DENTAL CARIES AND ITS

CONSEQUENCES
• DEFINATION
• CLASSIFICATION
• THEORIES
• EITIOLOGY
• DIAGNOSIS
• TREATMENT
• PREVENTION
• CONSEQUENCIES OF CARIES
CLASSIFICATION OF DENTAL CARIES
[1] According to location on individual teeth
- Pit and fissure caries
- Smooth surface caries
- Root caries
[2] According to the rapidity of the process
- Acute dental caries
- Chronic dental caries
[3] According to origin
- Primary caries (virgin)
- Secondary caries (recurrent)
 DEFINITION
Dental caries is an irreversible microbial
disease of the calcified tissue of the teeth,
characterized by demineralization of
inorganic portion and destruction of organic
substance of the tooth.
Pit and fissure caries Smooth surface caries
Acute Rampant caries Radiation caries
4. G.V. BLACK CLASSIFICATION

CLASS I – cavities on the occlusal surface of premolars and

molars, on the occlusal two-third of the facial and lingual
surface of molars, on lingual surface of maxillary incisors.
CLASS II – cavities on the proximal surface of posterior teeth
CLASS III - cavities on the proximal surface of anterior teeth that
do not include the incisal angle
CLASS IV – cavities on the proximal surface of anterior teeth
that include the incisal angle
CLASS V – cavities on the gingival third of the facial or lingual
surface of all teeth
CLASS VI - cavities on the incisal edge of anterior teeth or
occlusal cusp height of posterior teeth
THEORIES OF CARIES FORMATION

 Chemical (acid) theory

 Parasitic (septic) theory
 Miller’s chemicoparasitic theory – Acidogenic theory
 Proteolysis theory
 Proteolysis chelation theory
 Sucrose – chelation theory
 Miller’s chemicoparasitic theory –
Acidogenic theory
Acidogenic theory or the chemicoparasitic theory explained by
D Miller about the etiology of dental caries is the most widely
accepted and most useful.
Chemicoparasitic theory= chemical theory + parasitic theory
Dental decay is a chemicoparasitic process consisting of two
stages
• Decalcification of enamel and dentin (preliminary stage)
• Dissolution of the softened residue (subsequent stage)
BACTERIA + SUGARS + TEETH = ORGANIC ACID + CARIES
 Evidence of acidogenic theory
Within 1-3 minutes of rinsing with glucose or sucrose solution,
the PH fall from 6.5 below 4.5 to 5.0. In about 10-30 min, the
PH returned to normal. If there is an intake of glucose or
sucrose during this period ( before returns to normal Ph)
there is further decrease in PH, requiring more time to return
to normal. A graphic representation of this is called
stephen’s curve.
Critical PH for enamel 5.2-5.5 for dentin 6.2.
 PROTEOLYSIS CHELATION THEORY
Proteolysis chelation theory says that the initial lesions of
caries is believed to be the result from an enzymatic attack
on some organic constituents of enamel which need not be
previously demeneralized for this to occur.
Products resulting from the breakdown of the organic matter
are capable of complexing calcium as a result of which more
or less simultaneous demineralization accompanies
destruction of the organic component.
 ETIOLOGIC FACTORS IN DENTAL CARIES

• Dental caries is a multifactorial disease

in which there is an interplay of 3
principle factors.
I. The host ( teeth, saliva etc.)
II. Micro flora
III. Substrate (diet)
• In addition the fourth factor, time must
be considered.
 I. HOST FACTORS
Tooth
• Composition
• Morphologic characteristics
• Position
Composition of tooth
Enamel:-
- Inorganic : 96%
- Organic + water : 4%
Dentin:-
- Organic matter +water :35%
- Inorganic :65%
Cementum:-
- Inorganic : 45-50%
- Organic +water : 50- 55%
Morphological characteristics of the tooth
• Feature predisposed to the development of
dental caries is presence of deep narrow occlusal
fissure/ buccal and lingual pits

