CARIOLOGY

1. CARIOLOGY UNCLASSIFIED//REL TO NATO/ISAF

2. OVERVIEW • Information in this unit will introduce dental caries and its relationship to Restorative Dentistry. • Preventive measures can affect the initiation of a lesion, but after a definite lesion is established preventive measures alone are usually inadequate to stop its development. AFAMS Dental Advisor Team

3. OVERVIEW • Once a cavity exists on a tooth surface, restorative procedures are necessary to control the progress of the lesion. • A thorough knowledge of dental caries can help ensure proper identification and removal of the carious lesion. AFAMS Dental Advisor Team

4. Bacterial Plaque • Colonies of bacteria always present in the mouth enter the acquired pellicle and adhere to the tooth surface. • This almost invisible mass of bacteria and matrix is known as bacterial plaque. Unless it is stained or very thick, it is difficult to detect. AFAMS Dental Advisor Team

5. Bacterial Plaque • Colonies form as the bacteria multiply and grow. Maturation occurs within 8 to 24 hours after a thorough cleaning of teeth (brushing and flossing). • Once the colonies mature, bacterial plaque becomes harmful. AFAMS Dental Advisor Team

6. Bacterial Plaque • The total metabolic activity of bacterial plaque is responsible for dental caries and periodontal disease. • Calcified plaque forms dental calculus. AFAMS Dental Advisor Team

7. Bacterial Plaque • Bacterial plaque accumulates most readily on the surfaces of the teeth that are protected from the:  • mastication of food • movement of the tongue, lips and cheeks • preventive home care procedures AFAMS Dental Advisor Team

8. Bacterial Plaque • The heaviest plaque deposits tend to occur on the buccal surfaces of the maxillary molars and the lingual surfaces of the mandibular molars AFAMS Dental Advisor Team

9. Bacterial Plaque • Factors that favor plaque accumulation include:  • crowding of teeth • rough surfaces of teeth • rough or overhanging dental restorations • Deposits of calculus • teeth out of alignment or out of occlusion • a diet consisting chiefly of soft, sticky foods • poor oral hygiene • dry mouth (xerostomia = decreased amounts of saliva) AFAMS Dental Advisor Team

10. Process of Dental Caries • Dental caries is an infectious disease (bacterial infection). • Dental caries is characterized by demineralization of the enamel, proceeding to the formation of open carious lesions commonly known as cavities. AFAMS Dental Advisor Team

11. Process of Dental Caries • As the process may take many months or years, there is time for the initiation of the disease to be arrested or its progress slowed or halted if prevention or treatment begins early enough. • Unfortunately, the diagnosis of dental caries in its earliest stages could be imprecise. AFAMS Dental Advisor Team

12. Process of Dental Caries • On many occasions, lack of diagnosis and treatment leads to penetration of the decay into the dentin and formation of a cavity. • Further advance of the lesion can produce inflammation, infection and death of the pulp. AFAMS Dental Advisor Team

13. Process of Dental Caries AFAMS Dental Advisor Team

14. Process of Dental Caries AFAMS Dental Advisor Team

15. Process of Dental Caries • To summarize, there are four essential requirements for dental caries to occur: • a susceptible tooth • bacterial plaque • fermentable carbohydrates • Time • If plaque is not present, dental decay will not occur AFAMS Dental Advisor Team

16. Methods of Dental Caries Detection Methods: • 1. Visual • 2. Tactile • 3. Radiographic AFAMS Dental Advisor Team

17. Methods of Dental Caries Detection Visual • A clean, dry, well-illuminated tooth surface can be investigated visually with the aid of a mouth mirror. • Opacity or darkness of enamel surrounding a pit or fissure or overlying an interproximal area can indicates undermined or demineralized enamel AFAMS Dental Advisor Team

18. Methods of Dental Caries Detection Visual… • Color: • white or brown spots on smooth surface enamel • brown or black areas on exposed dentin • Shadows: • enamel may not appear its usual colour when its translucency reveals changes in the colour and structure of underlying dentin AFAMS Dental Advisor Team

19. Methods of Dental Caries Detection AFAMS Dental Advisor Team

20. Methods of Dental Caries Detection Tactile • Softening of tooth structure at the base of a pit or fissure can be detected using an explorer • The use of the dental explorer is particularly useful for probing caries in proximal areas when lesions are advanced AFAMS Dental Advisor Team

21. Methods of Dental Caries Detection • A lesion may be determined by pressing the point of an explorer into the gingival embrasure against the surface of the tooth just gingival to the contact area. If a defect is present, a slight catch or roughness can be felt. AFAMS Dental Advisor Team

22. Methods of Dental Caries Detection • Gingival areas of all teeth may be chalky in consistency and rough to touch with the point of a sharp explorer. Softened enamel can be flaked away with an explorer. AFAMS Dental Advisor Team

23. Methods of Dental Caries Detection • More advanced caries will exhibit a pull or resistance to removal, with moderate pressure, by an explorer. It is important, however, never to use a lot of pressure when probing with an explorer as this in itself can harm the enamel surface. AFAMS Dental Advisor Team

24. Methods of Dental Caries Detection Radiographic • Use of radiographs can confirm the presence of a carious lesion and give an indication of the extent of its progress AFAMS Dental Advisor Team

