TRAUMA FROM OCCLUSION

source – don’t remember, had written it long back.

Nutrition, Diet & Dental Caries

  • Nutritional effects – systemically
  • Dietary effects – Locally

Vitamin D :-

➡️ Vit. D along with Parathyroid hormones & calcitonin play primary roles in regulating the concentration of Calcium & inorganic phosphate in plasma & ECF and in controlling mineralization of bones & teeth.

➡️ Quantitive defect in enamel tissue from metabolic injury to Ameloblasts – ENAMEL HYPOPLASIA

Source: Google
  • Clinical Significance: Roughened surface with discrete pitting / circumferential band like irregularities which post eruptively acquire a yellow brown stain.

Carbohydrate intolerance & Dental Caries:

➡️ Intolerance occurs because of deficiency of a specific enzyme involved in metabolism of sugar.

Hereditary fructose intolerance: (Froesch,1959)

  • Inborn error of fructose metabolism transmitted by an autosomal recessive gene.
  • Episodes of pallor, nausea, vomitting, coma & convulsions following ingestion of fruit containing fructose/cane sugar.
  • ⬇️ Dental caries.

Diet Modification:

➡️ Dietary sucrose has 2 effects on plaque:

  1. Frequent ingestion – S. Mutans colonization ⬆️
  2. Mature plaque exposed to sucrose metabolizes to organic acids – ⬇️ pH

Dietary Measures:

Source: mfine
  1. No. of meals + snacks as low as possible.
  2. Sugars – eliminated; Active chewing foods ➡️ desirable
  3. Fermentable Carbs.
  4. Flouride, Calcium, Phosphate, fats & proteins – in diet.
  5. Sugar substitutes – ⬇️ acid formation.

Adequacy of Diet:

Source: mfine
  1. Fats, oils, sweets – use sparingly.
  2. Milk, yogurt, cheese group: 2-3 servings
  3. Vegetable group: 3-5 servings
  4. Fruit group: 2-4 servings
  5. Meat, fish, eggs, nuts: 2-3 servings
  6. Bread, Rice, Pasta, Cereal: 6-11 servings.

Anti-cariogenic foods:

Source: Foodsmix
  1. Milk – least cariogenic
  2. Cheese – casein phosphatase
  3. Fibrous foods
  4. Tea
  5. Chewing gum – Salivary stimulant
  6. Xylitol👇🏻
  • Bacteriostatic
  • ⬆️ salivary flow
  • ⬆️ concentration of Amino acids & NH3 – Neutralize plaque acids.
  • Prevents S. Mutans binding to sucrose.

➡️ Dietary and nutrition education appropriate for dental settings are an essential component of guidelines or standards of practice that determine successful management of dental caries and the patient’s quality of life accross time.

Nutrition, Diet & Dental Caries:
Dr. Mehnaz Memon

References: Practical manual guide by CM Marya, Internet

Pit & Fissure Caries

➡️ Morphology of Fissures:

Based on morphological alphabetical description of shape – 4 types:

  1. V + U (Self-cleansing)
  2. U
  3. K

Note: Pit & fissure with high steep walls & narrow bases are more prone to caries.(Developmental faults)

Occlusal fissures: Deep invagination of enamel, described as broad/narrow funnels, constricted hour glasses, multiple invaginations with inverted Y-shaped divisions & irregularly shaped.

Deep and narrow Pit & Fissure

⬇️

Retention of food debris & microbes

⬇️

Fermentation of food by microbes

⬇️

Formation of Acid

⬇️

Caries

➡️ The lesions develops from attack on their walls.

  • Cross section: Inverted “V” (A narrow entrance & wider involvement closer to DEJ)
  • Therefore, Greater no. of Dentinal Tubules are involved.
  • Early dentin involvement – When enamel at bottom of Pit & fissure is thin.

Caries when occur at Pit & Fissure follow direction of ENAMEL RODS

ENAMEL LAMELLAE – Initiation of Caries

The Initial Carious lesion of Enamel:-

• Clinical View:

  • Visual Changes – Chalkiness, yellow/brown/black discoloration.
  • Soft & ‘catch’ a fine explorer point.
  • Enamel bordering them is opaque bluish white & undermined ➡️ Lateral spread of caries at DEJ
  • Sign on stained tooth (Brown P/F)
  • Newly erupted teeth – underlying decay; Older: Arrested lesion

References: Wheeler’s Textbook, Google images