Dental Caries

Dental Caries is an
irreversible microbial
disease of the calcified
tissues of the teeth,
characterized by
demineralisation of
inorganic portion and
destruction of organic
substance of the tooth,

Role of acid

.. dental caries is caused by

acid produced by microorganisms
from the fermentation of dietary
carbohydrates
W. D. Miller, 1889 _Millers
Chemicoparasitic Theory

Chemical Theory

Parasitic
Theory

most accepted & backbone of current knowledge

and understanding of etiology of Dental caries

Role of acid

ACID CAUSE DISSOLUTION OF THE

HYDROXYAPATITE CRYSTALS OF THE
ENAMEL FOLLOWED BY DENTINE
(Demineralisation)

Major degradation product of carbohydrates;

Lactic acid
Butyric acid
Resulting from anaerobic catabolism

Role of Dental Plaque

Miller ruled out role
of Plaque in Carious
process and regarded it
as a protective layer
over the enamel
G. V. Black, 1889,
associated Dental
Plaque with caries and
described it as a
separate identity
Bibby described the
nature of plaque, its
role in caries and
adherence on tooth
surface

Initiation of Plaque
is with formation of
acquired pellicle
from salivary
glycoproteins which
later harbors
organisms such as S.
sanguis, A. viscous,
A. naeslundii,
Veillonellae aka
pioneering organisms
S. mutans appears in
due course

 Harbors the cariogenic

tooth surface
Acid
production
interface
through
carbohydrates

bacteria

on

on
plaque-tooth
fermentation
of

Localisation of acid thus produced

Prevents the diffusion of acid
Restrict
saliva

the

buffering

action

of

Proteolytic theory
It was given by Gottlieb (1994)
and
Gottlieb,
Diamond
and
Applebaum (1946).
Organic or protein elements of a
tooth are the initial pathway of
invasion by microorganisms
Enamel lamellae are pathways for
organisms in the progress of
dental caries.

Caries, a Proteolytic process

Proteolytic enzymes liberated by
cariogenic bacteria
destruction of the organic matrix
detachment of inorganic crystals from
one another
collapse of whole structure
CAVITATION.
_Proteolytic theory

CARIES = acidogenic + proteolytic,

Possible mechanisms;

microorganisms invade enamel lamellae,

attack enamel and involve dentine before
clinical evidence of caries.

Alteration in enamel prior to invasion by

micro organisms through decalcification

Proteolytic Chelation theory

Proteolytic breakdown of organic portion
of enamel
Proteolytic breakdown products +
acquired pellicle + food debris =
chelating agent
CHELATION -vely charged chelating
agent releases +vely charged Calcium
ions from enamel/dentine
Dissolution of inorganic component of
tooth
_______ Schatz et al, 1955

Factors that influence Dental Caries

(Workshop on Dental Caries mechanisms & Control Techniques,
University of Michigan, 1947)

Host factors

Components

A. Tooth

1. Composition
2. Morphologic
characteristics
3. Position

B. Saliva

1. Composition
a. Inorganic
b. Organic
2. pH
3. Quantity
4. Viscosity
5. Antibacterial

C. Diet

D. Systemic conditions

factors

1. Physical factors
a. Quality of Diet
2. Local factors
b. Carbohydrate content
c. Vitamin content
d. Fluorine content

SUGAR

TEETH + MICROORGANISMS

ORGANIC ACID

Caries

Role of Carbohydrates

Carbohydrate
caries
content in diet incidence
suggested by;
HopeWood House Study,

Sullivan and Harris-

1958, Harris-1963

Vipeholm Study, Gustaffson et al, 1954

Patient with Hereditary Fructose
Intolerance have less chance of
developing caries, Newbrun- 1969

Role of Carbohydrates

Fermentable Carbohydrates
CARIOGENIC

acid

BACTERIA

Role of microorganisms
S. mutans : development of early
carious lesions in enamel
Lactobacilli : associated with
dentinal caries
Actinomyces : associated with root
surface caries
Vellionella: possibly anti-cariogenic

s
u
c
c
o
c
o
t
p

e
Catalase -ve, gram +ve,
r
s
t
n
S
a
t
anaerobic cocci
u
m
Grow as convex colonies in

facultative
mitis

salivarius bacitracin agar

Cariogenicity due to:

Aciduric, can survive at pH as low as 4.2

Present in large number in saliva
Can adhere to acquired pellicle thus facilitating
plaque formation
Can adhere and grow even in hard and smooth tooth
surfaces
Homofermentive; lactic acid being the major
product

Role of S. mutans:
a) Lactic acid production
b) Formation of adhesive plaques
c) Production of fermentable sugars

Sucrose

glucose + fructose

invertase

Glucosyl
transferase

Fructosyl
transferase

enzymes
produced by
S. mutans

glucans

fructans
Promote
accumulation
of plaque

reservoir
for
fermentable
sugars for
oral
bacteria

References
Shafer, Hine, Levy; Shafers
Textbook of Oral Pathology; 6 th
Ed.; Elsevier; 2009
Shobha Tandon; Textbook of
Pedodontics; 2nd Ed.; Paras
Medical Publisher