INTRODUCTION TO CARIOLOGY.pdf

SCHOOL OF DENTISTRY SY 2023 – 2024 1ST Semester CARIOLOGY Dr. Pamela Rose D. Raytana, DMD. MSD PT-UDZ-001A; Revision 3.0.0; October 05, 2022  CARIES CARIES...

SCHOOL OF DENTISTRY SY 2023 – 2024 1ST Semester CARIOLOGY Dr. Pamela Rose D. Raytana, DMD. MSD PT-UDZ-001A; Revision 3.0.0; October 05, 2022  CARIES CARIES DRY ROT It is a slow disintegration of any biological hard tissue as a result of bacterial action. Dental caries = Slow disintegration of hard tissues of the tooth. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Dental Caries At the 1948 conference on caries, Dental caries was considered as a disease of the calcified tissues of the teeth: Caused by acids resulting from the action of micro-organisms on carbohydrates Characterized by decalcification of the inorganic portion Disintegration of the organic substance of the tooth. PT-UDZ-001A; Revision 3.0.0; October 05, 2022 DEFINITIONS It is a localized post eruptive, pathological process of external origin involving softening of the hard tooth tissue and proceeding to the formation of a cavity. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  DEFINITIONS Dental caries is defined as the chemical dissolution of the calcium salts, first of the enamel then of the dentin by lactic acid. Greene Vardiman Black PT-UDZ-001A; Revision 3.0.0; October 05, 2022  DEFINITIONS SHAFER: Dental caries is defined as irreversible microbial disease of the calcified tissues of the teeth characterized by demineralization of the inorganic portion and destruction of organic substance of the tooth. STURDEVANT: It is a localized post eruptive, pathological process of external origin involving softening of the hard tooth tissue and proceeding to the formation of a cavity. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  DEFINITIONS SIKRI: Dental caries is an infectious disease caused by imbalance of oral micro-organisms leading to acid production and subsequently dissolving the hard tissues of tooth. OSTROM: Dental caries is a process of enamel or dentin dissolution that is caused by microbial action at the tooth surface and is mediated by physiochemical flow of water dissolved ions. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  DEFINITIONS SELWITZ: Dental caries is a multifactorial disease that starts with microbiological shifts within the complex biofilm and is affected by salivary flow and composition, exposure to fluoride, consumption of dietary sugars and by preventive behaviours (cleaning teeth). However, it is mainly a disease that dates back to antiquity and has also occurred in populations that have never used sugar or processed foods. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  DEFINITION OF TERMS Attrition It is the physiologic wearing away of hard tissue of teeth due to tooth-to-tooth contact in functional occlusion. Abrasion It is the pathologic wearing away of hard tissues of teeth because of abnormal and mechanical forces. Abfraction It is a wedge shaped defect at the cement-enamel junction caused by deviated occlusal forces leading to tooth flexure, subsequently microfracture of cervical enamel and dentin. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  DEFINITION OF TERMS Demastication It is wearing away of tooth tissues during mastication of food Erosion It is the as the loss of dental hard tissues due to acids or chelation without bacterial involvement. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  DEFINITION OF TERMS The caries process and the associated terms Caries Process The demineralization and remineralization is a continuous process. A shift in the balance between protective factors and the destructive factors is the caries process. Arrest The demineralization process is stopped with no further loss of minerals from the active caries process. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  DEFINITION OF TERMS The caries process and the associated terms Caries Lesion/Carious Lesion This is a clinical manifestation of caries process. It is a detectable change in the tooth structure resulting from bacteria tooth interactions due to caries. Caries Lesion Severity The extent of progress of caries lesion towards pulp. