In the name of god

Today were going to talk about carries in dentin. The shape of the carries in dentin differs from it in enamel. How? The base of the cone is towards the dento-enamel junction (DEJ) and the apex is towards the pulp (picture in slide # 13). Now what happens when carries attack dentin? (Histological appearance of the lesion before cavitations occurs) The dentine is formed by dentinal tubules and inside these tubules we have Odontoblast processes which are the cells that from dentin, the bodies of these cells are located in the pulp and their processes are in the dentin. Now when carries attack dentin, the odontoblast processes disappear so the dental tubules are calleddead tracts. And these tubules contain: gases Fluids Degenerating cell remnants from the bacteria. If the carious process continues cavitation is going to happen in dentin and bacteria will have direct access to dentin as well as the dentin tubules. The body of the lesion in dentin can be divided into three structural components according to the invasion of the bacteria the caused the carries in the first place : 1. Demineralized dentin: at the advanced edge of the lesion, no bacteria. Explanation: this area has demineralization but the bacteria hasnt entered yet. (El-bacteria lessa ma weslt la honak).

2-zone of penetration: dentin has become penetrated by bacteria, but there is no destruction 3- Zone of destruction: zone of necrosis, destruction of the dentin substance. The doctor repeats that these three zones of the body of the lesion depend on the invasion of the bacteria. (All of this is slide # 14) Now the in last slide we have a diagram that also shows the invasion this is dentinal tubule, dentin and here we have a block section. (A) So we can see enamel, dentin, and pulp. (Look at the last 3 pictures in the slides to understand) We can see the odontoblasts which we mentioned before, they have a body which is located in the pulp and processes located in the dentin tubules. (B) Here we have three sections showing us the three structural components: (look at the sections from left to right) This is the destruction zonewhy? Because the bacteria has already invaded the dentin and caused destruction Zone of penetration: bacteria have invaded dentinal tubule but no destruction happened. Deminerlized zone: no invasion of bacteria. The doctor asked: why is this important?? Because later on when u want to remove the carries ( or lesion) its important to know what are the parts of dentin that were invaded by bacteria and which werent , and there are certain criteria that we will talk about, which is how to determine if the dentin is infected and which are affected. Infected: the bacteria reached the dentin or invaded it Affected: not invaded by bacteria. We will talk about this later but the doctor said to keep it in mind! Lets move to classification of dental carries yeee fakrt bs mo7frah lazem afr3 tel3le hadya mo7drah # 2.. how lucky am i!!!

Okay breathe in..now out. Ok lets move on!! There is no universally accepted classification of the disease.( Ma fee eshe motafq ben el 3olam2 3n the classification of the carries) But on the basis of clinical features and patterns, dental carries may be classified in many ways: 1morphology (location of the lesion) y3nee, location (in the crown or in the root) or the size of this lesion. We will talk about this. 2-prior condition of the tooth: In arabic:Y3nee el sen ma7she wala msh m7she b 7ashweh In English: If the tooth is restored or not If it has initial carries or the carries are around the restoration. 3-dynamics (rate of destruction of the lesion). Means how fast the lesion moves towards (destruction of the lesion) the tooth structure wither enamel or dentin. 4-extent of the lesion Progression of the lesion wither toward enamel or dentin 5- Chronology (age) Which age group is affected by carries? 1-Classification based on the morphology (location of the lesion): We know that the tooth is composed of two parts: a- crown b- Root. So if the lesion affected the crown, we call it crown carries. And if it affected the root, we call it root caries.

Crown carries could be divided into: A-Occlusal: on the occlusal part of tooth. (The doctor asked if we took it before, and ever1 said nooooooo we didnt) B-Smooth surface carries :( buccal, lingual, and interproximal) You have to know that the crown has surfaces: The occlusal surface: (al-sat7 el- ta7en) The buccal surface: This is near (towards) the cheek (ele bkon fee jeht el 5ad) The palatal surface: towards the palate (Fe jeht saqf el 7alq) The lingual surface: towards the tongue (Fee jeht el lessan) Interproximal: between the teeth (ben el snan) Any surface other than the occlusal surface is called smooth surface. (Buccal, lingual.. the ones we mentioned above) Crown caries: A- Occlusal carries:

Occurs in the pits and fissures of the occlusal surface. We know that the occlusal surface of the tooth has pits and fissures they call it occlusal carries or they refer to it as PIT AND FISSURE CARRIES. It also includes buccal pits of molars. And lingual surface of maxillary anterior teeth. Although lingual surfaces of maxillary teeth are considered as smooth surfaces they have lingual pits sometimes. And because they have pits we consider it as occlusal surface. Occlusal caries usually appears earlier in life before smooth surface caries.

