerosis
Behind the transparent sclerotic zone, decalcification of dentin appears.
In the earliest stages, when only few tubules are involved, microorganisms may
be found penetrating the tubules Pioneer Bacteria.
3. Root Caries
Root Caries
Root caries is a soft, progressive lesion that is found anywhere on the root
surface that has lost its connective tissue attachment and is exposed to the
environment.
-the root surface must be exposed to the oral environment before caries can
develop here.
-Plaque and micro-organisms are essential for the cause and progression of the
lesion, mostly Actinomyces,
-micro-organisms invade the cementum either along the Sharpey’s fibers or
between the bundles of fibers.
-spread laterally, since cementum is formed in concentric layers.
-after decalcification of cementum, destruction of matrix occurs similar to
dentin with ultimate softening and destruction of this tissue.
-invasion of micro-organisms into the dentinal tunbules, finally leading to pulp
involvement.
-the rate is slower due to fewer dentinal tubules than crown area
Thank you