CARIES

1. Work in groups. Discuss on the relevance of the following key points.

Caries can be classified by location, etiology, rate of progression and affected hard tissues.
Caries is described in other ways that might indicate the cause. The Black classification is as follows:
  Class I – occlusal surfaces of posterior teeth, buccal or lingual pits on molars, lingual pit near
cingulum of maxillary incisors
 Class II – proximal surfaces of posterior teeth
 Class III – interproximal surfaces of anterior teeth without incisal edge involvement
 Class IV – interproximal surfaces of anterior teeth with incisal edge involvement
 Class V – cervical third of facial or lingual surface of tooth
 Class VI – incisal or occlusal edge is worn away due to attrition
Dental radiographs (X-rays) may show dental caries before it is otherwise visible, in particular caries
between the teeth.
Bacteria can penetrate the enamel to reach dentin, then the outer surface may remineralize, especially
if fluoride is present.

Vocabulary
bacteriostasis-  inhibition of the growth of bacteria without destruction;
bacterium /bækˈtɪəriəm/ (pl. bacteria /bækˈtɪəriə/- the simplest and smallest forms of life;
bactericidal [bækˈtɪərɪsaɪdl] - destroying bacteria;
Sjögren syndrome -a long-term autoimmune disease that affects the body's moisture-producing (lacrimal and
salivary) glands, and often seriously affects other organs systems, such as the lungs, kidneys, and nervous
system;
fluoride [ˈflʊəraɪd] - a compound of fluorine;
fluorosis [flʊəˈrəʊsɪs]- an abnormal condition (such as spots on the teeth) caused by fluorine (a nonmetallic
gaseous chemical element) or its compounds;
to overwhelm /ˌəʊvəˈwelm/- to have such a strong emotional effect on somebody that it is difficult for them to
resist or know how to react;
foul /faʊl/- dirty and smelling bad;
streptococcus /ˌstreptəˈkɒkəs/(plural streptococci/ˌstreptəˈkɑːkaɪ/-a type of bacteria, some types of which can
cause serious infections and illnesses;
lactobacillus/ˌlæktəʊbəˈsɪləs/-a type of bacteria that produces lactic acid;
lactic acid/ˌlæktɪk ˈæsɪd/-a substance that forms in milk that is no longer fresh and is also produced in the
muscles during hard exercise;
sarcoidosis |ˌsɑːkɔɪˈdəʊsɪs|-a disease involving abnormal collections of inflammatory cells that form lumps
known as granulomata.
lump /lʌmp/- a swelling (= an area that is larger and rounder than normal) under the skin, sometimes a sign of
serious illness;
granuloma (pl. granulomata) - a mass or nodule of chronically inflamed tissue with granulations that is
usually associated with an infective process.
attrition [əˈtrɪʃn]- a process of making something;
hydroxyapatite [haɪdrɒksɪəˈpɑːtaɪt ]-  a naturally occurring mineral form of calcium apatite [ˈæpətaɪt] (a
group of phosphate minerals);
varnish /ˈvɑːnɪʃ/- a liquid that is painted onto wood, metal, etc. and that forms a hard shiny surface that you
can see through when it is dry;
cingulum |ˈsɪŋɡjʊləm| - a girdle-like part, such as the ridge round the base of a tooth or the band of fibres
connecting parts of the cerebrum;
pit- a small shallow hole in the surface of something, especially a mark left on the surface of the skin by some
disease.

