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Dental Caries

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Rachael Wiebe

on 14 September 2013

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Transcript of Dental Caries

Dental Caries
Dental Explorer
Visual Examination
Enhanced by intraoral cameras
Indicator Dyes
Caries Detection Devices
Laser Caries Detector

Detection of Dental Caries
Dilutes and removes acidic components of dental plaque, clears oral cavity or food debris (carbohydrates)
Importance of Saliva
Dental sealants

Controlling Dental Caries
Secondary or Recurrent Caries
Enamel surfaces: mesial, distal, facial, and lingual
Prevent by good oral hygiene

Smooth surface caries
Pit-and-Fissure caries
Smooth surface caries
Root caries
Secondary or recurrent caries
Rampant caries

Types of Lesions

The Perfect Environment
Susceptible host (a susceptible tooth)
Diet rich in fermentable carbohydrates
All sugars: evens fruits, breads, rice, pasta, and potatoes.
Specific Bacteria (MS and LB)

Process of Dental Caries Formation

Formation of a Pellicle
Forms on the tooth surface by selective adsorption of protein components from the saliva.
Bacterial Multiplication and Colonization
Microcolonies form in layers as the bacterial colonies multiply.
Biofilm Growth and Maturation
Biofilm grows as it is left undisturbed- the bacteria multiplies

Formation of Biofilm

Acquired Pellicle- Thin film of protein, only removed with coronal polish, reforms within minutes of removal.
Biofilm- “Plaque” organized matrix of microorganisms.
Materia Alba-Soft grayish-white mixture of bacteria, saliva protein, and usually food debris. Looks white and cottage cheese-like.
Food debris- Particles of food that are left after eating

Types of Plaque and Other Soft Tooth Deposits

Plaque is a colorless, soft, sticky coating that adheres to the tooth.
MS and LB live in the dental plaque
May only be removed mechanically
Flossing and Toothbrushing
Rinse with water or mouthrinse have no effect on plaque
200-500 microorganisms live in 1gm. Of plaque.

Plaque and Dental Caries
Infectious and communicable
A laser caries detector cannot be used to diagnose interproximal caries because of limited access to interproximal surfaces. When using a laser caries detector, a carious tooth will show more fluorescence, and a clean, healthy tooth will show less fluorescence. The laser caries detector is equally effective in both primary and permanent teeth. It cannot detect caries under dental sealants or an amalgam restoration, although it will detect decay around the occlusal margins of a restoration.
Laser caries detectors work by passing a beam through the tooth surface. A clean, healthy tooth will have a baseline reading of 0.
A DIAGNOdent reading of 15 to 20 indicates preventive therapy and sealants.
A false-positive is possible if plaque or food particles are present in fissures; therefore it should not be used as the only diagnostic tool.

Laser Caries Detection
Tooth decay is the single most prevalent disease of childhood.
Causes dental pain and swelling the in the gums.
#1 reasons for children to miss school
More common in families with low socioeconomic status
Also common in special needs children
Baby Bottle Tooth Decay
Early Childhood Caries
Multiple lesions throughout the mouth.
Associated with poor homecare and excessive/frequent intake of sucrose or xerostomia
Maybe frequent in children
Rampant Caries
Root caries
Demineralization begins, possibly maybe remineralized. The caries is less than ½ way through the enamel.
Stages of Caries

Within 5 mins after eating/drinking bacteria converts the sugars into acid (the bacteria’s by-product from eating the sugar).
The acid attacks the tooth, dissolves the calcium and phosphate from the enamel.
When this process is left undisturbed, dental caries are formed.

Process of Dental Caries Formation

Day 1-2
Gram-positive bacteria, Steptococcus mutans and Steptococcus sanguis.

Days 2-4
Still mainly gram positive, cocci bacteria, continued thickening

Days 4-7
Rod shaped bacteria begin to accumulate, gram-negative spirochetes and vibrios begin to appear. Thickens at gingival margin.

Days 7-14
Biofilm is not materia alba. White blood cells in body begin to increase, more gram-negative bacteria ,along with anaerobic organism, appear.

Days 7-21
Vibrios and spirochetes are highly prevalent, gingivitis is clinically evident.

Changes in biofilm Microorganisms

Formation of Biofilm
Changes in biolim Microorganisms
Stages of
Plaque Formation
Bacterial Infection
May be passed from one person to another
(ie: mother to child-a childs mouth is actually bacteria free at birth)
Mutans Streptococci (MS) and Lactobaccilli (LB)
Form around an existing restoration at the margins and/or interproximal areas.
Maybe difficult to detect with dental explorer and radiographs.
New restorative materials (Glass Ionomers) slowly release fluoride, reducing the risk of secondary caries development.

Formation of caries at gingival margin on the exposed root surface.
Xerostomia increases the risk of root caries
Appearance: brown or black
Prevalent with the elderly
People living longer
More likely to have recession
Typically on medications which cause xerstomia

Pit-and-Fissure caries

Occlusal surfaces, grooves extending over the marginal ridge, or buccal/ lingual pits.

Saliva can neutralize the acid and mineral may assist with the replacement of lost tooth structure: calcium and phosphate in saliva, supplements of fluoride.
Called Remineralization
Incipient lesion
Overt or frank lesion
Cavitation of the tooth, must be repaired. The caries is over ½ way through the enamel.

Tooth Decay
Baby Bottle
Early childhood caries
Baby bottle syndrome
Limiting snacks
Do not sip soda all day, rinse with water after drink the soda, after your last sip of soda your mouth is at an acid level for 20 mins.
Oral Hygiene
Xylotol gum
Makes the tooth more resistant to demineralization
Helps prevent bacteria from adhering to the tooth.
Brushing at least 2 times a day for 2 mins.
Antibacterial rinses
Neutralizes the acids
Physical Protection
Immunoglobulins to work against bacteria.
Chemical Protection
Contains calcium, phosphate, and fluoride (amount is dependant on fluoride supplements and water fluoridation)
Antibacterial Protection
Materia Alba
Dental Biofilm
Full transcript