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Dental Caries
TERMINOLOGY
CARIES LESION
It is the clinical manifestation of caries disease. A patient diagnosed with caries disease can have few or many caries lesions (a clinical manifestation), and the number and extent of these lesions are measures of disease severity. Based on clinical parameters, each caries lesion may be classified as noncavitated or cavitated.
NON CAVITATED
- Refers to initial caries lesion development, before cavitation occurs.
- Noncavitated lesions are characterized by a change in color, glossiness or surface structure as a result of demineralization before there is macroscopic breakdown in surface tooth structure.
- These lesions represent areas with net mineral loss due to an imbalance between demineralization and remineralization.
- Reestablishing a balance between demineralization and remineralization may stop the caries disease process while leaving a visible clinical sign of past disease.
CAVITATED
- Denotes a loss of surface integrity.
- In some cases, cavitation can be restricted to the enamel (for example, microcavitation).
- Note that these lesions should be differentiated from linear enamel hypoplasia and molar incisor hypomineralization, which are often associated with higher risk of caries disease.
DETECTION OF CARIES
The ADA CCS( American Dental Association Caries Classification System) scores each surface of the dentition based on the following: tooth surface,
- Presence or absence of a caries lesion,
- Anatomic site of origin,
- Severity of the change,
- Estimation of lesion activity.
Clinical application of the ADA CCS relies upon examinations conducted on a clean tooth with compressed air, adequate lighting, and the use of a rounded explorer or ball-end probe. Indicated radiographs also should be available.
Detection criteria for tooth surface sites of origin are as follows:
- pit and fissure;
- cervical and smooth surface;
- root.
CLASSIFICATION OF DENTAL CARIES
G.V. BLACK’S CLASSIFICATION OF DENTAL CARIES
Caries lesions were classified according to G.V. Black’s Classification of Dental Caries, which was first introduced in 1908 and is still used today. Black’s original classification consisted of five categories, with a sixth added later.
CLASSIFICATION BY THE RATE OF ATTACK:
- Acute caries
- Chronic caries
- Arrested caries
| Acute caries | Chronic caries: | Arrested caries |
|---|---|---|
|
|
Enamel, dentine or root caries that become static and slower |
CLASSIFICATION ACCORDING TO SEVERITY
- Incipient: Lesion that extends less than halfway through the enamel
- Moderate: Lesion that extends more than halfway through enamel but does not involve the dentino-enamel junction (DEJ)
- Advanced: Lesion that extends to or through the DEJ but does not extend more than half the distance to the pulp
- Severe: Lesion that extends through enamel, through dentin, and more than half the distance to the pulp
CLASSIFICATION BY THE SITE OF ATTACK
- Pits and fissure caries
- Smooth surface caries
- Root caries (cemental caries)
- Recurrent caries
CLASSIFICATION BASED ON NUMBER OF TOOTH SURFACE INVOLVED
- Simple
- Compound
- Complex
EARLY CHILDHOOD CARIES
- Rampant caries (nursing bottle caries)
- Present on the labial surfaces of the primary teeth of infants
- Caused by a habit of leaving the feeding bottle containing milk or juice in the infants mouth when sleeping
THEORIES OF DENTAL CARIES
There are different theories about the progress of dental caries,most important theories are
- Acidogenic theory (miller’s theory)
- Proteolytic theory
- Proteolytic chelation theory
Acidogenic theory Proposed by W.D Miller in 1882
- Miller proved after certain experiments that certain bacteria present in mouth, produce acids from carbohydrates which causes demineralization of the dental tissues
- Consumption of more refined carbohydrates was associated with more caries
- According to him dental decay is a chemoparasitic process
- It is a two stage process there is decalcification of the enamel which also results in the destruction of the dentin. in the second stage there is dissolution of the softened residue of the enamel and dentin.
- In the first stage there is destruction is done by the acid attack where as the dissolution of the residue is carried by the proteolytic action of the bacteria.
- This whole process is supported by the presence of carbohydrates microorganisms and dental plaque
PROTEOLYTIC THEORY
- The evidence given by the acidogenic theory was considerable but it was not conclusive, and alternative explanation was given in the form of proteolytic theory.
- Workers like Heider, Bodecker (1878)and Abbott(1879) contributed considerably to this theory.
- There has been evidence that the organic portion of the tooth plays an important role in the development of dental caries
- It has been established that enamel contains 0.56 of organic matter of which 0.18 is keratin and 0.17 is a soluble protein
- The are some enamel structure which are made of the organic material such enamel lamelle and enamel rods
- These structure prove to be the path ways for the advancing microorganisms.
- Microorganisms invade the enamel lamelle and the acid produced by the bacteria's causes damage to the organic pathways in advance.
- The production of the yellowish pigment produced by the proteolytic bacterias the presence of this pigment was only possible in the presence of dietary carbohydrates
PROTEOLYSIS CHELATION THEORY
- Some of the minor flaws of the acidogenic and the proteolytic theory were addressed in the proteolysis chelation theory.
- This theory was put forward by Schatz and his co-workers .
- It is a process in which there is complexing of the metal ions to form complex substance through coordinate covalent bond which results in poorly dissociated /or weakly ionized compound
- The bacterias attack on the surface of the enamel this is initiated by keratinolytic microorganisms this result in the breakdown of the protein chiefly keratin and results in the formation of soluble chelates which decalcify enamel even at neutral PH
- Mucopolysaccarides may also act as secondary chelators.