READING AND WRITING

 CARIES
Tooth decay, also known as dental caries or cavities, is the breakdown of teeth due to acids made by bacteria.
The cavities may be a number of different colors from yellow to black. Symptoms may include pain and
difficulty with eating. Complications may include inflammation of the tissue around the tooth, tooth loss and
infection or abscess formation.
The cause of cavities is acid from bacteria dissolving the hard tissues of the teeth
(enamel, dentin and cementum). The acid is produced by the bacteria when they break down food debris or
sugar on the tooth surface. Simple sugars in food are these bacteria's primary energy source and thus a diet
high in simple sugar is a risk factor. If mineral breakdown is greater than build up from sources such as saliva,
caries results. Risk factors include conditions that result in less saliva such as: diabetes mellitus, Sjögren
syndrome and some medications. Medications that decrease saliva production include antihistamines and
antidepressants. Dental caries are also associated with poverty, poor cleaning of the mouth, and
receding gums resulting in exposure of the roots of the teeth.
Prevention of dental caries includes regular cleaning of the teeth, a diet low in sugar, and small amounts
of fluoride. Brushing the teeth twice per day and flossing between the teeth once a day is recommended.
Fluoride may be acquired from water, salt or toothpaste among other sources. The earliest sign of a new
carious lesion is the appearance of a chalky white spot on the surface of the tooth, indicating an area of
demineralization of enamel. This is referred to as a white spot lesion, an incipient carious lesion or a
"microcavity".As the lesion continues to demineralize, it can turn brown but will eventually turn into a
cavitation ("cavity"). Before the cavity forms, the process is reversible, but once a cavity forms, the lost tooth
structure cannot be regenerated. A lesion that appears dark brown and shiny suggests dental caries were once
present but the demineralization process has stopped, leaving a stain. Active decay is lighter in color and dull
in appearance. As the enamel and dentin are destroyed, the cavity becomes more noticeable. The affected areas
of the tooth change color and become soft to the touch. Once the decay passes through enamel, the dentinal
tubules, which have passages to the nerve of the tooth, become exposed, resulting in pain that can be transient,
temporarily worsening with exposure to heat, cold, or sweet foods and drinks. A tooth weakened by extensive
internal decay can sometimes suddenly fracture under normal chewing forces. When the decay has progressed
enough to allow the bacteria to overwhelm the pulp tissue in the center of the tooth, a toothache can result and
the pain will become more constant. Death of the pulp tissue and infection are common consequences. The
tooth will no longer be sensitive to hot or cold, but can be very tender to pressure.
Dental caries can also cause bad breath and foul tastes. In highly progressed cases, an infection can spread
from the tooth to the surrounding soft tissues. Four things are required for caries to form: a tooth surface
(enamel or dentin), caries-causing bacteria, fermentable carbohydrates (such as sucrose), and time. This
involves adherence of food to the teeth and acid creation by the bacteria that makes up the dental plaque.
However, these four criteria are not always enough to cause the disease and a sheltered environment promoting
development of a cariogenic biofilm is required. The caries disease process does not have an inevitable
outcome, and different individuals will be susceptible to different degrees depending on the shape of their
teeth, oral hygiene habits, and the buffering capacity of their saliva. Dental caries can occur on any surface of a
tooth that is exposed to the oral cavity, but not the structures that are retained within the bone.
Tooth decay is caused by biofilm (dental plaque) lying on the teeth and maturing to become cariogenic
(causing decay). Certain bacteria in the biofilm produce acid in the presence of fermentable carbohydrates such
as sucrose, fructose, and glucose. Caries occur more often in people from the lower end of the socioeconomic
scale than people from the upper end of the socioeconomic scale. The most common bacteria associated with
dental cavities are the mutans streptococci, most prominently Streptococcus mutans and Streptococcus
sobrinus, and lactobacilli. However, cariogenic bacteria (the ones that can cause the disease) are present in
dental plaque, but they are usually in too low concentrations to cause problems unless there is a shift in the
balance.This is driven by local environmental change, such as frequent sugar intake or inadequate biofilm
removal (toothbrushing). If left untreated, the disease can lead to pain, tooth loss and infection.
The use of tobacco may also increase the risk for caries formation. Some brands of smokeless
tobacco contain high sugar content, increasing susceptibility to caries. Tobacco use is a significant risk factor
for periodontal disease, which can cause the gingiva to recede. The incidence of cemental caries increases in
older adults as gingival recession occurs from either trauma or periodontal disease. It is a chronic condition
that forms a large, shallow lesion and slowly invades first the root's cementum and then dentin to cause a
chronic infection of the pulp (see further discussion under classification by affected hard tissue) because dental
pain is a late finding, many lesions are not detected early, resulting in restorative challenges and increased
tooth loss.
2. Answer the questions
1. What is tooth decay?
2. What are the symptoms of tooth decay?
3. What is the cause of cavities?
4. What sre the risk factors?
5. What does the prevention of dental caries include?
6. What can dental caries include?
7. What mat the use of tobacco increase?
3. GAP FILL

factors, detection ,visible, structure, dentists, mirror, used, identify, explorers, cavity,
perforated, enamel, tooth, surface

