DENTAL CARIES

SUBMITTED TO SUBMITTED BY :
:
Bhavya Gupta
Rudrakshini Jodha
III BDS
Batch- (2015-20)
CONTENTS
• DEFINITION
• CLASSIFICATION
• THEORIES
• CONTRIBUTORY FACTORS
• ENAMEL CARIES
• DENTINAL CARIES
• CEMENTAL CARIES
• TREATMENT
DEFINITION
The microbial disease of the calcified tissues
of teeth, characterized by demineralization
of the inorganic portion and destruction of
organic substance of tooth. (according to
Shafer)
 CLASSIFICATION
1. According to morphology of teeth.
2. According to rapidity.
3. According to number of tooth surface involved.
4. According to new or recurrent caries.
5. According to extent of caries.
6. According to pathway.
7. According to cavity preparation and restoration
ACCORDING TO MORPHOLOGY OF TEETH

A. PIT AND FISSURE CARIES – Caries occurring

on anatomical pits and fissures of all teeth. This
is also referred to as TYPE I caries.

B. SMOOTH SURFACE CARIES – Caries

occurring on smooth surfaces of all teeth. It is
also referred to as TYPE II caries.
C. ROOT CARIES - Caries occurring at the
cemento-enamel junction or cementum. It
occurs predominately in the older age
when there is gingival recession.

C. LINEAR ENAMEL CARIES - Caries

occurring on the labial surface of anterior
teeth. Also known as‘odontoclasia’.
 ACCORDING TO RAPIDITY
A. ACUTE DENTAL CARIES-It is a rapid
process involving a large number of
teeth. Their carious consistency makes
the excavation difficult. Pulp exposure
and sensitive teeth are often observed.

B. CHRONIC DENTAL CARIES-Lesions

usually of long standing involvement,
affect a fewer number of teeth.
Pain is not a common feature because of
protection afforded to pulp by secondary
dentin. The decalcified dentin is dark brown
and leathery.

C. ARRESTED CARIES- It is a tooth decay

in which the area of decay has stopped
progressing and infection is not present,
but in which demineralized area in the tooth
remains as a cavity.
ACCORDING TO NUMBER OF TOOTH SURFACE INVOLVED
A. SIMPLE CARIES
Caries involving only one surface of tooth

B. COMPOUND CARIES
Caries involving two surfaces of tooth

C. COMPLEX CARIES
Caries involving three or more surfaces of tooth
ACCORDING TO NEW OR RECURRENT CARIES
A. PRIMARY or INITIAL CARIES-Initial
attack on tooth surface by microbes.
Lesions on unrestored tooth are known
as primary caries.

B. RECURRENT CARIES- Lesions

developing adjecent to restoration is
known as recurrent caries. It can be
due to inadequate extension of
restoration or adaption which may lead
to retention of food.
RESIDUAL CARIES- Caries that remains in completed
tooth preparation whether by operator intentionally or
by accident. It is not acceptable if at the DEJ or on the
prepared enamel tooth wall. It may be acceptable when
it is present in affected dentin, specially near
the pulp.
ACCORDING TO EXTENT OF CARIES

A. INCIPENT CARIES (reversible)- It

appears as a white opaque region on
any tooth surface. Only surface
demineralization of enamel occurs. A
white or incipient lesion can undergo
remineralization.
B. CAVITATED CARIES (irreversible)-
Lesion where enamel surface is broken
and lesion reaches dentin.
Remineralization is not possible.
Treatment by tooth preparation and
restoration is indicated.
ACCORDING TO PATHWAY
A. FORWARD CARIES- Whenever the caries cone
in enamel is lager or atleast same size of dentin.
B. BACKWARD CARIES- When the spread of caries
is along the DEJ exceeds the caries in contiguous
enamel, caries extent into enamel from the
junction.
ACCORDING TO CAVITY PREPARATION AND RESTORATION
CLASS I- Pit and fissure caries
Occlusal surfaces of molars and premolars
Occlusal 2/3rd of buccal and lingual surface of
molars
Lingual surfaces of anterior teeth

CLASS II- Restorations on the occlusal surface including

proximal surfaces of posterior teeth.
CLASS III- Restorations on the proximal
surfaces of anterior teeth wihout involving
incisal angle.

CLASS IV- Restorations on the proximal

surfaces of anterior teeth which involve
the incisal angle.
CLASS V - Restorations present on the
gingival third of facial and lingual
surfaces of all teeth.

CLASS VI – Restorations on the incisal

edges of anterior teeth and cuspal tips of
posterior teeth.
 THEORIES

1. WORM THEORY - it states that

caries are caused by worms into
teeth.

2. HUMORAL THEORY- it states that

caries are produced by internal action of
acids and corroding humors. The four
recognized humors of body were blood,
phlegm, black bile and yellow bile. The
imbalance in these humors result in the
diseases process.
 3. VITAL THEORY- It stated that the decay originated
from within the tooth itself.

4. CHEMICAL THEORY- It signified that teeth were

destroyed by acids formed in oral cavity. The nature and
formation of acids were unknown. But later it was found
that acids were formed by fermentation of food particles.
Another postulate given was that the putrefaction of
protein gave rise to ammonia, which was subsequently
oxidized to nitric acid. And another was food was
decomposed to sulphuric acid.
5. ACIDOGENIC THEORY-
W D Miller, an American, in beginning of 1890 gave the
following hypothesis in which he stated:
“Dental decay is a chemico-parasitic process
consisting of two stages, the decalcification of
enamel, which results in its total destruction and the
decalcification of dentin as a preliminary stage,
followed by dissolution of the softened residue.

The acid which affects this primary decalcification, is

derived from the fermentation of starches and sugar
lodged in the retaining centres of the teeth.
Subsequently, he isolated numerous microorganisms
from the oral cavity, many of which were acidogenic and
some were proteolytic.

