By the name of Allah Today we will talk about the etiology of dental caries, what causes .

dental caries; we have talked about this briefly in the introduction We will talk a little bit about different theories in the history of dental caries, what was thought about dental caries until our current understanding. We will go through some old theories about the etiology .of dental caries These are some of the theories about etiology of dental caries, of course there are some other theories but these are the main. They depend on the humans understanding of the causes of diseases, according to mechanisms they have in the investigation of disease one of them is dental caries-the development of understanding the disease .as a whole & the factors that causes and affects the disease We dont consider dental caries as a problem in the tooth alone; .we consider it as a disease affecting human beings in general :Any way these are some of these theories Worms Humor Vital Chemical * Parasitic * * Chemo-parasitic * * Proteolytic* * Proteolysis-chelating*

These theories are not applicable nowadays. Remember that they .are just theories explaining old thinking about causes of dental caries WORMS :)First one is worm (dedan They thought that worms can cause disease, and one of them is dental .caries, in other words they consider dental caries as a result of worms

This is called (legend of the worm) which came from ancient Sumerian text; they thought that worms is the cause of every disease & .related they toothaches to worms The early history of India, Egypt, and the writing of Homer also .make reference to the worm as a cause of toothache The great surgeon of the middle ages ( Guy de Cahuliac ) still .support the belief that worms cause dental caries HUMORAL THEORY Later on as they were thinking about the 4 elements that form human )body (blood, phlegm, black bile, and yellow bile .)dam, bal3am, 3o9ara sawda2, & 3osara 9afra2( = So the thought was that if there is imbalance between these 4 elements decay or any other disease may occur. Even Hippocrates the father of medicine believed in humeral theory in causing dental caries, although he believed that accumulated food debris in teeth can cause .dental caries VITAL THEORY :Another theory developed later on says that As gangrene that causes disease in bone develops from bone itself, .tooth decay may originate from within the tooth itself They mentioned in vital theory that decay develops from inside teeth itself but they didnt provide any further explanation about the .theory

CHEMICAL (ACID) THEORY Another theory developed after the development of chemistry in

17th & 18th centuries, which believes that teeth can be destroyed by .acids formed in oral cavity One suggestion was that putrefaction of protein give rise to ammonia ( this ammonia will be oxidized into nitric acid ( nitric acid will .affect teeth Other suggestion was that food in saliva, decomposes to form .sulfuric, nitric, or acetic acid ( these acids will cause dental caries Roberston in 1835 proposed that dental decay was caused by acid .formed by fermentation of food particles around teeth Fermentation was, at that time, considered to be a strictly non-vital process, so the possibility that micro-organisms were involved wasnt .yet recognized .This theory is called non-vital theory :In summary this theory says that Food debris may undergo fermentation by any way( this ( fermentation produces acids ( these acids will affect tooth causing )decay

PARASITIC (SEPTIC) THEORY Later on after was the discovery of microscopes, they discovered that .carious regions may contain some types of micro-organisms In 1843 Edrl described filamentous parasites in a membrane removed from teeth, so they came out with the parasitic theory, which says that .dental caries is caused by specific parasites A few years later in 1847, a physician called Ficinus observed .filamentous organisms in enamel cuticle and in carious regions .enamel cuticle ( surface protein membrane of teeth *

Dental caries was thought to develop as a result of the infiltration & decomposition of enamel cuticle, the interprismatic substance of .enamel, & then dentine Ficiuns was one of the first to recognize the presence of organic matrix in enamel, but the explanation of the mechanism by which micro.organisms caused decay was not attempted until later The Dr. said that all the previous information is to give you an idea about the development of etiology of dental caries, so understand that our .current understanding didnt come from nothing MILLERS CHEMICOPARASITIC THEORY After that they combined chemical & parasitic theories in :CHEMICOPARASITIC THEORY that says Micro-organisms in the mouth can work on food debris to form some kinds of acids that can cause decay; by causing dysfunction of the organic content of the tooth( then by the process of mastication caries form in enamel ( then when micro-organisms penetrate enamel into .dentine caries can occur in dentine The features of chemicoparasitic theory are present in slide 9 ** . page 5, go & read them

Although Millers chemo-parasitic theory aid in our knowledge of dental caries nowadays, there are many critique :Problems) with miller theory( It was unable to explain the predilection of specific sites on a tooth to .dental caries; he didnt explain how caries develop on smooth surfaces

He worked with mixed culture from saliva & with techniques that didnt attempt to ascertain types of organisms present ( he said that micro.organisms can cause caries BUT he didnt specify these micro-organisms The theory didnt explain why some populations are caries free, you see that some people dont develop caries but Miller was unable to explain .why As we said in the previous lecture (Classification of dental caries; that caries could be either active or arrested), some people develop caries in the middle < proximal surfaces > & these caries can be interrupted . arrested He believed that in some systemic conditions the inorganic salts within the tooth could be withdrawn & the organic- inorganic bonds could be weakened, but he didnt produce any experimental evidence that teeth are subject to some systemic influences( it is explained by the current theory that systemic disease can affect teeth, some teeth become more .resistant to caries than others

