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1、EtiologyofDentalCariesThefourcirclesdiagrammaticallyrepresentthefactorsinvolvedinthecariousprocess.allfourfactorsmustactconcurrently(overlappingofthecircles)forcariestooccurMicro-organismshost&toothSub-stratecariestimenocariesnocariesnocariesnocariesH
2、ostfactor:salivaWhatissalivaheremean?a.majorsalivaglandsSalivaparotid,submandibular,sublingualb.minorglandc.gingivalexudateWhySaliva?AnimalexperimentsClinicalobservationsAnimalexperimentGroupNo.hamstersAvg.no.Avg.cariescariousteethscoreIntactsalivaryg
3、lands202.34.0Desalivated*1010.539.0*Parotid,submandibular,andsublingualglands.EffectofdesalivationoncariesinhamstersClinicalobservationsXerostomia:decreasedorlackofsalivarysecretionCause:therapeuticradiationsalivaryglandsdisorder(e.g.sjogrensyndrome)t
4、akingmedicineClinicalobservationCariesinapatientwithimpairedsalivaryfunctionasresultofradiationtherapy(courtesyofDrsJansmaandVissink,RUG,theNetherlands.Thecariesisdifferentfromcommon.Decayofferseenincervicalarea,arapiddemineralizationoverbroadsurfaces
5、withnocavity.thehugechangeinquantityofsalivaisresponsible.InxerostomiaTheamountofbacteriaThequalityofplaquechangeS.mutans,Lactobacillus,Yeast,ActinomyceS.sanguis,Veillonella,NeisseriaAcasereportDecayed,missing,andfilledteethpriortotheanticholinergicth
6、erapyobtainedfromthepatient’sdentalrecordsandroentgenographsFull-mouthroentgenographsofpatientshowingrampantcariesandpulpalinvolvementofmandibularanteriorteethDecayed,missing,andfilledteethofapatientwhoreceivedprolongedanticholinergictherapyforaduoden
7、alulcer.Notethesteepcariesincrement(DMFT27)thatoccurredduringthetimeofxerostomiaSalivarycompositionandcariesRelationshipbetweensalivarycharacteristicsandcariesprevalencePropertyRelationshipPropertyRelationshipFlowrate±pH-Buffercapacity+Ca-PO4-NH3-Amyl
8、aseViscosity-Urea-+positiverelation;±somerelation;-norelation.Whyflowrate?Flushingandneutralizingeffectreferedas“SalivaryClearance”or“OralClearanceCapacity”TheDawes(1983)modeloforalclearance.Salivaisproducedataratedependentontheconcentrationof