Miller’s theory was unable to explain the predilection of

specific sites on a tooth to dental caries and the initiation
of caries on smooth surfaces.
Also miller’s theory doesn’t explain why some
populations are caries-free and the phenomenon of
arrested caries.
6. PROTEOLYTIC THEORY-
Heider, Bodecker(1878) and Abbott(1879) thrown
considerable light to this theory.
Acc. To this theory, organic portion of the tooth plays an
important role in development of dental caries.It has
been recognized that enamel contains 4% of organic
matter. Enamel structure which is made up of structure
such as enamel lamellae and enamel rods are the
pathways for the advancing
microorganisms.Microorganisms invade the enamel
lamellae and the acid produced by the bacteria Causes
damage to these pathways.
This theory was not accepted as enamel is highly
mineralized tissue. Though enamel contain 1.0-1.5%
organic matrix out of which 0.6% is protein. Initiation of
caries with breakdown of small percentage of protein is
highly questionable. And significant loss of enamel tissue
through proteolytic activity has not been proved
experimentally.
7. PROTEOLYSIS-CHELATION THEORY-
The theory states that the bacterial attack on the
enamel, initiated by keratinolytic microorganisms,
results in breakdown of protein and other organic
components of enamel, chiefly keratin. This
results in the formation of substances which may
form soluble chelates with mineralized
component of tooth and thereby decalcify enamel
at a neutral or even alkaline pH. This theory
states initial attack of dental caries is on organic
and inorganic portion of enamel simultaneously.
CONTRIBUTORY FACTORS IN DENTAL CARIES
THE HOST FACTOR

A. TOOTH-
Tooth morphology plays an important factor for
initiation of caries. Deep pits and fissures are
more prone to caries because of food
impaction and bacterial stagnation. Mandibular
first molar are most susceptible. Irregularities
in arch form, crowding and overlapping of teeth
also favor the development of caries. Presence
of inorganic constituents such as dicalcium
phosphate dihydrate, and fluoroapatite etc.
makes the enamel resistant to some extent.
B. SALIVA –

Continuous flow of saliva effects the oral environment from all

spheres. Caries prone individuals have low calcium and
phosphorous levels and greater ammonia content. A variety of
enzymes have been isolated from saliva, the most prominent
and important ones are amylase and ptyalin.
The pH at which any particular saliva ceases to be saturated with
calcium and phosphorus is referred to as the ‘critical pH’which is
5.5 in normal condition. Below this value, the inorganic material
of tooth may dissolve. Normal ph of resting saliva is 6-7.
MICROFLORA
Factors that prove the role of bacteria in caries :
• Caries will not occur in complete absence of
microorganisms.
• Caries can occur in animals even if kept on single
type of bacterial growth.
• All oral organisms are not cariogenic, but
histologically majority can be isolated from carious
enamel and dentin.
1. OCCLUSAL CARIES – The main etiological
microorganism in occlusal and pit and fissure caries
is Streptococcus mutans.

2. DEEP DENTINAL CARIES – As the environment is

different in deep dentinal lesions it is certain that
flora of deep caries would be different. The most
common are Lactobacilli which account for one third
of the oral flora.

3. CEMENTAL CARIES – Mandibular molars are more

susceptible to these. The organisms involved are
Actinomyces viscosus, Streptococcus mutans.
SUSBRATE OR DIET
1. PHYSICAL NATURE OF DIET – It affects caries indirectly.
Modern diet includes foods, soft drinks and eatables which lead
to collection of debris predisposing to more caries. It is
observed that mastication of food reduces no. of
microorganisms. Mechanical rubbing and cleaning plays role in
caries reduction.
2. CHEMICAL NATURE OF DIET – The main ingredient is
carbohydrate which is most important factor in dental caries
process. For caries production following factors are responsible
:
Type of carbohydrate
Frequency of intake
Time of stagnition
• Sugar given in solution form, is much less capable in
producing caries than the same amount of sugar
incorporated in food.
• Vitamin B deficiency may exert a caries protective
influence on teeth since it is essential in growth of
oral acidogenic flora. Vitamin D is necessary for
normal development of teeth, as malformation
especially hypoplasia and increase caries incidence
has reported in vitamin D deficiency cases.
• Calcium plays role in infancy as it can lead to poor
calcification of teeth, whereby carious progression
becomes easier.
ENAMEL CARIES
The earliest macroscopic evidence of
caries may be seen on a tooth as a
small opaque white region positioned
on either one or both of the proximal
surfaces. Many times these incipient
lesions get mineralized and appear as
brown pigmented areas. Histologically,
if the lesion has invaded two third of
the enamel only then it is visible
radiographically.
Microscopically caries of
enamel has revealed four
distant zones :

• A translucent zone which is

the advancing front of the
lesion
• A dark zone separating the
translucent zone from the
body of the lesion
• The body of the carious
lesion, which is markedly
radiolucent
• Intact enamel surface layer
DENTINAL CARIES
When the carious lesion has
penetrated the enamel it spreads
laterally along the dentino-enamel
junction, undermining the enamel.
The lesion then invades dentin along
the dentinal tubules. The pattern of
invasion is depicted as cone shaped
lesion with base at DEJ and apex
towards pulp.
The pathological changes have been
divided into various zones
CEMENTAL CARIES
It is usually seen where there is gingival recession and
the oral hygiene is poor. Clinically lesion appear as
saucer shaped cavities. A radio-opaque surface layer
covering sub-surface demineralised cementum is a
common finding.
TREATMENT
• Tooth preparation and restoration, root canal
treatment(if pulp is involved), artificial
crown(when the remaining part may not be able
to provide enough support to the filling material
to repair)
“ PREVENTION IS BETTER THAN CURE”