Dental Caries

“An aching tooth is better out than in. To lose a rotting member is a gain.”

                                           Richard Baxter

·        Introduction

·        Causes

·        Signs & symptoms

·        Treatment

·        Prevention

·        Conclusion

 

Introduction

          Dental caries, commonly known as The Tooth Worm in some local areas of Asia, is the most prevalent oral disease in the world. It is also the most common cause of tooth loss in children and elder people.

Dental caries can be defined as;

                                  “The localized destruction of dental hard tissues by acids produced from bacterial fermentation of dietary carbohydrates.”

It can be arrested in the early stages, but when the disease is progressed to a certain level, it does not stop until the whole tooth is decayed.

According to the World Health Organization, approximately 3.6 billion people have dental caries in their dentition.

There is a very long history of this disease. From archaeological evidence, we know that tooth decay is an ancient disease dating far into prehistory. The neolithic period shows signs of caries.

The rate of caries sharply increased during the middle ages, when sugar cane became more accessible to the western world.

According to a report, untreated dental caries results in productivity losses of $27 billion dollars per year.

Extensive research has been conducted on the causes and treatment of this disease and now we have vast knowledge which is helping us to prevent this and make people smile again.

Causes

              Dental caries is a multifactorial disease and there are so many factors which are involved in its development and progression.

 The mechanism of this disease is that the bacteria in the oral cavity produce acidic by-products by fermentation of carbohydrates. The acid produced by these bacteria lowers the pH of the oral cavity which causes demineralization of dental tissues.

 These bacteria largely include Streptococcus mutans, Streptococcus sobrinus, and Lactobacillus spp.

Plaque formation and development of bacterial colonies in the plaque is the main factor involved in this process.

Some risk factors which are strongly related to dental caries include;

·        Excessive consumption of dietary carbohydrates

·        No or very less fluoride intake

·        Consumption of vegetables and fruits

·        Poor oral hygiene

·        Compromised immune system

·        Inadequate brushing

·        Stomach acidity

·        Eating disorders like Anorexia and Bulimia etc.

The salivary flow and composition of the Saliva of the patient also affect the disease process.

When someone eats a sugary food, the teeth are vulnerable to damage from the acid for the next 20 minutes so it is important to rinse the mouth or use a toothbrush to remove particles adherent to the tooth.

Signs & Symptoms

          Signs & symptoms may vary from person to person. These depend upon the extent, size and location.

 When a cavity is in its initial state, the patient may have no symptoms at all. When it gets larger and bigger, signs & symptoms appear which may include;

Ø Toothache

Ø Brown or black staining on tooth

Ø Holes or pits in the teeth

Ø Mild or sharp pain during eating

Ø Bad breath

Ø Foul tastes

Ø Fracture of tooth

Ø Gingivitis or pulpitis

In some cases, when an infection has spread, serious complications such as cavernous sinus thrombosis and Ludwig angina.

          As sometimes the symptoms are not clear, it’s important to have regular dental checkups and cleanings even when there is no apparent infection.

Treatment

          While there is a consensus of people that a beautiful and sound dentition not only helps in mastication and tearing of food but also plays an important role in the general appearance of the face, there is an enormous amount of money which is spent on dental treatment.

For a long time, dentists have thought of tooth restoration as a cure for dental caries. With the passage of time and increasing knowledge of the disease process, more strategies have been introduced by dentists.

In clinical practice, the management of caries by restorative treatment, despite its tendency to promote repeated restorations, is still the favored method in many countries. However, in some developed countries, a shift from treatment to more preventive measures has taken place in the last few decades.

The main disadvantage of restoration without a proper prevention approach is the short durability of restorations and the chances of new caries to form at the margins of restorations.

When the disease is developed to a level that only the restorative treatment can be done, the use of modern micro-restorative techniques in which new adhesive materials are used can also preserve tooth structure.

Prevention

       Effective caries prevention programs use a wide range of interventions which include;

ü Community fluoridation of water or salt

ü School water fluoridation

ü School mouth-rinse programs

ü Fluoride tablets and

ü School dental sealant programs etc.

There are some additional interventions that focus on saliva. Lack of saliva, as in Sjogren’s syndrome, may result in catastrophic dental consequences with rapidly progressive caries.

New strategies are emerging which focus on the reduction of transmission of cariogenic organisms to prevent early childhood caries.

On a personal level, caries can be prevented by;

Ø Using fluoridated toothpaste

Ø Regular and proper brushing

Ø Less consumption of sweets, chocolates, and other dietary carbohydrates

Ø Topical fluoride application

Ø Pit and fissure sealants

Ø Fluoride gel and varnishes

Other than dentists, if clinicians are appropriately trained, they may also be helpful in the prevention and control of dental caries. Children should be examined by their pediatrician for signs of early carious lesions, which may include white areas around the gingival margin or brown-stained pits and fissures.

Patients undergoing radiotherapy of the head and neck make sure to have regular dental examinations before and after the treatment.

The detection of tooth decay and referral to appropriate dental care professionals for treatment should be thought of as a secondary preventive measure.

Conclusion

Dental caries can greatly affect the health and quality of life of the patient, so it is necessary to increase the knowledge towards its causes and mechanism of disease progression. We should also focus on prevention and the correct therapeutic need.

A complete approach including oral hygiene, dietary modifications, brushing & flossing and regular dental checkup can greatly reduce the risk of tooth decay.

 

References

https://en.m.wikipedia.org/wiki/Tooth_decay

https://crest.com/en-us/oral-health/conditions/cavities-tooth-decay/cavities-tooth-decay-symptoms-causes-treatment

https://www.mayoclinic.org/diseases-conditions/cavities/symptoms-causes/syc-20352892

https://www.ncbi.nlm.nih.gov › pmc
Prevention of dental caries: A review of effective treatments - NCBI

https://scientonline.org › dent...PDF
Dental Caries: A Review - Scient Open Access

https://www.who.int/oral_health/publications/sugars-dental-caries-keyfacts/en/