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CARIOLOGY
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2. OVERVIEW
Information in this unit will introduce dental caries and its relationship to Restorative Dentistry.
Preventive measures can affect the initiation of a lesion, but after a definite lesion is established preventive measures alone are usually inadequate to stop its development.
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3. OVERVIEW
Once a cavity exists on a tooth surface, restorative procedures are necessary to control the progress of the lesion.
A thorough knowledge of dental caries can help ensure proper identification and removal of the carious lesion.
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4. Bacterial Plaque
Colonies of bacteria always present in the mouth enter the acquired pellicle and adhere to the tooth surface.
This almost invisible mass of bacteria and matrix is known as bacterial plaque. Unless it is stained or very thick, it is difficult to detect.
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5. Bacterial Plaque
Colonies form as the bacteria multiply and grow. Maturation occurs within 8 to 24 hours after a thorough cleaning of teeth (brushing and flossing).
Once the colonies mature, bacterial plaque becomes harmful.
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6. Bacterial Plaque
The total metabolic activity of bacterial plaque is responsible for dental caries and periodontal disease.
Calcified plaque forms dental calculus.
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7. Bacterial Plaque
Bacterial plaque accumulates most readily on the surfaces of the teeth that are protected from the: 
mastication of food
movement of the tongue, lips and cheeks
preventive home care procedures
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8. Bacterial Plaque
The heaviest plaque deposits tend to occur on the buccal surfaces of the maxillary molars and the lingual surfaces of the mandibular molars
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9. Bacterial Plaque Factors that favor plaque accumulation include:
crowding of teeth
rough surfaces of teeth
rough or overhanging dental restorations
Deposits of calculus
teeth out of alignment or out of occlusion
a diet consisting chiefly of soft, sticky foods
poor oral hygiene
dry mouth (xerostomia = decreased amounts of saliva)
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10. Process of Dental Caries
Dental caries is an infectious disease (bacterial infection).
Dental caries is characterized by demineralization of the enamel, proceeding to the formation of open carious lesions commonly known as cavities.
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11. Process of Dental Caries
As the process may take many months or years, there is time for the initiation of the disease to be arrested or its progress slowed or halted if prevention or treatment begins early enough.
Unfortunately, the diagnosis of dental caries in its earliest stages could be imprecise.
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12. Process of Dental Caries
On many occasions, lack of diagnosis and treatment leads to penetration of the decay into the dentin and formation of a cavity.
Further advance of the lesion can produce inflammation, infection and death of the pulp.
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13. Process of Dental Caries
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14. Process of Dental Caries
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15. Process of Dental Caries
To summarize, there are four essential requirements for dental caries to occur:
a susceptible tooth
bacterial plaque
fermentable carbohydrates
Time
If plaque is not present, dental decay will not occur
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16. Methods of Dental Caries Detection
1. Visual
2. Tactile
3. Radiographic
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17. Methods of Dental Caries Detection
Visual
A clean, dry, well- illuminated tooth surface can be investigated visually with the aid of a mouth mirror.
Opacity or darkness of enamel surrounding a pit or fissure or overlying an interproximal area can indicates undermined or demineralized enamel
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18. Methods of Dental Caries Detection
Visual…
Color:
white or brown spots on smooth surface enamel
brown or black areas on exposed dentin
 Shadows:
enamel may not appear its usual colour when its translucency reveals changes in the colour and structure of underlying dentin
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19. Methods of Dental Caries Detection
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20. Methods of Dental Caries Detection
Tactile 
Softening of tooth structure at the base of a pit or fissure can be detected using an explorer
The use of the dental explorer is particularly useful for probing caries in proximal areas when lesions are advanced
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21. Methods of Dental Caries Detection
A lesion may be determined by pressing the point of an explorer into the gingival embrasure against the surface of the tooth just gingival to the contact area. If a defect is present, a slight catch or roughness can be felt.
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22. Methods of Dental Caries Detection
Gingival areas of all teeth may be chalky in consistency and rough to touch with the point of a sharp explorer. Softened enamel can be flaked away with an explorer.
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23. Methods of Dental Caries Detection
More advanced caries will exhibit a pull or resistance to removal, with moderate pressure, by an explorer. It is important, however, never to use a lot of pressure when probing with an explorer as this in itself can harm the enamel surface.
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24. Methods of Dental Caries Detection
Radiographic
Use of radiographs can confirm the presence of a carious lesion and give an indication of the extent of its progress
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25. Methods of Dental Caries Detection
Radiographic:
Interproximal decay at the gingival border of contact areas and dentinal caries below occlusal enamel are indicated by radiolucent (darker) areas on bitewing radiographs.
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26. Methods of Dental Caries Detection
Radiographic:
Any radiographic findings should prompt more careful clinical examination (visual and tactile) to verify the presence and extent of dental caries.