25. Methods of Dental Caries Detection Radiographic: • Interproximal decay at the gingival border of contact areas and dentinal caries below occlusal enamel are indicated by radiolucent (darker) areas on bitewing radiographs. AFAMS Dental Advisor Team

26. Methods of Dental Caries Detection Radiographic: • Any radiographic findings should prompt more careful clinical examination (visual and tactile) to verify the presence and extent of dental caries. AFAMS Dental Advisor Team

27. Common Sites of Dental Caries •  Sites: • pit and fissure caries • smooth enamel surface caries • exposed root surface caries • Around existing restorations AFAMS Dental Advisor Team

28. Common Sites of Dental Caries Pits and fissures • They are the most susceptible sites. • They have a small site of origin, sometimes visible on the tooth surface. AFAMS Dental Advisor Team

29. Common Sites of Dental Caries • Pits and fissures: • In a cross-section through the enamel, the appearance of an enamel lesion is V-shaped with the widest area of involvement at the DEJ. • After caries extends to the DEJ there is both lateral spread along the DEJ and extension pulpally. • A cross-section of caries in dentin is always V-shaped with its base at the DEJ. AFAMS Dental Advisor Team

30. Common Sites of Dental Caries Pit and fissure caries progress AFAMS Dental Advisor Team

31. Common Sites of Dental Caries • Smooth enamel surfaces • The gingival border of the contact area on the proximal surfaces of teeth is most susceptible to caries because of the extra shelter this area provides for bacterial plaque. AFAMS Dental Advisor Team

32. Common Sites of Dental Caries • Smooth enamel surfaces AFAMS Dental Advisor Team

33. Common Sites of Dental Caries • Smooth enamel surfaces progress AFAMS Dental Advisor Team

34. Common Sites of Dental Caries • Exposed root surfaces • Recession of the gingiva exposes the root surface to the oral environment and the accumulation of bacterial plaque. c – exposed root surface caries p - pulp c AFAMS Dental Advisor Team

35. Common Sites of Dental Caries • Exposed root surfaces • Root caries originates on cementum which is mineralized to a lesser extent than dentin. AFAMS Dental Advisor Team

36. Common Sites of Dental Caries Around existing restorations: • A carious lesion that develops at this interface is called RECURRENT CARIES • Recurrent lesions may indicate an unusual susceptibility to caries attack, a poor cavity preparation, a defective restoration, or a combination of these factors. AFAMS Dental Advisor Team

37. Common Sites of Dental Caries • Around existing restorations: AFAMS Dental Advisor Team

38. Types of Dental CariesBased on Morphology, Depth and Severity of the Lesion • Smooth Surface Enamel Caries : • The earliest evidence of caries on the smooth enamel surface of a tooth crown is a white spot. • It is caused by the demineralization of the enamel in the presence of bacterial plaque. AFAMS Dental Advisor Team

39. Common Sites of Dental Caries Smooth Surface Enamel Caries: • White spot: AFAMS Dental Advisor Team

40. Common Sites of Dental Caries Smooth Surface Enamel Caries: • Incipient caries of enamel can remineralize; remineralization cannot repair a cavity (hole). AFAMS Dental Advisor Team

41. Common Sites of Dental Caries Smooth Surface Enamel Caries: • White spot lesions are undetectable on the proximal surfaces by visual, tactile (explorer), or radiographic examination • When the first radiographic evidence of a proximal lesion is seen in the enamel, the lesion is much further advanced and the underlying dentin has already been affected. AFAMS Dental Advisor Team

42. Common Sites of Dental Caries Smooth Surface Enamel Caries: • Sometimes a remineralized lesion appears as a brown spot. • Trapped organic debris and metallic ions are presumably the cause of the discoloration. AFAMS Dental Advisor Team

43. Common Sites of Dental Caries Smooth Surface Enamel Caries: • These discoloured, remineralized areas are more resistant to caries attack than unaffected enamel and should not be restored unless cosmetically unacceptable. AFAMS Dental Advisor Team

44. Common Sites of Dental Caries Pit and Fissure Enamel Caries:Occur on the bottom and sides of deep clefts so early white or brown spot lesions are not always easy to detect. AFAMS Dental Advisor Team

45. Common Sites of Dental Caries Pit and Fissure Enamel Caries: • Large lesions may be clinically visible due to a colour change to greyish opalescence resembling mother-of-pearl along the length of the fissure. AFAMS Dental Advisor Team

46. Common Sites of Dental Caries Dentinal Caries • spreads rapidly along the DEJ. • It is extremely important in restorative dentistry that the significance of this pattern of spread along the dentoenamel junction is understood. AFAMS Dental Advisor Team

47. Common Sites of Dental Caries • Dentinal Caries • There is a danger that this lateral extension of decay may be overlooked after a cavity preparation is cut and enamel rods may not be supported by healthy dentin. • Unsupported enamel will fracture and affect the longevity of a restoration. • All enamel must be supported by sound dentin. AFAMS Dental Advisor Team

48. Common Sites of Dental Caries • Dentinal Caries – spreads rapidly along the DEJ. AFAMS Dental Advisor Team

49. Common Sites of Dental Caries Dentinal Caries progression AFAMS Dental Advisor Team

50. Common Sites of Dental Caries • Dentinal Caries – • The pulp and dentin should be considered as a single unit. • When dentin is cut, the cellular processes of the pulp are also cut. The response of the dentin to insult is based on the cellular activity of the pulp. AFAMS Dental Advisor Team