Preventive Dentistry I & II

Preventive Dentistry I & II Dental caries Dr. Caroline Mohamed Dr.Caroline Mohamed

Objectives • Define: • Dental caries • The dental caries process • The role of diet in dental caries • Classification of dental caries • Epidemiology • Incidence and prevalence and how can be measured • Caries risk Dr.Caroline Mohamed

1. Dental caries definition Dental caries is a multifactorial microbial disease of the calcified tissues of the teeth, characterized by demineralization of the inorganic portion and destruction of the organic substance of the tooth, which often leads to cavitations. Dr.Caroline Mohamed

Two groups of bacteria are responsible for initiating caries: Streptococcus mutans and Lactobacillus. If left untreated, the disease can lead to pain, tooth loss, infection, and, in severe cases, death. • Today, caries remains one of the most common diseases throughout the world. • Cariology is the study of dental caries. Dr.Caroline Mohamed

The presentation of caries is highly variable; however, the risk factors and stages of development are similar. Initially, it may appear as a small chalky area that may eventually develop into a large cavitation. • Sometimes caries may be directly visible, however other methods of detection such as radiographs are used for less visible areas of teeth and to judge the extent of destruction. Dr.Caroline Mohamed

Tooth decay is caused by specific types of acid-producing bacteria that cause damage in the presence of fermentable carbohydrates such as sucrose, fructose, and glucose. • The mineral content of teeth is sensitive to increases in acidity from the production of lactic acid. Specifically, a tooth (which is primarily mineral in content) is in a constant state of back-and-forth demineralization and remineralization between the tooth and surrounding saliva. • When the pH at the surface of the tooth drops below 5.5, demineralization proceeds faster than remineralization (meaning that there is a net loss of mineral structure on the tooth's surface). This results in the ensuing decay. Dr.Caroline Mohamed

Dr.Caroline Mohamed

Host Educational level Socio-Economical Situation FLORA Fluoride in plaque Lactobacilli Oral Hygiene Streptococci Virulence factors Transmissibility HOST Age Fluoride Genetics Morphology Nutrition SUBSTRATE Carbohydrates Frequency of eating Oral clearance Physical nature of food Detergency of food SALIVA pH Flow rate Composition Buffering capacity Bicarbonate levels SALIVA Behavior Knowledge Dr.Caroline Mohamed

The role of diet in dental caries Dr.Caroline Mohamed

Substrate • Readily fermentable • Sucrose- arch criminal • Cariogenicity determined by • Frequency of ingestion • Physical form • Chemical composition-detergency • Texture of food • Presence of other constituents Dr.Caroline Mohamed

Cariogenicity determined by • Frequency of ingestion Dr.Caroline Mohamed

Frequency of ingestion D Caroline Mohamed

Tooth enamel dissolves at 5.5 ph D Caroline Mohamed

Chemical composition-detergency • Cow’s milk (cheese) contains calcium, phosphorus, and casein • Wholegrain foods require more chewing • Peanuts, hard cheeses, and chewing gum • Black tea extract ( fluoride) Dr.Caroline Mohamed

CA R I E S CARIES PROCESS Pulpal lesion RESTORATION NO CAVITY Dentin lesion Enamel lesion CAVITY White spot De-Remineralization DIAGNOSIS Colonization TIME Adhesion Dr.Caroline Mohamed

Depending on the extent of tooth destruction, various treatments can be used to restore teeth to proper form, function, and aesthetics, but there is no known method to regenerate large amounts of tooth structure, though stem cell related research suggests one possibility. • Instead, dental health organizations advocate preventive and prophylactic measures, such as regular oral hygiene and dietary modifications, to avoid dental caries. Dr.Caroline Mohamed

EpidemiologyDefinition of Epidemiology The word epidemiology comes from the Greek words: • epi , meaning on or upon • demos , meaning people, and • logos , meaning the study of • "the study of what is upon the people", Dr.Caroline Mohamed

Incidence and prevalence and how can be measured • Prevalence • Number or proportion of persons in a population affected by a condition at a given point of time • Can be expressed as, count, proportion or percentage. • Incidence • Number of new cases of condition over a given point of time. • Change in prevalence or severity. The period of time depend on time needed to disease to be observed • expressed as a rate (case per the population per time) • Determine the progress of condition Dr.Caroline Mohamed

Different Age Groups • Key risk groups from ages • Age-Three peaks 4-8yrs 11-18yrs 55-65yrs • 1 to 2 years ( baby bottle caries) • 5 to 7 years ( primary caries) • 11 to14 years • Key risk age group in young adults • and adults( secondary caries/ root caries) • Sex- both sexes early eruption in females Dr.Caroline Mohamed

Adults continue to experience primary dental caries, but they also experience a significant amount of secondary caries around existing restorations. • Children today, in developed countries, have comparatively few, if any restorations and experience mostly primary caries of the noncavitated type. • Between 40 and 76% of dental carie in adults are arrested, a condition uncommoly observed in children. Dr.Caroline Mohamed

Variation within dentition: Dr.Caroline Mohamed Early plaque formation occurs faster. In lower jaw, compared to upper jaw. In molars areas. On buccal tooth surfaces, compared to oral sites. In interdental regions compared to strict buccal or oral surface.

Mineralization- Hypomineralization/ Dentinogenese imperfecta Trace elements Fluoride/ dental fluorose Tooth composition Dr.Caroline Mohamed

Dr.Caroline Mohamed Dentinogenese imperfecta Dental Fluorose

Individual Teeth Dr.Caroline Mohamed First primary molars and first permanent molars are high risk.