The doctor asked: why are the occlusal surfaces more susceptible to have carries??? It's because the bacteria, food particles, plaque will be accumulated in pits and fissures more than it would be on the smooth surfaces and it's also difficult for the saliva to clean these areas. B-Smooth surface caries: Occurs on the smooth surfaces on the teeth, these include: Interproximal surface caries occur at the mesial or distal contact points. (between the teeth) Cervical and gingival surface caries occurs on the buccal or lingual surfaces near CEJ. Root caries Slide #3 here is a tooth this is the crown and this is the root. Note: the doctor repeated what she just said above: If the caries are on: 1-the occlusal surface 2- The buccal here 3-the lingual 4-interproximal What do we call these caries?? Smooth surface caries. If the caries occurred on the root, we call it root caries: It is the caries that is initiated at the root portion of the tooth. The word initiated is important here, why? Because the caries started at the roots (its origin) (y3nee el caries balshat 3nd el root, aslha 3nd el root). But sometimes the caries may start at the crown and then spread to the root SO WE DONT CALL IT ROOT CARIES WE CALL IT CROWN CARIES.

This type of caries is predominantly found in teeth of older age group with significant gingival recession leading to exposed root surfaces. Usually in healthy teeth there is no recession of the gingiva (tarjo3 la el Letha) the root is covered by gingiva but due to periodontal diseases some recession happens so the gum will come down exposing the roots, thats why root caries occur.

The doctor repeats again: The pink here is the gingiva, so if the gingiva recedes (y3ne el letheh za7at) then that means that the root surface is now exposed, and also cementum and dentin will be exposed. The bacterial flora causing the root caries maybe different from the flora that initiate the enamel caries. We will talk about this when we talk about microbiology of caries. Here is another picture we have pit and fissure caries which we said is another name for occlusal caries We also see smooth surface caries which is interproximal or buccal. And on the root there is caries, below the CEJ. This line is called CEJ, cemnto-enamel junction the jxn between the enamel and cementum, cemntum covers the root and enamel covers the tooth. Like the jxn (junction) between the dentin and enamel: DEJ. 2- CLASSIFICATION BASED ON THE PRIOR CONDITION OF THE TOOTH.

Primary (initial) caries : The process attacks the tooth surface for the first time, regardless of the progression or extent. That means that the tooth doesnt have any restoration and the caries attacked it for the first time. (Y3nee ma fee 7ashwat fe el sen wo awal mara behajam el caries el tooth). Secondary (recurrent) caries:

The process attacks the tooth at the margin or margins of an existing restoration, regardless of the extension or progression. Look at the picture in slide# 4. Here we can see primary and secondary: This tooth at its interproximal surface doesnt have restoration so we call the caries primary, while here (The square in the picture) this is an old filling or restoration, if the caries attack the margins, we call it secondary caries (recurrent). Recurrent means: caries happened before then were treated with a cavity filling Cavity: the hole (el 7ofra ele btn3amal) Restoration: the hole and the filling. (El 7ofar ele btn3aml wo el madeh ele btn7at jowa) CLASSIFICATION BASED ON THE SEVERITY AND RATE OF CARIES PROGRESSION.

Dental caries may be classified according to the severity and rapidity of attack: I. Acute caries (rampant caries). II. Chronic caries. III. Active caries. IV. Arrested caries.

ACUTE CARIES (RAMPANT CARIES): Rampant: really quick and affects a lot of teeth, a lot of surfaces in the mouth. (Saree3 o bseeb asnan kteereh m3 b3ad) Here is a picture of rampant caries. Slide# 5 Some of these teeth have normal structures and some have been restored. This type of caries is characterized by: 1-Sudden, rapid, and almost uncontrollable destruction of teeth. (Bseer b wa2et 2sser wo b3mal destruction la asnan kteereh)

2-rampant caries also involves surfaces of the teeth that are relatively caries free (proximal and cervical surfaces of the anterior teeth including mandibular incisors). We said that occlusal caries develop faster than smooth surface caries, because its easier to clean the smooth surfaces than to clean the occlusal surfaces which have pits and fissures, also because caries can stick to the pits and fissures. So usually rampant caries affect surfaces of the teeth like the buccal, lingual surfaces. Usually the anterior mandibular teeth are least affected by caries, why? Because the orifices of the submanbular gland and the sublingual gland (salivary glands) are located here 3-Rampant caries is most often observed in the primary teeth of young children and permanent teeth of teenagers, 11-19 years. CHRONIC CARIES: chronic means: over a long period of time Much lower progression of the lesion. So it needs more time to develop or to cause cavitations.

The average lesion size is smaller than in acute caries. In the picture (slide #6) we can see caries, dark in colour. What type of caries is this?? Depending on location? Its occlusal carries or pit and fissure carries. If we compare this picture with the first one we see that the caries progression is slow, thats why its chronic caries! The involved tooth structure is stained a darker color. stain is darker in color much lower progression So: CHRONIC CARIES Why is the stain dark in color??

