Schulich Dentistry

D5170 Oral Diseases

Schulich Dentistry
D5170 Oral Diseases

Overview
Thursday 4th February 2016

Today
1. DDS course so far: Oral Diseases &
Cariology in context of DDS from
here
2. Aims of the Oral Diseases and
Cariology course
3. Definition of caries and overview

Today
1. DDS course so far: Oral Diseases & Cariology in
context of DDS from here

2. Aims of the Oral Diseases and Cariology course

3. Definition of caries and overview

1. Oral Diseases in context: DDS

Basic
Science
(core)

Clinical
skills
training

Clinical
Practice

DDS: Basic science

Anatomy
Physiology
Biochemistry
Pharmacology
Microbiology
Pathology
Materials science
General medicine
General surgery

No intent to make
you an expert in
any one of these
A dentist needs all
of these

DDS: Clinical skills training

Operative dentistry
Periodontology
Complete
prosthodontics
Partial (removable)
prosthodontics
Fixed prosthodontics
Endodontics
Oral surgery
Paediatric dentistry
Implantology

No intent to make
you an expert in
any one of these
A dentist needs all
of these

DDS: Clinical practise

Operative dentistry
Periodontology
Complete
prosthodontics
Partial (removable)
prosthodontics
Fixed prosthodontics
Endodontics
Oral surgery
Paediatric dentistry
Implantology

Oral medicine
Gerodontology
Special needs
Medically
compromised

DDS: Where does Oral Diseases fit?

what we know

Basic
Science
(core)

Clinical
skills
training

what we do
D5170

Clinical
Practice

Today
1. DDS course so far & Cariology in context of
DDS from here
2. Aims of the Oral Diseases and Cariology course
3. Definition of caries and overview

Oral Diseases

Cariology
Periodontology
Oral Pathology
Regressive
changes
Developmental
anomalies

Common
conditions
that dentists
see and treat
daily

Cariology: an applied science

Epidemiology
Microbiology
Biochemistry
Physical Chemistry
Histology
Pathology
Physiology
Radiology

Rationale for
clinical
interventions
and
treatments

Cariology: Epidemiology

Size of the problem

Who gets caries
What causes caries
What prevents caries
How effective are treatments

Cariology: Microbiol & caries

Which bacteria cause caries
Nature of the biofilm/ structure of
plaque
Chronology of plaque formation
Plaque formation in the mouth
Modification of plaque

Cariology: enamel de-remineralization 1

Aims: Review the concepts of solubility and saturation as they apply to
biominerals. Describe the thermodynamic factors governing crystal
nucleation. Describe the role of the organic matrix in enamel
mineralization. Learning outcomes :
By the end of this session the student should be able to:
i.
Define solubility product, activity product and related concepts.
ii.
Describe the effects of fluoride on the solubility of
hydroxyapatite.

Cariology: enamel de-remineralization 2

Aims: Describe the role of plaque bacteria in enamel demineralization. Explain how
the balance between enamel demineralization and remineralization is disrupted in
caries. Discuss current and experimental anti-caries therapies.
Learning outcomes :
By the end of this session the student should be able to:
Describe the diurnal cycle of plaque pH (Stephan curve).
Explain the concept of critical pH.
Describe how protein catabolism affects the pH of plaque.
Describe the role of the end-products of bacterial metabolism in enamel
demineralization and caries
Describe the mechanisms of action of agents used to prevent or treat caries

Cariology: Histopathology

List the changes in enamel observed with the onset of

caries the classic sub-surface demineralization
zones and relative porosities
Describe in detail dentinal (and pulpal) reactions to the
carious process.
Describe the features and process of dentinal caries
following enamel cavitation and bacterial invasion
Recognize the different appearance of lesions arising
from smooth surfaces, root surfaces and occlusal
surfaces and how anatomical differences account for
the different presentation of lesions at these sites.

Cariology: Saliva & Caries

Be able to describe in detail the components and function of related to protection

against dental caries.secretory mechanisms
Understand the role of saliva in maintaining the health of the oral environment.
List the inorganic components of saliva: Saturation with respect to calcium and
phosphate
Know the buffering systems that exist in saliva: phosphate; bicarbonate; proteins
Be able to describe the interactions between saliva, tooth surfaces and its
consequence in the biofilm formation.the plaque biofilm (in particular diffusion of
various compounds discussed above through the biofilm)
Be aware of how saliva may be evaluated clinically in terms of quality and
quantity
Cite the evidence linking salivary flow and caries
List the causes of reduced salivary flow
Have knowledge of the principles of management for those with reduced salivary
flow.

Cariology: Caries diagnosis & risk

assessment

Be able to explain in detail the clinical appearance, favoured

sites and presentation of caries
Be able to describe in detail the clinical appearance of the
white spot lesion
Know how to undertake a systematic clinical examination for
caries
Understand the role of special investigations such as
radiographs in caries diagnosis
Be aware of other, newer methods for detecting caries
Be able to list intra-oral features that constitute a greater caries
risk
Know the general/ demographic factors that contribute to
caries risk

Cariology: Fluoride interventions

Describe the discovery of fluoride and cite the observational and

interventive studies that give evidence for its efficacy
Know the physiology of fluoride: absorption; distribution and
elimination from the human body
Know fluoride toxicology and relate this to products used in
dentistry
Describe the action of fluoride during tooth development,
advantages and side effects
Describe the topical actions of fluoride
Know various strategies for fluoride application at a community
level and the controversy surrounding this issue.
List the various agents for application of fluoride for the individual
patient.