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  DEFINITION OF TERMS The caries process and the associated terms Non-cavitated Lesion It is the one whose surface appears macroscopically intact Incipient lesion or initial lesion Cavitated Lesion The surface that is not intact macroscopically with distinct discontinuity or break in surface integrity PT-UDZ-001A; Revision 3.0.0; October 05, 2022  DEFINITION OF TERMS The caries process and the associated terms Active Caries Lesion The continuation of mineral loss over a period of time The lesion is progressing Inactive Caries Lesion (Arrested Caries) The lesion is no longer progressing The mineral loss is stopped after sometime PT-UDZ-001A; Revision 3.0.0; October 05, 2022  DEFINITION OF TERMS The caries process and the associated terms Caries Lesion Regression Replacing the loss of minerals affected during demineralization. Hidden Caries Lesion Lesions which are missed on visual examination, but are sufficiently demineralised to be viewed radiographically or detected by optical means. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  DEFINITION OF TERMS The caries process and the associated terms White Spot Lesion It is the initial, non-cavitated caries lesion, seen as white appearance on enamel surface. Brown Spot Lesion White lesions when acquire intrinsic or exogenous pigments appear as brown surface over the enamel. PT-UDZ-001A; Revision 3.0.0; October 05, 2022 ETIOLOGY PT-UDZ-001A; Revision 3.0.0; October 05, 2022  ETIOLOGY Bioanthropology: Study of the relation between disease, as well as social and environmental phenomena, enhancing the already strong connection between lifestyle and health conditions during history of humankind. Paleopathology: Study of dental diseases. PT-UDZ-001A; Revision 3.0.0; October 05, 2022 ETIOLOGY Broken Hill, Northern Rhodesia (Zambia) Oldest evidence of caries comes from a fossil found in 1921. Showed extensive dental caries and coronal destruction. Caries origin: interdental spaces PT-UDZ-001A; Revision 3.0.0; October 05, 2022  ETIOLOGY The Neanderthals: 230,000-30,000 BP Showed a high prevalence of enamel hypoplasias, antemortem tooth loss, periodontal disease and abscesses but dental caries is very rare among them. PT-UDZ-001A; Revision 3.0.0; October 05, 2022 PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Caries increase tendency seems to have been constant during the second half of the 19th century and the first half of the 20th century, worldwide. In 1970s, striking decline in caries experiences has been observed throughout industrialized countries. PT-UDZ-001A; Revision 3.0.0; October 05, 2022 Theories Of Dental Caries EARLY THEORIES ENDOGENOUS THEORIES EXOGENOUS THEORIES PT-UDZ-001A; Revision 3.0.0; October 05, 2022  EARLY THEORIES “The Legend of the Worm” Tooth worm Cause of dental pain Found in Sumerian text, writings of Homer Also been found in ancient India, Egypt, Japan, and China. Promoted by the Surgeon Guy de Chauliac still (300 AD) PT-UDZ-001A; Revision 3.0.0; October 05, 2022  EARLY THEORIES “The Legend of the Worm” Van Leeuwenhoek Observed three different worms from the extracted teeth. Tooth cavity “Hole” Similar worm hole seen in wood Common treatment for worms: Oil of vitriol (sulphuric acid) PT-UDZ-001A; Revision 3.0.0; October 05, 2022  ENDOGENOUS THEORIES 1. Humoral Theory 2. Vital Theory PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Endogenous Theories “Humoral Theory” Hippocrates (400 BC) and Galen (130 AD) Caries was due to humoral pathology. Suggested that dental decay was due to accumulation of certain juices in the tooth. Accdg. To Galen, “When the head becomes disordered in nature, it produces many excrements from which lesions of lower organs occurs.” Dental caries is produced by internal action of acid and corroding humors. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  ENDOGENOUS THEORIES “Vital Theory” Tooth decay originated from within the tooth itself like ‘gangrene’. Originated like bone gangrene from within the tooth itself. Proposed during 18th century until the middle of the 19th century. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  EXOGENOUS THEORIES 1. Chemical Theory 2. Parasitic Theory 3. Miller’s Chemico Parasitic Theory 4. Proteolytic Theory 5. Proteolysis – Chelation Theory PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Chemical Theory During early 19th century, Teeth were destroyed by unidentified chemical agent (acid) formed in the oral cavity. Robertson (1835) Acid was formed by fermentation of food particles around teeth. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Chemical Theory Ficnus (1847) Attributed dental caries to ‘denticolae’ Generic term for decay related micro-organisms. Leber and Rotenstein (1867) Presence of micro-organisms in caries affected teeth. