Dental Cariology Basics

Dental Cariology

• Dental caries is a multifactorial, transmissible, infectious oral disease affecting teeth, resulting in localized dissolution and destruction of calcified tissue.
• A key concept is the balance between demineralization and remineralization processes.
• Cariogenic bacteria metabolize sugars to produce organic acids that lower the pH in the biofilm.
• A low pH dissolves calcium and phosphate, causing demineralization of the tooth.
• As the pH returns to neutral, mineral can re-crystallize on the tooth surface, causing remineralization.
• The balance between these processes determines caries development.
• Factors influencing caries include primary (tooth anatomy, saliva, fluoride use, diet) and secondary (socioeconomic factors, education, lifestyle).
• Pathologic factors (frequent sugar consumption, inadequate fluoride, poor oral hygiene) promote demineralization, while protective factors (healthy diet, fluoride toothpaste, preventative sealants) promote remineralization..
• Caries lesions can differ in location: smooth-surface caries, pit-and-fissure caries, occlusal caries, and proximal caries.
• Enamel caries is a lesion in enamel that hasn't penetrated into dentin, whereas dentin caries has penetrated into dentin.
• Primary caries are not next to a restoration, secondary caries are adjacent to a restoration.
• Residual caries are carious tissue that wasn't completely removed before a restoration.
• Active caries lesions show ongoing demineralization, while inactive caries lesions have stopped, but clinical signs remain.
• Rampant caries describes multiple extensive cavitations in a person.
• Dental plaque, now called biofilm, is a tenacious film on teeth composed of bacteria, their byproducts, extracellular matrix, and water.
• Caries-related biofilm growth is influenced by saliva (flow rate, buffering capacity).
• The mechanisms by which saliva protects against caries include bacterial clearance, direct antibacterial activity, buffering, and remineralization.
• Factors like decreased salivary production may increase caries susceptibility.
• Oral hygiene (brushing and flossing) disrupts biofilm and promotes a clean enamel surface, but doesn't eliminate all bacteria.
• High-frequency exposure to fermentable carbohydrates such as sucrose is a primary factor in producing cariogenic biofilm.
• In the absence of fermentable carbohydrates, biofilm growth typically does not lead to caries.
• The pH in the mouth fluctuates throughout the day, with a critical pH at which teeth begin to dissolve (around 5.5).
• The length of exposure to fermentable carbohydrates affects the duration of the demineralization process.