Etiology of Dental Caries

M.R.
AMBEDKAR DENTAL COLLEGE

AND HOSPITAL
DEPARTMENT OF PUBLIC HEALTH

DENTISTRY
TOPIC : ETIOLOGY OF DENTAL CARIES
AYSHIL MARY SAJI

Reg No: 15D3416
FINAL YEAR BDS
DENTAL CARIES
 The word CARIES is derived from the Latin
meaning ‘rot’ or ‘decay’.
 DENTAL CARIES is defined as a microbial
disease of the calcified tissues of the teeth
characterized by demineralization of the
inorganic content and dissolution of the organic
substance of the teeth .
SHAFERS
CLASSIFICATON OF DENTAL
CARIES
 According to location
- PRIMARY CARIES
a) Pit and Fissure caries
b) Smooth surface caries
c) Root caries
- SECONDARY CARIES
 According to direction
- FORWARD CARIES
- BACKWARD CARIES
 According to extent
- INCIPIENT CARIES (reversible)
- CAVITATED CARIES (irreversible)

 According to the rate of caries formation
- ACUTE (rampant) caries
- CHRONIC (arrested) caries

ETIOLOGIC FACTORS IN
DENTAL CARIES
EPIDEMIOLOGICAL TRIAD
 Dental caries is a multifactorial disease in which
there is interaction between three principle :
a) A Susceptible Host
b) Microflora with cariogenic potential
c) A Suitable local substrate
* In addition, a fourth factor TIME must be
considered.
 The concept of the interaction between these
factors are represented in ‘KEYES DIAGRAM’.
 All the factors must be present and must interact
for dental caries to develop.
A SUSCEPTIBLE HOST
 Host factors include :
- Tooth
- Saliva
- Age
- Gender
- Race
- Socioeconomic status
- Familial and genetic patterns
i) TOOTH
 The morphologic characteristics of tooth have been suggested
as influencing the initiation of dental caries.
 The morphologic features that contribute to the development
of caries is the presence of deep, narrow, occlusal fissures or
buccal and lingual pits.
 Such fissures tend to trap food, debris and bacteria and leads
to development of dental caries.
 Tooth position may also play a role in dental caries, seen in
malaligned, out of position or rotated tooth as they will be
difficult to cleanse and also favour food accumulation
Saliva
 Since the teeth are in constant contact with and
bathed in saliva this would profoundly influence
the oral health, including carious process.
 Saliva helps in removal of bacteria and food
debris from the mouth.
 The composition of saliva varies between
persons and concentrations of inorganic calcium
and phosphorous show considerable variation,
depending upon rate of flow.
pH
 The pH of saliva is determined mainly by its
bicarbonate concentration. Saliva pH increases
with flow rate.
 Saliva maybe slightly acidic as it is secreted at
unstimulated flow rates but it may reach a pH of
7.8 at high flow rates.
 The ability of saliva to neutralise acid, is also
contributed by salivary phosphate, salivary
proteins, ammonia etc.
Quantity
 The quantity of saliva secreted normally is 700-
800 ml/day. The quantity of saliva may influence
caries incidence as is especially evident as in
cases of salivary gland aplasia and xerostomia in
which salivary flow maybe entirely lacking.
Viscosity
 This has been suggested to be of some
significance in accounting for differences in
caries activity between different persons.
 High caries incidence is associated with a thick,
mucinous saliva.
ANTIBACTERIAL PROPERTIES
1.Lactoperoxidase
 These enzymes participate in killing microbes by

