Dental caries

DENTAL CARIES

Dr.Manjula Muthuraj BDS.Dental Surgeon

Dental Caries

DENTAL CARIES Dental Caries

• Progressive bacterial damage to teeth exposed to saliva.

• one of the most major causes of all diseases and major cause of tooth loss.

• ultimate effect-to breakdown enamel and dentin and open a path for bacteria to reach pulp.

• Consequences-inflammation of pulp and periapical tissues.

Definition

• It is a disease of microbial origin in which the dietary carbohydrates are fermented by the bacteria forming an acid which causes the demineralization of the inorganic part and disintegration of the organic part of the tooth.

Causes

• Four major factors involved in etiology:-

• Cariogenic bacteria

• Bacterial plaque

• Susceptible tooth surface

• Fermentable bacterial substrate (sugar)

Multi-Factorial Disease

Cariogenic prop of strep mutans

• Produces lactic acid from sucrose• Can live at ph as low as 4.2• Forms large amounts of

extracellular,sticky,insoluble glucan plaque matrix.

• Adheres to pellicle and contributes to plaque formation.

Bacterial Plaque

• Adherent deposit on the teeth.• BIOFILM-consists of viscous phase

formed from bacteria and extracellular polysaccharide matrices.

• In stagnation areas,plaque bacteria can form acid from sugars over long periods to attack tooth surfaces.

• Production of high acid concentration contributes to low ph.

Sucrose• SUCROSE• Colonisation by cariogenic bacteria is highly

dependant on sucrose content of diet.• In absence of sucrose-S mutans cannot be made to

colonise the mouth.• Severe reduction in dietary sucrose-causes

Strep mutans to decline in number or disappear from the plaque.

• Frequent feeds of small quantities are more cariogenic.

CCaries Spread To Enamels spread to namel

• Acids formed by bacterial fermentation from dietary sugars leads to a pH fall in the plaque which dissolve tooth enamel, initiating the development of carious lesions.

• The progression of demineralization in enamel continues to the point where dissolution of hydroxyapatite exeeds remineralization.

• Bacteria cant invade enamel until demineralization provides them pathways to enter.

Caries Spread To Dentin

• Non bacterial pre-cavitation,acid softening of the matrix.

• Migration of bacteria along the tubules.

• Distortion of tubules

• Breakdown of intervening matrix forming liquefaction foci.

• Progressive disintegration of remaining matrix

Pulpal Response

• Pulpal tissue subjacent to deep caries lesions often shows the presence of chronic inflammation, including lymphocytes, macrophages and plasma cells.

• Formation of tertiary dentin is usually visible on the pulpal aspect and the increase in dentin thickness.

Symptoms and Signs

•Caries initially involves only the enamel and produces no symptoms.

Symptoms and Signs

•A cavity that invades the dentin causes pain, first when hot, cold, or sweet foods or beverages contact the involved tooth, and later with chewing or percussion.

• Pain can be intense and persistent when the pulp is severely involved

Examination

• Direct inspection

• Sometimes use of x-rays or special testing instruments

• Routine, frequent (q 6 to 12 mo) clinical evaluation identifies early caries at a time when minimal intervention prevents its progression.

• A thin probe, sometimes special dyes, and transillumination by fiberoptic lights are used, frequently supplemented by new devices that detect caries by changes in electrical conductivity or laser reflectivity.

• However, x-rays are still important for detecting caries, determining the depth of involvement, and identifying caries under existing restorations

CLINICAL SIGNIFICANCE

• Pulp involvement?

• Reversible or irreversible pulpitis?

• Spread?

Consequences of Dental Caries

•Possible facial cellulitis requiring hospitalization

•Impaired language development

•Reduced self-esteem

•Possible systemic illness for children with special health care needs

Consequences of Dental Caries

Oral health consequences

• Apical periodontitis,

• Periapical abscess,

• Cellulitis,

• Osteomyelitis of the jaw

Spread from maxillary teeth

• May cause purulent sinusitis,

• Meningitis,

• Brain abscess,

• Orbital cellulitis,

• Cavernous sinus thrombosis.

Spread from mandibular teeth may cause

• Spread from mandibular teeth may cause

• Ludwig's angina,

• Parapharyngeal abscess,

• Pericarditis,

Complications

• Pain.•  Spread of infections around the tooth.•  Distant spread of infections.•  Oral abscess and respiratory complications.•  Heart complications:

Infective endocarditic, Infection of heart valves.

•  Worsening of existing medical illnesses such as diabetes.

•  Death may result from complication of dental caries.