Current Concepts in Etiology of Caries

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
KEYES TRIAD
Interaction of 3 primary factors (Keyes,1960) Susceptible host
Cariogenic micro flora Local substrate
Caries Tetrology
Newbrun 1982
Time
The host-tooth
CompositionSurface enamel resistant More mineral Less carbonate & water MorphologyEnamel hypoplasia Deep fissures PositionAlignment
Microbiology of caries
Caries- infectious disease Streptococcus mutans Streptococcus sobrinus Lactobacillus acidophilus Actinomyces- root caries
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
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
Window of infectivity
Caufield,1993
19-31 months 6-12 years
Substrate (Diet):
Readily fermentable Sucrose (table sugar)- Arch criminal
Cariogenicity determined by
Frequency of ingestion
List of Food containing sugar
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
Physical form
Dried fruit and honey should not be eaten frequently Soft drinks, sport drinks and fruit juice
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
Suggest substitutes for food items
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
Environment:
Saliva Composition Flow rate Buffer capacity Dental plaque
De-mineralisation & Remineralisation:

Caries is a dynamic disease Loss of mineral replacement
Surface enamel functions as a diffusion matrix Normally equilibrium exists

Surface enamel functions as a diffusion matrix
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.
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
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
Thank You

Current Concepts in Etiology of Caries

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CURRENT CONCEPTS IN DENTAL CARIES

Virulence traits of S.mutans

lactic acid acetic, formic, propionic, butyric acids

List of Food containing sugar

Presence of other constituents

Isolate sugar factors

Suggest substitutes for food items

DETERMINE THE ADEQUACY OF DIET

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

De-mineralisation & Remineralisation:

Surface enamel functions as a diffusion matrix Normally equilibrium exists

Surface enamel functions as a diffusion matrix

Concept of critical pH (contd)

Concept of critical pH (contd)

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