Transcript DENTAL CARIES DENTAL CARIES Chronic, painless slowly

DENTAL CARIES
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
dental caries are:
control
– 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.
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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.