The presentation of caries is highly variable, however, the risk (1)_______and stages of development are
similar. Initially, it may appear as a small chalky area (smooth surface caries), which may eventually
develop into a large cavitation, sometimes caries may be directly(2)________. However other methods of
detection such as X-rays are (3)_________for less visible areas of teeth and to judge the extent of
destruction. Lasers for detecting caries allow detection without ionizing radiation and are now used for
(4)_______of interproximal decay (between the teeth). Primary diagnosis involves inspection of all visible
tooth surfaces using a good light source, dental (5)__________ and explorer. Large areas of dental caries are
often apparent to the naked eye, but smaller lesions can be difficult to(6)_________. Visual
and tactile inspection along with radiographs are employed frequently among (7)__________, in particular
to diagnose pit and fissure caries. Early, uncavitated caries is often diagnosed by blowing air across the
suspect surface, which removes moisture and changes the optical properties of the unmineralized
(8)________. Some dental researchers have cautioned against the use of dental explorers to find caries, in
particular sharp ended (9)_________. In cases where a small area of tooth has begun demineralizing but has
not yet cavitated, the pressure from the dental explorer could cause a (10)__________. Since the carious
process is reversible before a cavity is present, it may be possible to arrest caries with fluoride and
remineralize the tooth (11)_________. When a cavity is present, a restoration will be needed to replace the
lost tooth (12)_______. At times, pit and fissure caries may be difficult to detect, these caries, sometimes
referred to as "hidden caries", will still be visible on X-ray radiographs, but visual examination of the tooth
would show the enamel intact or minimally (13)__________. The differential diagnosis for dental caries
includes dental fluorosis and developmental defects of the tooth including hypomineralization of the tooth
and hypoplasia of the (14)________.