PROTEOLYTIC THEORY :Another theory is the photolytic theory which depends on .)Discovery that enamel is made up of protein (organic component The process of Proteolysis (degradation of protein in the tooth .)structure The surface coverings found on the tooth in grooves & pits are * organic , also enamel contains significant amounts of organic material ( proteolysis of organic material can lead to destruction of tooth structure, so proteolysis of organic component of the tooth can lead to liquefaction & depolymerization of organic component, this is the : opposite of our current knowledge We know that the 1st thing to happen is demineralization by an

.acid then the breakdown of the organic component PROTEOLYSIS-CHALATION THEORY :This theory combines Proteolysis ( degradation of proteins-1 Chalation ( compounds that are able to bind metallic ions (Ca, Fe, and -2 ).Cu.etc The resulting chalets are 1- non ionic Soluble ( make tooth more -2 .soluble :In other words First proteolysis acts on proteins organic material in the tooth & destroys them ( degradation of protein results in the break down of the mineral component of the tooth ( among these minerals is Ca which can, by chalation, form soluble compounds or non-ionic compounds that can .cause destruction of tooth structure & finally CARIES )Proteolysis ( demineralization ( caries( NOTE: Dr. said that the previous theories are not of that importance & asked us to read about them quickly at least to know that theres .proteolytic, parasitic etc .But she didnt say dont study them at all The most important part of the lecture is what is coming [current .]knowledge of dental caries CURRENT CONCEPT Current concept considers dental caries as a multifactor disease, meaning that it is not caused by a single factor, collection of factors .should exist in order to the occurrence of dental caries

Caries is a result of interaction between primary factors important in .the initiation & the progression of it MicrofloraAcidogenic bacteria that lives on tooth surface and cause plaqueHost patient -According to quantity, quality of saliva & Quality of tooth.DietIntake of fermentable carbohydrates especially saccharine.Time During which teeth is exposed to the inorganic acids .produced by bacteria .All of these factors should be available in order for decay to occur** .Presence of 1, 2 or 3 of these factors will not cause caries **

Previous studies & theories about dental caries lacked experimental evidence, but our current understanding of dental caries, .which is called acidogenic theory has been proven by experiments ESSENTIALITY OF ORAL BACTERIA They noticed that penicillin added to diet & drinking water of rats, reduces experimentally induced caries. This study provided evidence for ??the earlier assumption that bacteria are involved in caries.how They noticed that experimental rats that have penicillin in their food or water have reduced caries even if they were given cariogenic food, we know that penicillin is an antibiotic, so we understand that bacteria is involved in the etiology of dental caries and even a specific type of bacteria, because penicillin acts only on gram positive bacteria, so specific type of bacteria is essential for development of dental caries..(We will have a separate lecture about microbiology of dental .)caries the hypothesis that bacteria are responsible for initiation & ** progression of dental caries was clinched by Orland by germ free ?????animal studies. What do they do

They brought 2 groups of animals st one is germ-free means that they didnt come in contact with 1 bacteria at all ((these animals were born by cesarean 3maleyye .))8ay9areyye and then they were isolated in a bacterial-free place nd group of animals lived in normal conditions ((meaning they were 2 )) exposed to bacteria :Both groups were fed by cariogenic food, the result was that .Group # 1- germ free- didnt develop caries .Group # 2-control bacteria- developed caries CONCLUSION ( bacteriaoral bacteria-is essential in development of .dental caries

ESSENTIALITY OF LOCAL SUBSTRATE ) Substrate : carbohydrate ( cariogenic food The study which indicates that a local substrate is essential for the oral .flora to initiate dental caries, was tube feeding experiment They brought 2 groups of animals and gave them cariogenic food, 1st ** .)group was fed using stomach tube (not orally .nd group was fed orally2 Group # 1 didnt develop caries Group # 2 developed caries Conclusion: substrate (carbohydrates) is essential for development of .dental caries SECONDARY FACTORS In addition to the four major factors we talked about [microflora, host, substance, and time] there are secondary factors, these factors affect

rate of progression of dental caries, so absence of secondary factors will .not prevent development of dental caries :Examples of secondary factors ** Salivary composition - flow rate of saliva Oral hygiene - diet:Secondary factors affect one or more of the following ** .Increase or decrease the tooth resistance of dental caries ( Increase or decrease the quantitative & qualitative nature of the oral ( .microflora involved in dental caries .Increase or decrease the carcinogenetic of the local substrate ( SO secondary factors affect the main causes of dental caries Last thing to talk about is saliva :SALIVA is a secondary factor that has many functions, among them .Cleansing effect ( Buffering capacity: regulation of the pH ( Provision of an environment saturated with calcium & phosphate ( .Antibacterial action ( The last two slides will be discussed next lecture which will be on *** 26th of MarchSOOO ( On the 19th of March there will be no lecture

The EXAM will be on 16th of April END OF THE LECTURE I apologize 4 any mistakes Special thanks 4 all the lovely girls in group K27 . Special thanks & .respect 4 Mu3taz & Ayat 4 their hard work Ghada AL-Khatib