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27. Common Sites of Dental Caries
pit and fissure caries
smooth enamel surface caries
exposed root surface caries
Around existing restorations
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28. Common Sites of Dental Caries
Pits and fissures
They are the most susceptible sites.
They have a small site of origin, sometimes visible on the tooth surface.
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29. Common Sites of Dental Caries
Pits and fissures:
In a cross-section through the enamel, the appearance of an enamel lesion is V-shaped with the widest area of involvement at the DEJ.
After caries extends to the DEJ there is both lateral spread along the DEJ and extension pulpally.
A cross-section of caries in dentin is always V-shaped with its base at the DEJ.
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30. Common Sites of Dental Caries
Pit and fissure caries progress
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31. Common Sites of Dental Caries
Smooth enamel surfaces
The gingival border of the contact area on the proximal surfaces of teeth is most susceptible to caries because of the extra shelter this area provides for bacterial plaque.
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32. Common Sites of Dental Caries
Smooth enamel surfaces
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33. Common Sites of Dental Caries
Smooth enamel surfaces progress
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34. Common Sites of Dental Caries
Exposed root surfaces
Recession of the gingiva exposes the root surface to the oral environment and the accumulation of bacterial plaque.
c – exposed root surface caries
p - pulp c
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35. Common Sites of Dental Caries
Exposed root surfaces
Root caries originates on cementum which is mineralized to a lesser extent than dentin.
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36. Common Sites of Dental Caries
Around existing restorations:
A carious lesion that develops at this interface is called RECURRENT CARIES
Recurrent lesions may indicate an unusual susceptibility to caries attack, a poor cavity preparation, a defective restoration, or a combination of these factors.
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37. Common Sites of Dental Caries
Around existing restorations:
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38. Smooth Surface Enamel Caries :
Types of Dental CariesBased on Morphology, Depth and Severity of the Lesion
Smooth Surface Enamel Caries :
The earliest evidence of caries on the smooth enamel surface of a tooth crown is a white spot.
It is caused by the demineralization of the enamel in the presence of bacterial plaque.
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39. Common Sites of Dental Caries
Smooth Surface Enamel Caries:
White spot:
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40. Common Sites of Dental Caries
Smooth Surface Enamel Caries:
Incipient caries of enamel can remineralize; remineralization cannot repair a cavity (hole).
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41. Common Sites of Dental Caries
Smooth Surface Enamel Caries:
White spot lesions are undetectable on the proximal surfaces by visual, tactile (explorer), or radiographic examination
When the first radiographic evidence of a proximal lesion is seen in the enamel, the lesion is much further advanced and the underlying dentin has already been affected.
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42. Common Sites of Dental Caries
Smooth Surface Enamel Caries:
Sometimes a remineralized lesion appears as a brown spot.
Trapped organic debris and metallic ions are presumably the cause of the discoloration.
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43. Common Sites of Dental Caries
Smooth Surface Enamel Caries:
These discoloured, remineralized areas are more resistant to caries attack than unaffected enamel and should not be restored unless cosmetically unacceptable.
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44. Common Sites of Dental Caries
Pit and Fissure Enamel Caries: Occur on the bottom and sides of deep clefts so early white or brown spot lesions are not always easy to detect.
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45. Common Sites of Dental Caries
Pit and Fissure Enamel Caries:
Large lesions may be clinically visible due to a colour change to greyish opalescence resembling mother-of-pearl along the length of the fissure.
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46. Common Sites of Dental Caries
Dentinal Caries
spreads rapidly along the DEJ.
It is extremely important in restorative dentistry that the significance of this pattern of spread along the dentoenamel junction is understood.
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47. Common Sites of Dental Caries
Dentinal Caries
There is a danger that this lateral extension of decay may be overlooked after a cavity preparation is cut and enamel rods may not be supported by healthy dentin.
Unsupported enamel will fracture and affect the longevity of a restoration.
All enamel must be supported by sound dentin.
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48. Common Sites of Dental Caries
Dentinal Caries – spreads rapidly along the DEJ.
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49. Common Sites of Dental Caries
Dentinal Caries progression
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50. Common Sites of Dental Caries
Dentinal Caries –
The pulp and dentin should be considered as a single unit.
When dentin is cut, the cellular processes of the pulp are also cut. The response of the dentin to insult is based on the cellular activity of the pulp.
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51. Common Sites of Dental Caries
Dentinal Caries –
Long-term low-level stimulation (irritation) caused by slowly advancing caries results in sclerotic dentin.
Radiographically, sclerotic dentin is more radiopaque (lighter) than the surrounding unaffected dentin.
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52. Common Sites of Dental Caries
This triggers the formation of reparative dentin on the pulpal wall.
This layering of dentin is localized and usually irregular in structure.
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53. Common Sites of Dental Caries
Dentinal Caries –
Severe irritation overpowers dentinal defences and results in infection, abscess and death of the pulp.
