CHAPTER II

DISCUSSION
A. Definition of Caries
Caries is a hard tissue of teeth (email, dentin, and cementum) which is
chronic progressive and caused microorganic activity in carbohydrates that can be
distributed is characterized by demineralization of hard tissue and followed by
damage to organic substances (Mansjoer, 2000: 151)
Dental caries or tooth decay is a disease in dental hard tissue which is
characterized by the broken of the email and dentin caused by the activity of the
metabolism of the bacteria in plaque that causes demineralization due to
interactions between the products of microorganisms, saliva and parts are derived
from foods and email .
In the 1960s by Keyes and Jordan (cit. Harris and Christen, 1995), caries
was stated as a multifactorial disease, that presence of several factors that cause
caries formation. There are three main factors that play a role, namely the host or
host factor, agent or microorganism, substrate or diet and time factor, which is
described as three overlapping circles. For caries process, the condition of each of
these factors must be mutually supportive, ie vulnerable hosts, cariogenic
microorganisms, suitable substrate and a long time.

B. Caries Process
The process of dental caries involves several factors that they dont stand alone but
cooperate with each other . For caries, requirements are needed, namely the
presence of susceptible teeth, the presence of acidogenic agents or bacteria, the
presence of cariogenic substrates and their interactions in sufficient time. An
explanation of the 4 important factors that interact with each other in the
formation of dental caries, is as follows:
1. Host or Host Factor

There are several factors that are associated with the tooth as a host to caries,
namely tooth morphology (tooth size and shape), enamel structure, chemical and
crystallographic factors. The morphology of each human tooth is different, the
occlusal surfaces of teeth have various curves and fissures with different depths.
Teeth with deep grooves are areas that are difficult to clean from attached food debris
so that plaque will easily develop and can cause dental caries.

Dental caries often occurs on specific tooth surfaces in both

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Milk teeth will easily experience caries on a smooth surface while caries in permanent
 teeth is found on the surface of the pit and fissure. Pits and fissures in posterior teeth
are very susceptible to caries because food scraps easily accumulate in the area
especially deep pits and fissures . In addition, rough tooth surfaces can also cause
plaque to adhere easily and help the development of dental caries.

2. Factor Agent or Microorganism

Microorganisms play a role in causing caries. Streptococcus mutcins and

Lactobacillus are 2 of 500 bacteria found in dental plaque and are the main bacteria
causing caries. Plaque is a solid mass that is a collection of bacteria that are not
calcified, adheres tightly to the surface of the tooth, resistant to rinse or soft tissue
physiological movements where these bacteria can multiply on a matrix that is formed
and is firmly attached to the surface of the teeth that are not cleaned .

Plaque will form on all surfaces of teeth and fillings, the best development in
areas that are difficult to clean, such as the gingival edge, on the proximal surface, and
in the fissure.

At the beginning of plaque formation, gram-positive cocci are the most

common types such as Streptococcus mutans, Streptococcus sanguis, Streptococcus
mitis and Streptococcus salivarius and several other strains. Streptococcus mutans is
recognized as the main cause of caries because it has acidogenic and asiduric
properties (resistant to acids).

The cariogenic bacteria will ferment sucrose into lactic acid which is very
strong so that it can cause demineralization.

3. Substrate

Cariogenic substrates or leftovers are in the form of sugars such as glucose

and fructose. Carbohydrates, which are a great source of energy for the human body,
are a source of glucose for oral bacteria, so that every time people eat they
automatically supply food for these bacteria.

S ubstrat or diet can influence the formation of plaque because it helps the
propagation and colonization of microorganisms that exist on the surface of the
enamel. In addition, it can affect the metabolism of bacteria in plaque by providing
the materials needed to produce acids and other active ingredients that cause caries.
 The role of food in causing caries is local, the degree of cariogenic food
depends on the component. Food scraps in the mouth (carbohydrates) are substrates
fermented by bacteria to get energy. Sucrose and gluose are metabolized in such a
way that intracellular and extracellular polysaccharides are formed so that bacteria are
attached to the tooth surface. In addition sucrose also provides energy reserves for
cariogenic metabolism. Sucrose by cariogenic bacteria is broken down into glucose
and fructose, further glucose is metabolized into lactic acid, formic acid, citric acid
and dextran.

The results showed that people who consumed a lot of carbohydrates,

especially sucrose, tended to experience tooth decay, whereas those on diets that were
high in fat and protein had little or no dental caries. This is important to show that
carbohydrates play an important role in caries.

4. Time

Besides these three factors, the development of dental caries is time

dependent. Caries is a disease that develops slowly and its activity runs gradually and
is a dynamic process characterized by periods of demineralization and
remineralization. In general, caries is considered a chronic disease in humans that
develops over several months or years. The length of time it takes for caries to
develop into a cavity is quite varied, estimated at 6-48 months. The speed of caries in
children is higher than the speed of adult tooth decay.

Interaction between host, agent and substrate factors will produce acid in
time -3 minutes. Acid produced will reduce the pH of plaque and saliva to be very
low or called a critical pH of 5-4.5. This condition will last until neutralized by saliva
with its flow and buffer ability within 10-30 minutes.