c
c



  





 

O It is the most prevalent chronic disease affecting the
modern race.
race. The disease is unique in respect to all
others in that it is unhealing and irreversible but recently
demineralized intact tooth structure could be healed by
remineralization..
remineralization
O Shafer defined caries asas:: it is a disease of the calcified
tissues of the teeth, characterized by a demineralization
of the inorganic portion and destruction of the organic
substance of the tooth.
tooth.
Or
O Dental caries is an infectious microbial disease that
results in breakdown or softening of the enamel and
dentin.. This destructive processes more rapidly in dentin
dentin
than in enamel to create an undermining effect, hence
the term " cavity".
 c
 

O There are four theories

1.The acidogenic theory (chemico-

(chemico-parasitic
theory)..
theory)
O It was formulated by miller about 1882 1882..
O He assumed that this was a bacterial process.
process.
O Carbohydrates+saliva containing bacteria
O at body temperature
temperature|| produce|||
||produce enough acid within
|||enough within|||
|||
48||hours|
48 decalcifying hard tooth structures
structures


O Cooked starch, sucrose, glucose)+ anaerobic
bacteria (lactobacilli and streptococci) organic
acids ( lactic, pyruvic, citric)
citric)


^ c
 
 

O The proteolytic microorganisms invade the

organic pathways in the enamel and
destroy them in their advance

advance

O ÿroteolytic bacteria in the oral cavity
produce bacterial enzymes as keratinase
and collagenase
collagenase


O These enzymes dissolve the connective
tissue protein of the tiny hydroxyapatite
crystallites, which then simply float away
as a colloidal cloud
cloud


O - 
 
 

O Hydrolysis of the sulfate containing
mucopolysaccharides such as Nasmyth's
membrane|| | and other enamel proteins by
membrane
bacterial enzyme sulfatase, will release
sulfuric acid which is a high ionized acid
and will act as decalcifying agent for
enamel


enamel
Sulfatase enzyme+mucopolysccharides
|| Demineralization of enamel surface.
||Demineralization surface.
O º ÿ 
 
 

O rlycolytic enzymes which act on
carbohydrates lead to the formation of
compounds such as citric, lactic and pyruvic
acids, all of these are chelating agents
agents


O ‰ good chelating agent is any substance which is
capable of forming with calcium more than one
bond, one of these bond is a coordinate covalent
bond..
bond
O Coordinate covalent bond means contributing of
two electrons and sharing them with a cation as
calcium..
calcium
O ‰ ligand is of this nature, it usually contains a
pair of electrons

electrons

O Chelating agents form calcium complexes,
complexes, which
are soluble in oral fluids.
fluids.
O ÿroduction and release of amino acids which act as
good chelating agents may occur. occur. ÿroteolytic bacteria
produces enzymes
enzymes;; keratinase and collagenase
collagenase,, which
act on the protein of the tooth and also on the protein
of the food lodged in the oral cavity .
O These acids can pick up calcium of the tooth and form
calcium complexes which are soluble in oral fluids.
fluids.
O ÿroteolysis of keratin and collagen could have the
following solubilizing effects
effects::
1. Direct release of crystallites.
crystallites.
2. Formation of amino acids which solubilize Ca
and ÿo 4.
ÿo4
3. Ionized amino acid is a chelating agent for Ca .
4. H+ released during ionization of amino acids
converts ÿO ÿO44 into HÿO
HÿO4 4 which is more
soluble..
soluble
 Œ


ëë

Œ



1. Discoloration of the tooth structure
structure..
2. The softening of tooth structure due to
loss of minerals.
minerals.
3. The loss of surface continuity.
continuity.
Œ




O  c


O Π 
 : :- The amount of fluoride

in a sound tooth is 4 times as that of a
carious tooth while the amount of Ca/ ÿ
and Mg is the same

same

O ë 
 : Teeth with deep fissures
and pits are more liable to become
carious


carious
O ÿ 
  : Teeth which are not in
proper alignment (rotated, deviated or
inclined) will favour collection of food

food

O II)|a 
|
II)|
O |§uantity, viscosity and antibacterial
property of the saliva have a direct
relationship with the caries index of the
different cases.
cases. The less the amount, the
higher the viscosity and the less the
inhibiting effect of the saliva on bacterial
growth, the higher the tendency for caries
incidence


incidence
O III) D

D

O ) ÿ 
 
 



O Food containing fibres will not adhere to the teeth and

have a cleaning action on them
them..
O While soft food adheres to the teeth surfaces and caries
starts to occur.
occur.
O ) Π 
 