4. Find the synonyms to the following words in the text: DENTAL CARIES AND PULPITIS
intake
caries
to start
to develop
because of
first of all
a wide-spread disease
to get into the pulp
 DENTAL CARIES AND PULPITIS
Modern science tells us that caries originates under the combined effect of microorganisms and sugar.
Bacteria absorb on the surface of the teeth due to the acid that occurs in saliva. Every bite of food containing
sugar gives the bacteria energy allowing them to multiply and start producing acids. The result is the
formation of cavities. The initial lesion of dental caries clinically is a white spot which may become stained
brown. Adults of all ages can suffer from tooth decay. Two of three cavities in people older than 50 involve
decay around fillings. Another type of tooth decay common in older people is root caries. Root caries
generally occurs in adults who suffer from periodontal disease, when the roots are exposed. As the root
surface is softer than the enamel the decay occurs more easily. A balanced diet that provides a sufficient
amount of proteins, carbohydrates, fats, vitamins, minerals and water is important for both dental and
general health. Other methods of dental caries control are: brushing teeth, fluoridation of water and early
restoration of carious lesions.
There are two broad classifications of tooth decay based on the anatomy of the tooth surface involved: pit
and fissure, and smooth surface. The pattern by which the spread of dental caries occurs as it enlarges and
deepens differs in these two types. Pit and fissure carious lesions begin in the depth of pits and fissures
which form from incomplete fusion of enamel lobes during tooth development and are nearly impossible to
keep clean. Fissures and pits are commonly located on the occlusal surfaces of posterior teeth (molars and
premolars), as well as on the lingual surface of maxillary molars, the buccal surface of mandibular molars,
and the lingual fossae of maxillary incisors, especially lateral incisors. In contrast to pit and fissure caries,
smooth surface carious lesions occur on the smooth surfaces of the anatomic crown of the tooth in the areas
which are least accessible to the natural cleansing action of the lips, cheeks, and tongue. The pattern of
spread within enamel for smooth surface caries is different from that for pit and fissure caries since it begins
as a relatively broad area of destruction just beneath the outer layer of enamel, but it narrows as it progresses
more deeply toward the dentinoenamel junction. Once it reaches dentin, however, it spreads out wider at the
dentonoenamel junction, just like pit and fissure caries.
Root surface caries is another type of smooth surface caries that occurs on cementum, most frequently in
patients with disease of the periodontium, patients with decreased saliva flow, or in older patients who have
had gingival recession which increases the potential for accumulation of caries-forming plaque on the
cementum of root surfaces. Treatment in these cases can include polishing the root, applying fluoride
(topical or fluoride containing varnishes), and keeping the roots clean through good oral hygiene.
In 1908, Dr. G.V. Black developed a comprehensive method of classifying carious lesions that has been
useful when describing specific principles of cavity preparation. The original classifications were G. V.
Black Class I, II, III, IV, and V. All pit and fissure type lesions are Class I, whereas Class II, III, IV, and V
caries are all smooth surface type lesions.
Diseases of the teeth develop primarily due to poor oral hygiene but the general state of health is also of
some importance. Depending on the state of the whole body diseases of the teeth may run a more acute
course and may quickly involve a number of teeth. Dental caries (tooth decay) and pulpitis are probably the
most common of all diseases of the highly developed countries. All groups of population can suffer from
tooth decay. The main causes of dental caries are poor oral hygiene, the character of nutrition (high
consumption of sweets), the temperature of the food and physiological state of the human body. The disease
begins with decalcification of the enamel and ends in destruction of the hard dental tissues. Carious lesions
usually occur in those parts of the teeth that cannot be well cleaned by a toothbrush, the molars being most
frequently affected. If caries is left untreated microorganisms can gain entrance into the pulp and cause its
inflammation (pulpitis). During pulpitis teeth are sensitive to chemical, mechanical and thermal stimuli.
Spontaneous severe pain is the most characteristic symptom of pulpitis. The pain may spread over the jaw,
ear or temple. It may be very severe and last for a long time. Pulpitis may result in gangrene of the pulp and
its decomposition. The treatment of pulpitis must consist in mortification and removal of the pulp tissue and
filling the tooth.
Tooth decay is an ongoing process that begins with plaque, a soft, transparent, sticky layer of harmful
bacteria that constantly forms in the mouth. Certain bacteria in plaque use the sugar and starches in the food
you eat to produce acids. The sticky plaque holds these acids on the teeth where they can destroy tooth
