Dental caries is an irreversible microbial disease that causes demineralization and destruction of tooth structure. It is characterized by the interaction of bacteria, fermentable carbohydrates like sugar, and time. Three main factors must be present for caries to develop: susceptible tooth surfaces, diet high in sugars, and cariogenic bacteria. While it was once considered a disease of modern civilization, evidence from prehistoric skulls shows the earliest occurrences of caries coincided with the development of agriculture and consumption of starchy crops. Modern theories emphasize the role of dental plaque in localizing acid production and preventing remineralization by saliva.
2. Is an Irreversible 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 lead to cavitation.
3. Dental Caries –Disease of modern Civilization
Studies revealed that
Doliocephalic Skulls(Long Skull) from
Preneolithic Periods did not exhibit Caries
Neolithic period – Initiation of Farming
Brachycephalic skulls of Neolithic-Caries Present-
Just below Contact area
13. Many Theories
3 theories which have stood the test of time
1.Acidogenic theory of Miller (Miller’s Chemico-
Parasitic Theory),
2.The Proteolytic theory and
3. The Proteolysis Chelation Theory
14. 1.The Legend Of Worms-
earliest reference to tooth Decay
Ancient Sumerian Text Known as “Legend of
Worms”
Homer-Pain in tooth due to worm
15. The ancient Greek theory of the four body hu
mors (blood, yellow bile, black bile, and phle
gm) that determined health and disease.
Caries is due to acid production and
disturbance in body humors.
Also caries is similar to bone gangrene which
initiates within itself.
17. Erdl -1843
Filamentous organisms present in surface
membrane of tooth
Dresden-German Physician-Dental Caries-
”Denticolae”- Generic term for decay related
microorganism.
18. Blend of above theories
Willoughby D Miller (1882)
Theory: Caries caused by acids produced by
microorganisms of the mouth
Dental decay is a chemico-parasitic process
consisting of 2 stages:
1.Decalcification (preliminary step)
2.Dissolution (subsequent step)
Acids are produced by bacteria’s
fermentation of sugar and starch
19. Backbone of current knowledge and
understanding for etiology of dental caries
3 factors essential for caries production:
Oral microorganism
Carbohydrate substrate
Acid
20. Unable to explain:
Site predilection
Dental plaque
Caries-free population
Role of plaque:1897 by Mr Williams
localizes acid produced by bacteria
prevents anti- caries effect of saliva
20
21. Gottlieb,1947
Enamel lamellae
Organic matrix would be attacked before
mineral phase of enamel
The proteolytic enzymes liberated by
oral bacteria destroy the organic matrix
of enamel, loosening apatite crystals, so
that they are eventually lost and the
tissue collapses.
22. 2 types of carious lesions:
1. Microorganism enamel lamellae attack
enamel and dentin (before clinical evidence of
caries)
2. No lamellae, bacteria in dental plaque acids
enamel decalcification.
The early lesion chalky white
23. Schatz and Martin (1955)
Initial attack breakdown of organic matter
Breakdown products chelate with minerals of enamel
dissolves it
Chelates (Metal-substance Complex with Covalent
bonds)can be formed at neutral or alkaline pH, the
theory suggests that demineralization of enamel could
arise without acid formation.
28. Micro flora: Acidogenic bacteria that colonize
the tooth surface.
Host: Quantity and quality of saliva, the quality
of the tooth, etc.
Diet: Intake of fermentable carbohydrates,
especially sucrose, but also starch.
Time: Total exposure time to inorganic acids
produced by the bacteria of the dental plaque
29. Position Of teeth
Surface enamel more resistant than subsurface enamel
Surface – More fluoride, zinc, iron and lead,
Less dissolution to acids
More inorganic material and less water
Subsurface – More carbonate, magnesium, sodium
Decreased enamel density
and increase permeability
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30. Deep occlusal fissures
Buccal or lingual pits
Mand 1 molar > max 1st molar> max & mand 2nd molars
Mand incisors & canines - least
Surface susceptibilty
molars → Occlusal
lateral incisor → Lingual
30
32. 1. Fluoride in saliva
Formation of fluoroapatite in surface enamel
protection against caries.
Inhibits Enolase Enzyme –Inhibiting Glucose transfers in
Micro organisams
predetermined by the amount ingested.
Composition of saliva
33. 2.Organiccomponents
a)Ammonia
High ammonia concentration retards plaque
formation, neutralizes acid
reduction of caries
Urea converted to Ammonium carbonate which
increases the neutralizing power of saliva
Composition of saliva
34. b)Histatins (Histidine rich proteins)
Antibacterial action
Released from Salivary glands present at the
back of tongue(Ebner’s Gland)
Composition of saliva
35. 1. LACTOFERRIN
• Iron binding protein
• Prevents iron utilization by aerobic and facultative anaerobic bacteria
prevents metabolism
2. Lysozyme
Hydrolytic enzyme with direct antimicrobial effect
Salivary gland fluid and crevicular fluid
Acts in many ways
36. 1. Lysozyme - Positively charged enzyme
Binds to salivary ions like HCO3
-, F-, I-, NO3
-
Complex binds to the cell wall of bacteria
Hydrolysis of glycosidic bonds between polysaccharides
in the cell wall
Destabilization of cell wall
Autolysis
Antibacterial properties of saliva
Lysozyme
37. 3. Salivary peroxidase system
Salivary Glands secrete salivary Periodase &
Thiocyanate(SCN-)
Reacts With H2O2 produced by certain Bacterias
Oxidation of Thiocynate(OSCN-)
Inhibits Metabolisam of Bacteria
38. IgA is predominant immunoglobin in saliva.
• Inhibits adherence and prevents colonization on
mucosal surfaces and teeth.
39. Primitive Man-Roughage/Raw Food
Soil along with food
Flattened Occlusal and Proximal Surface –Less
caries
Modern Diet
Soft Sticky Carbohydrate-More carious
Less Roughage
40. Total exposure time to inorganic acids
produced by the bacteria of the dental
plaque