Cariology: Radiology

Understand the rationale for radiography in caries detection and monitoring

Know the issues surrounding risks/ benefits of radiography for caries
Be able to list the views which are commonly used for caries diagnosis:
their advantages and disadvantages.
Describe in detail how the radiographic image of a lesion is formed
Describe the radiographic appearance of lesions at various sites and
stages
List other radiographic phenomena that may mimic caries
Understand the value of bitewings in terms of diagnostic yield/
improvement over simple visual examination and how this varies with tooth
surface affected
Appreciate how well radiographs correlate to actual disease status of tooth
surfaces
Explain the correct timing of prescribing radiographs based on the patients
caries risk, age and other factors

Cariology: Management

Understand the caries management tree

List the risk factors associated with caries: general; medical; oral and
dental
Know the sites favoured for plaque retention and therefore at risk for
caries
Be able to describe the clinical appearance of caries and how this
correlates to presence and extent of disease
Know how to undertake a systematic clinical examination for caries
Appreciate the value of diagnostic aids
Understand the dynamic nature of caries
List the non-operative methods of managing caries
Appreciate the importance of caries control by the patient
Appreciate the role of operative dentistry is to repair irreversibly
damaged teeth

Today
1. DDS course so far & Cariology in context of
DDS from here
2. Aims of the cariology course
3. Definition of caries and overview

Caries definition - general

decay and crumbling of a tooth
or bone
-(arch. from Latin)
The Concise Oxford Dictionary, (Clarendon Press,
Oxford, 1995).
Nowadays caries is synonymous with tooth decay

Caries definition
CARIES IS A MICROBIAL DISEASE
AFFECTING THE CALCIFIED TISSUES OF
TEETH, CAUSING LOCALISED
DISSOLUTION OF INORGANIC STRUCTURE
AND SUBSEQUENT DISINTEGRATION OF
ORGANIC MATRIX.

Caries definition
CARIES IS A MICROBIAL DISEASE
AFFECTING THE CALCIFIED TISSUES OF
TEETH, CAUSING LOCALISED
DISSOLUTION OF INORGANIC
STRUCTURE AND SUBSEQUENT
DISINTEGRATION OF ORGANIC MATRIX.

Caries definition
CARIES IS A MICROBIAL DISEASE
AFFECTING THE CALCIFIED TISSUES OF
TEETH, CAUSING LOCALISED
DISSOLUTION OF INORGANIC
STRUCTURE AND SUBSEQUENT
DISINTEGRATION OF ORGANIC MATRIX.

Caries definition
CARIES IS A MICROBIAL DISEASE
AFFECTING THE CALCIFIED TISSUES OF
TEETH, CAUSING LOCALISED
DISSOLUTION OF INORGANIC
STRUCTURE AND SUBSEQUENT
DISINTEGRATION OF ORGANIC MATRIX.

Caries definition
CARIES IS A MICROBIAL DISEASE
AFFECTING THE CALCIFIED TISSUES OF
TEETH, CAUSING LOCALISED
DISSOLUTION OF INORGANIC
STRUCTURE AND SUBSEQUENT
DISINTEGRATION OF ORGANIC MATRIX.

Further Definition of caries:

a dynamic process taking place in the
microbial deposits (dental plaque on the
tooth surfaces) which results in a
disturbance of the equilibrium between the
tooth substance and the surrounding plaque
fluid so that, over time, the net result is a
loss of mineral from the tooth surface.

Thylstrup & Fejerskov 1994

What factors combine to

produce caries?

SALIVA

Fluoride

Kidd, Edwina A. M.
Essentials of dental caries : the disease and its management
3rd ed. Oxford ; New York : Oxford University Press, 2005.

Substrate = (sugar)

Pathogenisis of Dental Caries

Pathogenisis of Dental Caries

SALIVA

PLAQUE
PLAQUE

ENAMEL
TOOTH

Polysaccharides

NET LOSS OF MINERAL

FROM
TOOTH TISSUE

Calcium
Salts
Plaque
buffers

SUGARS
Calcium
Salts

Bacterial
Enzymes
Salivary
buffers

ACID

Caries History

Known since antiquity

Treatments developed before aetiology known
Precise mechanism known for well over 100 years
Modified in recent years

Pierre Fauchard
The father of
modern dentistry
Wrote The
Surgeon Dentist
in 1728

1728

Surgical techniques and even

instruments developed before
the nature of the disease was
known

What about bacterial plaque?

Antonie van
Leeuwenhoek 1683
"a little white matter,
which is as thick as if
'twere batter."
Animalcules were in
such enormous
numbers, that all the
water seemed to be
alive

J.L. Williams

G.V. Black

W.D. Miller
Chemoparasitic theory
Aetiology of dental caries
(1880s)

Louis Pasteur

Robert Koch

Clinical presentation of caries occlusal

caries

Clinical presentation of caries

Caries represents a spectrum of disease
Treatment depends upon lesion
Lesion depends on:
Tooth affected
Site affected
Extent of disease

Caries Progression

Tooth surface demineralized

Enamel becomes porous
Porosity visible as white spot lesion
Enamel becomes mechanically weaker
Enamel breakdown carious cavity
Cavity allows accumulation of more
plaque and dentin caries progresses

Required
reading

Further
reading