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Current Concepts in Etiology of Caries

Dental caries is a dynamic process involving the demineralization and remineralization of tooth enamel. It results from an interaction between susceptible host factors, cariogenic bacteria like Streptococcus mutans, and fermentable carbohydrates in the diet. Keyes identified these three factors as the main contributors to caries development. Newbrun later added time as a fourth factor in his "caries tetrology". The document discusses the roles of these factors and bacteria like S. mutans in the pathogenesis of dental caries. It also explores dietary determinants of caries risk and the concepts of critical pH in demineralization.

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407 views28 pages

Current Concepts in Etiology of Caries

Dental caries is a dynamic process involving the demineralization and remineralization of tooth enamel. It results from an interaction between susceptible host factors, cariogenic bacteria like Streptococcus mutans, and fermentable carbohydrates in the diet. Keyes identified these three factors as the main contributors to caries development. Newbrun later added time as a fourth factor in his "caries tetrology". The document discusses the roles of these factors and bacteria like S. mutans in the pathogenesis of dental caries. It also explores dietary determinants of caries risk and the concepts of critical pH in demineralization.

Uploaded by

smritinarayan
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© Attribution Non-Commercial (BY-NC)
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CURRENT CONCEPTS IN DENTAL CARIES

Dr.M.Ganesh,MDS(Pediatric Dentistry)

CARIES IS..
Dynamic process of de-mineralization and re-mineralization Complex, multi-factorial disease

Dr.M.Ganesh,MDS(Pediatric Dentistry)

KEYES TRIAD
Interaction of 3 primary factors (Keyes,1960) Susceptible host
Cariogenic micro flora Local substrate

Dr.M.Ganesh,MDS(Pediatric Dentistry)

Caries Tetrology
Newbrun 1982
Time

Dr.M.Ganesh,MDS(Pediatric Dentistry)

The host-tooth
CompositionSurface enamel resistant More mineral Less carbonate & water MorphologyEnamel hypoplasia Deep fissures PositionAlignment
Dr.M.Ganesh,MDS(Pediatric Dentistry)

Microbiology of caries
Caries- infectious disease Streptococcus mutans Streptococcus sobrinus Lactobacillus acidophilus Actinomyces- root caries

Dr.M.Ganesh,MDS(Pediatric Dentistry)

Virulence traits of S.mutans


Acidogenicity- produce weak acids as by-products of carbohydrate metabolism
Aciduricity- acid tolerance Proteolysis

lactic acid acetic, formic, propionic, butyric acids

Dr.M.Ganesh,MDS(Pediatric Dentistry)

Virulence traits
Produces extra-cellular polysaccharides Mediates irreversible accumulative adhesion Increases plaque thickness Intracellular polysaccharides synthesis Acid production in reduced substrate availability Maintains acidogenecity & fosters demineralisation in low salivary secretion
Dr.M.Ganesh,MDS(Pediatric Dentistry)

Window of infectivity
Caufield,1993
19-31 months 6-12 years

Dr.M.Ganesh,MDS(Pediatric Dentistry)

Substrate (Diet):
Readily fermentable Sucrose (table sugar)- Arch criminal

Dr.M.Ganesh,MDS(Pediatric Dentistry)

Cariogenicity determined by
Frequency of ingestion

Dr.M.Ganesh,MDS(Pediatric Dentistry)

List of Food containing sugar

Dr.M.Ganesh,MDS(Pediatric Dentistry)

Chemical composition-detergency
Cows milk (cheese) contains calcium, phosphorus, and casein Wholegrain foods require more chewing Peanuts, hard cheeses, and chewing gum Black tea extract

Presence of other constituents

Dr.M.Ganesh,MDS(Pediatric Dentistry)

Physical form
Dried fruit and honey should not be eaten frequently Soft drinks, sport drinks and fruit juice

Dr.M.Ganesh,MDS(Pediatric Dentistry)

Dr.M.Ganesh,MDS(Pediatric Dentistry)

Isolate sugar factors


Identification of food causing oral diseases Code by two colors Taking it as a game for children Total number of exposures Exposure- Eating food at one time Time of exposure to acid= total exposure x 20 minutes
Dr.M.Ganesh,MDS(Pediatric Dentistry)

Suggest substitutes for food items

Dr.M.Ganesh,MDS(Pediatric Dentistry)

DETERMINE THE ADEQUACY OF DIET

Dr.M.Ganesh,MDS(Pediatric FOOD GUIDE PYRAMID Dentistry)

Substrate
Readily fermentable Sucrose- arch criminal Cariogenicity determined by Frequency of ingestion Physical form Chemical composition-detergency Route of administration Presence of other constituents
Dr.M.Ganesh,MDS(Pediatric Dentistry)

Environment:
Saliva Composition Flow rate Buffer capacity Dental plaque

Dr.M.Ganesh,MDS(Pediatric Dentistry)

De-mineralisation & Remineralisation:


Caries is a dynamic disease Loss of mineral replacement

Surface enamel functions as a diffusion matrix Normally equilibrium exists


Dr.M.Ganesh,MDS(Pediatric Dentistry)

Surface enamel functions as a diffusion matrix

Dr.M.Ganesh,MDS(Pediatric Dentistry)

Dr.M.Ganesh,MDS(Pediatric Dentistry)

Dr.M.Ganesh,MDS(Pediatric Dentistry)

Concept of critical pH
pH of saliva 7.0 + 0.4
Early concept :
pH at which saliva was no longer saturated with respect to calcium & phosphate ions, thereby permitting hydroxyapatite to dissolve.
Dr.M.Ganesh,MDS(Pediatric Dentistry)

Concept of critical pH (contd)


Plaque fluid:
aqueous phase of plaque which forms the interphase between enamel crystals & their environment & constitutes the milieu in which plaque microorganisms grow & metabolize Plaque fluid is involved in demineralization Between pH 5-6, saliva & pf cease to be saturated, average 5.5 pH safe for teeth is 5.7 Unionized lactic acid molecules diffuse more readily into enamel; increases as pH falls demineralization
Dr.M.Ganesh,MDS(Pediatric Dentistry)

Concept of critical pH (contd)


Present concept:
pH at which the environment of enamel becomes unsaturated and in addition that pH at which sufficiently high concentrations of un-ionized acid are present to ensure the inward diffusion of enough acid to extend to the inner lesion Lactic acid brings about subsurface demineralization
Dr.M.Ganesh,MDS(Pediatric Dentistry)

Thank You

Dr.M.Ganesh,MDS(Pediatric Dentistry)

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