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Chemical Theory Clark (1871), Tomes (1873) and Magitot (1878) Bacteria were essential for initiation of caries, although they suggested an exogenous source of acids. The tooth worm disappeared from the prevailing view and investigators recognized fungi and long leptirichia – type organisms on the tooth surface and within the carious lesion. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Parasitic Theory In 1843, Erdl described filamentous parasites in the membrane of tooth surfaces. He suggested that it was not the tooth worm but filamentous organisms on the tooth surface, which might have infiltrated into the tooth and produced dental caries. Infiltration and decomposition of enamel cuticle Dental caries Filamentous parasites dental caries PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Parasitic Theory Filamentous Parasites Tooth Structure Infiltration and Decomposition of Enamel Cuticle Dental Caries PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Miller’s Chemico Parasitic Theory It is a blend of chemical and septic theories which is hypothesized by WD Miller (1882). Dental caries is caused by acids produced by micro – organisms of the oral cavity. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Miller’s Chemico Parasitic Theory Dental decay is a chemicoparasitic process consists of two stages: 1. Decalcification of enamel and dentin a. Preliminary stage b. Results in its total destruction and the decalcification of dentin 2. Dissolution of the softened residue a. Subsequent stage b. Signifies total destruction PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Miller’s Chemico Parasitic Theory Two main factors were recognized in the caries process: 1. Quantity and quality of carbohydrates. 2. Acid producing oral micro-organisms. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Proteolytic Theory The proteolytic enzymes liberated by oral bacteria destroy the organic matrix of enamel resulting in loosening of apatite crystals with eventual loss of minerals. The initial attack on enamel is proteolytic rather than acidic. The gram-negative bacilli produce sulphuric acid during their invasion of organic pathway, subsequently destroying the inorganic minerals. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Proteolysis – Chelation Theory A simultaneous microbial degradation of organic components (proteolysis), and the dissolution of minerals of the tooth by a process known as ‘chelation’. The theory was based on the chemical aspects of chelation, with a little direct evidence of proteolysis-chelation as a mechanism in the caries process. It considers dental caries to be a bacterial destruction of teeth where the initial attack is on the organic components of enamel. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Other Theories Putrefaction Theory Few authors suggested putrefaction as the cause of dental decay. But the availability of skeletal remains and the evidence that putrefaction did no advance the dental lesion quickly dispelled the idea. Septic Theory Underwood and Milles (1880) hypothesized that acid capable of causing decalcification was actually produced by bacteria. They reported micrococci as well as other forms of organisms in sections of decayed teeth. PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Other Theories Diet Detergent Theory Wallace (1910) hypothesized that the fibrous part of diet acts as detergent, which leads to physical removal of substrate required for initiation of caries. 2 Categories of Food: Food that tends to leave viscous and fermentable carbohydrates Food that tends to brush tooth surface during mastication PT-UDZ-001A; Revision 3.0.0; October 05, 2022 CLASSIFICATIONS OF DENTAL CARIES PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Based on Location PITS AND FISSURE CARIES SMOOTH SURFACE CARIES ROOT CARIES PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Based on Extent of Caries Based on the Number of Surfaces Involved Incipient caries Simple caries Reversible Compound caries Cavitated caries Complex caries Non-reversible PT-UDZ-001A; Revision 3.0.0; October 05, 2022  Based on the Age of the Patient Based on Rapidity of Caries Nursing bottle caries Acute dental caries Adolescent caries Chronic dental caries Root caries Arrested dental caries PT-UDZ-001A; Revision 3.0.0; October 05, 2022 Based on the Treatment and Restorative Design (GV Black) PT-UDZ-001A; Revision 3.0.0; October 05, 2022 Based on the Treatment and Restorative Design (GV Black) PT-UDZ-001A; Revision 3.0.0; October 05, 2022