TYPES OF DENTAL CARIES

PRESENTED BY MADHUKAR YADAV MANISH PANDEY MRATYUNJAY ZAFAR UNDER GUIDANCE OF Dr. Anuraag Agarawal Dr. Anjali Singh

Definition
DENTAL CARIES IS DEFINED AS A PROGRESSIVE IRREVERSIBAL MICROBIAL DISEASE AFFECTING THE HARD PART OF THE TOOTH EXPOSED TO THE ORAL ENVIRONMENT RESULTING IN DIMINERALIZATION AT THE INORGANIC CONSTITUENT & DISSOLUTION AT THE ORGANIC CONSTITUENTS. Cariology is the study of dental caries.

 Food acid plaque tartar Two groups of bacteria are responsible for

initiating caries :-

Streptococcus mutans Lactobacilli.

Stages of caries
[1] Early stages : acides dissolve

the enamel in the crown of the tooth

[2] Moderate tooth decay : here

the dentine is attacked by acids and bacteria invade the cavity.

[3] Advanced tooth decay :

inflammation of the pulp.

[4] Necrosis (death) of the pulp

tissue.
[5] Periapical abcess forms at the

apex of the root

Theory of dental caries

3 theories of dental caries:-

The acidogenic theory The proteolytic theory Proteolysis chelation theory

The acidogenic theory

W.D Miller was the first well known scientist and investigator of dental caries and published his

results in 1882. According to him dental decay is a chemoparasitic process It is a two stage process there is decalcification of the enamel which also results in the destruction of the dentin. In the second stage there is dissolution of the softened residue of the enamel and dentin.

 In the first stage there is destruction is done by the acid attack where as the dissolution of the

residue is carried by the proteolytic action of the bacteria's

This whole process is supported by the presence of carbohydrates microorganisms and dental plaque .

The proteolytic theory

The evidence given by the acidogenic theory was

considerable but it was not conclusive, and alternative explanation was given in the form of proteolytic theory.
Workers like Heider, Bodecker (1878)and Abbott (1879)

contributed considerably to this theory There has been evidence that the organic portion of the tooth plays an important role in the development of dental caries There are some enamel structure which are made of the organic material such enamel lamelle and enamel rods These structure prove to be the path ways for the advancing microorganisms.

 It has been established that enamel contains 0.56 % of

organic matter of which 0.18% is keratin and 0.17 % is a soluble protein

Microorganisms invade the enamel lamelle and the acid produced by the bacteria's causes damage to the organic pathways in advance

The production of the yellowish pigment produced by the proteolytic bacterias the presence of this pigment was only possible in the presence of dietary carbohydrates.

Proteolysis chelation theory

Some of the minor flaws of the acidogenic and the

proteolytic theory were addressed in the proteolysis chelation theory. This theory was put forward by Schatz and his coworkers .

CHELATION It is a process in which there is complexing of the metal ions to form complex substance through coordinate covalent bond which results in:
poorly dissociated weakly ionized compound

Classification
Location
Etiology

Rates of progression
Affected hard tissues

Location
There are two types of caries when separated

by location: caries found on smooth surfaces caries found in pits and fissures.

 Pits are small, pinpoint depressions that are

most commonly found at the ends or crosssections of grooves.

For all types of pits and fissures, the deep

infolding of enamel makes oral hygiene along these surfaces difficult, allowing dental caries to develop more commonly in these areas.

Smooth-surface caries
There are three types of smooth-surface

caries.
Proximal caries, also called interproximal caries,

form on the smooth surfaces between adjacent teeth. Root caries form on the root surfaces of teeth. Caries that occur on any other smooth tooth surface.

Proximal caries
Proximal caries form cervically, toward the roots of a tooth just under the contact between two

teeth.
Under Black's classification system: proximal caries on posterior teeth (premolars and

molars) are designated as Class II caries. Proximal caries on anterior teeth (incisors and canines) are indicated as Class III if the incisal edge (chewing surface) is not included and Class IV if the incisal edge is included.

Root caries
usually occur when the root surfaces have

been exposed due to gingival recession. Mandibular molars are the most common location .

Baby bottle caries

Baby bottle caries, "early childhood caries", or

"baby bottle tooth decay" is a pattern of decay found in young children with their deciduous teeth. but all teeth can be affected.

most likely affected are the maxillary anterior teeth, The name for this type of caries comes from the fact

that the decay usually is a result of allowing children to fall asleep with sweetened liquids in their bottles or feeding children sweetened liquids multiple times during the day.

 Rampant caries, which signifies advanced or severe decay on multiple surfaces of many teeth. It may be seen in individuals with xerostomia, poor oral hygiene, stimulant use due to druginduced dry mouth or large sugar intake. If rampant caries is a result of previous radiation to the head and neck, it may be described as

radiation-induced caries

Problems can also be caused by the self destruction of roots and whole tooth resorption when new teeth erupt or later from unknown causes.

Rate of progression
Temporal descriptions can be applied to caries to indicate the progression rate and previous

history. Acute caries signifies a quickly developing condition Chronic caries describes a condition which has taken an extended time to develop where thousands of meals and snacks, many causing some acid demineralisation that is not remineralised and eventually results in cavities. Arrested caries lesions that no longer grow. It can be caused by the altered condition.

RECURRENT CARIES
Recurrent caries, also described as secondary, are caries that

appears at a location with a previous history of caries. This is frequently found on the margins of fillings and other dental restorations. On the other hand, incipient caries describes decay at a location that has not experienced previous decay. Arrested caries describes a lesion on a tooth which was previously demineralized but was remineralized before causing a cavitation.

Affected hard tissue

Depending on which hard tissues are affected, it is possible

to describe caries as involving enamel, dentin, or cementum. Early in its development, caries may affect only enamel. Once the extent of decay reaches the deeper layer of dentin, dentinal caries is used. Since cementum is the hard tissue that covers the roots of teeth, it is not often affected by decay unless the roots of teeth are exposed to the mouth. Although the term "cementum caries" may be used to describe the decay on roots of teeth, very rarely does caries affect the cementum alone. Roots have a very thin layer of cementum over a large layer of dentin, and thus most caries affecting cementum also affects dentin.

Other sensitive areas

Facial caries Lingual caries Cervice caries Occlusal caries Incisal caries Mesial caries Distal caries

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