Dental Caries

DENTAL CARIES
Dr. SHIKHA ADHIKARI

INTRODUCTION
• Dental caries and periodontal diseases are probably
the most common chronic dental diseases in the
world.
DEFINITION (DENTAL CARIES)
Dental caries is a irreversible, multifactorial microbial

infectious disease characterized by demineralization of
the inorganic and destruction of the organic substance
of the tooth.
ETIOLOGY OF CARIES
• No universally accepted opinion of etiology of dental caries.
• 3 theories have evolved:
(1) Acidogenic theory (Miller's chemico- parasitic theory)

(2) Proteolytic theory
(3) Proteolysis-chelation theory
1) Acidogenic theory (Miller's chemico-parasitic theory):
Dental caries or dental decay is a chemico-parasitic process consisting

two stages:
• The decalcification of enamel and destruction

• Decalcification of dentine with dissolution of softened residue.
Factors that causes decay:
(1) Role of carbohydrates
(2) Role of microorganisms
(3) Role of acids
(4) Role of dental plaque
ROLE OF CARBOHYDRATES
• Caries is caused by acid resulting from action of microorganisms on
carbohydrates
The cariogenicity of dietary carbohydrate varies with:
1. Frequency of intake: increase caries

2. Chemical composition, for example, monosaccharides and
disaccharides are more carious than polysaccharides
3. Physical form like solid, sticky food increase caries
4. Increase in time of contact of carbohydrate with the tooth increases
caries
5. Presence of other food components like presence of high fat or
proteins makes carbohydrate less cariogenic.
ROLE OF MICRO-ORGANISM
• Initiation of caries Streptococcus mutans, S. milleri, S. mitior,

S.sanguis, S. salivaris
• Progression of caries:Lactobacillus.acidiphlius, lactobacilus. casei
• Root caries: Actinomycosis viscosus, A. Israeli, A. odontolyticus
ROLE OF ACIDS
• play most important role in pathogenesis of dental caries
• pH 5.5 is called critical pH of enamel
• Below this pH demineralization of tooth substance begins
• The enzymatic breakdown of carbohydrates (sugar), results in the
formation of acids, chiefly lactic acid.
• Localization of acids in dental plaque serves a major role in dental
caries.
• Carbohydrates+Enzymes--Acids (lactic acid)
ROLE OF DENTAL PLAUE
• Dental plaque also known as microbial plaque is important for

beginning of caries because it provides the environment for bacteria
to form acid, which causes demineralization of hard tissue of teeth.
Proteolytic Theory
It has been found that enamel has 0.56% of organic matter .

Microorganisms produce proteolytic enzymes, which destroy the
organic matrix of enamel, loosening the hydroxyapatite crystals and
eventually the outer surface of teeth collapse.
Proteolysis Chelation Theory
• suggests that caries is caused by simultaneous events of
proteolysis + chelation
• Proteolysis
destruction of organic portion of tooth by proteolytic microorganisms
• Chelation :removal of calcium by forming soluble chelates
• oral bacteria attack organic component of enamel (proteolysis)
• breakdown products have chelating ability and this dissolves tooth
minerals.
Predisposing factors:
• Poor oral hygiene
• Dental plaque
• Smoking and areca nut chewing
• Tobacco chewing
• Iatrogenic
Clinical features
• Initial caries will appear as white spot, which is present even after the
tooth surface is dried.
• Discoloration may range from light yellow to dark brown and black
• As it progresses cavitation(pit) occurs
• Sensitivity to cold, heat, sweet, sour food and air.
• White using explorer or probe, there is a definite catch due to
softened dentin.
Management
• Early detection through regular checkups, radiographs and restoration
with appropriate restorative materials.
Prevention
• Plaque control (proper teeth
brushing, flossing and
cleansing)
• Brush twice daily using
proper brushing technique.
• Rinse mouth after eating
food especially sugar
containing foods.
• If severe caries on multiple teeth diet modification is done.( restrict
sugar intake, especially foods that are sticky and increase
consumption of fibrous foods)
• Use fluoride containing mouth washes.
• Routine dental checkup every 6 months.
• Use of fluoride containing toothpaste.
• Topical fluoride application.
Complications
• Pulpitis
• Periodontitis
• Osteomyelitis
• Tooth fracture
• Tooth loss
• Plaque deposition on caries causes
gingival and periodontal disease
• Hopeless teeth that leads to eventual
extraction of teeth
• Destruction of jaw bone

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DENTAL CARIES

Dr. SHIKHA ADHIKARI

DEFINITION (DENTAL CARIES)

Dental caries is a irreversible, multifactorial microbial

• 3 theories have evolved:

(1) Acidogenic theory (Miller's chemico- parasitic theory)

Dental caries or dental decay is a chemico-parasitic process consisting

• The decalcification of enamel and destruction

1. Frequency of intake: increase caries

• Initiation of caries Streptococcus mutans, S. milleri, S. mitior,

• Dental plaque also known as microbial plaque is important for

It has been found that enamel has 0.56% of organic matter .

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