 


O The more the amount of carbohydrates in the diet,

the more is the occurrence of caries

caries

O | ) V




O Úitamin ‰ and D are concerned with the

development of the tooth.
tooth. ÿeople with deficiency in
vitamin B, have a low caries index (vitamin B is essential
for the metabolism of bacteria producing caries)
caries)

O IV) F  


O Fluoride in drinking water causes significant

reduction in caries than fluoride in the diet

diet

O )a
 


Hereditary, pregnancy and lactation

lactation


1. The liability to caries will be very similar between
children and parents in the great majority of
cases if the children live in the same area and in
the same conditions as their parents in their
childhood..
childhood
2. ÿregnant and lactating women usually neglect
oral hygiene because of the other duties
attendant to the birth of baby.
baby.
3. There is no mechanism for withdrawal of Ca from
teeth, once calcified, they never lose Ca, unlike
the case of bone.
bone.
ë



ë


1. Chemical measures.
2. Nutritional measures.
3. Mechanical measures.
  Œ

Œ



O ‰)
    



  









O j.g. Fluoride, silver nitrate, zinc chloride, potassium ferrocyanide
ferrocyanide|

|

O Fluoride is supplied in two ways|

|| I)|||||||in the drinking water

water

O II) by topical application (directly on the tooth).

O ë   
    


1. The most acceptable theory is that fluoride is incorporated in crystal
apatite of enamel producing fluoroapatite
fluoroapatite,, thus rendering the enamel
less soluble in organic acid.
2. Some authors believe that it inhibits the growth of microorganisms,
but this is not true.
3. Others believed that fluorides inhibit enolase reaction, enolase is an
enzyme necessary for the metabolism of carbohydrates but this
theory is neglected.
4. Decrease the tooth surface tension and thus prevent and / or reduce
bonding of the dental plaque.
O ) a
    
 

 
 
 
 
 
 


 

   


ii

O Œ) a
    
 
 


 
  
  ii
O Àrea was found to prevent acid formation by
interfering with bacterial growth, or by producing
ammonia, which neutralizes acids formed through
carbohydrate fermentation by bacteria of the
mouth..
mouth
O Chlorophyll:: The green pigment of plants is
Chlorophyll
bacteriostatic with respect to many bacteria in the
mouth including lactobacilli and streptococci .
O ^.| D

ëë

D


O Caries is more common in patients who
eat refined carbohydrates.
O Caries is not common in people who eat
fresh fruits and vegetables.
O ÿatients suffering from caries should
restrict their carbohydrate intake
especially in-
in-between meals.
O - ë
 



1. By mechanical measures, the patient will be

able to remove food debris clinging to the teeth

teeth

2. Dental prophylaxis by the dentist.
dentist.
3. Tooth brushing
brushing..
4. Mouth rinsing
rinsing.. (Lestren)
(Lestren)..
5. Dental floss and toothpicks
toothpicks..
6. Detergent food (hard fibrous food).
food).
7. Chewing gum
gum..
Œ



||

Œ




O ‰ ‰



O 1. ÿits and fissure caries

caries

O 2. Smooth surface caries.
O ‰



 
ë


‰



 
ë

O 1. ‰cute caries (rapid).
O 2. Chronic caries (slow).
O Œ ‰


 


 








O |1. ÿrimary caries (Úirgin).
O 2. Secondary caries (recurrent).
Occlusal ÿit & Fissure Caries
Class I Cavities
Class I Cavity preparation of Molars
and ÿremolars
- Dental caries.
O c  



|) ÿ
    I

O Occurs in the occlusal surface of molars and premolars,

the occlusal 2/3 of the buccal and lingual surfaces of
molars and the palatal surface of upper incisors
incisors..
O This type is characterized by having a small opening or
orifice..
orifice
O It spreads in a cone shape in the enamel, the base of
the cone being at the dentino-
dentino-enamel junction (D(D..j.J)
and the apex at the surface of enamel.
enamel.
O Caries spreads laterally along the D.j.J, then in the
dentin in the form of a cone, a base at the D.j.J and the
apex pointing towards the pulp , i.e. there will be 2
cones, the base of the cone of enamel is against the
base of the cone in the dentin this can be explained due
to
to::-
1. The arrangement of enamel rods in the occlusal surface
is such that enamel rods converge where there is a
depression or concavity and diverge where there is an
elevation or convexity .i.e. enamel rods converge in
fissures and diverge in cusps and ridges
ridges..
2. The enamel rods are cemented together by
intercementing substance, which is less calcified than
the prisms.
prisms. So they are attacked more rapidly by acids
than the prisms.
prisms.
3. Class I caries occurs in fissures and pits where enamel
rods converge.
converge.
4. The result will be that caries will progress in a cone, the
apex of which is towards the occlusal surface and the
base towards the D.j.J.
5. Reaching the D.j.J, caries will spread laterally along it
because dentin is softer than enamel
enamel..
6. Caries starts to penetrate deep in dentin
dentin..
7. The concentration of acid is more in the center than at
the periphery of the lateral spreading in the dentin.
dentin.
8. Thus, caries will have the form of a cone, the base is at
the D.j.J., and the apex is towards the pulp.
pulp.
Class II Cavities
- ÿroximal caries.
*ones Of Caries
Class II Cavity preparation in
posterior teeth
O ^) ÿ        
 II