Because of the debris (if it stayed in the mouth for a long period of time) in the oral environment can stick to the cavity and give it a dark color or black (the doctor said we took it in the introduction) ACTIVE CARIES: Describe lesion that progressively destroys more tooth structure. Means that the carious process is active or growing. Look at the picture in slide # 6. This is upper lateral incisor and canine, and they have smooth surface caries. ARRESTED CARIES: occurs when the active degradative process is interrupted or ceases. Some remineralization and discoloration usually characterize it. Arrested means that the carious process has been interrupted for some reason. Sometimes when there is remineraliaztion, in the early carious region, when the tooth isnt cavitated yet, the carious process can be reversed, and demineralization can be shifted again to remineralization so the tooth can reminerlize without any cavities. This is exactly what the dr. said I couldnt write it in another way. For example: picture slide # 7 This tooth is lower 7, lower 5 and the dr. thinks that lower 6 is missing. By the way this is interproximal and stained (tooth # 7) Here we have caries on the interproximal surface and this surface is hard to clean so its easier for caries to develop. If the other tooth was extracted (#5)then it will be easier to clean the surface of tooth #7. Imagine these squares are the teeth, and the circle is interproximal caries.

So its easy for the caries to develop on the interproximal surface because the teeth are adjacent so its hard to clean between the teeth. If we removed this tooth (the square that doesnt have the circle) then the surface can be cleaned easily. So the process of caries is interrupted. And reminerlization and discoloration characterize it. Another example: when caries occur on buccal surfaces of the tooth, and the patient has poor oral hygiene and has a lot of sugars carbohydrates and the caries are in their initial process, Then he started to brush his teeth so the process of the caries stops so there is a chance for this region to remineralize. So its important to know when its arrested and when its active CLASSIFICATION BASED ON EXTENT OF THE LESION Incipient caries: the lesion is confined to enamel and does not penetrate the DEJ. The early carious lesion on visible smooth surfaces of the teeth is clinically manifested as a white, opaque region (remember we took it last time). An important feature of the early lesion is the apparently intact surface layer of demineralization. Look at the two pictures beside the text in slide # 7 A-shows us enamel, dentin and the pulp with no attack of caries. B-shows us how the caries doesnt attack the DEJ Opposite to it: Advanced caries: The lesion penetrates the DEJ and creates a lesion that usually requires restoration. The cavitation has already occurred, look at picture C: Here we see advanced caries in its early stages it has reached the DEJ. PIC B: Reaches dentin. PIC C: Reaches the pulp.

Last classification yallaaaa e5las ya tafr3 ALLAH Y3EEN EELE BFR3O HEAD AND NECK!!!! CLASSIFICATION BASED ON CHRONOLOGY (AGE) INFANCY CARIES. ( THE DOCTOR SAID THAT WERE GONA TAKE THIS IS PEDIATRICS ) ADOLESCENT CARIES. INFANCY CARIES: In children with infancy caries, there is a unique distribution of dental decay. The four maxillary anterior incisors are affected first; these teeth are anatomically positioned in the mouth that is frequently bathed by a feeding formula. example: Some moms or dads dip pacifiers in honey then put it in their babies mouth. B3d el omhat or el abhat b7to lahyeh bkoon 3aleha 3asal or sugars fe fam el tefl. But the mandibular teeth are not affected because they are always covered with saliva but the upper teeth are in contact with the bottle or the pacifier note: the dr. didnt even read the last 3 points and said:im not gonna talk about this but know this information. Infancy caries is most common seen in children with unusual dietary history such as addition of syrup, honey or other sweeteners. It has been reported that prolonged and unrestricted nighttime breast-feeding can result in increased caries rate. The stagnation of milk about the neck of the anterior teeth and fermentation of disaccharide lactose contribute to carious process.

Adolescent caries: There are two chronological periods. When acute rapidly, progressed caries is commonly observed. Acute exacerbation (eshteded) in caries rate is usually seen at the 4-8 years of age and at 11-18 years of age. The acute attack in the period of 11-18 years of age usually characterized as adolescent caries. The characteristic features of this type of caries are: 1- Lesions are in teeth and surfaces that relatively immune to caries. 2- lesions had relatively small openings in enamel with extensive undermining (this is noticed a lot in teenagers) lama yejek mareed ykon 3mro mn (11-18) and u see occlusal carries, when u open the enamel u are surprised with the destruction and undermining because it spread very fast along the DEJ.
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There is rapid penetration of enamel and extensive involvement of dentin. Again there will be openings in the enamel, extensive demineralization that will spread along the DEJ. THE END Done by: Banan Al-Natour Reviewed by: Amani Khasawneh