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Dental Pulp-1.1 Caries-Overview of Caries
The temporary manifestation of dental caries is one of the symptoms after tooth decay. Caries is a bacterial disease that can trigger pulpitis, apical periodontitis, and even inflammation of the alveolar bone and jaw bone.
Edited at 2023-11-01 17:23:55
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- Outline
1． Caries – Overview of Caries
definition
A disease in which various factors, mainly bacteria, affect the chronic and progressive destruction of the hard tissues of the lower teeth.
Basic changes: demineralization of inorganic matter and decomposition of organic matter.
Clinical features: changes in color, shape and quality of dental hard tissue
Cause
dental plaque
definition
It is a thin, dense membrane composed of bacteria, bacterial products, and components from the host. It is a microbial environment for bacterial growth.
Dental plaque is the most important factor in the development of dental caries
Characteristics of cariogenic bacteria (cariogenic mechanism):
① It has strong adhesion to the tooth surface, easily forms plaque, and plays a role in plaque;
②Acidogenic and acid-resistant;
③Has the ability to synthesize intracellular polysaccharides and extracellular polysaccharides
Composition: Composed of bacteria and matrix
Formation process
acquired membrane-forming salivary proteins
Bacterial adhesion and aggregation
Plaque biofilm maturation
Film adsorption → bacterial aggregation → plaque formation → demineralization formation
Sugar + acidogenic bacteria → organic acid → demineralization
structure
Plaque-tooth interface (basal layer): acquired film
Middle layer: dense layer (cocci); plaque body (clump-like, palisade-like)
Plaque surface (wheat ear-like)
cariogenic bacteria
1． Streptococcus
Streptococcus mutans
Strong acidogenicity and acid resistance
The strongest ability to metabolize sucrose
Pit and fissure caries are the most common
Streptococcus sanguinis
One of the earliest bacteria to colonize tooth surfaces
Decrease in number as caries progresses
Streptococcus mitis
2. Lactobacillus
Dentin caries is most common
Increased numbers are not the cause of the onset of caries, but the result of their progression
3. Actinomyces viscosus promotes the colonization of Streptococcus mutans on the root surface, and may have an important synergistic effect on the formation of root surface plaque and the occurrence of root surface caries.
dietary factors
1． carbohydrate
1． The relationship between sugar consumption and the incidence of dental caries: positive correlation
2. Types of sugar: Sucrose has the strongest ability to cause smooth surface caries, and Streptococcus mutans has the strongest ability to metabolize sucrose.
3. The order of cariogenic bacteria: sucrose>glucose>fructose>maltose>lactose>starch>sorbose>xylitol
4. Eating frequency: positive correlation
5. Physical properties and intake methods of sugary foods Fine, sticky foods are highly cariogenic
2. Fluoride
1． Systemic effects
During the development period, stable calcium fluoride phosphate crystals are formed to enhance the acid solubility of enamel.
2. local effect
1． Reduces the solubility of enamel hydroxyapatite, improves crystal structure, and promotes remineralization of decalcified minerals
2. Inhibition of growth of enzymes and cariogenic bacteria in plaque bacteria
3. Release the adsorption of proteins and/or bacteria on enamel surface and reduce surface free energy
3. Phosphate
host factors
1． tooth
1． Tooth shape: The fissures and fissures of posterior teeth are places where microorganisms and food residues tend to stay, and are prone to caries.
2. Teeth composition
AB6 Maxillofacial surface O> Buccal surface B > Mesial surface D > Lingual surface L
CD6 maxillofacial surface O> mesial surface M > palatine surface P > buccal surface B > distal surface D
3. Dentition shape constant: lower 6> upper 6> upper and lower 7> upper and lower 5> upper 1> upper and lower 4> lower 1> upper and lower 3
4. Physical and chemical properties of teeth, degree of calcification, trace element content and other factors
2. saliva
Changes in saliva secretion, composition, buffering capacity and antibacterial system are closely related to the occurrence of caries.
3. whole body state
Insufficient systemic nutrition in childhood, resulting in deficiencies of calcium, phosphorus, vitamins, and protein and metabolic disorders, can seriously affect tooth development and mineralization, thereby increasing susceptibility to dental caries and significantly worsening the incidence of dental caries.
etiology of caries
1． chemical bacteriology
2. protein dissolution theory
3. Protein solubilization* chelation theory
4. Modern concepts of caries etiology: the tetrad of factors
5. Generalized ecological hypothesis of caries
pulp-dentin complex
1． definition
The dental pulp and dentin are closely related to embryogenesis and have interconnected effects in response to external stimuli. They can be regarded as a biological whole.
