Dental caries Aethiology • Infectious disease - Microbs - Fermentable sugars Antony van Leeuwenhoek First who observed microbs of oral cavity 17.ct 1889,,Die Mikroorganismen der Mundhöhle“,,,The MicroOrganisms of Human mouth“. Explained dental caries as a reslut of decalcification (acids from microbial metabolism) Willoughby Dayton Miller (1853 -1907) Green Vardiman Black (1836 – 1915) When we will well understand reasons of dental caries, we will be able to heal it. (G.V. Black 1900) Preparation • Preparation is an instrumental treatment of carious tooth that that leaves the rest of the tooth that is restorable, resistent and that prevent the origin of dental caries at the same surface. 1914 Microbiom Human body 1014 Living cells 10% Cells of human body Mikcobiom Oral microbiom Dental biofilm • Pelicle–Protective effect • Pelicle–monomolecular proteinic layer rich on prolin and phosphates and glycoproteins, sulphates • Bind to Ca2+ ions of enamel • Protective effect - Erosion ‐ Dentin hypersensitivity ‐ Key role by remineralization Biofilm • Adherence - Adhezins - Fimbries Biofilm - colonization ‐ multiplication ‐ koagregation Biofilm • Maturation lenka.roubalikova@tiscali.cz 13 Biofilm Higher metabolic activity Higher resistency (CHX 300x, AF 75x) Hihger virulency Good conditions for survival Cariogenicity • Streptococcs : mutans, sanguis, mitis, sobrinus. • Laktobacils • Production of acids (acidogenity) • ‐ Production of extra aand intracelullar polysacharids • ‐ Survival in acidic environment (aciduricity) Acidobasic dynamic in biofilm Glykolysis • Lactic acid and other acids H+ Base production Metabolism of proteins and NH4 • Sugars 20 – 40% - tendency to acid púroduction and decalfication Metabolic procedures in dental biofilm lenka.roubalikova@tiscali.cz 16 pH 0 50 min 5,0 Stephan Critical pH HA 5,7 FA 4,6 Mikrobs Hard dental tissues Sugar Time lenka.roubalikova@tiscali.cz 18 Ca2+ PO4 3- F- Ca2+ PO4 3- Ca10(PO4)6(OH)2 Ca10(PO4)6F2 OH- lenka.roubalikova@tiscali.cz 19 Decalcification Time Cavitated lesion Non cavitated lesion Biofilm Non specific hypothesis • Plaque is always the reason • Specific hypothesis • Only pathogenic plaque is the causal factor Saliva and dental caries 700 –80ml. (0,3ml), stimulated(1ml).0 • Product of salivary glands 700 – 800 ml/24 hours Rested (0,3ml(min), stimulated(1ml/min). Clearence - Microbs - Rests of food Saliva and dental caries Minerals • Calcium and phosphates – oversaturated solution: remineralization • Proteins • Glykoproteins ‐ pelicle, barrier against overgrowing of crystala on the surface Buffer capacity of saliva • Bicarbonate system • Phosphate system • In saliva not in plaque Slina • Key role in maturation of enamel • Remineralization of initial caries lesions Inicial lesion Superficial zone 5 % Body of lesion 25% Dark zone 2 –4% Translucent zone 1% Normal enamel 0,1%% Porosity Histology x mikroradiography x BW Diagnosis • Vizual inspection (ICDAS) • Radiography • Photography • Optical nonfluorescent methods • Optical fluorescent methods • Transilumination • Measurement of electrical impedancy Visual inspection, magnification, dry surface Photography • Good documentation and evaluation of lesion • Flash and light can misrepresent Radiography bite wing D1 – outer midle of enamel D2 – innervmidle to enamel – dentinoenamel Junction D3 – outer half of dentine D4 inner half of dentine Radiography Outer third of enamel Inner third of enamel Outer third of dentine Midle third of dentine Inner third of dentine Optical non fluorescent methods • Distorsion og lihgt (OCM) Non invasive, various results Optical fluorescent methods • Principle: Absorption and irradiation back • DIAGNOdent, DIAGNOdent pen, QLF, Vista Proof Infrared laser fluorescency • DIAGNOdent, DIAGNOdent pen Calibration, display • More than 24 (DIAGNOdent), more than 17 (DIAGNO dent pen) – caries • False poritive results – dental biofilm DIAGNODENT Quantitative Light – i n d u c e d F l u o r e s c e n c y QLF Vista Proof Vista Cam iX SoproLife FOTI – fibre optic transillumination Proximal caries lesion DIFOTI (D i g i t a l F i b r e O p t i c T r a n s – I l l u m i n a t i o n) DIAGNOCam • DIFOTI (Digital Imaging Fiber Optic Transillumination) • light(700‐1400nm) • Caries lesions and cracs–light absorption–dark spots • (higher content of mwater in caries lesions – higher absorption of light) • Documentation DIAGNOCam- klasifikace nálezu • 0 – • 1. DIAGNOCam- klasifikace nálezu • 2- caries in enamel • 3 - caries in enamel and dentin DIAGNOCam- klasifikace nálezu • 4 - kaz ve sklovině zasahující do dentinu – použít minimálně invazivní metodu • 5 – kaz rozšířený do dentinu – použít invazivní metodu DIAGNOCam Diagnocam Bitewing Transilumination using optical fibre FOTI • KaVo DIAlux probe – proximal caries • + higher sensitivity than x-ray - no sensitivity on secondary caries - no archivation Measurement of electrical resistancy Pit and fissure caries • Class I. acc. to Black Caries danger area Special morphology Special sructure of enamel Diagnosis ICDAS–INTERNATIONAL CARIES DETECTION AND ASSESMENT SYSTÉM ICDAS–INTERNATIONAL CARIES DETECTION AND ASSESMENT SYSTEM • ICDAS(2002)–6 code, later ICDAS –II –4code • 􀂃 Caries lesionsin pit and fissures, smooth surfaces, roots and enext to fillings –CARS (Caries Associated with Restoration and Sealants • Blunt probe • Clean and dry surfaces, time of observation 5 s • http://www.icdas.org/courses/english/index.html ICDAS Before assesment Clean and dry teeth surfaces Blunt probe 5 seconds observation ICDAS – criteria • 0 no changes observed ICDAS - criteria • 1.- first visual changes observed on dry surface only (opaque, white, brown) ICDAS - criteria • 2. – first visual changes on wett surfaces ICDAS - criteria • 3 – enamel is still present, zone of decalcification is out of fissure, dentin is affected ICDAS - criteria • 4 – dark colour around the fissure (grey, blue, brown), enamel can be broken ICDAS - criteria • 5 – cavitated lesion ICDAS - kritéria • 6 – large cavitation UniViss – universal scoring system (occlusal surface) UniViss (smooth surface) Classification acc to Black Classification acc to Black Classification acc to Black Classification acc to Black Classification acc to Black Classification of dental caries Mount and Hume • Location • 1.Occlusal • 2. Proximal • 3.Cervical • Size • 1.Small • 2. Medium • 3. Big • 3.Large