DENTAL CARIES

DENTAL CARIES

INTRODUCTION: 

It is also termed as tooth decay or cavities. Dental caries is the most common preventable disease that cause oral pain and tooth loss. It is the breakdown of teeth caused by bacteria due to acids.

DEFINITION: 

It is a multifactorial infectious disease characterised by demineralisation of inorganic and destruction of organic substance of teeth.

CAUSES

1. Poor oral hygiene: Improper brushing may result in accumulation of plaque that attacks the enamel of teeth.

2. Plaque formation: If plaque is not removed regularly, it adheres to your teeth and builds up over time. In the presence of plaque sugars, acids are produced that attack teeth enamel causing teeth holes.

3. Eating: This cause plays a major role in the formation of cavities. When you eat, especially carbohydrates remain on your teeth until you brush. You may not be able to remove all the remnant food particles.

4. Dry mouth: saliva helps to wash away plaque from teeth and buffers acid.  Plaque accumulation is present if dry mouth is seen.

5. Medical conditions: in some head and neck cancers, when exposed to radiation cavities are formed due to changes in saliva make up. 

SYMPTOMS

1. Pain

2. Sensitivity

3. Visible holes

4. Blackish discolouration

PATHOGENESIS

Teeth are bathed in saliva and have a constantly developing layer of bacteria (biofilm) on them. Biofilm production starts with the creation of pellicles. Pelliculus is an acellular protein film that protects the teeth. Bacteria colonize their teeth by adhering to the surface coated with pellicles. A mature biofilm is formed over time, and this produces a cariogenic atmosphere on the surface of the tooth. The minerals in the teeth's hard tissues (enamel, dentin, and cement) are continuously being demineralised and demineralization is higher than remineralization and a net mineral loss occurs. This happens when there is an ecologic shift within the dental biofilm, from balanced population of micro-organisms to a population that produce acids and can survive.

DIAGNOSIS  

Traditionally, apparent alteration of color and texture, tactile sensation using a dental explorer, and x-rays has detected dental caries. Radiographs, however, are not effective for the identification of early enamel caries, so it is difficult to track the development of dental caries so measure their reversal using these techniques. Many new technologies have recently emerged to help diagnose, especially early lesions, which can help reverse the process before cavity filling is needed.

DIAGNODENT uses laser fluorescence to test bacterial products in caries and may be sufficiently sensitive to detect early demineralization. The fluorescence intensity is shown at a number value from 0 to 99. Digital Imaging Fiber -Optic Transllumination (DIFOTI) uses fiber optic light to produce an image that can be useful for detecting initial areas of demineralization, cracks or fractures, and provides a quantitative characterization of the caries process. Quantitative fluorescence caused by light (QLF) uses the human enamel's ability to display fluorescence under some conditions. Demineralised enamel has decreased fluorescence due to dispersion.

PREVENTION

1. Oral hygiene:

Without the bacteria present in dental plaques, dental caries do not progress; daily plaque removal by brushing, flossing, and rinsing is one of the best ways to prevent dental caries and periodontal disease. During regular check-ups correct brushing and flossing methods can be taught at the dental office

2. Use of fluorides:

Fluoride prevents dental caries by inhibiting demineralization and enhancing remineralization of the crystal structures inside the tooth. The remineralised surface is acid attack resistant. The fluoride also inhibits bacterial enzymes. Fluoride treatment methods include oral fluoridation, toothpaste with fluoride, mouth fluoride rinses and varnishes.

3) Pit and fissure sealants:

The majority of dental caries in young children occur in pits and fissures. Pits and fissures are more susceptible to dental caries because the anatomy favours plaque accumulation; these areas are often too narrow for any oral hygiene measures to be effective. By filling such irregularities with flowable restorative material, the area becomes less morphologically susceptible. This is especially recommended in young patients with erupting teeth and adults with a high caries index.

TREATMENT:

Basically, there are four main ways to treat with dental caries. These treatments carried out by dentists which can help treating dental caries.

• Fillings: 

The most common type of treatment for the disease is fillings. A dentist drill into the damaged area of the teeth removes the decayed material within the prepared cavity and fills the empty space with a suitable dental filling material. Depending on the region where caries have happened, there are various forms of filling material that can be used. Composite resin, the most common filling medium in the developing world, has a large colour pallet that dentists can use to fix teeth damage from caries that is usually noticeable when you smile. In the case of the back teeth, some dentists   use much stronger dental filling MATERIALS.

• CROWNS: 

Crowns are another choice for dentists. When dental caries are treated and are only used when disease kills a significant proportion of the tooth. As tooth decay contributes to the need for large fillings, the tooth becomes more vulnerable to cracks and ultimately breaks. The dentist will attempt to extract the damaged part and eventually fit the tooth with an alloy or porcelain crown cover.

• ROOT CANAL: 

Another method of treatment, dentists use is called a root canal. As tooth decay advances and reaches the enamel and settles in the center of the tooth, it may damage the nerves in future, in the root. Dentists would remove the damaged or dead nerve with the surrounding blood vessel tissue (pulp) and fill the area. The procedure usually ends with the dentist placing a crown over the damaged part.

• Extraction:

 In some cases the tooth can be infected even after restoration and must be removed if the risk of infection extends to the jaw bone. The removal of certain teeth that affect the alignment of those left in the mouth, therefore it is recommended that a partial denture, bridge or implant be inserted in these edentulous areas.

By- M. Pavani (BDS)

Mallareddy Institute of Dental Science