Caries


CARIES

Description:

Alternative Names: Tooth decay; Cavities - tooth

Tooth decay describes the condition wherein the tooth, under a variety of harsh conditions, break down leading to the formation of a cavity. It starts with a hole/opening in the enamel. If this is not treated, it progressively reaches the deeper sections of the tooth, where the pulp and the nerves are causing the tooth to become sensitive to a variety of stimuli, a variety of gum problems such as inflammation and swelling, pain and ultimately tooth loss.

Tooth decay is a common dental ailment that may occur at any time or age. However, since the onset of tooth decay is strongly related to the unregulated consumption of sweet foods and beverages; it tends to affect the young and adolescents more than any other age. One form is diagnosed in nursing infants and is referred to as nursing caries.

Caries

A serious form of tooth decay affects nursing infants and is called 'Nursing caries' or 'Baby bottle tooth decay'. In infants who are nursed continuously with a bottle/ formula milk/ pacifiers; the milk is retained in the mouth as the child falls asleep with the bottle. This milk is an excellent nutritive media for a variety of germs present in the mouth. The milk is broken down by the germs to form harsh acids which lead to the formation of a cavity on the tooth.

Symptoms:

The following are the most common symptoms of tooth decay and dental caries. However, each child may experience symptoms differently. Symptoms may include white spots on the teeth that appear first. Then, an early cavity appears that has a light brown color on the tooth. The tooth color progressively becomes darker.

Other symptoms include:

  • Toothache -- particularly after sweet, hot, or cold foods and drinks.

  • Visible pits or holes in the teeth.

Causes and Risk factors:

Tooth decay is one of the most common of all disorders, second only to the common cold. It usually occurs in children and young adults but can affect any person. It is the most important cause of tooth loss in younger people.

Bacteria are normally present in the mouth. The bacteria convert all foods -- especially sugar and starch -- into acids. Bacteria, acid, food debris, and saliva combine in the mouth to form a sticky substance called plaque that adheres to the teeth. It is most prominent on the back molars, just above the gum line on all teeth, and at the edges of fillings. Plaque that is not removed from the teeth mineralizes into tartar. Plaque and tartar irritate the gums, resulting in gingivitis and ultimately periodontitis.

Plaque begins to accumulate on teeth within 20 minutes after eating (the time when most bacterial activity occurs). If this plaque is not removed thoroughly and routinely, tooth decay will not only begin, but flourish.

The acids in plaque dissolve the enamel surface of the tooth and create holes in the tooth (cavities). Cavities are usually painless until they grow very large inside the tooth and destroy the nerve and blood vessels in the tooth. If left untreated, a tooth abscess can develop. Untreated tooth decay also destroys the internal structures of the tooth (pulp) and ultimately causes the loss of the tooth.

Carbohydrates (sugars and starches) increase the risk of tooth decay. Sticky foods are more harmful than nonsticky foods because they remain on the surface of the teeth. Frequent snacking increases the time that acids are in contact with the surface of the tooth.

Frequent consumption of sugary foods and drinks increases the risk of decay, especially if allowed to bathe the teeth for long periods (for example, if teeth aren't brushed regularly or if a baby sucks on a bottle full of sweet drink).

Dental decay is very common. The addition of fluoride to toothpaste has helped to protect teeth and cut decay, but the trend towards sweeter snack foods in children's diets is working against this.

Children should have check-ups at the dentist every six months so decay can be spotted early. If your child has toothache, get the advice of a dentist. They'll be able to spot decay by examining the teeth and may take an x-ray to investigate the extent of damage.

Diagnosis:

    Dental caries should be diagnosed and managed as a dynamic disease of enamel and dentin.

  • The disease process is initiated whenever a tooth surface is exposed to acids produced by the fermentation of carbohydrates in cariogenic bacteria.

  • In enamel, calcium and phosphate are lost from the enamel crystals on the surface and sub-surface layers after the pH of the oral fluids drops to less than 5.5. This loss usually occurs if the defensive mechanisms in the oral cavity are not sufficient to protect enamel from the detrimental effects of frequent acid attacks.

  • If the loss of calcium and phosphate continues from the crystals, large microporous areas develop. These areas are identified visually as "white spots" when the tooth is dried, or are seen visually without drying when large microporous areas develop in enamel. If the loss of tooth structure continues, a cavity develops. On the roots, early carious lesions usually have softened and yellowish-colored dentin. These characteristics result from the loss of organic and inorganic components of dentin in the root.The goal of examining a patient for presence of dental caries is to detect the earliest signs of this disease in enamel and root surfaces. If early signs of demineralization are detected, advise the patients and provide preventive care to reverse the caries process.

