A SEMINAR PRESENTATION

ON

DENTAL CARIES
BY
BALOGUN, FOLASHADE
CHRISTIANA

OUTLINE
INTRODUCTION
CAUSES OF DENTAL CARIES
CLASSIFICATION
PATHOGENESIS
CLINICAL CHARACTERISTICS
EPIDEMIOLOGY
DIAGNOSIS
PREVENTION
CONTROL
CONCLUSION
REFERENCES

INTRODUCTION
Dental caries, also known as tooth decay or a cavity, is an
irreversible infection usually bacterial in origin that causes
demineralization of the hard tissues( Enamel Dentin and
Cementum) and destruction of the organic matter of the tooth,
usually by production of acid by hydrolysis of the food debris
accumulated on the tooth surface.
If demineralization exceeds saliva and other remineralization
factors like from calcium,fluoridated tooth pastes, these tissues
progressively break down, producing dental caries (cavities,
holes in the teeth).
Tooth decay is caused by specific types of acid-producing
bacteria that cause damage in the presence of fermentable
carbohydrate such as sucrose, fructose and glucose.
Cariology is the study of dental caries (Rogers, 2008).

CAUSES OF DENTAL CARIES

There are mainly four main criteria required for caries
formation:
A tooth surface (enamel or dentin)
Caries-causing bacteria e.g. Streptococcus mutans and
Lactobacilli.
Fermentable carbohydrate(such as sucrose), and
Time (Southam, 1993).

CLASSIFICATION

Caries can be classified by location, aetiology, rate of progression and

affected hard tissues. These forms of classification can be used to
characterise a particular case of tooth decay in order to more
accurately represent the condition to others and also indicate the
severity of tooth destruction.
Location: there are two types of caries when separated by locations.
These are: caries found on smooth surfaces and caries found in pit
and fissures (Schwartz et al., 2001).
Aetiology: caries are described in other ways that might indicate the
cause. These are: baby bottle caries, early childhood caries,baby
bottle tooth decay or bottle rot. It is a pattern of decay found in
young children with their deciduous baby teeth. The teeth most likely
affected are the maxillary anterior teeth, but all teeth can be affected
(American Dental Association, 2006).

CLASSIFICATION (cont)

Rampart caries may be seen in individuals with xerostomia,

poor oral hygiene, stimulant use (due to drug-induced dry

mouth), and/or large sugar intake.
Rate of progression: temporal description can be applied

to caries to indicate the progression rate and previous

history. Acute signifies a quickly developing condition,
whereas chronic describes a condition that has taken an
extended time to develop, in which thousands of meals and
snacks, many causing some acidic demineralisation that is
not remineralized, eventually results in cavities.
Affected hard tissues: depending on which hard tissues

are affected, it is possible to describe caries as involving

enamel, dentin or cementum (Sonis, 2003).

PATHOGENESIS
Mutans streptococci participate in the formation of biofilms on tooth

surfaces. These biofilms are known as dental plaque(s). Sucrose is

required for the accumulation of mutans streptococci. Also required
for this accumulation are the enzymes glucosyltransferases (GTFs),
which are constitutively synthesized by all mutans streptococci.
A: Initial attachment of mutans streptococci to tooth surfaces. This

attachment is thought to be the first event in the formation of

dental plaque. The mutans streptococcal adhesin (known as antigen
I/II) interacts with -galactosides in the saliva-derived glycoprotein
constituents of the tooth pellicle. Other moieties at the surface of
mutans streptococci include glucan-binding protein (GBP), serotype
carbohydrate and GTFs.

PATHOGENESIS (cont).

B: Accumulation of mutans streptococci on tooth surfaces in the presence

of sucrose. In the presence of sucrose, GTFs synthesize extracellular
glucans from glucose (after the breakdown of sucrose into glucose and
fructose), and this is thought to be the second event in the formation of
dental plaque. The mutans streptococcal protein GBP is a receptor-like
protein that is distinct from GTFs, and it specifically binds glucans. GTFs
themselves also have a glucan-binding domain and can therefore also
function as receptors for glucans. So, mutans streptococci bind preformed glucans through GBP and GTFs, and this gives rise to aggregates
of mutans streptococci.

