‫بسم ال الرحمن الرحيم‬

Lec. Cons # 1
Wednesday24/9/08
Dr.zakrYA

1st of all I wanna say that it's my first lecture

and it’s a very easy lecture
U will see that all of information is repeated
from last year
Unfortunately doctor didn’t give us the slides
so I added few pictures from the internet

?Why do we restore teeth ♦

It’s a very important question you must know
to restore its function_1
to restore esthetic of the tooth_2
to restore integrity of tooth (keep the tooth_3
(as one unit
(to remove the disease (dental caries_4

There are four conditions that can♦

result in defective tooth structure
dental caries_1
trauma_2
developmental defects_3
(tooth wear (ex. Bruxism_4

♦Dental caries
Defined as: Posteruptive (very rare in
uneruptive teeth) pathological process of
external origin (not internal) involving
softening of the hard dental tissue and

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proceeding to cavitate the tooth (form a
(cavity in it

Epidemiology ♦
Dental caries more in industrialized than 3rd *
world countries (Love to eat chocolate and
(sweet things

Decay missing filled teeth (DMFT): the *

number of DMFT
In 3rd world countries (2)
in developed countries (5_2)
in Jordan (2.51)
In Saudi Arabia (2)

Water fluoridation decreases the *

prevalence of dental caries and there is
.evidence
Ex: ???? (sorry its not clear ) Population
produce water fluoridation and dental caries
incidence dropped to 50%
In Denmark it felled down from 6.4 in 1978 to
1.6 in 1988 because of water fluoridation

♦Dental caries
Any body who is willing to talk about caries *
should know about dental plaque
(Suitable carbohydrate (mainly sugar *
(Susceptible tooth structure (surface *
in time they should give dental caries *
These four factors if they meet together
provided with sufficient time the resultant is
for sure dental caries

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How to prevent dental caries ♦
Eliminate one of previous four factors so no
caries occur
Tooth: you can't remove the tooth

Carbohydrate (sugar): you can interfere with

it, don’t give the boy sweets so it's less likely
to develop dental caries in his teeth or
substitute the carbohydrate so it's less likely
to develop dental caries

How I am going to play around with time, if

you brush your teeth (leave the plaque for 24
hrs then brush… plaque is gone) you
eliminate the plaque other factors may be
there but they need time so there is no
dental caries

This is the famous circle*

Plaque

Susceptib
substrate
le tooth

time

Meeting point between all of these four

circles is caries if not meet there is no caries

♦ Signs of dental caries

opaque enamel surface_1

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rough tooth surface_2
sticky fissure_3
hole in a tooth_4

To examine dental caries I have to have ♦

light_1
dry field-2
explorer_3
All of these are requirements for the
diagnosis of dental caries

…The doctor show us a picture of a Fissure*

The bristle of the brush can't go in, so when
you brush your teeth don’t think that you
have eliminated the plaque of all surfaces of
the tooth, plaque may be inside this fissure
you can't remove

the Use of explorer ♦

You have to be careful when you use your
,explorer
If you have incipient lesions take the tip of
explorer of the explorer try to force it on, it
will be transfer from incipient to vast(not
sure) lesion
‫بواسطة‬incipient lesion ‫)بمعنى راح تكسر الغطاء القشره الموجودة على‬
(explorer

You have to use alight pressure when you*

use your explorer
?How do I determine the light pressure
Its just pressure enough to make your finger
(blanch (go white

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The uses of the explorer ♦
remove plaque_1
feel the surface of the tooth_2
see if the fissure is sticky or not_3

Remember sometimes the explorer are

misled because you have very narrow fissure,
when you insert the explorer in this very
narrow fissure it will stick because of its
anatomical configuration rather than because
of dental caries

Most susceptible surfaces to ♦

dental caries
enamel pits and fissures_1
approximal enamel smooth surfaces_2
enamel at cervical region_3
margins of restorations_4

Somebody who was genius in past and he ♦

was an oral pathologist classified for us
(dental caries (cavities
Class 1 caries on occlusal surfaces and
buccal and lingual pits of posterior teeth and
lingual pits of anterior teeth
Class 2 caries on approximal surfaces of
posterior teeth
Class 3 caries on interproximal surfaces of
anterior teeth (cuspid to cuspid) without
involving incisal angle

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Class 4 caries on interproximal surfaces of
anterior teeth involving incisal angle
Class 5 caries on buccal and lingual surfaces
not on pits
Class 6 caries on cusp tips
This is Black's classification of carious
lesion and still standing to this time

