DENTAL CARIESDENTAL CARIESDENTAL CARIESDENTAL CARIES

RUBAB HAIDERRUBAB HAIDERRABIA IQBAL RABIA IQBAL

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.

AETIOLOGY

• Four major factors involved in etiology:-• Cariogenic bacteria• Bacterial plaque• Susceptible tooth surface• Fermentable bacterial substrate (sugar)

Bacteriology of Dental Caries

• Major organisms responsible for caries are:-

• Strep mutans• Lactobacilli• Other strains of

streptocooci

•

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 attcack tooth surfaces.

• Production of high acid concentration contributes to low ph.

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 S

mutans to decline in number or disappear from the plaque.

• Frequent feeds of small quantities are more cariogenic.

CARIES SPREAD TO ENAMEL

• 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.

CLINICALCLINICALCLINICALCLINICAL

Symptoms and Symptoms and SignsSigns

Caries initially involves only Caries initially involves only the enamel and produces no the enamel and produces no

symptoms. A cavity that symptoms. A cavity that invades the dentin causes invades the dentin causes

painpain, first when , first when hot, cold, or hot, cold, or sweet foods sweet foods or beverages or beverages

contact the involved tooth, and contact the involved tooth, and later with chewing or later with chewing or percussionpercussion. Pain can be . Pain can be

intense and persistent when intense and persistent when the pulp is severely involved the pulp is severely involved

CLINICAL• 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

SIGNIFICANSE

CLINICAL SIGNIFICANCE• Pulp involvement?• Reversible or

irreversible pulpitis?

• Spread?

Consequences of Dental Consequences of Dental CariesCaries

Consequences of Dental Consequences of Dental CariesCaries

•Possible facial cellulitis Possible facial cellulitis requiring hospitalizationrequiring hospitalization

•Impaired language Impaired language developmentdevelopment

•Reduced self-esteemReduced self-esteem•Possible systemic illness Possible systemic illness for children with special for children with special

health care needs health care needs

Consequences of Dental Caries

ORAL HEALTH CONSEQUENCES

• apical periodontitis,• periapical abscess,• cellulitis,• and osteomyelitis of the jaw

Spread from maxillary teeth

• may cause purulent sinusitis,• meningitis, • brain abscess,• orbital cellulitis,• and cavernous sinus thrombosis.

Spread from mandibular teeth may cause

• Spread from mandibular teeth may cause

• Ludwig's angina,• parapharyngeal abscess,• mediastinitis, pericarditis,

• empyema, and jugular thrombophlebitis.