catalysing the hydrogen peroxide meditated
oxidation of a variety of substances in the
microbes.
 Lactoperoxidase has a high affinity for the
enamel surface and it forms an important defense
mechanisms limiting early microbial colonisation
of tooth surfaces.
2. Lysozyme
 It is a small, highly positive enzyme that
catalyzes the degradation of the negatively
charged peptidoglycan matrix of microbial cell
walls.
 In areas of large plaque deposits, a low local pH
may interfere with optimal lysozyme binding and
function.
3. Lactoferrin
 Its an iron binding basic protein, found in saliva
with molecular weight near 80,000.
 In oral cavity, it tends to bind and limit the
amount of free iron which is necessary for
microbial growth, thus this salivary protein is an
active defense mechanism.
4. IgA
 It’s a predominant immunoglobulin present in
saliva with concentration around 6%.
 It inhibits adherence and prevents colonization of
mucosal surfaces and teeth by organisms.
Other Host Factors
Age
 Age is directly and strongly associated with
prevalence of dental caries. Although considered
a disease of childhood, caries is at present viewed
as a lifetime disease.
 Enamel carries is more prevalent among young
people and root carries in the elderly.
Race
 Earlier it was thought that caries prevalence
varied in different racial groups. However, its
accepted today that there is no relationship
between race and dental caries.
Gender
 Prevalence of dental caries in children is higher
among girls compared to boys. This might be due
to early eruption of teeth among girls.
Socioeconomic Status (SES)
 It is inversely related to the incidence of many
diseases and to characteristics thought to affect
health.
 The filled component was higher in the higher
SES groups and decayed component was higher
in lower SES groups.
MICROFLORA WITH A
CARIOGENIC POTENTIAL
 A variety of microbial factors have been
associated with caries activity. Various
observations indicate a causal relationship
between Streptococcus mutans and development
of early carious lesion of enamel.
Role of microbes in caries:
 Microbes are a prerequisite for caries initiation.
 The ability of producing acid is a prerequisite for
caries induction, but not all acidogenic organisms are
cariogenic.
 Streptococcus strains that are capable of inducing
caries also synthesize extracellular dextrans and
levans.
 Organisms vary greatly in their capacity to induce
caries.
Role of Dental Plaque
 Dental plaque is a complex, metabolically
interconnected, highly organized, bacterial
ecosystem. It is a contributing factor to initiation of
carious lesion.
 The microbiology of dental plaque includes 3 groups
of microbes – Streptococci, Actinomyces and
Veillonellae – which are considered the chief
etiologic agent in dental caries.
SUITABLE LOCAL SUBSTRATE - DIET
 Diet is defined as types and amounts of food
eaten daily by an individual.
 The role of diet and nutritional factors deserves a
special consideration because of the often
observed differences in caries incidence of
various populations who subsist on dissimilar
diet.
Physical properties of food and
cariogenicity:
 The physical properties of food maybe significant
by affecting food retention, food clearance,
solubility and oral hygiene
 Properties that improve cleansing action and
reduce retention of food within the oral cavity
and increase saliva flow are caries preventive.
Physical nature of diet :
 Diet of primitive men consisted of a great deal of
roughage, which cleanses teeth of adherent debris
during mastication.
 In modern diet, soft refined food cling on to the
teeth and mechanical cleansing is required to
control the caries.
Carbohydrate content of diet:
 It is one of the most important factor in dental
caries process and one of the few factors that can
be voluntarily altered as a preventive dentistry
measure.
 They can be classified into – monosaccharides,
disaccharides, oligosaccharides and
polysaccharides.
 Sucrose which is a disaccharide is the major
cause of caries.
Vitamin Content of Diet:
 Vitamin A: It’s deficiency has definite effect on
developing teeth in animals.
 Vitamin D: Vitamin D is necessary for normal
development of teeth. Evidence shows that Vitamin D
supplements may reduce dental caries increment,
particularly in children who may not be receiving
adequate Vitamin D.
 Vitamin K: There are no known effects.
 Vitamin B Complex: Pyridoxine(Vitamin B6) is
known to act as an anti-caries agent as it selectively
alters oral flora by promoting growth of non-cariogenic
organisms which suppress cariogenic forms.
Mineral Content 0f Diet
 Calcium and Phosphorous : Disturbance in
calcium and phosphorous metabolism during
tooth development may result in enamel and
dentin hypoplasia.
 Fluoride : Fluoride in diet may not have a
significant effect on the tooth especially after
tooth formation . Topical application of fluorides
have a greater effect on caries prevention.
ENVIRONMENTAL FACTORS
IN DENTAL CARIES:
 Variations in dental caries has been identified
with latitude and distance from sea coast.
 UV light from the sun is known for its ability to
promote synthesis of Vitamin D and thus
sunshine is thought to reduce caries incidence.
 Thus closer to the equator a location resides,
more sunlight will the location receive thus
preventing caries.
REFERENCES
1. ESSENTIAL OF PUBLIC HEALTH

DENTISTRY –
SOBEN PETER 6TH EDITION
2. STURDEVANT’s ART AND SCIENCE OF
OPERATIVE DENTISTRY
THANK YOU

Etiology of Dental Caries

Uploaded by

Copyright:

Available Formats

Etiology of Dental Caries

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Etiology of Dental Caries

Uploaded by

Copyright:

Available Formats

M.R.

AMBEDKAR DENTAL COLLEGE

DEPARTMENT OF PUBLIC HEALTH

TOPIC : ETIOLOGY OF DENTAL CARIES

AYSHIL MARY SAJI

- CAVITATED CARIES (irreversible)

- CHRONIC (arrested) caries

 These enzymes participate in killing microbes by

1. ESSENTIAL OF PUBLIC HEALTH

You might also like