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Dental caries Presented by:

Dr. Shady A. M. NegmBachelor's Degree School of Dentistry,

Pharos University.

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Outline

• Definitions “caries “

• Distribution over time of dental caries

• Variation of caries within the mouth

• Susceptability of dental caries

• Determinant and Risk factor

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Definition of dental caries:

•   An infective destructive process causing decalcification of the tooth enamel and leading to continued destruction of enamel and dentin, and cavitation of the tooth dental caries.

Or

• The formation of cavities in the teeth by the action of bacteria; tooth decay.

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• Bacteria : St. mutans (initiation) Lactobacilli ( Progression )

• Actinomycetes (root caries)

• Diet : frementable CHO

• PH : below 5.5 ( acidic medium )

N.B

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Variation of caries within the mouth

• The distribution pattern of dental caries follows the accumulation of plaque (Bacteria+Acids+Food debris)

• The most common sites are:• Pits and fissures• proximal areas• cervical areas• root caries oocurs in old age (>60) due to:

gingival recession ,plaque accumulation on the root , xerostomia .

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Types of dental caries:

• Rampant caries • Recurrent caries• Arrested caries• Root or cemental

caries ( senile )• Baby bottle caries

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Susceptibility of dental caries

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Susceptibility of dental caries

THE LOWER MOLARS are THE MOST SUSCEPTIBLE TO CARIES DUE TO:

• Its morphology( pits & fissures )favors for caries, is overcomed by pit & fissure sealents.

• Forces of mastication.• Effect of gravity • The lower 6 is the first to erupt, so it stays for a longer

time.. The lower anterior teeth are the least susceptible to

caries due to:• The effect of the tongue( washing &cleaning) • Opening of the duct of submandibular gland (saliva)• They are mostly covered by the upper anterior teeth

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Triad of dental caries (risk factors)

+ T

ime

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I. Host factors. (man)

II. Agent factors.

III. Environmental factors.

Dental caries results from 3 groups of factors:

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1- Age:It was found that the

greatest caries incidence in permanent teeth occurs between 17 to 26 years of age.

Pit and fissure caries is the predominant type occurring at this period.

I. Host factors:

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• A pronounced decrease in caries incidence was shown at the period between 26-35 years of age since the more susceptible tooth surfaces have already been affected by caries

• Another increase in caries incidence occurs at about 45-55 years which is the proximal type

• Over 60 years of age, root caries occurs because root surfaces, become denuded by gingival recession.

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2- Sex: Although the

female might be expected to show a higher caries rate due to earlier tooth eruption, a sex difference was not clearly demonstrated.

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3- Race:• In USA, studies have

shown marked difference in caries experience between white and black.

• Black have more caries than white people. The difference in caries experience indicates that white people receive different standards of care than black.

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4- Familial and genetic pattern of caries:

It is difficult to distinguish between true inheritance through the chromosomes and the dietary and other habits in the family.

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5- Emotional disturbance: Emotional disturbance, particularly

anxiety states, influence the incidence of dental caries.

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6- Variation of caries within the mouth:

A) According to the tooth surfaces attacked:

a. pit and fissure caries,

b. Proximal caries,

c. Cervical caries,

d. Root caries.

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B) Frequency with which teeth are attacked:

Lower incisors are the least teeth

exposed to caries.

C) Bilateral symmetry

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1-Bacterial factors: Certain strains of

streptococci can

induce plaque and cavitations.

II. Agent factors:

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2- Role of carbohydrates:

Freely fermentable carbohydrates have an essential role in caries process. Also the rate of clearance from the mouth affects the rate by which bacteria may act upon carbohydrates to produce acids.

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Carbohydrates with rapid oral clearance seem to be less risky in the development of dental caries than those which remain in the mouth for a longer time thus sticky carbohydrates have higher risk for caries.

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1. Geographic variation:A) Temperature:• Temperature acts to vary the caloric

requirements as well as the water intake of human beings.

• Inhabitants of colder climates eat more processed carbohydrates as carbohydrates are quick cheap source of warmth and energy.

III. Environmental factors:

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• This is associated with decrease in water intake and therefore, caries incidence increases. And the reverse occurs in areas with high temperature.

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B) Sunshine:

As the sunshine increases, the amount of ultraviolet rays increases which supply vit. D. Also, there will be increased demand for water consumption, which help wash away food debris from the mouth.

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C) Rain fall: As the rain fall increases leaching of the minerals from soil especially fluorides will lead to reduction of fluoride concentration in crops. Rain fall is accompanied by heavy clouds which block sunlight.

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D) Humidity:

As humidity rises, the DMF rises too. This is because of the decreased demand of water intake in areas with high humidity levels.

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2- Fluoride:

Fluoride in the drinking water during the time of tooth formation and mineralization results in formation of fluoroapatite crystal, which are more caries- resistant.

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3- Total water hardness:

Measured in terms of calcium carbonate. An inverse relation was reported between DMF and the total water hardness.

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4- Trace elements:• Some are found in water but most are found

in greater concentration in food-stuffs.• It has been found that there is marked

increase in dental caries in areas where selenium was high both in water and food-stuffs.

• On the other hand, molybdenum and vanadium have caries inhibiting influences.

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5- Degree of urbanization:• Urbanization may be accompanied by an

increase in dental caries. • This may be due to the type of diet in urban

areas (refined and freely fermentable carbohydrates).

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6- Social factors: Good economic status and social pressure

in the direction of good mouth appearance are both strong factors in creating demand for dental treatment, so the incidence of caries is low.

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Conclusions

• It’s the time that preventive measures should take place in egypt.

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References

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