II

O Caries is hidden, always gingival to the contact point.

point.
O Has the tendency to spread bucco-
bucco-lingually.
lingually.
O May undermine the marginal ridge.
ridge.
O May undergo extensive spreading gingivally, and if the
filling improperly restores the contact point, there will be a
great tendency for recurrence of decay gingivally.
gingivally.
O Caries will spread in the form of 2 cones.
cones. The base of the
enamel cone is towards the periphery and the apex is
towards the pulp (following the arrangement of enamel
rods in the proximal surface).
surface). In dentin it spreads in a
cone, the base is at the D.j.J, and the apex pointing
towards the pulp as mentioned with pits and fissure caries
before..
before
Class III & IÚ Cavities
Class Ú Cavities
O -) ÿ  
      
 III&IV

III&IV

O Caries occurs in the triangular proximal surface.

surface.
O Caries may extend labially or palatally.
palatally.
O It may extend incisally, resulting in destruction of tooth
angle (class IÚ) or if not it is class III.
III.
O It may extend deep gingivally
gingivally..
O º) G
 c    V

O Π   
 
     
 


  

 
 
  
   

  
  Π 



   




 
 


 

  


 

          
  

 

   
  
  
)

)
O In its first stage, enamel is etched then becomes
becomes|| | | chalky
white


white
O The cavity is very sensitive to mechanical and thermal irritation.
irritation.
O Caries usually extends to the axial angle and if neglected, caries may join
a proximal cavity.
cavity.
Class Ú Class III
 

||




O |
Is a mechanical loss of hard tooth substance
|
resulting from friction between the opposing teeth with no
foreign substances intervening

intervening

O It is commonly seen in anterior teeth
|
O ‰


 
 ÿhysiologic wearing away of dental hard
tissue..
tissue
O  is a common cause of pathologic wear
wear..
O Occlusal abnormalities coupled with nervous tensions
cause a patient to ganish his teeth together.
together.
O Over a period of months or years the occlusal enamel
wears away, exposing the softer dentin underneath
underneath..
jxtensive Occlusal Wear

Incisal Wear
 III‰  



O Is a mechanical loss of hard tooth

structure through abnormal mechanical
processes involving foreign objects or
substance repeatedly introduced in the
mouth and contacting the teeth

teeth

O ‰brasion results|
results| | from incorrect tooth-
tooth-
brushing habits also to be seen as notches
on the facial sides of root surfaces

surfaces

 IV   |
|

O It is a chemico
chemico--mechanical loss of hard tooth
substance resulting from direct chemical action on the
tooth surface without bacterial involvement.
involvement.
O The lesions are sensitive in their initial stage and this
decreases gradually due to deposition of secondary
dentin..
dentin
O It may involve enamel only or the lesion may expose the
underlying dentin
dentin..
O Sometimes the erosion lesion extends towards the pulp
causing pulp exposure
exposure..
O It is more commonly found on the bucco-
bucco-cervical areas
of maxillary and mandibular cuspids and bicuspids
bicuspids..
O It is also found in the labio-
labio-cervical areas of anterior
teeth..
teeth
 c





  
 
 !
!
 


O They are shallow concavities that most commonly occur on
the labial surface of the incisor teeth.
teeth.
O They appear glossy when the tooth is dried.
dried.
O It is mainly confined to the gingival half of the tooth.
tooth.
^  !
!
  !
  !
 
