PERDENT (intro to dental caries) Flashcards
is a multifactorial, transmissible,
infectious oral disease caused primarily
by the complex interaction of cariogenic
oral flora (biofilm) with fermentable
dietary carbohydrates on the tooth
surface over time.
DENTAL CARIES
characterized by
localized demineralization and loss of
tooth structure
dental caries
During an acid attack
PH level will go down
to critical level:
5.5 for enamel
6.2 for dentin
The low pH level will
trigger Phosphate and
Calcium minerals from
the tooth to the Biofilm
in attempt to balance or
to reach equilibrium.
DEMINERALIZATION
When pH neutralizes, the
concentration of soluble
calcium and phosphate is
supersaturated relative to that
in the tooth, mineral can then
be added back to partially
demineralized enamel
ReMINERALIZATION
Repeated demineralization events may
result from a predominantly pathologic environment causing the localized dissolution and destruction of the calcified dental tissues,
caries lesion or a “cavity.”
factors that can affect the process of
demineralization and remineralization
Number and type of microbial flora in the biofilm
diet
oral hygiene
genetics
dental anatomy
use of fluorides and other chemotherapeutic agents
salivary flow and buffering capacity
inherent resistance of the tooth structure and composition.
is a term historically
used to describe the soft,
tenacious film
accumulating on the
surface of teeth.
Dental plaque
has been more recently
referred to as a plaque
biofilm, or simply biofilm
Dental plaque
is composed mostly of bacteria,
their by-products, extracellular
matrix, and water.
biofilm
Teeth normally have a biofilm
community dominated by
Streptococcus sanguis and S.
mitis
The population size of mutans
streptococci (MS) or S.
mutans on
teeth varies.
tooth habitats for cariogenic biofilms
Pits and fissures
Smooth enamel surfaces
Root surfaces (cervical areas)
Subgingival areas
provide excellent mechanical shelter for organisms
and harbor a community dominated by S. sanguis and
other streptococci
pits and fissures
immediately gingival to
the contact area are the second most susceptible areas to caries
Smooth Enamel Surfaces
particularly near the cementoenamel junction (CEJ), often is unaffected by the action of hygiene procedures such as flossing because it may have concave anatomic surface contours (fluting) and occasional roughness at the termination of the enamel.
root surfaces
Caries originating on the root is
alarming because:
1.it has a comparatively rapid
progression.
2.it is often asymptomatic.
3.it is closer to the pulp.
4. it is more difficult to restore.
Accomplished primarily by
proper tooth brushing and
flossing, is another ecologic
determinant of caries onset
and activity.
oral hygiene
Careful mechanical cleaning
of teeth disrupts the biofilm
and leaves a clean enamel
surface.
oral hygiene
The cleaning process does
not destroy most of the oral
bacteria but merely removes
them from the surfaces of
teeth.
oral hygiene
is an extremely important
substance for the proper digestion
of foods, and it also plays a key
role as a natural anticaries agent
saliva
protective mechanisms
that maintain the normal oral flora
and tooth surface integrity include
bacterial clearance, direct
antibacterial activity, buffers, and
remineralization
saliva
anticaries properties of saliva
Bacterial Clearance
Direct Antibacterial Activity
Buffer Capacity
Remineralization
The amount of saliva secreted
varies greatly over time. When
secreted, saliva remains in the
mouth for a short time before
being swallowed.
bacterial clearance
Adults produce ___ of saliva a
day, very little of which occurs
during __.
1-1.5 L, sleep
most effective
during mastication or oral
stimulation, both of which
produce large volumes of saliva.
flushing
play an important role in the
protection of soft tissue in the
oral cavity from infection by
pathogens, they have little effect
on caries because similar levels of
antibacterial proteins can be
found in caries-active and caries-
free individuals.
direct bacterial activity
also can
dilute and buffer biofilm acids.
Large volumes of saliva
may have significantly higher
caries susceptibility.
Individuals with decreased
salivary production (Dry mouth)
medical term for Dry mouth.
Xerostomia
`xeros =
stomia =
= dry
= conditions of the mouth
is to
reduce the potential for acid
formation.
buffer capacity
Without a means to control
precipitation of these ions, the
teeth literally would become
encrusted with mineral deposits.
remineralization
provides a constant opportunity
for remineralizing enamel and can
help protect teeth in times of
cariogenic challenges.
remineralization
Acidogenic
Acido =
genic =
Acid
forming/producing
The eventual metabolic product of
cariogenic diet is
acid,
leads to the development of caries,
the exposure to acidity from other
sources also may result in caries.
acid
Cariogenic
Cario =
genic =
Caries
forming/producing
clinical characteristics
Pits and Fissures
Smooth enamel surfaces
Root surfaces
the earliest
evidence of caries on the smooth
enamel surface of a crown is a
white spot.
are chalky white, opaque areas
that are revealed only when the
tooth surface is desiccated and
are termed noncavitated enamel
caries lesions.
white spots
is affected
less by drying and wetting
hypocalcified enamel
caries
partially or totally disappears
visually when the enamel is
hydrated (wet),
Noncavitated (white spot)
(international caries dectection assessment system) ICDAS
1
2
3
4
5
6
7
1 - Sound surface
2 - First visual change in enamel (seen only after prolonged air‐drying or
restricted to within the confines of a pit or fissure)
3 - Distinct visual change in enamel
4 - Localized enamel breakdown (without clinical visual signs of dentin
involvement)
5 - Underlying dark shadow from dentin
6 - Distinct cavity with visible dentin
7 - Extensive distinct cavity with visible dentin
buccal and linggual
grade 1 (B1)
grade 2 (B2)
grade 3 (B3)
grade 4 (B4)
grade 5 (B5)
GRADE 1- white or discolored enamel, no cavitation clinically.
GRADE 2- small cavitation in enamel.
GRADE 3- moderate sized cavity in enamel with exposed dentin
GRADE 4- large cavity in enamel and moderate cavity in dentin
GRADE 5- extensive cavity in enamel and substantial loss of denitn
occlusal
grade 1(o1)
grade 2(O2)
grade 3(o3)
grade 4(o4)
grade 5(05)
GRADE 1- white or brown discoloration in enamel, no clincial cavitation, no radiographic
GRADE 2- small cavity formation
GRADE 3- moderate sized cavity and radiolucency in the outer third
GRADE 4- Big cavitation in the middle third
GRADE5- very big in the iner third
