Related to focal degradation of the tooth structure.
Dental caries is the most common chronic disease in the world.
Dental caries refers to the demineralization of teeth, which occurs after bacteria metabolize dietary carbohydrates into acid.
More than 90% of US adults experience caries and 26% have untreated caries.
Most common cause of tooth loss before the age of 35 years.
Approximately 40% of individuals with untreated caries have pain, and the toothache generally arises after caries spread deeper into the tooth causing pulpal infection and inflammation.
In individuals with caries without pain, percussion of the affected tooth may elicit pain if inflammation extends to the periapical tissues.
Carious lesions are different in color from the rest of the tooth from chalky white initially to black or brown for advanced lesions.
Advanced caries may present with erythema or fluctuaance of the adjacent soft tissue, sinus tract formation, and swelling.
In most industrialized countries, tooth decay affects 60–90% of schoolchildren and the vast majority of adults.
In the U.S., minorities and the poor both have higher rates of decayed and missing teeth, and their children have less dental care.
Dental caries is the most common chronic disease of children in US and disproportionately affects the vulnerable and underserved.
The problem appears to be less in Africa’s developing countries, but is expected to increase in several countries there because of changing diet and inadequate fluoride exposure.
Modern oral microbiota are significantly less diverse than historic populations.
Only a limited set of microbes cause tooth decay, with most of the bacteria in the human mouth being harmless.
Tooth decay is an infectious disease: increased within dental plaque of bacteria such as Streptococcus mutans and Lactobacillus.
These organisms produce organic acids when carbohydrates, especially sugar, are eaten.
When enough acid is produced to lower the pH below 5.5, the acid dissolves carbonated hydroxyapatite, the main component of tooth enamel, in a process known as demineralization.
Cavities result when the rate of demineralization exceeds the rate of remineralization, typically in a process that requires many months or years.
Caries are caused by bacteria that erode the enamel outside shell of the tooth and the dentin underneath.
Additional risk factors include consumption of sucrose containing carbohydrates, poor oral hygiene, xerostomia, and substance use.
Fluoride exposure from water fluoridation and toothpaste, strengthens tooth enamel, and is inversely associated with the development of caries.
Caries disproportionally affect people at risk for poor access to dental care, include low income individuals, and those racially and ethnically minorities groups.
Bacteria builds up on the surface of teeth as plaque which consists of both bacteria as well as food and saliva.
Dental plaque is a biofilm of oral bacteria and is associated with caries development.
Streptococcus mutans and lactobacilli in plaque metabolize dietary carbohydrates into acid, which demineralizes the enamel and causes caries.
As the starches in the mouth turn into acid, it dissolves the enamel and forms a pit that gradually grows in size.
Carbonated hydroxyapatite enamel crystal is demineralized by acid in plaque and becomes partly dissolved crystal.
Demineralized enamel crystal is remineralized by fluoride in plaque to become fluorapatite-like coating on remineralized crystal
The oral microbiome in essential in dental health, as commensal microflora can switch to an opportunistic pathogenic flora.
Progressive caries can extend to the tooth pulp and can cause abscess with cellulitis with infection that can spread to major officials facial spaces of the head and neck, can compromise airway and cause vision loss, CNS involvement, or sepsis.
Ludwig’s angina is a life threatening compromise of the airway due to neck infection.
Early childhood caries, defined as the decay in the primary dentition of children six years of age or younger, and may be present in up to 50% of children.
Caries, have become a major endemic disease, affecting 60-90% of schoolchildren in industrialized countries.
When tooth decay is small, patients may be asymptomatic, but as the decay grows the tooth may become sensitive.
Caries can be prevented by brushing and flossing daily as well as using antibacterial mouthwash in order to reduce the amount of bacteria in the mouth.
Once a cavity occurs, the tooth will require repeated restorations, with estimates for the median life of an amalgam tooth filling ranging from 9 to 14 years.
Over 80% of cavities occur inside fissures in teeth where brushing cannot reach food left trapped after eating and saliva and fluoride have no access to neutralize acid and remineralize demineralized teeth, unlike easy-to-clean parts of the tooth, where fewer cavities occur.
In these fissures saliva and fluoride have no access to neutralize acid and remineralize demineralized teeth, unlike easy-to-clean parts of the tooth, where fewer cavities occur.
A cavity starts in a tooth’s outer enamel and spreads to the dentin and pulp inside.
Affected teeth generally are tender to percussion and temperature.
Teeth cleaning is the removal of dental plaque and tartar from teeth to prevent cavities, gingivitis, gum disease, and tooth decay.
Between cleanings by a dental hygienist, good oral hygiene is essential for preventing tartar build-up which causes problems, and it is done through frequent brushing with a toothbrush, combined with the use of dental floss or interdental brushes to prevent accumulation of plaque on the teeth.
Powered toothbrushes reduce dental plaque and gingivitis more than manual toothbrushing in both short and long term.
Early childhood caries is more prevalent in lower socioeconomic groups.
Tooth decay is one of the most prevalent chronic diseases worldwide.
Although it is rarely life-threatening, tooth decay can cause pain and impair eating, speaking, facial appearance, and acceptance into society,and it greatly affects the quality of life of children, particularly those of low socioeconomic status.
Caries associated with exacerbation of medical conditions: diabetes, obesity, iron deficiency, anemia, and depression
Children with severe early childhood caries have lower hemoglobin and ferritin levels than children without such problems.
Are the result of dissolution of mineral tooth structure by acid metabolic end products of oral bacteria capable of fermenting sugar.
Sugar is the most important dietary factor in the development of dental caries: the incidence of caries is lower when sugar intake is less than 10% of total energy consumed.
Rate is highest in industrialized countries where processed foods with high carbohydrate content is readily available.
Rate has dropped secondary to improved oral hygiene and the use of fluoridation in drinking water.
Fluoride enters the crystalline structure of enamel with the formation of fluoroapatite, which resists bacterial acid degradation.
The decline in caries in certain segments of the world is due to the addition of fluoride to public drinking water.
Dental sealants, cover and protect fissures and grooves in the chewing surfaces of back teeth, preventing food from becoming trapped and thereby halt the decay process.
radiographs are obtained to evaluate caries extent and surfaces not seen clinically.
Management:
Moderate and advanced caries require treatment as any carious tooth that causes spontaneous pain requires removal of the infected pulp inside the tooth (root canal) or tooth extraction.
Combining NSAIDS with acetaminophen is effective to treat dental pain.
Patients with localized, abscess, swelling, or systemic spread should be treated with antibiotics.
For caries that do not extend to the dental pulp, treatment usually involves a restoration (filling) or full coverage crown.
Crowns are indicated if caries compromise the tooth structural integrity.
Caries extending into the pulp, require either root canal or an extraction.
Incidentally identified caries can be treated with fluoride varnish and silver diamine fluoride.