 



O They are Ú-shaped lesions and most commonly occur in the
mesial aspect of the buccal surfaces of bicuspids and molar
teeth..
teeth
O This type causes pulp irritation and tends to involve the pulp
early..
early
-   
 


O These lesions occur in the proximal and lingual surfaces of
teeth


teeth
O They often result from severe systemic or environmental
disorders such as chemical fumes or chronic regurgitation

regurgitation

O Restorative measures are difficult in these lesions.
lesions.
Œ


Œ
O The Chief cause may be a combination of chemical and mechanical
factors


factors
O There are 3 theories involved;
involved; acid, abrasion and alkaline theories
concerning erosion
erosion


  ‰
  ë

O ‰cids play a great role in the production of tooth erosion
erosion..
O ‰cids have a decalcifying effect on the tooth hard structure
structure..
O Citric acid was found to be the most damaging to the tooth structure
structure..

1. Habitual drinking of acid beverages (pH of 2 or 3) and

excessive consumption of citrus fruit are the most common
cause of the occurrence of erosion .
2. In case of traumatic occlusion, more acids were found
around eroded teeth as a result of local acidosis in
periodontal tissues
tissues..
3. ‰nother cause of erosion is industrial atmospheric
pollution.. This condition is found in workers in acid fumes
pollution fumes..
4. Habitual regurgitation of gastric contents is another source.
source.
 ^  ‰
  !
O jxtensive researches indicated that abrasion accelerates
the process of erosion.
erosion.
O Consequently, improper tooth brushing technique and
the use of stiff bristles toothbrush with rough abrasive
particles accelerate the erosion process.
process.
O It was found that cementum and dentin were found
to be more abraded than enamel, resulting in tooth
sensitivity and accelerated erosion.
erosion.

3. ‰
  
O ‰lkaline materials can affect the tooth producing
decalcification of its surface.
surface.
O ÿyrophosphate resulting from fermentation of
carbohydrates by oral microbes is an effective chelating
agent capable of increasing the incidence of clinical
erosion..
erosion
 VD 

 


O describes the wearing away of tooth

substance during the mastication of food
with bolus intervening between opposing
teeth..
teeth Demastication is normally
physiological primarly affecting the
occlusal and incisal surfaces but may be
pathological due to abnormal consumption
such as betel nut

nut

 VI‰
 

O It is a wedge shaped defect at the cemento-

cemento-
enamel junction of the tooth.
tooth. This lesion may be
observed on a single tooth or non adjacent
teeth


teeth
O In malocclusion areas, due to the
parafunctional forces created, one or several
teeth to strong tensile, compressive or shearing
stresses.. These forces are concentrated at CjJ,
stresses
creating microfractures in enamel and dentindentin..
The microfractures are thought to propagate
with time perpendicular to the long axis of the
stressed teeth until enamel and dentin break
away


away
 VII" 
 


O It is a biological removal of dental hard

(degradation).. This can be occur in case of root
(degradation)
resorption of deciduous teeth (physiologically) or as
in case of resorption due to trauma or cysts
(pathologically).. This is done by increasing of
(pathologically)
cementoclastic, dentinoclastic and ameloclastic
activity

(internal or external ).
activity

VIIIF




O Loss of tooth structure due to trauma (fall, blow,

fights or sudden biting on a hard substance)
substance).. There
are two types of fracture|
fracture|
O ||| jnamel fracture
|||jnamel
O ||| jnamel and dentin fracture with/without pulpal
|||jnamel
involvement
 IXD 
 
O Deviation from the normal colour of one or more than
one tooth

tooth

O The cause may be either extrinsic due to surface
staining, calculus or any other surface deposits or
intrinsic as in cases of pulpal necrosis, tetracycline taken
during the formation of dentin or enamel, hypoplasia
and hypocalcification of enamel and pigmentation and
staining of the dentin by corrosion products and
medicaments|

jnamel hypoplasia

hypoplasia

O It is a defect in enamel due to improper matrix formation

caused by injury to ameloblasts
ameloblasts


O Lesions ranges from isolated pits to wide spread defects,
depression or loss of a segment in the enamel. enamel. The
discoloration of these defects increase by time
time


 jnamel hypocalcification

hypocalcification

It is improper mineralization of enamel matrix due to

destruction of the ameloblasts.
ameloblasts. The affected areas are
chalky, soft to indentation and stainable but has normal
shape and thickness
thickness.. This lesion can be easily chipped

Causes of enamel hypoplasia and hypocalcification

hypocalcification

1. Systemic disorders such as nutritional deficiencies (vit

‰,C and D), hypocalcimia or microbial process as in
syphilis


syphilis
2. localized disorders such as in cases of periapical
infection of traumatic intrusion of the preceding
deciduous tooth
tooth


3. fluorides
fluorides:: excessive amount of fluoride could poison the
ameloblasts and disturb their activities

activities