enamel. Each time acid is produced, it attacks the tooth enamel for about 20 minutes. Plaque is most harmful
when the bacteria have had time - about 25 hours - to organize into colonies. After repeated acid attacks, and
if plaque is not removed daily, the enamel eventually breaks down and decays. Once that happens, the decay
progresses inward to the centre of the tooth. If left untreated, the decay reaches the pulp of the tooth and an
abscess forms at the root end, causing pain.
The tooth will need endodontic (root canal) treatment. Without treatment, the tooth must be extracted.
Here are some warning signs of dental decay: a tooth that is sensitive to heat, cold or sweets; pain when
chewing; swelling or drainage at/or below the gumline; a brown spot on a tooth; a persistent pain in the
mouth or sinus area.
Dental caries is a disease of the calcified tissues of the teeth caused by the action of microorganisms on
fermentable carbohydrates. It is characterized by demineralization of the mineral portion of enamel and
dentine followed by disintegration of their organic material. As the disease approaches the pulp, it produces
changes in the form of reactionary dentine and pulpitis and may result in bacterial invasion and death of the
pulp. The infected necrotic pulp then produces further changes in the periapical tissues. On the other hand,
the disease can be arrested in its early stages since it is possible for remineralization to occur. In addition,
progress of the disease to a clinical cavity is not inevitable, and can be completely prevented by relatively
simple measures. Four factors are necessary to produce dental caries: dental plaque, carbohydrate,
susceptible tooth surface, time.
Unfortunately, caries presents symptomatically at a relatively late stage. The patient may feel a 'hole in a
tooth' with the tongue, brown or black discoloration or cavities may be seen, or frank pain may be suffered.
There are four approaches to the management of caries: attempt to arrest the disease by preventive measures,
remove and replace the carious tissues, a combination of these two approaches, extract the tooth. Early
diagnosis of the carious lesion has become even more important since the realization that caries is not
simply a process of demineralization but an alternating process of destruction and repair. Saliva is an
excellent remineralizing fluid and the balance can be tipped in favour of repair by modifying diet, careful
use of fluoride, and removing plaque.
Pulpitis may be painful or painless, but even the painless form may become painful in response to certain
stimuli. For example, the tooth with painless pulpitis may become painful when percussed or may produce
prolonged pain in response to electrical or thermal stimulation. Pulpitis may produce spontaneous pain,
which may become severe.Pulpitis does not always develop from caries. It may result from trauma, internal
resorption or both. Apparently, pulpitis from caries is reversible until the pulp is invaded by
microorganisms. Its reversibility then depends on the number and virulence of the organisms and on therapy.
Following invasion of the pulp by microorganisms, the prognosis for prolonged pulp viability is poor.
Irreversible pulpitis continues to progress at varying rates through the pulp chamber and along the root
canal. This progression leaves the contents of the pulp chamber necrotic or filled with pus and unable to
respond to electrical or thermal stimuli. As the disease process passes through the apical foramina, it
becomes apical periodontitis. Reversible pulpitis is treated by sedative dressings, while irreversible pulpitis
is managed with endodontic therapy or extraction of the tooth.
5. Answer the following questions to the text «Dental Caries and Pulpitis»
1. When do diseases of the teeth develop?
2. What are the two most common diseases of the teeth?
3. What are the main causes of dental caries?
4. What are the symptoms of caries?
5. What parts of a tooth do carious lesions most frequently affect?
6. What are the symptoms of pulpitis?
7. What complications may pulpitis result in?
8. What does the treatment of pulpitis consist of?
9. What causes caries?
10. When does root caries develop?
11. What are the methods of dental caries control?
6. Fill in the blanks with suitable words from the text. The first letters are given to help you
1. P ... and f ... are nearly impossible to keep clean.
2. The s ... surfaces of the crown, least a ... to cleansing are susceptible to s ... surface carious lesions.
3. Pits and fissures result from incomplete fusion of enamel l ... during tooth development.
4. Older patients who have g ... r ... are likely to develop root surface caries.
5. Root surface caries can be treated by p ... the root, applying fluoride and good oral hygiene.
6. An American dentist G.V. Black made a c ... analyses of cavities design and suggested steps of their
preparation.
7. Speak about caries and pulpitis using the questions as a plan. Summarise the text
using the following introductory phrases: 
The text is headlined ...
The text reads about …
According to the text ...
The main methods of caries control are enumerated ...