Different tooth surfaces: Dr.Caroline Mohamed Are high risk: Interproximal surfaces of primary molars. Occlusal surfaces of first permanent molars.

Tooth morphology Dr.Caroline Mohamed Pits & fissures Irregularities in arch form Crowding Overlapping

Tooth morphology Dr.Caroline Mohamed

Behavior • Age Dr.Caroline Mohamed

Regularity of snaks, more than 3 times a day, snacking between meals, this increases the acid challenge to the teeth for a high level • Nocturnal bottle usage- additive • On pacifier during sleep • Breast feeding (Kawaba et al., 1997) Dr.Caroline Mohamed

Drinking sweet beverage • Brushing by mother • (Kawaba et al., 1997) Dr.Caroline Mohamed

Dental Caries classification 1.based on anatomical site 2.based on progression 3.based on virginity of lesion 4.based on extend of caries 5.based on tissue involvement 6.based on chronology 7. based on whether caries is completely removed or not. 8.based on surfaces to be restored 9. WHO system 9.Black’s classification 10.Caries riskAssessement Dr.Caroline Mohamed

Classification: 1) Based on anatomic site: Root caries Crown caries Pit & Fissure Caries Smooth surface Caries

Pits and fissures are anatomic landmarks on a tooth where the enamel folds inward. Fissures are formed during the development of grooves but the enamel in the area is not fully fused. As a result, a deep linear depression forms in the enamel's surface structure, which forms a location for dental caries to develop and flourish. Fissures are mostly located on the occlusal surfaces of posterior teeth and palatal surfaces of maxillary anterior teeth. Dr.Caroline Mohamed

Pits are small, pinpoint depressions that are most commonly found at the ends or cross-sections of grooves. In particular, buccal pits are found on the facial surfaces of molars. For all types of pits and fissures, the deep infolding of enamel makes oral hygiene along the surfaces difficult,allowing dental caries to develop more commonly in these areas. Dr.Caroline Mohamed

The occlusal surfaces of teeth represent 12.5% of all tooth surfaces but are the location of over 50% of all dental caries. Among children, pit and fissure caries represent from 80 to 90% of all dental caries. Pit and fissure caries can sometimes be difficult to detect. As the decay progresses, caries in enamel nearest the surface of the tooth spreads gradually deeper. Once the caries reaches the dentin at the dentino-enamel junction (DEJ), the decay quickly spreads laterally. Dr.Caroline Mohamed

Within the dentin, the decay follows a triangle pattern that points to the tooth's pulp. This pattern of decay is typically described as two triangles (one triangle in enamel, and another in dentin) with their bases conjoined to each other at the DEJ. This base-to-base pattern is typical of pit and fissure caries, unlike smooth-surface caries (where base and apex of the two triangles join). Dr.Caroline Mohamed

Clinical Manifestation: • Entry site may appear much smaller than actual lesion, making clinical diagnosis difficult. • In cross section, the gross appearance of pit and fissure lesion is inverted V with a narrow entrance and a progressively wider area of involvement closer to the DEJ. • a) Initially, caries of pit & fissures appears brown or • black in color & with fine explorer, it will feel soft & a • catch is felt ( don´t do it ). • The enamel which borders the pit & fissures appears • opaque bluish white. Dr.Caroline Mohamed

Shape, morphological variation and depth of pit and fissures contributes to their high susceptibility to caries. • The appearance ofs.mutans in pits and fissures is usually followed by caries 6 to 24 months later. • Sealing of pits and fissures just after tooth eruption may be the most important event in their resistance to caries. Dr.Caroline Mohamed

Smooth surface caries • Smooth surface caries occurs on the gingival third of • the buccal, lingual & proximal surfaces. • On proximal surface, caries begins below the contact area • & in early stage this appear as a faint white opacity of • enamel without loss of continuity of surface. • As caries progresses, it appears bluish white in later • stage. • Caries in cervical area are in the form of crescent • shaped cavities. It appear as a slightly roughened, • chalky area which gradually becomes deeper

Types of smooth surface caries • Proximal caries, also called interproximal caries, form on the smooth surfaces between adjacent teeth. • Root caries form on the root surfaces of teeth. • The third type of smooth-surface caries occur on any other smooth tooth surface. Less favorable site for plaque attachment, usually attaches on the smooth surface that are near the gingiva or are under proximal contact. Dr.Caroline Mohamed

Proximal caries are the most difficult type to detect. Frequently, this type of caries cannot be detected visually or manually with a dental explorer. • Proximal caries form cervically (toward the roots of a tooth) just under the contact between two teeth. As a result, radiographs (bitewings) are needed for early discovery of proximal caries. Dr.Caroline Mohamed

In very young patients the gingival papilla completely fills the interproximal space under a proximal contact and is termed as col. Also crevicular spaces in them are less favorable habitats for s.mutans. • Consequently proximal caries is less lightly to develop where this favorable soft tissue architecture exists. Dr.Caroline Mohamed

Proximal surfaces Caries • The proximal surfaces are particularly susceptible to caries due to extra shelter provided to resident plaque owing to the proximal contact area immediately occlusal to plaque. • Lesion have a broad area of origin and a conical, or pointed extension towards DEJ. • V shape with apex directed towards DEJ. • After caries penetrate the DEJ softening of dentin spread rapidly and pulpally Dr.Caroline Mohamed

Preventive Dentistry I & II