  • In the management of dental caries, it is also important to consider that dental caries is an infectious disease. "Drilling and filling" a tooth is not the only solution to the damage caused by the caries process and is not an effective method to treat the cariogenic infection. A comprehensive preventive and treatment program is necessary to manage dental caries, especially for patients with progressive or rampant caries.

  • When examining patients, the goal is to predict the caries process as well as to diagnose the presence of dental caries.

Treatment:

Very minor decay can sometimes remineralise on its own, if the plaque on the tooth is cleared and better oral hygiene started, with the use of a fluoride gel. But usually a filling will be needed. If the nerve inside the tooth is infected or damaged, the roots may need to be filled using a special technique or the tooth itself removed if it's a baby (milk) tooth.

Prevention is vital to avoid tooth decay. Cut down the amount of sweet snacks your child is allowed (including acidic fizzy drinks). Help your children brush their teeth twice a day and after meals, and take them for regular check-ups at the dentist. Make sure your water supply is fluorinated or discuss fluoride drops with the dentist.

You may also want to consider fissure sealant treatment for permanent teeth.

Teeth that have been affected by tooth decay (caries or cavities) require a filling. There are many different types of fillings, including:

Dental Amalgams - Dental amalgams, also known as silver fillings, are comprised of a mixture of mercury (45 to 50 percent), and an alloy of silver, tin, and copper (50 to 55 percent). When combined with other materials in a dental amalgam, mercury's chemical nature changes. Recently, controversial views have emerged regarding mercury in dental amalgams. Some dentists feel strongly that existing mercury amalgams should be removed and replaced with substitutes. Other dentists feel there is no harm from mercury amalgams. Consult your child's dentist for further information on this topic.

Composite Resins - Also known as white fillings, a composite resin is a tooth-colored plastic mixture filled with glass (silicon dioxide) that is used primarily for cosmetic improvements of the smile by changing the color of the teeth or reshaping disfigured teeth.

Other alternatives to restoring damaged or decayed teeth:

    Porcelain veneers - A ceramic material is bonded to the front of teeth to change the tooth's color, size, and/or shape.

  • Crown - a cap that covers a cracked or broken tooth, unfixed by a filling, to approximate its normal size and shape.

  • Cast gold restorations - This type of restoration is often more costly and may require more than one dental fitting.

Oral hygiene is necessary to prevent cavities. This consists of regular professional cleaning (every 6 months), brushing at least twice a day, and flossing at least daily. X-rays may be taken yearly to detect possible cavity development in high risk areas of the mouth.

Chewy, sticky foods (such as dried fruit or candy) are best if eaten as part of a meal rather than as a snack. If possible, brush the teeth or rinse the mouth with water after eating these foods. Minimize snacking, which creates a constant supply of acid in the mouth. Avoid constant sipping of sugary drinks or frequent sucking on candy and mints.

Dental sealants can prevent cavities. Sealants are thin plastic-like coating applied to the chewing surfaces of the molars. This coating prevents the accumulation of plaque in the deep grooves on these vulnerable surfaces. Sealants are usually applied on the teeth of children, shortly after the molars erupt. Older people may also benefit from the use of tooth sealants.

Fluoride is often recommended to protect against dental caries. It has been demonstrated that people who ingest fluoride in their drinking water or by fluoride supplements have fewer dental caries. Fluoride ingested when the teeth are developing is incorporated into the structure of the enamel and protects it against the action of acids.

Topical fluoride is also recommended to protect the surface of the teeth. This may include a fluoride toothpaste or mouthwash. Many dentists include application of topical fluoride solutions (applied to a localized area of the teeth) as part of routine visits.

Tooth Decay - Surgery

You may need surgery if tooth decay has damaged the pulp and the tooth.

Surgery Choices:

In extraction, your dentist removes the decayed tooth.

In root canal treatment, your dentist removes the pulp from the center of a tooth and fills the pulp cavity.

After removing your tooth, your dentist will replace it with a bridge or an implant.

If your tooth is severely damaged, it may be easier and may cost less to remove the tooth than to have a root canal treatment. If you have root canal treatment, you will need a crown.

Dental surgery can cause bacteria in the mouth to enter the bloodstream and cause infections in other parts of the body. People who have a difficult time fighting off infections may need to take antibiotics before and after dental surgery. Such people include those who have artificial heart valves or were born with heart defects.

Medicine and medications:

Your dentist may prescribe chlorhexidine gluconate (Peridex, Periogard), a prescription mouthwash, to reduce the bacteria that cause tooth decay. He or she may also recommend or prescribe other types of fluoride treatment, such as fluoride mouthwash, toothpaste, or supplements.

Over-the-counter medicine can also relieve pain and swelling in your face and jaw caused by tooth decay. These include acetaminophen, such as Tylenol or Panadol; ibuprofen, such as Advil or Motrin; and aspirin. Do not give aspirin to anyone younger than 20 because of the risk of Reye's syndrome.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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