C: Acid production by mutans streptococci. The metabolism of various

saccharides (including glucose and fructose) by the accumulated bacterial
biofilm results in the production and secretion of considerable amounts of
the metabolic end-product lactic acid, which can cause demineralization
of the tooth structure when present in sufficient amounts in close

FIGURE 1: molecular Pathogenesis of

dental caries associated with mutans
streptococci (Nature review

CLINICAL CHARACTERISTICS

The clinical characteristics of caries are more or less widespread

signs of demineralization of the enamel and infiltration of existing
feelings. The advance phases of the disease are frequently
associated with partial or total destruction of the crowns of the
teeth. An accurate analysis of the status of the caries is made
possible through X-ray.

During the first appointment, after the

clinical examination of the oral cavity and the radiographic

examination, the dentist formulates a diagnosis and defines the
treatment plan giving due consideration to two important aspects:

Caries activity, which refers to the process on an individual tooth

surface

Caries risk, which describes the genera status of the patient,

defined as the likelihood that the patient will contract new caries.

CLINICAL
CHARACTERISTICS(cont)
In defining
the individual risk factor of each patient, the dentist
assesses the teeth that are already decayed, missing, or filled
(DMF), the patients medical history and he may receive further
information following salivary tests.

The hygienist can help the dentist to effect these salivary tests,
which make it possible to assess:
The quantity of salivary flow in a unit of time
The buffer capacity of the saliva, which is its capacity to
prevent the process of demineralization and to promote the
processes of remineralization
The presence and the quantity of Streptococcus mutans and
Lactobacillus (American Dental Association, 2006).

PLATE1:DECAYED TEETH AND HOLE IN

TOOTH

EPIDEMIOLOGY
Worldwide, most children and an estimated ninety percent of adults
have experienced caries, with the disease most prevalent in Latin
American countries, countries in the Middle East, and South Asia,
and least prevalent in China.

In the United States, dental caries is the most common chronic

childhood disease, being at least five times more common than
asthma. It is the primary pathological cause of tooth loss in
children. Between twenty-nine and fifty-nine percent of adults over
the age of fifty experience caries.
Worldwide, most children and an estimated ninety percent of adults
have experienced caries, with the disease most prevalent in Latin
American countries, countries in the Middle East, and South Asia,
and least prevalent in China (World Oral Health Report, 2003).

EPIDEMIOLOGY(cont).
In the United States, dental caries is the most common chronic

childhood disease, being at least five times more common than

asthma.It is the primary pathological cause of tooth loss in
children. Between twenty-nine and fifty-nine percent of adults over
the age of fifty experience caries.
The most prominent characteristics of oral health in Africa are; low

to very low caries prevalence and severity with little increase, few
oral care personnel and an imbalance between personnel types
and population needs, rural and periurban communities without
basic care or with emergency care only, due to the high cost or
unavailability of other treatment, the low priority given to oral
health care due to the presence of several general health problems
and enormous development needs (Zadik and Bechor, 2008).

DIAGNOSIS
Primary diagnosis involves inspection of all visible tooth surfaces
using a good light source, dental mirror and explorer.
Dental radiographs(X-rays) ,may show dental caries before it is
otherwise visible in particular caries between the teeth.
Large dental caries are often apparent to the naked eyes, but the
smaller lesions can be difficult to identify.
Visual and tactile inspection along with radiographs are employed
frequently among dentists, in particular to diagnose pit and
fissures caries.
Early, uncavitated caries is often diagnosed by blowing air across
the suspected surface, which removes moisture and changes the
optical properties of the unmineralised enamel (Rosentiel and
Stephen, 2000).

PLATE 2: Visible and

radiographic diagnosis of caries

PLATE 3:
dental
explorer

PREVENTION
Oral hygiene
Personal hygiene care consists of proper brushing and
flossing daily.
The

purpose

of

oral

hygiene

is

to

minimise

any

aetiological agent of disease in the mouth.

Dietary modification
For dental health, frequency of sugar intake is more
important than the amount of sugar consumed.

In the presence of sugar and other carbohydrates,

bacteria in the mouth produce acids that can demineralize
enamel, dentin, and cementum.

PREVENTION(cont).

