Grace Gumuruh drg. MM.

, SpKG

Mini Lecture

is a microbial disease of the calcified

tissues of teeth, characterized by
demineralization of inorganic portion

and destruction of organic substance of

tooth

DEFINITION
is

a disease of microbial origin in

which the dietary carbohydrates are
fermented (glukosiltransferase
glukan) by the bacteria, forming an
acid which causes the
demineralization of the inorganic part
and disintegration of the organic part
of the tooth

Keyes Diagram
microorganism

carie
s

dental
susceptibl
e

diet

 Dental

caries has a multi-factorial

cause
Dental caries is an oral infection.
Dental caries is a dynamic process.
Dental caries can be modified by
protective factors.

Germ free rats that were fed high sucrose

containing diets did not develop dental caries.
When the same animals were infected with
specific strain of micro-organisms, caries
developed.
Experiments also document that micro-organisms
could be recovered from a carious lesion, isolated,
cultured, and used to infect caries- free animals,
resulting in caries.
Antibiotics have been shown to reduce the
incidence and severity of caries in experimental
animals.

 Bacterial-induced tooth
demineralization or cavitation
from imbalance between
risk factors and
protective factors over time
Harris and Christen ( Primary Preventive Dentistry, 1995),
Larsen and Bruun (Clinical Cariology, 1994)

Keyes Diagram
microorganism

carie
s

dental
susceptibl
e

diet

Bacteria plus food

makes the saliva
very acidic within
5 minutes

Demineralizati
on

Remineralizatio
n

Saliva is normal
30 minutes
after eating

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CARIES CONTROL

DENTAL
CARIES
Tooth

Diet

Age
Frequency
Morphology
Sucrose
Fluoride
Acidic F&B
White spots
Restoration,3 yrs
Enamel lesion
Dentinal lesion
Pulpal lesion
Filling
Dental appliance

Bacteria

Saliva

S. Mutans
Flow rate
Plaque
Viscosity
Brushing
Buffering
Flossing
Restoration

Remineralization

Demineralization

Cavity

Infrequent or inadequate tooth cleaning

Frequent meals and snacks
Large amount of decay causing bacteria
Deficient fluoride in saliva

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Clinical Correlation
of

ACCORDING TO THE PROGRESSION RATE

Acute caries

Active caries

Rampant caries
Chronic caries
Arrested caries
Secondary caries

Arrested caries

 GV

BLACK classification of caries:

class I , II , III , IV , V and VI
Rampant caries
Recurrent caries
Arrested caries
Root or cemental caries
Baby bottle caries

1.

Pit-and-fissure caries
develop initially in the
fissures of the teeth, but can
spread into the dentine

2.

Smooth-surface caries are

most common on interdental
surfaces, but can occur on
any smooth surface of the
tooth

3.

Root caries attack the

cementum and dentine,
which becomes exposed as
gums recede

Dental Caries

Enamel Caries

Smooth surface caries

Dentin Caries

Cementum Caries
(Root caries)

Pit and fissure caries

Primary Caries: lesions on unrestored

tooth surface
Secondary (recurrent) caries: lesions
that developed adjacent to a filling
Residual caries: demineralized tissue
that has been left behind before a filling
is placed

Active caries lesion:

progressive carious lesion

White spot caries: the first sign of a caries

lesion on enamel that can be detected with the
naked eye. Also known as initial or incipient
caries.

DX

ACTIVE

INACTIVE

COLOR

LIGHT

DARK

CONSISTENCY

MUSHY

FIRM

MOISTURE

WET

DRY

SYMPTOM

SENSITIVE

NONE

SHAPE

DEPTH>WIDTH WIDTH>DEPTH

Translucent
zone
Dark zone
Body of the
lesion
Surface
zone

 lesion that may

have formed
years previously
and then
stopped further
progression

multiple active carious lesions occurring in the

same patient

frequently involves surfaces of teeth that do not

usually experience dental caries eg, bottle or
nursing caries, baby caries, radiation caries, or
drug-induced caries.

Nursing caries

Drug induced caries

Radiation caries

 Mount and Hume(1998)

Defines the extent and complexity

of

a cavity and at the same time

encourages a conservative approach
to the preservation of natural tooth
structure.
Designed to utilize the healing
capacity of enamel and dentine.

Site 1 Pits, fissures and enamel defects on

occlusal surfaces of posterior teeth or
other smooth surfaces
Site 2 Proximal enamel immediately below area
in contact with adjacent teeth
Site 3 The cervical one third of the crown or
following gingival recession, the
exposed root

Site
Pit/fissure 1
Contact area
2
Cervical 3

Size
Minimal 1 Moderate 2 Enlarged 3 Extensive 4

1.1

1.2

1.3

1.4

2.1

2.2

2.3

2.4

3.1

3.2

3.3

3.4

Size1:Minimal involvement of dentin just

beyond treatment by remineralization
alone.
Size2: Moderate involvement of dentin.
Following cavity preparation,
remaining
enamel is sound, well supported by
dentin and not likely to fail under
normal
occlusal load.
The remaining tooth structure is
sufficiently
strong to support the
restoration.

Size 3: the cavity is enlarged beyond

moderate.
The remaining tooth structure is
weakened to the extent that
cups or incisal edges are split, or are
likely to fail or left exposed to
occlusal or incisal load. the cavity
needs to be further enlarged so that
the restoration can be designed to
provide support and protection to the
remaining tooth structure.
Size4: Extensive caries with bulk loss of
tooth structure has already occurred.

Bitewing foto

Periapical foto

The arrow points to incipient lesions on the mesial

of 36 and the distal of 35

Incipient
Moderate
Advanced

The bottom arrow points to a moderate lesion on

the distal of # 20. The upper arrow points to one of
several incipient lesions on the molar and
premolars.

Moderate lesion seen on previous film

Class III moderate lesion seen in the anterior

region

Advanced lesion identified by arrows.

Advanced lesions seen on previous film

Advanced lesion

Advanced lesion

Severe lesion

Severe Caries Lesion

Occlusal caries

Occlusal caries

Lingual caries (Cant tell whether its buccal or

lingual from one radiograph

Buccal caries with severe interproximal

caries on # 12

Root caries

Root caries

Recurrent caries

Recurrent caries

Recurrent caries