Dental Caries (Tooth Decay): Definition, Etiology, Complications And Preventions

What is Dental Caries?

Dental Caries: According to World Health Organization, is a localized post-erupted pathological process of external origin involving softening of the hard teeth tissue and proceed to the formation of a cavity.

What causes dental caries?

Dental caries are caused by bacteria and damaging substances, such as acid, that come into contact with your teeth. After you eat, normal bacteria in your mouth combine with food remnants and acids to create a sticky film called plaque. If you do not remove plaque regularly by flossing and brushing, it can build up or harden into a substance known as tartar. Plaque and tartar, in addition to bacteria and acids, can degrade the enamel on your tooth, leading to holes in the enamel called dental caries, or cavities. Dental caries usually begin as small, shallow holes; left untreated, they can become larger and deeper and potentially lead to tooth destruction or loss.

What are the Aetiological processes of Dental Caries?

Dental Caries also known as tooth decay or cavity has a microbial aetiology, caries can not form in the absence of bacteria regardless of sugar intake. There are four main criteria required for caries formation; A tooth surface (Enamel or dentine), caries causing bacteria, refined carbohydrate such as sucrose and time factors.

     1. Teeth

Certain disease and disorders affecting teeth that may lead an individual at a greater risk for cavity formation.

    2. Amenogenesis Inperfecta

This is a medical condition in which the enamel of tooth does not fully form.

The teeth may be left more susceptible to decay because the enamel is not able to protect the tooth.

   3. Bacteria

The mouth contains a wide variety of oral bacteria but only a few specific species of bacteria are belief to cause dental caries e.g Streptococcus mutuns, Lactor bacilli, Actenomyset. If left untreated the diseases can lead to pain, tooth loss and infections.

   4. Carbohydrate

Bacteria in the mouth convert glucose, fructose and most commonly sucrose in to an acid such as lactic acid through a glycotic process called Fermentation. If left in contact with the teeth this acid may cause Demeniralization which is dissolution of it's menirals content.

   5. Time Factor

The frequency of which the teeth are exposed to Cariogenic (acid) Environment affects the development of dental caries. After meals or snack the bacteria in the mouth metabolised sugar resulting in an acid by-product decreases pH. As time produce the development of dental caries relies heavily on the frequency of acid exposed.

  Risk factors of dental caries.

Everyone who has teeth is at risk of getting cavities, but the following factors can increase risk:

  Tooth location. 

Decay most often occurs in your back teeth (molars and premolars). These teeth have lots of grooves, pits and crannies, and multiple roots that can collect food particles. As a result, they're harder to keep clean than your smoother, easy-to-reach front teeth.

Inadequate brushing. 

If you don't clean your teeth soon after eating and drinking, plaque forms quickly and the first stages of decay can begin.

Not getting enough fluoride. Fluoride, a naturally occurring mineral, helps prevent cavities and can even reverse the earliest stages of tooth damage. Because of its benefits for teeth, fluoride is added to many public water supplies. It's also a common ingredient in toothpaste and mouth rinses. But bottled water usually does not contain fluoride.

  Certain foods and drinks. 

Foods that cling to your teeth for a long time — such as milk, ice cream, honey, sugar, soda, dried fruit, cake, cookies, hard candy and mints, dry cereal, and chips — are more likely to cause decay than foods that are easily washed away by saliva.

  Frequent snacking or sipping. 

When you steadily snack or sip sugary drinks, you give mouth bacteria more fuel to produce acids that attack your teeth and wear them down. And sipping soda or other acidic drinks throughout the day helps create a continual acid bath over your teeth.

  Bedtime infant feeding. 

When babies are given bedtime bottles filled with milk, formula, juice or other sugar-containing liquids, these beverages remain on their teeth for hours while they sleep, feeding decay-causing bacteria. This damage is often called baby bottle tooth decay. Similar damage can occur when toddlers wander around drinking from a sippy cup filled with these beverages.

  Younger or older age. 

In the United States, cavities are common in very young children and teenagers. Older adults also are at higher risk. Over time, teeth can wear down and gums may recede, making teeth more vulnerable to root decay. Older adults also may use more medications that reduce saliva flow, increasing the risk of tooth decay.

  Dry mouth. 

Dry mouth is caused by a lack of saliva, which helps prevent tooth decay by washing away food and plaque from your teeth. Substances found in saliva also help counter the acid produced by bacteria. Certain medications, some medical conditions, radiation to your head or neck, or certain chemotherapy drugs can increase your risk of cavities by reducing saliva production.