Tooth position
• Which are malaligned, out of position, rotated or
otherwise not normally situated, may be difficult
to clean and tend to favor the accumulation of
food and debris which subsequently lead to
dental caries
Saliva
• Composition
• PH
• Quantity
• Viscosity
• Antibacterial factors
PH of saliva
• Determined by bicarbonate concentration
• PH increases with flow rate, normal PH 7.8
• Sialin is an arginine peptide described PH rise
factor, present in saliva
Quantity of saliva
• Normal quantity 700-800 ml per day
• In case of salivary gland aplasia and xerostomia
in which salivary flow may entirely lacking,
resulting in rampant dental caries
Viscosity of saliva
• Thick, mucinous saliva increases the dental
caries
Other host factors
Age
• Dental caries decreases as age increases
• Root caries are common in elders
• Gingival recession  cemental exposure
(improper brushing)
Socioeconomic status
• High  low chance
• Low  more chance
 II. MICROFLORA
• Strep. mutans  early carious lesions of enamel
• Lactobacilli  dentinal caries
• Actinomyces  root caries
 III. DIET
• Increase in carbohydrate increase carious activity
• Risk of caries is greater if the sugar is consumed in a form
that will be retained on the surface of the teeth
• Risk of sugar increasing caries activity if it is consumed
between meals
• Increasing caries activity varies widely between individuals
• Upon withdrawal of the sugar rich foods the increased caries
activity rapidly disappears
• High concentration sugar in solution and its prolonged
retention on the tooth surface leads to increased caries
activity
• Clearance time of the sugar correlates closely with caries
activity
Progression of caries
 DIAGNOSIS
CONVENTIONAL ADVANCED METHODS
• Visual and tactile 1. Dental digital radiography
examination 2. Subtraction radiography
3. Tuned aperture computer
 Mouth mirror and probe tomography
 Tooth separation 4. Fiber optic trans-illumination
5. Digital fiber optic trans-
illumination
• Radiographic method
6. Quantitative light induced
fluorescence
 IOPA
7. Laser fluorescence
 Bite wing
 OPG 8. Electric conductance measurement
9. Electric conductance impedance
measurement
• Xeroradiography 10. Ultrasonic imaging
• Dyes 11. Endoscope
 CONVENTIONAL METHODS

• If in the opinion of the

examiner after visual
inspection a doubt exists, the
surface should be
investigated with a blunt
probe and unless the point
enters the lesion, the surface
will be regarded as sound.
The blunt probe should have a
tip of 0.5mm.
• Dental caries appears as radiolucency in
radiograph.
• Tooth should be 30-40% demineralized to be
detected under radiographs.
• Various dyes like procion
dye, calcein dye,
flouroscent dye, brilliant
blue, basic fuschin, acid
red, carbolan green etc
are used.
 TREATMENT OF DENTAL CARIES
• The treatment goal in caries management
should be:
• To prevent new lesions from forming
• To detect lesions sufficiently early in process
that they can be treated and arrested by non
operative means.

• If these attempts have failed, restorations

will be required to restore the integrity of
the tooth surface
If the examination reveals
arrested caries
NO treatment is required
NO treatment is required
NO treatment is required
Indication for restorative treatment

1. The tooth is sensitive to hot, cold or sweet……

2. Occlusal and proximal lesions extend into dentin
3. The pulp is endangered
4. Previous attempts to arrest the lesion have failed and the
lesion is progressing
5. The patient’s Ability to provide effective home care is
impaired
6. Drifting might occur due to loss of proximal contact
7. Esthetic reasons
If restoration is required then which restorative
material to use??

