DENTAL CARIES

Chronic, painless slowly progressive and destruction of the enamel and dentin by the acid produced by plaques bacterial that ferments carbohydrates. Acid enhanced demineralization.

DENTAL CARIES The prevention and control of dental caries. The role of dietary factors, including minerals, vitamins trace elements, and carbohydrates on tooth formation and their relation to dental caries development have been discussed before.

Protecting the teeth One of the major to caries prevention to protect the teeth from the attack of acid which occurs as a result the fermentation of carbohydrates, these can be achieved by.

1. Fluoride Water fluoridation, salt fluoridation, fluoride containing tablet or gels all of these found to be capable of preventing caries in population or selected subjects.

People exposed to one part of a million of fluoride or more in their drinking water had fewer cavities than those who drink fluoride – free water. Field studying showed that fluoride reduces the incidence of caries in children by as much as 50 %.

These are means by which fluoride shows its cariestatic effect by: 1. Anti-acid 2. Remineralizations 3. Antibacterial 4. Inhibition translocation of sugar across the cell membrane into the cell.

Antacid (Resistant to acid attack). Conversion of hydroxyapatite basic component of enamel and dentin to flouroapatite. So the flouroapatite dissolve slowly in acid and becomes more resistant to acid attack.

Remineralizations of caries lesions Fluoride act as an enzymes inhibitor to prevent oral bacteria from converting carbohydrate to acid as a result they produce a remineralization of caries lesions by causing calcium phosphate to precipitate from a saturated saliva. In addition deposition of a mixture of fluoride containing salt in caries lesion.

Antibacterial (bactericidal) effect. Fluoride can acts as an antibacterial which decrease acid production by plaque bacteria by dissolving number of bacteria.

Topical application of stannous fluoride is more effective than the sodium fluoride. Application of fluoride phosphate mixture (1:23) topically to the teeth of children decreased caries from 30 to 70 %

2. Antimicrobial agents The relations between antibiotics and reduction of caries development have been observed in: 1.Animal supplied with antibiotics in their food and water 2.Patients receiving penicillin each day for rheumatic fever 3.Patients with chronic respiratory diseases.

Dental caries development reduced in all cases mentioned about than others who do not take antibiotic.

The cariestatic effects of large number of antibiotic have been studied including: Penicillin, kanamycin, vancomycin, auromycin, bacitracin, chloramphenicol, streptomycin and tetracycline.

Penicillin: is the most wildly tested as a caries preventive in man and animals. It acts in acidogenic gram positive (+) in particular streptococci bacteria that inhibit caries activity by decreasing the oral microbial flora.

Vancomycin: Is a cell wall inhibitor, act on gram positive (+) bacteria. It does not absorbed into the body, so it can be used as a topical anti-caries agent. It suppresses the levels of s. mutant on occlusal surfaces.

Generally. Penicillin has the most cariestatic activity. Chloramphenicol, streptomycin, and terramycin are moderately effective. Other antibiotics have slight effect.

Complications of antibiotics used for control dental caries are: – Prolonged treatment with penicillin eradicate gram positive (+) cocci, while encourage the gram negative (-) flora (E. coli, K.pneumoniae and P. aeruginosa in the mouth and upper respiratory tract). Also encourage Candida albicans.

– Oral intake of chloramphenicol and oxytetracyline can convert the intestinal flora to staphylococcus aureus which produce severe entiritis. – Development of resistant bacterial strains. Many oral and nasopharyngeal staphylococcus are resistant to penicillin. – Allergy to penicillin.

3. Topical antiseptics Cholorohexidine Used as a mouth rinse/mouthwash Antimicrobial against many organism including many members of the oral flora Studies in humans and animals showed that cholorohexidine mouth rinsing inhibit development of plaques.

Cholorohexidine side effect. Bitter taste. Staining of the enamel and the tongue. Development of resistant microorganism.

4. Enzyme preparation Enzymes that are capable of disrupting plaque have been studied. Dextranses disrupt the extracellular glucans, the important component of plaque. Therapeutic dentrifrices: Dentrificas were designed to maintain oral hygiene by cleansing the teeth and periodntrium by liquid paste and powder to prevent periodontal disease.

5. Immunization against caries S. mutant produce glucans from sucrose by the effect of dextransuxcrose (glucosyltransferase). Dextransucrose is a good antigen to be used in a caries vaccine.Antibody against this enzymes will inhibit glucan preparation.

When crude enzyme is injected in the salivary gland of rats and hamsters, a local protective secretory immune response is induced (active immunization). Caries immunization studies show that IgA antibody reveal protection against caries. Another type of caries immunization induce the passive transfers or direct suppling to the oral cavity of antibodies to bacterial.

7. Carbohydrate restriction Dental caries can be avoided by reducing sugar in diet or sweets between meals. Replacement of carbohydrates by proteins and fats can reduce dental caries.

Use non-carbohydrate sweetening materials or sugars. Substitute in food and drink, can reduce dental caries such as aspartame, this compound is 150 to 200 times sweeter than sucrose use in cold sweets, sugarless gums, drink mixes, coffee, tea.

8. Anti-carcinogenic effect of phosphate As mentioned dental cries decreased up to 70 to 90 % when phosphate increased in diet. Phosphate could buffer acid producers by plaque bacteria, affect bacterial metabolism.

Plaque bacteria Modify adsorption of proteins to enamel And alter adherence capacity of plaque bacteria.