Dental caries – A review Author: Professor Dr. Suhail Latoo Department of Oral Pathology and Microbiology, Government. Dental College, co Sgr author: Prof. (Dr.) Riyaz Farooq Head of the Department of Conservative Dentistry and Endodontics, Government. Dental College, Sgr. Dr Ajaz Shah A Professor and Head Department of Oral and Maxillofacial Surgery, Government. Dental College, Sgr. Dr. Amir Rashid Purra Department of Conservative Dentistry and Endodontics, Government. Dental College, Sgr. Rudra Dr Kaul Department of Conservative Dentistry Postgraduate Directory and Endodontics, Government. Dental College, Sgr. Dr. ullah Khateeb Shafait Endodontics Department of Conservative Dentistry & Government. Dental College, Sgr. Dr Shazia Qadir Department of Oral and Maxillofacial Surgery, Government. Dental College, Sgr. Dr. Babar Ali Shah Department of Oral and Maxillofacial Surgery, Government. Dental College, Sgr Dr Altaf H Malik Department of Oral and Maxillofacial Surgery, Government. Dental College, Dr Mubashir Mushtaq Sgr Dentistry Department of Endodontics & Conservative Government.
Dental College, Sgr. Dr Ali Aashiq Department of Oral and Maxillofacial Surgery, Government. Dental College, Sgr caries – a review Abstract caries is a pandemic disease that affects people of nearly all age groups. It is multifactorial, irreversible disease of microbial dental rigid network characterized by demineralization of the inorganic and organic material destruction of teeth, which often causes cavitation. It involves a complex and dynamic process with many factors that affect detection and disease progression. Although effective methods known for the prevention and management of dental caries, it is a major health problem for humanity, the activity continues throughout life despite treatment.
In this presentation we will discuss etiopathogensis, presentation, diagnostic tests and other treatments in dental caries. Introduction: Dental caries (caries) is one of the most common of all disorders, second in the common cold. This usually occurs in children and adolescents but can affect everyone. This is a common cause of tooth loss in young people.
Bacteria usually exist in the mouth. Bacteria convert food, especially sugar and starch into acids. Bacteria, acid, food scraps and spit in their mouths joined to form a sticky substance called plaque that stick to teeth. If plaque is not removed thoroughly and regularly, tooth decay will not only begin, but flourish. Acids in plaque dissolve the enamel surface of teeth and create holes in the teeth (cavities). Cavity is usually painless until they grow very large and affect nerves or cause a broken tooth.
If not treated, tooth abscess can develop. Untreated caries and destroy the internal structure of the tooth (pulp) and ultimately lead to tooth loss. The purpose of this review is to discuss etiopathogensis, presentation, diagnostic tests and other treatments in dental caries. Epidemiology: In the modern human population caries is the characteristic pattern. For all types of carious lesions, teeth most frequently affected, followed by premolars and front teeth later. Coronal caries is a disease of children, continued to increase to fifteen years or age, and then crashed in early adulthood.
This is more common in girls than boys, but earlier in girls at risk of tooth eruption puts more teeth. Root surface caries and approximal tooth surfaces, particularly affecting the cheek, but it is a disease of adults. Caries pattern similar to the members of one family over several generations, probably due to heredity, environmental factors such as dental care and diet also has a major role (Hillson, 1996). Etiopathogensis: dental caries caused by the interaction between oral bacteria access to the fermentation of carbohydrates and the teeth are vulnerable.
Currently the classical chart, which bears the name Stephen, showed a rapid decrease in plaque pH after a glucose rinse (Stephen and Miller, 1943). Decrease in pH resulting from fermentation of carbohydrates by certain bacteria plates. Gradual return of pH is the result of a buffer is present in plaque and saliva. Provided that the pH does not fall below 5. 3 enamel remains intact, but below the critical level of soluble apatite crystals. Fortunately plaque and saliva are saturated with calcium phosphate ions, so that if the pH is returned rather quickly during the fifth. Third level, the ions will return in the email and recrystallise. Remineralisation process takes much longer in the acid environment, but is quick email liquid is neutral or even alkaline.
Caries is unusual in the mouth and salivary glands near the mouth of the lower incisors when the teeth are always showered with buffer and calcium ion concentrations in saliva. If the total leakage of saliva can increase the chance for the safety of all teeth in the arch. Some foods like cheese stimulates saliva flow. Jenkins (1970) found that after eating cheese is not only a great way to end it, but especially both caries inhibitor. Sugar is also a good stimulator of saliva, but it certainly gives the most preferred nutrients for bacterial plaque.