1.Amalgam

2. Composite resin

3. Glass ionomer cement

 AMALGAM
• Used in posterior teeth where its strength,
abrasion resistance, and ability to retain a
good polish make it a popular material
 COMPOSITE RESIN
Tooth-colored esthetic restorative material used for anterior teeth where appearance
is most important . Also, some are designed to be used in posterior teeth where
strength and abrasion resistance are of prime importance.
 GLASS IONOMER CEMENT
• It is commonly not used when esthetic is a
major concern i.e.in anterior teeth. It is
recommended for patients with high caries
rates because they release fluoride.
 ROOT CANAL TREATMENT
• Root canal treatment is necessary when the pulp becomes
inflamed or infected.
The inflammation or infection can have a variety of causes ;
deep decay, repeated dental procedures on the tooth, faulty
crowns, or a crack or chip in the tooth.
Root canal treatment treats inside of the tooth. During root
canal treatment, the inflamed or infected pulp is removed
and the inside of the tooth is carefully cleaned and
disinfected then filled and sealed with a rubber like material
called gutta percha. The tooth is restored with a crown or
filling for protection, the tooth continues to function like
other tooth.
11
 METHODS TO CONTROL CARIES
1. Chemical measures
2. Nutritional measures
3. Mechanical measures
Chemical measures
Mouth rinsing
• Use of mouth wash for the benefit of its action in loosening
food debris from teeth has been suggested to be of value as
caries control measures.
Dental floss
• Dental flossing is effective in removing plaque and dislodge
the irritating matter that is real source of disease.
• Used in type I gingival embrasures
It is available in:
- Multifilament – twisted / non twisted
- Bounded / unbounded
- Thick / thin
- Waxed / non waxed
Oral irrigators
- Use of flushing devices
- Irrigation devices composed of a built in pump and a
reservoir
- It can also be used to deliver antimicrobial agents
 MECHANICAL MEASURES
• This refers to procedures specifically
designed for and aimed at removal of
plaque from tooth surface
Methods for cleaning tooth mechanically are:
1. Prophylaxis by dentist
2. Tooth brushing
3. Mouth rinsing
4. Use of dental floss or tooth picks
5. Incorporation of detergents foods in diet
6. Pit and fissure sealants
Dental prophylaxis
• Careful polishing of roughened smooth
surface and correction of faulty
restoration decreases the formation of
bacterial plaque and there by reducing
the development of new carious lesion

Tooth brushing
Types of tooth brushing
- Manual
- Powered
- Sonic and ultrasonic
- Ionic
 NUTRITIONAL MEASURES
The chief nutritional
measures advocated for
the control of dental caries
is restriction of refined
carbohydrate intake.

Other measures include

- Avoiding sugar that retains
of teeth surface
- Avoiding sugar in between
meals
- Eating of phosphated diets
 CONSEQUENCES OF CARIES
• Pulpitis: Inflammation of pulp tissue due to
any noxious stimuli.
• Reversible pulpitis: when caries just reaches
DEJ. Tooth is sensitive to hot, cold and sweet
food. Pulpal inflammation subsides if noxious
stimuli is removed in time.
• Irreversible pulpitis: when caries reaches pulp
tissue and infects it directly. Spontaneous pain
more at night, does not subside on its own.
 CONSEQUENCES OF CARIES
• Periapical abscess: this happens when the pulp
tissue gets necrosed due to infection from caries.
This type of abscess shows up at the tip of the root.
• Most abscesses are painful and so people seek
treatment right away.
• The build up of pressure causes severe pain in
periapical abscess.
• Drainage of abscess via sinus tract or fistula
through bone and mucosa/skin relieves pressures
and pain.
 CONSEQUENCES OF CARIES
• Odontogenic space infection:
– Spread of infection from periapical abscess to
various fascial spaces of face and neck occurs
when abscess reaches bony cortex.
– Fascial space involved is determined by involved
tooth and root location.
– Severest form of space infection due to lower
molars is known as Ludwig’s Angina where
bilateral submandibular, submental and sublingual
space is involved leading to airway compromise.
 CONSEQUENCES OF CARIES
• Osteomyelitis of jaw:
– Inflammation of bone and its marrow content.
– More common in mandible then maxilla due to
single end artery blood supply.
– Acute or chronic in nature
 CONSEQUENCES OF CARIES
• Tooth loss and edentulism
– Improper chewing of food leads to poor digestion
and absorption.
– Vitamin deficiency
– Premature aged appearance
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