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1、Dental Caries,Ouyang Yong Associate professor Department of Endodontics and Operative Dentistry Sun Yat-sen University,岳松龄 王满恩 史俊南 刘正 樊明文,李玉晶 王嘉德 周学东 高学军 凌均棨 刘天佳,学习龋病学需要了解的人,史俊南,刘正,樊明文,李玉晶,周学东,凌均棨,吴补领,高学军,Introduction,Photos of dental caries,Photos of dental caries,Photos of dental caries,Caries is
2、Latin for rot or rotten. Dental caries means rotten teeth. Caries is the noun which names the disease Carious is the adjective, not a caries, a carious area or an area of caries.,Dental caries can be defined as,Chronic progressive deconstructive disease of hard dental tissues Bacterial infected dise
3、ases caused by specific bacteria a reversible multifactorial process of tooth demineralization and remineralization.,Dental caries,Dental caries, a bacterial infection, may be define as a posteruptive pathological process of external origin, involving the softening of the hard dental tissue and proc
4、eeding to cavity formation. This is distinct from the dissolution of the hard dental tissues of an unerupted tooth which is not dental caries but tooth resorption.,The carious process,a pathological process of localized destruction of calcified tooth tissues by acids produced by organisms. Etiologic
5、ally caries is considered a multi-factorial disease, which involves interplay between the host (saliva and teeth) micro organisms (streptococcus mutans), and the substrate (dietary carbohydrate sucrose), with the production of Lactic acid. Dental plaque (Bio-film) serves as the medium for caries dev
6、elopment.,Basic pathological changes,demineralization of inorganic tissues of tooth Disintegration of the organic tissues of tooth involves enamel, dentin, cementum,Epidemiology of dental caries 流行病学,Prevalence rate（患病率）： is the proportion of a population affected by a disease of a condition at one
7、point time. Incidence（发病率）： is a mesurement of the rate at which a disease progresses the increase or decrease in the number of new cases occurring in a population within the same time period,Measuring caries activity,DMF index,D the mean number of decayed teeth with untreated carious lesions M the
8、mean number of teeth which have been extracted and are therefore missing F the mean number of filled teeth DMF(T) to denote decayed,missing, and filled teeth DMF(S) to denote decayed,missing, and filled surfaces in permanent teeth dmf(t) dmf(s) similar indices for the primary dentition,Frequency dis
9、tribution of dental caries according to various tooth location,permanent dentition,Deciduous dentition,distribution of dental caries according to tooth surface,Occlusal interproximal buccal,Caries is world wide in its distribution,The prevalence of dental caries increases with the development of eco
10、nomy High DMF before 1970 in the industrialized country To decrease after 1970 in the industrialized country More prevalence in industrialized than in the third word country Caries experience tends to increase in the developing country and decline in many western countries. Caries experience is high
11、er in urban than in rural communities in developing countries.,Prevalence of dental caries (1995)，special for 12-18Y age groupsis increased significantly （20-40%） In recent 10 years, prevalence of dental caries in primary dentition is increased significantly than the permanent,Why has caries prevale
12、nce decreased in modern population?,The is possibly attributable to The fluoridation of drinking water, use of fluoride toothpastes and improved oral health A changing pattern of sugar consumption A decrease in virulence(毒力) of the organsims,Aetiology of dental caries 龋病的病因学,The organic deposits on
13、the enamel surface,four factors is essential for the initiation of dental caries, namely:,Micro-organism mutans streptococci Lactobacilli Actinomyces,Substrate Refined carbohydrates(精制碳水化合物) such as sucrose蔗糖 provide a suitable substrate on which the cariogenic micro-organisms act to produce the aci
14、ds that lead to dissolution of the hard dental tissues Caries experience is influenced by the quantity, quality and especially frequency of consumption of the refined carbohydrate,Susceptible teeth易感牙 The ingestion of fluorides during tooth mineralization leads to the formation of fluor-apatite in e
15、namel. Its presence in enamel makes the tooth less susceptible to dental caries because it is less soluble in acid than the hydroxyapatite(羟磷灰石) which is normally present in the hard dental tissues,Time All the factors should be present for sufficiently long time for the caries process to be initiat
16、ed.,Definition:,Dental plaque（牙菌斑）,Classification of Dental plaque,supragingival plaque -dental caries subgingival plaque -periodontal diseases,STRUCTURE OF DENTAL PLAQUE,Plaque on smooth surface Plaque-dental surface Middle layer- condensed microbial layer body of plaque The surface layer of plaque
17、 Plaque in pit and fissure,Composition of Dental plaque,bacteria which form 50-70% of dental plaque a small number of epithelial cells Leukocytes Macrophages glycoproteins which, together with extracellular polysaccharides, form the plaque matrix mucopolysaccharides (粘多糖) such as glucans and fructan
18、s(右旋糖) Inorganic components calcium phosphorus fluorides .,MECHANISMS OF PLAQUE FORMATION,The attachment, growth, removal and reattachment of bacteria to the tooth surface is a continuous and dynamic process.,Several distinct processes can be recognized,Absorption of salivary proteins and glycoprote
19、ins, together with some bacterial molecules, to the tooth surface to form a conditioning film (the acquired pellicle). 获得性膜的形成 non-specific interaction of microbial cell surfaces with the acquired pellicle via van der Walls attractive forces.,Irreversible adhesion can occur if specific inter-molecul