2. reactive dentin
When external stimulation is relatively mild, the newly formed dentin formed by primary odontoblasts corresponding to the damaged area
3. restorative dentin
When external stimulation is strong and lasts for a long time, more necrosis occurs in local odontoblasts. At this time, mesenchymal cells in the dental pulp differentiate into odontoblast-like cells and migrate to the damaged pulp. cavity wall, the dentin produced by its secretion
4. osteoid dentin
In the third stage, dentin forms too quickly and the matrix may contain cells, giving it a bone-like appearance.
1. Caries - clinical manifestations and classification of caries
Clinical features
1． color
1． Color change is the earliest clinically noticeable change in caries.
2. The longer the caries lasts, the darker the color of the lesion will be
3. white-yellow-brown-brown-black
2. shape
1． Substantial defect Caries
2. Caries are the most significant clinical feature of dental caries
3. Smooth surface caries: large mouth and small base
4. Pit and fissure caries: small mouth and large base
3. quality
1． The hardness of the tooth tissue decreases and the texture becomes soft (from hard to soft)
2. Infection and softening of carious tissue in the cavity is called putrefaction or caries
4. progressive development
5. Feeling changes
Teeth and locations where caries are common
1． Teeth prone to hair loss
1． Permanent teeth: lower 6>lower 7>upper 6>upper 7>4>5>8>upper front teeth>lower front teeth
2. Deciduous teeth: lower V>upper V>IV>upper front teeth>lower front teeth
2. Favorable surfaces and locations for teething
Maxillofacial surface>Proximal surface>Tooth cervical root surface>Labial/buccal surface
3. The most common age
Before 1.3 years old, adjacent surface of front teeth (diet)
2.3-5 years old: Pit and fissure caries on deciduous molars
3.8 years old: Proximal caries on deciduous molars (jaw bone development)
4. Adolescents: pit and fissure caries on permanent teeth and proximal caries on upper anterior teeth
5. Middle-aged and elderly root surface caries
clinical classification
1． Intrusion depth
1． Superficial caries
Caries lesions in the enamel or root surface cementum layer, caries plaque, early caries
2. Medium caries
The front edge of the caries lesion is located in the superficial layer of dentin, and the dentin is superficially caries.
3. deep caries
Progression of lesions into deeper layers of dentin
2. anatomical parts
1． Pit and fissure caries are common on the occlusal surface, chalky in color, ink-soaked, equilateral triangle, with a small mouth and a large bottom, from the side wall to the bottom of the hole.
2. Smooth surface caries are more likely to occur on the proximal surface. They are chalky, yellowish brown, inverted triangle, with a large mouth and a small bottom.
3. Root caries
4. Linear enamel caries An atypical caries lesion occurring primarily at the neoline, or more precisely the neozoon, of the labial surface of the maxillary anterior teeth.
5. Occult caries commonly occurs below and adjacent to molar fissures.
3. Progressive site
1． Chronic caries progresses slowly, and the carious tissue is dark brown, dry and hard, and is also called dry caries.
2. acute caries
1． More common in children or young adults
2. The disease progresses quickly, and the diseased tissue is lighter in color, brown-black, and soft and moist in texture. It is also called wet caries.
3. The pulp tissue does not have time to produce repairing dentin, and pulp lesions are prone to occur.
3. static caries
When caries develops to a certain stage, due to changes in the lesion environment, the hidden parts become open, the original pathogenic conditions change, the caries no longer progresses, and the damage remains intact.
Early caries occurs on the proximal surface after tooth extraction; the edge of the molar (occlusal) cavity has no enamel fracture and opening.
Color: yellowish brown; shape: shallow dish; texture: smooth and hard
4. special reason
aggressive caries
There are multiple teeth and multiple tooth surfaces in the mouth at the same time in a short period of time, especially the mandibular front teeth that generally do not suffer from caries. If caries occurs, the mouth will become dry after radiotherapy.
5. The relationship between the occurrence of lesions and previous dental treatments
1． Primary caries Caries that develop on untreated teeth
2. secondary caries
Definition: Occurs in treated teeth, around or within old restorations
a. Due to the rupture of the tooth group around the filling edge or cavity, a plaque retention area is formed
b. The restorative material is not close to the tooth tissue, leaving a small gap.
c. It develops later because the diseased tissue was not removed during treatment.
3. Recurrent caries on the untreated surface of the same tooth