- Dental caries is defined as a chronic infectious disease which results from the demineralization of the inorganic portion and destruction of the organic portion of the tooth.
- Epidemiology of dental caries can be studied under the following heading: Host, agent and environment All these factors should react over a period of time for dental caries to occur.
- CARIES FORMATION
- Substrate (sugar) + microorganism (s.mutans in plaque) = lactic acid = causing demineralization
- Remineralization = fluoride, calcium, phosphate
- Fl = dentifrice
- Ca and PO4 = teeth and saliva
- HOST FACTORS
- TEETH
- 80% of caries occur on occlusal surfaces
- Lower incisors are the least affected teeth
- Malaligned rotated = bristles cannot reach and clean leading to increased caries
- Dentinogenesis and amelogenesis imperfecta = hypoplastic teeth and pitts = more prone to caries
- Caries is considered to be bilateral
- SALIVA
- COMPOSITION
- rich in calcium phosphate and fluoride = decrease in caries
- Rich in carbonate = increase in caries attack
- pH =
- unstimulated pH is slightly acidic
- High flow rate = pH increases
- pH of saliva = main is bicarbonate content
- Sialin, phosphate and ammonia = also determines pH of saliva
- QUANTITY
- Normal secretion = 700-800 ml/day
- Aplasia of glands and xerostomia = increase in rampant caries
- VISCOSITY
- Mucin responsible for viscous saliva
- Viscosity does not influence caries
- ANTIBACTERIAL PROPERTIES
- Lactoperoxidase = this prevents early microbial colonization of tooth
- Lysozyme = it is a positive enzyme that catalyzed the degradation of negatively charged peptidoglycans matrix of microbial cells
- Lactoferrin = iron binding protein = needed for microbial growth
- IgA = inhibits adherence and thereby prevents colonization on mucosal surfaces and teeth by organisms, facilitating their removal of swallowing
- COMPOSITION
- AGE = 3 peaks for caries development
- 4-8 years = manual dexterity is less
- 11 – 19 years = adolescents
- 55 – 65 years = root caries
- Gender = Reasons
- Early eruption of teeth
- More fondness of sweets
- Hormonal variations
- Morphological differences
- Familial hereditary
- Good or bad teeth seen in the family
- Morphology, occlusion, salivary flow
- Emotional disturbances
- Increase stress = decrease salivary flow = increased caries in oral hygiene is not followed
- Socio-economic status
- Low SES = increases decayed and increased missing
- High SES = increased filling
- Overall low SES = increase dental caries
- Reason = affordability for prevention and treatment
- Caries is considered as disease of poverty
- TIME FACTOR FOR DEVELOPMENT OF CARIES
- Peak susceptibility = 2-4 years after eruption
- TEETH
- Agent factors
- Diet
- Organisms = S.mutans = pioneer = acidogenic, aciouric, eat/consume sugar
- Extracellular = dextrans and fructans. Responsible for adhesion on tooth
- intracellular polysaccharide = glycogen
- Lactobacilli = secondary organisms, when caries have reached dentin. It kills all S.Mutans creates an environment of very low pH
- Veillonella = anti caries organism = consumes acid as food = produced by S.Mutans for demineralization
DIET OF DENTAL CARIES
- Diet = it is defined as type and amount of food eaten daily by an individual
- Nutrition = defined as seen of the processes by which an individual takes in and utilizes food
- Carbohydrates
- Organic compound containing carbon, hydrogen and oxygen
- Physical nature of diet = form, clearance, time, retention, oral hygiene
- Frequency of carbohydrate diet
- Types
- Monosaccharides = glucose, galactose, fructose
- Disaccharides = sucrose [ glucose+fructose]
- Polysaccharides = starch, glycogen
- Polyols of alcohol = xylitol, mannitol and sorbitol
Classification of sugars
Total sugars
- Intrinsic sugar
- Sugar molecules inside the cell
- Fruit and vegetable
- Extrinsic sugar
- Sugar molecules outsides the cell
- Milk sugar = found in dairy products = lactose
- Non milk sugar = honey, fruit juices, table sugar = responsible for the caries