20、ar interactions take place between adhesions on the cell surface and receptors in the acquired pellicle.,Secondary or late-colonizers attach to primary colonizers (coaggregation共集), also by specific inter-molecular interactions.,FORMATION AND DEVELOPMENT OF DENTAL PLAQUE,Formation of acquired pellic
21、le and primary aggregation Bacteria growth and development The mature of dental plaque,Development,Pellicle formation Microorganisms do not attach thermselves directly to the mineralized tooth surface and the teeth are always covered by an a cellular proteinaceous film, the pellicle Forms on the “na
22、ked” tooth surface within minutes to hours,Salivary glycoproterns Carbohydrates Lipid a lesser extent components from the gingival crevicular fluid(龈沟液),Major constituents of Pellicle,Because of its selective nature restrict transportation of irons in and out of the dental hard tissue. It may play a
23、n important modifying role in caries Provide further protection against demineralization of the enamel Modify the number of potential adsorption sites for different bacterial species As the substrate for the microorganisms,Function of Pellicle,microbial colonization,Initial microbial colonization st
24、reptococcus mutans(变形链球菌) accounting for 56% of the total initial microflora Actinomyces spp(放线菌) a minor proportion gram-negative bacteria(G-),Microbial succession,The initial establishment of a streptococcal flora appears to be a necessary antecedent for the subsequent proliferation of other organ
25、isms The most striking changed is shift from streptococcus-dominated plaque to plaque dominated by Actinomyces.,MICROBIAL AETIOLOGY OF CARIES,animal studies micro-organisms are involved in the aetiology of dental caries,cariogenic microorganisms,Streptococcus mutans lactobacillus Actinomyces,Carioge
26、nic properties (致龋菌的特性),they are able to produce acid rapidly from fermentable carbohydrates (acidogenic). They thrive under acid conditions (aciduric) able to adhere to the tooth surface because of their ability to synthesize sticky extracelluar polysaccharides from dietary sugars,Advanced lesions
27、often have a high proportion of lactobacilli dentinal lesions have a diverse micro flora with many Gram positive Gram negative bacteria. Root surface caries was originally associated with Actinomyces spp. but recent studies suggest a similar aetiology to enamel caries Rampant caries can occur in xer
28、ostomic patients and in infants fed with high levels of sugar in pacifiers (nursing bottle caries). The plaque contains high levels of mutans streptococci and lactobacilli.,Micro-organism and caries,Hypotheses and theory relating to Aetiology of dental caries,Chemico-parasitic theory (化学细菌学说),This p
29、ostulates that oral bacteria act on sugar to produce acid which demineralizes the inorganic component of enamel, resulting in the development of a carious lesion.,Proteolytic theory(蛋白溶解学说),It is thought that the organic component of enamel is first broken down by proteolytic enzymes, opening up pat
30、h-ways for bacteria to attack the enamel by other processes such as by acid or by chelation.,Chelation theory(螯合学说),This postulates that enamel is demineralized by chelating agents at neutral pH. Protein breakdown products as well as lactic acid are some chelating agents known to exist in nature.,Au
31、to-immunity theory,In this theory, it is suggested that forbidden clones of lymphocytes attack target cells (odontoblasts) rendering the tooth vulnerable to caries attack.,Four foctors theories,caries,The four circle diagrammatically represent the parameters involved in the carious process. All four
32、 factors must be acting concurrently (overlapping of the circles) for caries to occur.,The role of dietary carbohydrate,Nutrition - systemic dietary effects Diet - local dietary effects,Caries prevalence is low in populations adhering to a primitive way of living and a diet of local products with li
33、ttle sugar A drastic increase in caries is invariably seen when these population “improve”their standard of living and adopt a modern “civilized”diet with high sugar content A strong correlation between caries development and sugar consumption,epidemiological studies,Sucrose(蔗糖)-called the arch-crim
34、inal in dental caries Monosaccharides ,disaccharides and of the polysaccharide starch can be fermented to acid by the plaque bacteria Sorbitol（山梨糖） xylitol (木糖醇) -sugar substitutes used in sugar-free chewing-gums Dietary habits and caries prevalence,Host & tooth (susceptible teeth),It was a clinical
35、 experience that not all individuals with poor oral hygiene and frequent sugar consumption develop caries In the laboratory, extracted teeth exposed to the same acidic buffer challenge certainly do not develop artificatial caries-like lesions to the same degree within a short period of time,Tooth mo
36、rphology: susceptible sites Environment of the tooth: Saliva fluoride,Host & tooth,Tooth morphology bacterial plaque is an essential precursor of caries , sites on the tooth surface which favour palque retention and stagnation are particularly prone to decay Saliva under normal conditions, the tooth
37、 is continually bathed in saliva. It is capable of remineralizing the early carious lesion because it is supersaturated with Ca and P. when salivary buffering capacity has been lost, a low Ph environment is encouraged and persists longer Fluoride particular interest was the discovery of the associat
38、ion between fluoride concentration in water supplies and prevalence of dental caries in children,It is evident that the mere existence of the three factors operating together does not result in instantaneous mineral loss therefore a fourth circle is often added to stress the time dimension taken for dental caries to develop,Time,Other factors,Age Sex Geography Race Economics status Nutrition Health status,Thank you for your attention!,