However, sugar substitutes and no use of bacteria, saliva stimulants are also effective only as an act of chewing (Hector, 1985) so that the chewing gum, which is a biologically plausible artificial sweeter, but it actually has a role in stopping Caries (Kleinberg, 1985; Mäkinen et al , 1995). If the flow of saliva decreases, because every night the oral environment particularly susceptible to plaque acids. Sweets at bedtime, and thus have a greater impact on the acid at night than they do in the daytime. Stefan curve can be used to demonstrate the effect achieved by dental plaque pH after the second glucose rinse.
A plot of pH of plaque before and after the glucose rinse. In (a), the pH due to acid produced by bacterial fermentation of sucrose drops. At pH 5. 3 enamel began to dissolve. C(2), the pH increased because of buffering action of saliva and dental plaque. C (3), one side of the arch and scratched the pH rises to neutral value of 7. 0. C (4), glucose rinse plaque pH caused unbrushed two countries again fall below 5. 3. Drops on the same side brushed, but not at critical levels of pH (after Stephen and Miller, 1943) Decrease in plaque mass increase pH and reduce the breaking of the curve decreases after the second glucose rinse.
The mass of plaque bacteria can be reduced by as antibacterial mouthwash chlorhexidene (Joyston-Bechal et al, 1992). In short, there is ebb and flow of minerals from tooth enamel. Remineralisation of caries occur when the process is slower than the process of demineralisation and net loss of minerals in the environment. This can be prevented by restricting food intake of sugar and remove plaque, at least this is the method promoted by dentists in their own families (McDonald, Cowell and Sheiham, 1981).
This simple habit seems to have worked as a dental surgery children have fewer cavities than the general population (Ainamo and Holmberg, 1974). Diagnosis of caries: dental caries should be diagnosed and managed as a dynamic disease of enamel and dentin. Disease process begins when the surface of the tooth exposed acid produced by fermentation of carbohydrates on cariogenic bacteria. In an email, calcium and phosphorus released from the enamel crystals on the surface and sub-surface layer after oral fluid pH drops to less than 5. 5.
This loss usually occurs if the protection mechanism in the oral cavity is not sufficient to protect the email from the harmful effects of acid attacks frequently. If the loss of calcium and phosphate crystals from the continued, large areas of microporous develop. These areas are visually identified as “white spots” where the teeth are dried, or rendered visually, without drying microporous when a large area of developing enamel. If the lost tooth structure remains, the cavity develops. Roots, carious lesions are usually softened and beginning of yellowish dentin.
These characteristics result from the loss of organic and inorganic components of dentin on the roots. The purpose of examining a patient for the presence of dental caries is to detect early signs of this disease in the email and the root surface. If found early signs of demineralization, reverse the counseling of patients and prophylaxis of caries process. Early enamel caries: enamel almost entirely of heavy minerals (96%) but only 87% mineral by volume. So 13% of space in the email is water soluble and insoluble proteins (Le Geros, 1991). Water and organic components of the enamel allows the distribution of ions in plaque and saliva and email. Mineral part of enamel consists mainly of two varieties of biological apatite. An email early lesions observed in polarized light revealed four distinct zones of mineralization.
In an email early lesions consist of four zones with different levels of mineralization. This illustrates the dynamic nature of the caries process. The surface area of the block of calcium ions in the body of the lesion and can be removed in order to harm arrested (after Kidd & Joyston-Bechal, 1987). both the external surface area by ion replacement mineralization of plaque and saliva. But it’s bad body lesion mineralization. Deep in the lesion body, dark areas represent the remineralisation few, and the deepest area is again demineralized (Kidd and Joyston-Bechal, 1987). This region describes the dynamic sequence of events that have occurred in the early lesions. Caries not only demineralisation process continues. There is sufficient evidence that the initial lesion and the enamel can be reversed if the data remineralised deleted. email Arrested lesions are often seen in the interproximal surface of extracted teeth for some time after the neighbors. Just make the area more self cleaning helps reduce plaque mass.
Fluoride accumulates in remineralising emails make email more resistant to acid attacks. In such an artificial caries lesion, the components of milk (high in calcium and phosphate ions) capable of diffusion within the lesion (Mor and Rodda, 1983). However, sometimes the lesions progress, despite the presence of calcium and fluoride ions. Robinson et al, (1990) show that this is probably due to constraints on surface area, which limits the movement of calcium and fluoride ions in demineralized zone. These barriers may be due to the entry of the space between the crystalline enamel with salivary proteins. Mineral substitutes that do not get to the damaged site, but if the enamel surface treated with an agent-proteinising December, remineralisation occurs more easily.