  Worn fillings or dental devices. 

Over the years, dental fillings can weaken, begin to break down or develop rough edges. This allows plaque to build up more easily and makes it harder to remove. Dental devices can stop fitting well, allowing decay to begin underneath them.

  Heartburn. 

Heartburn or gastroesophageal reflux disease (GERD) can cause stomach acid to flow into your mouth (reflux), wearing away the enamel of your teeth and causing significant tooth damage. This exposes more of the dentin to attack by bacteria, creating tooth decay. Your dentist may recommend that you consult your doctor to see if gastric reflux is the cause of your enamel loss.

  Eating disorders. 

Anorexia and bulimia can lead to significant tooth erosion and cavities. Stomach acid from repeated vomiting (purging) washes over the teeth and begins dissolving the enamel. Eating disorders also can interfere with saliva production.

  What are the symptoms of dental caries?

You may experience symptoms of dental caries all the time or just occasionally. At times, any of these dental caries symptoms can be severe.

Symptoms of dental caries are usually localized to the mouth. They include:

Holes in the surface of a tooth

Pain when chewing

Sensitivity to hot or cold foods and beverages

Toothache.

  Symptoms that might indicate a serious condition.

In some cases, dental caries can be a serious condition that should be immediately evaluated in an emergency setting. Seek immediate medical care if you, or someone you are with, have any of these serious symptoms including:

Severe swelling or pain in the jawbone

Severe toothache that cannot be controlled by over-the-counter pain relievers.

  What are the clinical features of dental caries?

The earlier signs of a new carious region is the appearance of chalky white spot on the surface of the teeth. As the legion continue to demeniralize it can turned brown but will turn in to Cavitation. A brown spot which is dull in appearance is probable a sign of active caries.

  How to diagnose dental caries?

Tooth decay can be found during a regular dental check-up. Early tooth decay may look like a white spot on the tooth. If the decay is more advanced, it may appear as a darker spot or a hole in the tooth. The dentist can also check the teeth for soft or sticky areas or take an x-ray, which can show decay.

  Complications of dental caries

Cavities and tooth decay are so common that you may not take them seriously. And you may think that it doesn't matter if children get cavities in their baby teeth. However, cavities and tooth decay can have serious and lasting complications, even for children who don't have their permanent teeth yet.

Complications of cavities may include:

Pain

Tooth abscess

Swelling or pus around a tooth

Damage or broken teeth

Chewing problems

Positioning shifts of teeth after tooth loss.

When cavities and decay become severe, you may have:

Pain that interferes with daily living

Weight loss or nutrition problems from painful or difficult eating or chewing

Tooth loss, which may affect your appearance, as well as your confidence and self-esteem

In rare cases, a tooth abscess — a pocket of pus that's caused by bacterial infection — which can lead to more serious or even life-threatening infections.

How to treat dental caries?

Prompt treatment of dental caries by your dentist is important in preventing further damage to your tooth or an infection. A simple dental examination can identify dental caries, and an X-ray may help your dentist to determine the extent of the caries.

Dental caries are typically painless, but a larger or deeper area of destruction in the tooth may be painful. If you have a toothache, over-the-counter pain relievers, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol), may make you more comfortable until the caries are treated by your dentist.

In addition to medications, dental work is necessary to fill the cavity. Your dentist will begin by numbing your mouth with a local anesthetic. After your tooth is numb, your dentist will use a drill to clean out the area of decay and shape the surrounding tooth to allow it to be filled in smoothly with replacement materials. More severe caries may require more extensive dental work, including a root canal or tooth extraction.

How to prevent dental caries formation?

I. Dietary control: In preventing the occurrence of dental caries, dietary control or reduction has to be applied in the sense that sugar intake reduction is very important that person has to reduce the number of time He/She place the sugar in to the mouth.

II. Oral hygiene: Personal hygiene consist of proper brushing and flossing daily. The purpose of oral hygiene is to minimize (reduce) any aetiological agents of the diseases in the mouth.

III. Fluride therapy: Is often recommended to protect against dental caries. It has been demonstrated that water Fluridation and fluride supplement decrease the incidence of dental caries.

IV. Dental visit: Is very important in preventing of dental caries that dental visitation should be at least twice a year.

Sources:

Community Health unpublished lecture notes

www.mayoclinic.org

www.healthgrades.com

www.nidh.dhc.gov