Factors needed cares initiation 4

populated by organism with receptors specialized for attachment to the surface of epithelium.

plaque at the dorsum of the tongue.

dominated the teeth normally have plaque community.

Health History Factors Associated with Increased Caries Risk 6

due to aversion to sweet foods

due to prolonged antibiotic therapy

due to high salivary pH

due to high salivary

due to delayed or retarded eruption with consequently increased time for enamel maturation before exposure to the oral environment

Possibly related to delayed eruption & inter-dental spacing.

Due to inter-dental spacing.

alteration in the enamel and an increased caries incidence.

Gross carious teeth are seen

gross carious tooth is one of the clinical features

The marked caries results from poor dental care resulting from a small mouth opening, misalignment of the teeth & mental retardation

Increased susceptibility to caries has been found

present in the oral cavity of almost all individuals.

also known as dry mouth,is dryness in the mouth, which may be associated with a change in the composition of saliva, or reduced salivary flow.

process of neutralizing any added acid (H+ ions) or base (OH- ions) to maintain the moderate pH, making them a weaker acid or base.

5 BUFFERING SYSTEMS

3 minerals

(a proline-rich peptide) stabilizes Ca and PO4 ions and prevents excessive deposition of the ions to teeth

Enhances post-eruption maturation of teeth Remineralizes demineralized tooth structures

substances is facilitated by the flushing action of saliva

Lubrication

5 Antimicrobial

Digestion

produces abundant quantities of watery saliva

produces more viscous saliva.

normal daily secretion of saliva

whole unstimulated saliva flow rate is approximately

Morphologic and Structural Characteristics of Teeth that Increase Tooth Susceptibility to Dental caries

3 Smooth enamel surfaces that shelter plaque

areas are protected physically and are relatively free from the effects of mastication, tongue movement, and salivary flow.

In 17 th and 18 th century,there emerged a concept that teeth are destroyed by acids formed in the oral cavity by fermentation of food particles around the teeth

Microorganisms were associated with the carious process

was the first well known scientist and investigator of dental caries and published his results in 1882.

Importance of Saliva in the maintenance of normal flora (4)

brownish discoloration of enamel term

Excessive fluoride exposure (10 PPM/ more) results in

Substantially reduce sucrose from diet Eliminate sucrose from between meal snacks

Rationale: Reduce number, duration and intensity of acid attacks. Reduce selection pressure for MS

Goal of diet counseling is to identify source of sucrose in the diet and reduce the intake of these foods

Bactericidal mouth rinses (chlorhexidine) • Topical fluoride treatments • Antibiotic treatment (vancomycin, tetracycline, polymyxin B)

Rationale: Eliminate MS from mouth

least resistance to caries attach and allows rapid lateral spreading once caries has penetrated the enamel.

Often painful or hypersensitive - soft, wet and light yellow - demineralization penetrates deep into dentin

- commonly without clinical symptoms - hard, dry, and dark brown - very similar clinical appearance as arrested caries lesions

change in color is presumambly due to trapped organic debris and mettalic ions with the enamel.

Clinically observed as intact, but discolored usually brown or black spots.

Caries lesion left behind in the preparation or at the enamel margin of a preparation when a restoration is placed

Lesions found adjacent to restorations

Lesions found in intact tooth surfaces

Type of caries according to extent 2

mineralization occurs after cavitations , the remaining exposed surface becomes harder and softer and often becomes dark brown/ black in color

In enamel, it has a dull, white, opaque appearance. In dentin, a soft, yellowish or light to dark brown discolorations of the demineralized tissues prevail.

Varied appearance, ranging from a shiny, white, opaque or discolored spot in the enamel to a hard, dark dentinal surface exposed to the oral environment

Soft, light- colored lesion

Fairly hard or leathery texture and highly discolored

Hard, shiny, smooth surface with brown- black discoloration

Zones 3 and 4 - not significantly discolored - feels hard already - capable of remineralization

Zones 1 and 2 - significantly discolored - can be removed by excavators - stained with caries detector - needs to be removed unless judged to be within 0.5 mm of pulp

NORMAL DENTIN Has a tubule with odontoblastics rocesses that are smooth and no crystals in the line. no bacteria in the tubules

SUB TRANSPARENT DENTIN Zone of demineralized (by acid from caries) of the intertubular dentin and initial formation of very fine crystals in the tubules and lumen at the advancing prone. Damage to the odontoblastic process is ended, however no bacteria are founf in this zone.

TRANSPARENT DENTIN Zone of carious dentin that is softer than normal dentin. Shows further loss of mineral from intertubular dentin and many large crystals in the lower of dentinal tubules

TURBID DENTIN Zones of bacterial invasion marked by widening and distortion of dentinal tubules w/c filled with bacteria. Dentin in this zone will not self repair.

INFECTED DENTIN Outermost zone of infected dentin Decomposed dentin that is teeming with bacteria. No recognizable structure to dentin, seems to be absent of collagen and mineral.

• It recognized clinically, as a wet, mushy, easily removable mass. • This is structure less/ granular in histologic appearance and contain masses of bacteria.