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. Remineralizations3. 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.