dental caries. chronic, painless slowly progressive and destruction of the enamel and dentin by the...
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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.