Carious lesion on the pits of palatal surfaces *

of central incisor its class 1 because it's on a
pit although it's on anterior teeth

Class 3

♦Classification according to the sites

Pits and fissure caries (from book: caries in_1
occlusal surfaces of molars and premolars and buccal and
lingual surfaces of molars and lingual surfaces of maxillary
( incisors

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Smooth surface caries (from book: occurs on the_2
approximal surfaces and on gingival third of buccal and
( lingual surfaces

Root caries_3

Advanced root caries

we don’t know if Caries properly started in -

crown then spread down to root, but there is
a combination of caries in crown and root

Recurrent caries around old fillings_4

There was carious cavity the dentist
removed it and filled it with amalgam, after 5
years he examine his filling and found that
there is now again dental caries
neighboring(beside) the filling

*:Look at this picture

there is caries beside amalgam

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the doctor show us a picture where there is
* broken
Amalgam filling because of advanced
recurrent caries

when there is Non cavitated carious enamel*

but you can see discoloration
?Do I drill it or not
You have to evaluate the other situations
inside the oral cavity if it’s a neglected
mouth do it if there is fine oral hygiene wait
for it(not do it) properly this is arrested caries

Classification based on extent of ♦

dental caries (how much the dental caries
(advances in tooth structure
Only in enamel (incipient):just in enamel,_1
there is no cavity
Enamel_2
Dentineal_3
Cemental (from book: occurs when the root surface_4
is exposed to oral environment as a result of periodontal
(disease

More advanced carious lesion the more it

approach the pulp

How do you know if caries only in enamel or *

dentine or approach the pulp? by taking x-ray

*Important note

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In clinic you can't work on class 2 without
having an x-ray you have to be able to see
what you are doing

We can read x-ray and determine the type of

*caries
a_ Enamel caries: radiolucency not reach DEJ
it's confined to enamel tissues

b_ Dentine caries: radiolucency reach DEJ or

in dentine

You can see a hole approach dentine this mean the caries
is already inside the dentine

c _ If It's at the border of DEJ radiographicly ,

be sure that histologicaly and clinically it has
penetrated definitely the dentine

d_ If you see no radiolucency at all then the

tooth is sound

there are a number of cases where the*

patient has a grossly carious lesion on
anterior teeth

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If you look histologically at the carious ♦
lesions you can see the surface zone and
body of the lesion
This is incipient lesion you can't detect it by
x-ray

If you do sectioning and look at it at the*

microscope level you will see the body of
lesion where mineral has been lost but the
surface zone is intact and there is no cavity
at all this is called subsurface lesion or
incipient lesion

Surface zone relatively is infected by carious*

attack the cause in enamel are low and
surface is in contact with saliva so its
hypermineralized, serve as a barrier to
bacteria and mineral lose is minimal just
1_2% of mineral of the tooth tissue

Look at the body of lesion mineral loss is*

about 25% so the surface zone is intact while
the body is not intact

Looking at the cause in the surface zone*

they are fewer and they are in the size lower
than the cause of the body of the lesion, also
we have dark zone and advanced translucent
zone
(From book these zones are confined to enamel caries)
Here doctor skip few slides, to more information about)
(these zones you can return to oral patho book page 26

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♦ Classification based on rate
Acute (rapidly progressing caries involving many or_1
(all of the erupted teeth
chronic (progress slowly and involves the pulp much_2
(than in acute caries
rampant_3
radiation_4
arrested (caries become static and show no tendency_5
(for further progressing
nursing_6

:look at this picture*

Rampant caries affecting all surfaces of the tooth_

When you are older than what you are now_

you get married and you get a baby and he
wake you up…. you take bottle put nipple in
sugar or honey and give it to him…. only one
month all his teeth destroyed because of
nursing bottles syndrome

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Management of dental caries ♦
History *

Clinical examination by visual and take file *

and doing Special investigations

Bitewing radiograph *

Show you the crowns of upper and lower teeth

periapical radiographs: show you the root*

and area around apex

(Fiber optic transillumination (foti *

THE END

;I would like to thank my lovely friends

ESRA2 '3ZLAN ( elskot b2tol bs elklam ma
3m nt5ylo… love u )ZAIN( 2keed mktob

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3leeke l2no mo 9odfeh wrak wrak…bs ya
( 7zek

MARAM BATIHA( kol she 2esmeh o n9eeb

wafre 27lamek lshe tane)RUBA( kteer heek
5leha bebalek el7yah fora9…thanks
'3lbtek)HEBA( lazem men hla2 tet3wde
(☺n9e7ah

.………… O kol 3am o ento b5air

RAWAN RAHHAL

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