Escolar Documentos
Profissional Documentos
Cultura Documentos
Dr.Ghada Maghaireh
BDS,MS,ABOD
Worms
Probably the earliest reference to tooth decay and toothache came from the
ancient Sumerian text known as the 'Legend of the Worm'.
The text refers to the creation of the Heavens, the Earth, the Marshes and the
latter created the Worm.
The early history of India, Egypt, and the writing of Homer also make reference
to the worm as the cause of toothache.
The great surgeon of the Middle Ages, Guy de Cahuliac (1300- (1300-1368) still
espoused the belief that worms cause dental caries.
Humoral Theory
The legend of the worm faded over the early centuries as the Greek
physicians advanced the humoral theory of disease.
The four elemental humors of the body were blood, phlegm, black bile and
yellow bile.
According to Galen, the ancient Greek physician and philosopher, ‘dental
caries is produced by internal action of acrid and corroding humors’. An
imbalance in these humors resulted in disease.
Hippocrates, the 'Father of Medicine', while favoring the concept of humoral
pathology also referred to the accumulated debris around teeth and to their
corroding action.
He, also, stated that stagnation of juices in the teeth was the cause of
toothache.
Vital Theory
A vital theory of tooth decay was advanced, towards the end of the 18th
century, which postulated that tooth decay originated, like bone gangrene,
from within the tooth itself.
A forerunner to this theory may have been the observation that internal
resorption occurs in some teeth, or from the presence of deep, undermining
carious lesions with but pinpoint surface involvement of a pit or fissure.
Chemical (Acid) Theory
In the 17th and 18th centuries, paralleling new insights into chemistry, there
emerged the concept that teeth are destroyed by acids formed in the oral
cavity.
One suggestion was that putrefaction of protein gave rise to ammonia which
was subsequently oxidized to nitric acid; another was that food in saliva
decomposed to form sulfuric, nitric or acetic acids.
Robertson in 1835 proposed that dental decay was caused by acid formed by
fermentation of food particles around teeth.
Since fermentation was at this time considered to be a strictly non-vital
process, the possibility that microorganisms were involved was not, as yet,
recognized.
Proteolytic Theory
The surface coverings found on the tooth, in grooves and pits, are organic in
nature; also, enamel contains small but significant amounts of organic
material.
These observations and the fact that carious lesions are characterized
histologically by pigmentation, a phenomenon that was interpreted, without
evidence, as being indicative of proteolysis, led to the development of the
proteolytic theory.
It described caries-
caries-like lesions that were initiated by proteolytic activity at a
slightly alkaline pH, and considered that the process involved
depolymerization and liquification of the organic matrix of enamel.
To date no one has, under physiological conditions, successfully demonstrated
significant loss of enamel tissue through proteolytic activity.
Enamel is a highly structured tissue and the accessibility of organic material to
enzymatic action before decalcification is restricted.
Enamel can be dissolved under physiological
conditions only by demineralization with acids,
chelating or complexing agents.
Proteolysis-Chelation Theory
This theory proposed by Schatz et al. implies a simultaneous microbial
degradation of the organic components (hence, proteolysis), and the
dissolution of the minerals of the tooth by the process of chelation.
According to the proteolytic-
proteolytic-chelation theory, dental caries results from an
initial bacterial and enzymatic proteolytic action on the organic matter of
enamel without preliminary demineralization.
Such action, the theory suggests, produces an initial caries lesion and the
release of a variety of complexing agents, such as amino acids,
polyphosphates and organic acids. The complexing agents then dissolve
the crystalline appetite.
Less than 1% of mature enamel is organic in nature and the suggestion that
this material upon degradation can give rise to a significant concentration of
chelator sufficient to dissolve up to 96% mineral matter has no experimental
support.
Also, there is no substantial experimental evidence that the initial caries lesion
stems from a breakdown of organic matter, i.e. due to proteolytic action.
While proteolysis-
proteolysis-chelation is an important biological phenomenon, its primary
role in the etiology of dental caries has not been corroborated.
Current Concept
Dental caries is a multifactorial disease.
The term multifactorial is used to denote the interaction between the factors.
This model of viewing a disease process is applicable to dental caries.