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54. Common Sites of Dental Caries
Dentinal Caries – Severe irritation
Therefore, the dentin/pulp response is determined by the intensity of the stimulus and the adequacy of the pulpal blood supply.
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55. Common Sites of Dental Caries
Advanced Caries (Cavitation)…
The definite break in the enamel surface can be detected during careful examination with an explorer.
On smooth surfaces, this is easily detected by an explorer.
At the bottom of a pit or fissure, advanced tooth destruction may develop without any obvious clinical signs.
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56. Common Sites of Dental Caries
Advanced Caries (Cavitation)…
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57. Common Sites of Dental Caries
Advanced Caries (Cavitation
Clinically, enamel undermined by necrotic dentin is easily fractured away. 
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58. Common Sites of Dental Caries
Advanced Caries (Cavitation)
Superficial necrotic dentin is a wet, mushy, discoloured, easily removable mass
Deeper infected dentin is dry and leathery. It is easily removed by hand or rotary instruments and flakes off in layers.
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59. Common Sites of Dental Caries
Advanced Caries (Cavitation)
Further excavation will uncover harder and harder dentin.
If the lesion is progressing slowly, there will be a zone of sclerotic dentin below the demineralized dentin.
When this occurs, it represents the ideal excavation depth.
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60. Common Sites of Dental Caries
Advanced Caries (Cavitation)
Bacteria never penetrate as far as the advancing front of the lesion.
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61. Common Sites of Dental Caries
Infected/ Affected dentin:
Infected dentin is more superficial, softened and contaminated with bacteria.
Affected dentin is deeper, softened but not yet invaded by bacteria.
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62. Common Sites of Dental Caries
Infected/ Affected dentin:
Since it is clinically difficult to distinguish between these two types of dentin, it is important to remove all soft dentin from slowly advancing carious lesions
However, in rapidly advancing lesions removal of all soft dentin may risk pulp exposure and deliberate incomplete excavation of caries may be indicated.
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63. Common Sites of Dental Caries
Root Caries
Root caries is usually seen as a shallow, ill- defined softened area, often discoloured, and characterized by destruction of the cementum and penetration of the underlying dentin.
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64. Common Sites of Dental Caries
Root Caries
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65. Common Sites of Dental Caries
Root Caries
As it progresses, it extends circumferentially rather than pulpally and seldom produces cavitation.
Since the distance to the pulp is significantly less, the risk of pulpal involvement is significant.
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66. Types of Dental Caries Based on Rate of Progression
Rampant Caries :
a rapid carious attack involving several teeth including those surfaces that are usually caries free.
It generally occurs as a result of the frequent ingestion of sugar.
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67. Types of Dental Caries Based on Rate of Progression
Rampant:
Nursing bottle caries and nursing caries fall under this type.
It may also be the result if reduced salivary flow. Treatment of necessity involves dietary counselling.
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68. Types of Dental Caries Based on Rate of Progression
Chronic Caries
occurs in older teeth.
Penetration begins on a wide area on the enamel surface, with reduced involvement of the dentin.
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69. Types of Dental Caries Based on Rate of Progression
Chronic Caries
The decay process is slow because the large surface lesion becomes more cleansable and reparative dentin formation is good.
Pulpal exposure occurs at a later time as the lesion slowly progresses.
The dentin is usually dark brown and leathery.
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70. Types of Dental Caries Based on Rate of Progression
Arrested Caries
occurs when the factors that favour decay have been removed and demineralization is balanced by remineralization.
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71. Types of Dental Caries Based on Rate of Progression
Arrested Caries.
For example, interproximal decay may be halted if a tooth is removed and saliva is better able to cleanse the area and allow remineralization to take place.
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72. Dental Caries and Pain
Irritants that may initiate pain when tooth structure is affected by dental caries include: 
hot or cold air, liquids and food
sweet, spicy or acidic liquids and food
Pressure
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73. Dental Caries and Pain
When dental caries is confined to enamel no pain is usually felt.
Dependent on the amount of reparative dentin formed in response to dentinal injury, caries that has reached dentin may cause minor pain when irritated. This pain quickly dissipates when the irritant is removed.
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74. Dental Caries and Pain
Deep lesions may result in damage to the pulp tissue and may increase sensitivity to irritation that lasts long after the irritant is removed.
When dental caries results in pulpal death, pain may be constant if adjacent supporting tissues are infected.
Pain may also be absent if the infection has an area in which to drain.
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75. Dental Caries and Pain
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76. Determinants of Dental Caries (Risk Factors)
Rampant nursing caries
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77. Determinants of Dental Caries (Risk Factors)
Rampant nursing caries:
Milk is good for the health but the long exposition, when the baby sleep, to lactose, a sugar, will cause caries.
Its preferable that the baby drink water if he sleep with his bottle.
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