The more frequently teeth are exposed to this environment the

more likely dental caries are to occur. Therefore, minimizing
snacking is recommended, since snacking creates a continuous
supply of nutrition for acid-creating bacteria in the mouth.

Also, chewy and sticky foods (such as dried fruit or candy) tend
to adhere to teeth longer, and, as a consequence, are best eaten
as

part

of

meal.

Brushing

the

teeth

after

meals

is

recommended.
For children, the American Dental Association and the European

Academy

of

Paediatric

Dentistry

recommend

limiting

the

frequency of consumption of drinks with sugar, and not giving

baby bottles to infants during sleep (Rosentiel and Stephen,
2006).

PREVENTION(CONT)
Mothers are also recommended to avoid sharing utensils
and cups with their infants to prevent transferring bacteria
from the mother's mouth.
It has been found that milk and certain kinds of cheese like
cheddar cheese can help counter tooth decay if eaten soon
after the consumption of foods potentially harmful to teeth.
Other measures
The use of dental sealants is a means of prevention. A
sealant is a thin plastic-like coating applied to the chewing
surfaces of the molars (American Dental Association, 2006).

PLATE 5: A toothbrush for

cleaning teeth (Summit et al.,

 Destroyed

tooth

CONTROL

structure

does

not

fully

regenerate,

although remineralization of very small carious lesions may

occur if dental hygiene is kept at optimal level.
For the small lesions, fluoride Is sometimes used to

encourage remineralization.
For larger lesions, the progression of dental caries can be

stopped by treatment.
A dental hand piece (drill) is used to remove large portion of

decayed material from a tooth.

A spoon, a dental instrument used to remove decay carefully,

is sometimes used when the decay in dentin reaches near

the pulp.

CONTROL (cont).
Once the decay is removed,
the missing tooth structure
requires a dental restoration
of some sort to return the
tooth to functionality.
Restorative materials include
dental amalgam, composite
resin, porcelain and gold.

PLATE 6 : An amalgam used

as a decorative material in a
tooth (Disease control
priority project, 2006).

CONCLUSION
Dental caries is a disease that is common world wide. A
person experiencing caries may not be aware of the
disease especially when it is an incipent caries thus, it is
necessary to practice oral hygiene in order to avoid
accumulation of plaque on tooth surface which brings
about dental caries.

Already infected patients should visit dentists for

diagnosis to know the extent of caries and also the
necessary treatment required.

However, prevention is always better than cure.

REFERENCES
ADA Early Childhood Tooth Decay (2006). Baby Bottle Tooth Decay.
Hosted on the American Dental Association website.
Nature Publishing Group (2006). Nature reviews Immunology: Molecular
Pathogenesis of dental caries associated with Mutans streptococci.
Oral Health Topics: Dental Filling Options. hosted on the American Dental
Association website. Page accessed August 16, 2006.
Rogers AH (editor). (2008). Molecular Oral Microbiology.

Caister

Academic Press.
Rosenstiel, Stephen F. Clinical Diagnosis of Dental Caries: A North
American

Perspective. Maintained by the University of Michigan

Dentistry Library,

along with the National Institutes of Health,

National Institute of Dental

accessed August 13, 2006.

and Craniofacial Research. 2000. Page

 Schwartz,

R.B,

Summit,

James,

B.,

Robins,

J.

William

(2001).

Fundamentals of operative dentistry: a contemporary approach (2nd ed.).

Quintessence

Pub. Co. p. 30.

Sonis, Stephen T. (2003). Dental Secrets (3rd ed.). Philadelphia. pp.130.

Southam JC, Soames JV (1993). "2. Dental Caries". Oral pathology (2nd
ed.).

Oxford: Oxford Univ. Press.

Summit, James B., J. William Robbins, and Richard S. Schwartz.

"Fundamentals

of Operative Dentistry: A Contemporary Approach." 2nd

edition. Carol

Stream, Illinois, Quintessence Publishing Co, Inc, 2001,

p. 75.
The World Oral Health Report 2003: Continuous improvement of oral
health in
Health

the 21st century the approach of the WHO Global Oral

Programme, released by the World Health Organization.

Zadik Yehuda, Bechor Ron (2008). "Hidden Occlusal Caries - Challenge for
the Dentist. New York State Dental Journal 74 (4): 4650.