Remineralisation can be achieved by removing the surface area of these early lesions. This course is de-proteinising exploded from the surface, but there are indications that tooth wear can be substantially capture the process of enamel lesions. If white lesions returned to normal after removal of an email search or orthodontic bands or etching acids for use seems to weaken the enamel crystals with food and brushes (Holmen, Thylstrup and Artun, 1987). It is unlikely that the stain that was launched from the saliva of mineral crystal growth. In fact, precipitation of calcium phosphate crystal growth and can actually be inhibited by salivary proteins, statherin. Dentine caries: Although enamel caries is clearly a dynamic process, the process is very important in the sense that the reaction of living cells. Pulp and dentine has been really important network can be maintained. The relationship between the masses and promote the concept of dentin-pulp dentin as structural biology and functional units.
In the process of caries on dentin demineralisation involving mineral components and organic components from damage to collagen fibers. In the process of dentin caries on about two times faster in the email. Advanced lesions in carious dentin consists of two distinct layers with different chemical structure and microscopic (Daculsi et al, 1987). The outer layer is contaminated with bacteria that are mainly located in the tube. Denatured collagen fibers and matrix is not remineralised organic. Layer in the only infected but affected by plaque acid. Still contain high concentrations of mineral salts and can remineralised. Dentine caries consists of two main layers. In the outer layer of dentin was contaminated with bacteria. Both mineral and organic matrix has been lost and the dentin is desperately outdated.
In the deeper layer of dentin is affected by plaque acids demineralized. The number of colony-forming units (CFU) of bacteria decreased (approximately 100 times) Revenues affected cavity preparation in dentin. Damage to this layer is reversible if the metabolism of bacteria can be stopped. Translucent barrier (both minerals) dentine can be done before the disability forward. Reaction (secondary) dentin formed to protect the pulp from acid irritation (after Kidd & Joyston-Bechal, 1987). Dentine caries Microbiology: Although a large number of organisms isolated from dental caries are common and some unusual clan. The most frequently isolated from members of the streptococcal SP. and S. certain mutans in occlusal and smooth surface caries. Actinomyces sp. is the dominant species on the root surface caries (Calmes and Roth 1981). Deep dentinal caries showed the prevalence of Lactobacillus organisms with gram-positive rods and some other filaments. Kidd, Joyston-Bechal and Beighton (1993) take samples of carious dentin cavity during sample preparation and cultured for bacteria count. Since taken samples of dentin assessed whether mild, moderate or hard, wet or dry, light or dark. Significantly reduced the number of bacteria recovered as caries and hair becomes more difficult and the cavity becomes more.
Reduce the number of bacteria is not restricted, but the order of a hundred times smaller. There was no significant difference between the amount of cultivated organisms compared with the average hard dentin. Color samples are not related to the number of bacteria recovered. This means that after the removal of soft wet dentin, further removal of dentin stained solid media can not contribute to further reduction of the contaminated material. our traditional insistence that a cavity must be clean and hard, may not need to destroy materials and lead to tooth pulp exposure carious.
Questions immediately arise about the fate of small soft dentin if left behind, and whether it is a source of secondary caries. The study is the low end of the first signs of cavity aids are not always caused by cavity preparation is not complete. According Edwardsson (1987) left in the microflora recovery does not grow normally, although they can survive for several months. their survival is primarily affected by the size of the carious dentin was closed and the extent to which they are isolated from the oral cavity. Management: Traditional Test adequate caries removal during cavity preparation is to hear the sharp ring of the investigation on the hard floor dentin. Massler (1962) launched the idea that it does not need destructive and often can lead to exposure of the pulp cavity inside.
He believes that the soft dentin is not always infected, but can only be influenced by plaque acid. These prejudices are reversible and therefore can dentin remineralise, if given adequate protection. It offers a more conservative cavity preparation, which requires the elimination of only infected dentin, leaving a soft, but not infected, which is called dentin affected. remineralised affected dentin may be stopped if the acid. Although this idea is supported by experimental data Massler little, the idea of leaving the soft dentin, tooth and examined six weeks later, it is accepted.
This is somewhat noted that, within six weeks is too short to allow a significant proportion of other forms of dentine, but did not allow evaluation of the mass can be made (Schröder, 1985). Massler (1967) later claimed, with more evidence that the inflamed pulp to die one hand, and can be restored if the stimulus has been removed.He launched the idea that mass-reparative dentin has big power and should not be ignored in the management of caries.
Tags: Caries
