Aetiology of Dental Caries medium

Aetiology of Dental Caries

• Dental caries is a localized chemical dissolution of tooth surfaces.
• It's caused by metabolic activity within a microbial deposit (biofilm) on tooth surfaces.
• The process is highly dependent on the presence of fermentable carbohydrates.

Learning Outcomes

• Understand the aetiology (cause) and pathogenesis (development) of oral diseases.
• Recognize psychological and sociological factors affecting oral health.
• Discuss components of patient assessment processes.
• Explain the role of dental therapists in tooth restoration.
• Define dental caries.
• Explain the aetiology of dental caries.
• List and describe four aetiological factors causing dental caries.
• List evidence supporting the proposed aetiologies.

Why do we lose teeth?

• Periodontal disease
• Trauma
• Elective removal
• Dental caries

Burden of Dental Caries

• Average cost of a tooth extraction for a child under 5 is £836.
• £50.5 million was spent on tooth extractions for those under 19 between 2015 and 2016.
• £7.8 million was spent on tooth extractions for those under 5 during this time.

So What?

• Understanding dental caries is crucial for prevention and treatment.
• This impacts the quality of life and healthcare costs.

The Caries Process

• The process involves localized chemical dissolution of tooth tissues.
• It is a progressive disease (in its early stages it is reversible) of tooth hard tissues (enamel, dentin, cementum).
• Bacteria metabolize fermentable carbohydrates to produce acids

Main Points

• Caries is often localized.
• Involves chemical dissolution.
• Involves microbes and their metabolites.
• Affects all hard tissues.
• Involves fermentable carbohydrates.
• Can be reversible.

Aetiological Agents for Caries

• Susceptible tooth surface
• Plaque bacteria
• Fermentable carbohydrates
• Time

All-Encompassing Definition of Caries

• A localized chemical dissolution of a susceptible tooth surface, over time, caused by metabolic activity associated with fermentable carbohydrates and a microbial deposit (biofilm).

True Extent of Caries

• Factors like social class, education, income, diet, saliva composition, microbial frequency, behaviour & attitudes influence the development of dental caries

1. Susceptible Tooth Surface

• All dental hard tissues are susceptible to some degree of caries.
• Some areas are more susceptible due to factors like pits and fissures, smooth surfaces, proximals and defective margins.
• These areas are more prone to biofilm accumulation.

Which Areas of the Tooth are Susceptible?

• Pits and fissures
• Smooth surfaces
• Proximal surfaces
• Defective margins/ledges/overhangs

2. Fermentable Carbohydrates

• Bacteria need food to survive, and sugars in diets provide the substrate needed for their metabolism.
• This results in lactic acid production
• Not all sugars are equally cariogenic.
• Sucrose is the most rapidly metabolized.
• Intrinsic sugars are naturally occurring (e.g., fruit sugars).
• Extrinsic sugars are added to foods (e.g., table sugar).
• Complex carbohydrates (e.g., starch) are less cariogenic because these are not easily broken down within the mouth, which means that the time for acid production is increased and more difficult.

Bacteria and Simple Sugars

• Bacteria, in the presence of simple sugars, produce acids that can demineralize tooth surfaces.

What Does 'Critical' pH Mean?

• Critical pH is the point below which tooth tissues start demineralizing.

Critical pH Values

• Critical pH for enamel is approximately 5.5.
• Critical pH for dentin is approximately 6.5

3. Time

• Time is a crucial factor in the development of caries.
• For caries to develop, there needs to be a period of time where all the factors are present.
• The frequency of sugar intake is important-frequent intakes provide opportunity for more de-mineralization.
• Grazing, snacking, suckling increase instances of acid attacks within the mouth.
• Aim to reduce frequency of sugar intake and monitor

4. Plaque Bacteria

• Plaque bacteria are needed for caries to develop.
• The composition of the biofilm changes with time and pH fluctuations.
• Shifting bacterial populations influence the production of acids that demineralize enamel and dentin tissues.

Summary

• Caries develops in susceptible areas of the tooth, influenced by microbial activity, fermentable sugars and prolonged exposure.
• Frequent sugar intake increases the risk of acid production and demineralization.
• The see-saw of remineralization and demineralization is key and can be influenced by the frequency of sugar intake impacting the rate of demineralization influencing the likelihood of damage within the enamel.