8. PHRASE MATCH

1. Calcium, as found in food such as milk and green vegetables, is often recommended …
2. Fluoride helps prevent decay of a tooth by binding to the hydroxyapatite crystals in enamel…
3. Low concentration fluoride ions act as bacteriostatic therapeutic agent and… .
4. The incorporated fluorine makes enamel more resistant to… .
5. Topical fluoride is more highly recommended than …
6. Topical fluoride is used in toothpaste…
7. Supervised toothbrushing must also be done to children below 8 years of age to prevent …
8. In order to further increase a child's cooperation in caries management, good communication by …
9. This communication can be improved by calling the child by their name, using eye contact and …
10. Destroyed tooth structure does not fully regenerate, although remineralization of very small …
a) high concentration fluoride ions are bactericidal
b) streptococcus is the leading cause of tooth decay.
c) systemic intake to protect the surface of the teeth. 
d) demineralization and thus, resistant to decay
e) to protect against dental caries. 
f) mouthwash and fluoride varnish.
g) the dentist and the rest of the staff of a dental practice should be used.
h) carious lesions may occur if dental hygiene is kept at optimal level. 
i) including them in any conversation about their treatment.
j) swallowing of toothpaste.

9. Put the words in the right order

1. The, structures, goal, of, is, to, further, preserve, treatment, tooth, and, prevent, the, destruction, of, tooth.
2. A, handpiece, dental,  is, to, portions, remove, used, large, of, decayed, from, material, a, tooth.
3. A, instrument, spoon, a, dental, remove, is, used, to, decay.
4. Once, missing, the, caries, is, removed, the, tooth, dental, structure, requires, restoration.
5. Restorative, include, materials, dental,  composite, amalgam,  resin, , and, porcelain, gold.
6. Composite, porcelain, resin, and, can, be, made, to, color, of, meci, the, a, patient's natural, teeth.
7. In, certain, restoration, cases, endodontic, necessary, therapy, may, be, for, the, of, a, tooth.
8. The, performed, removal, of, tooth, the, decayed, tooth, is, if, the, is, too, far, destroyed.
9. In, portions, root, removed, canal, therapy, the, pulp, of, the, tooth, is, along, with, decayed, of, the, tooth.
10. An, treatment, extraction, dental, can, also, serve, as, for, caries.

10. MULTIPLE CHOICE - QUIZ

1. Endodontic therapy is recommended if:
a) the pulp dies from infection by decay-causing bacteria or from trauma.
b) stimulants, most notoriously methylamphetamine, also occlude the flow of saliva to an extreme degree.
c) submandibular gland and parotid gland, are likely to lead to dry mouth and thus to widespread tooth
decay.
2. Extractions are sometimes considered if:
a) medications, such as antihistamines and antidepressants, can also impair salivary flow
b) the tooth lacks an opposing tooth or will probably cause further problems in the future, as may be the case
for wisdom teeth.
c) medical conditions that reduce the amount of saliva produced by salivary glands.
3. Extractions may also be preferred by people unable or unwilling to undergo …
a) fluoride toothpaste or dental varnish may aid remineralization
b) the acidic environment created by certain foods.
c) the expense or difficulties in restoring the tooth.
4. The mouth contains a wide variety of oral bacteria, but only a few specific species of bacteria are
believed to cause dental caries: 
a) Streptococcus mutans and Lactobacillus species.
b) reduced salivary flow rate.
c) increased caries.
5. Bacteria collect around the teeth and gums in …
a) a low rate of salivary flow.
b) bacterial strains.
c) a sticky, creamy-coloured mass called plaque, which serves as a biofilm.
11. Word formation: nouns
1. to diagnose - diagnosis 9. to infect ______________
2. to examine ______________ 10. to carry ______________
3. to prescribe ______________ 11. to replace ______________
4. to suffer ______________ 12. to degenerate ___________
5. to operate ______________ 13. to refer ______________
6. to cure ______________ 14. to paralyse ______________
7. to recover ______________ 15. to obstruct ______________
8. to analyse ______________
12. Rewrite the sentences below, changing the verbs to nouns.
1. I diagnosed that the patient had a heart The lab made an…
condition. 9. We found that the tissue was infected.
My diagnosis was that the patient had a heart We found an…
condition. 10. Ten per cent of the population are thought to
2. I examined the patient fully. carry the bacteria.
I made a full… Ten per cent of the population are thought to be…
3. I prescribed a course of antibiotics. 11. We replaced the patient's hip.
I wrote a… The patient was given a hip…
4. He suffered very little. 12. His condition has degenerated.
He experienced very little… There has been a…
5. We operated immediately. 13. The patient was referred to a specialist.
The… The patient was given a…
6. This disease cannot be cured. 14. His arm was paralysed after the stroke.
There is no… He suffered…
7. He has recovered fully. 15. The artery was obstructed by a blood clot.
He has made a full The blood clot was forming an…
8. The lab analysed the blood sample.
 LISTENING

What is Caries? https://youtu.be/bdYC_lnZR30

Listening: Listening for the Main Idea: 
What did you find out?
_______________________________________________________________________________________
_______________________________________________________________

Listening for Details: Take notes of the ideas about DC

Make up 5 questions.
Write one critical thinking question and discuss it in your group. 
_______________________________________________________________________________________
_______________________________________________________________
Project: 
Review and reflect on DC. Point out 10 key points.