Dental Caries

 

Severe caries of anterior teeth shows esthetically unacceptable smile. These pictures were taken by a jordanian cosmetic dentist, Dr. Abdalrhman Abu Azza.

Introduction:

Teeth caries is destruction of teeth that can occur when caries-causing bacteria in your mouth make acidity that attack the surfaces of teeth, especially the enamel. This can lead to a small cavitation which can be larger within time. If teeth caries is not treated, it will leads to pain, discomfort, infection, and in advanced stages can lead to teeth missing.

 

prevalence of dental caries:

Universally, experts discovered that 2.1 billion people have caries at permanent teeth and 516 million children have caries at primary teeth. Occurrence of oral diseases increased universally with increasing of civilization and changes in life styles.

 

Symptoms:

The signs and symptoms of caries vary, According to the extent and location. When a caries is just starts, you will not have any discomfort at all. While the caries gets larger, it will cause signs and symptoms like:

• Tooth pain.

• Dental sensitivity.

• Toothache while eating or drinking sweet food, cold or hot.

• Visible cavities in your teeth.

• Color changes at any surface of a tooth.

• Pain while biting.

Causes:

Teeth holes caused by tooth Caries. And this process occurs within time. Here's how tooth caries develops:

 

Plaque forms. Teeth plaque is a clear sticky film which coats the surfaces of teeth. This is due to eating a too much sugars and starches and not cleaning the surfaces of teeth well. When sugars and starches aren't cleaned, bacteria rapidly begin feeding on them and the plaque is formed. Plaque which is on your teeth can become hard under or above your gum line into dental tartar .Tartar gives hardness to plaque and makes it difficult to remove plus being a shield for bacteria.

The erosion which happens causes small openings or holes the teeth surfaces. the first stage of cavitation occurs when sites of enamel are eroded, the bacteria and acids can reach the second layer which called dentin.

Attacks of plaque. The acidity of plaque remove the mineralization of your tooth, especially enamel layer of your tooth, then dentin. This layer is soft and less resistant to acids than enamel. Dentin has small tubules which directly contact with the innervation of the tooth causing dental sensitivity.

 

Continuous damage. As dental caries develops, the bacteria and acids continue their way through your tooth, moving next to last layer which called dental pulp that contains blood vessels and nerves. Pulp swelling and irritation of bacteria occur. Because of absence of space for the swollen pulp to expand inside of a tooth, the nerves becomes compressed, causing severe pain. This discomfort can extend to the bone around teeth.

 

Risk factors:

All persons who have teeth are at risk of getting teeth cavities, but these factors can increase risk:

 

Tooth position. Caries most often occurs in your posterior teeth which called premolars and molars. These teeth have lots of grooved cavities, pits and fissures, and multiple anatomical holes that can collect food. So they are very difficult to clean than your anterior teeth which have smooth surfaces.

Definite drinks and foods. Foods that contact to your teeth for a long period of time such as milky food, ice cream, honey, sugar foods, soda, dried fruit, cakes, cookies, hard candy and mints, dry cereals, and chips. They are more likely to cause caries than foods that are easily cleaned away by effect of saliva.

Frequent snacking or sipping. When you snack sugar drinks for long times, you give mouth bacteria more fuel to produce acidity that damage and wear down teeth. And drinking soda or other acidic drinks during the day helps in creating of a continual acid ways at teeth.

Bedtime infant feeding. Once baby is given bedtime bottle filled with milk, formula, juice or other sugar-containing liquids, these beverages persist on their teeth for many hours while sleeping, feeding caries-causing bacteria. This destruction is usually called baby bottle tooth caries. Similar destruction can occur when toddlers wander around drinking of cup filled with beverages like these.

Improper brushing. If the cleaning of your teeth was inadequate after eating and drinking, plaque will be formed quickly and the first stages of caries begins.

Little amount of fluoride. Fluoride, natural mineral, which prevents the cavitation of teeth and can reverse the earliest stages of tooth decay. Because of its advantages for teeth, fluoride is added to many public water supplies. It's a common ingredient in most toothpaste and mouth washes. But the fluoride is not content in bottled water.

Younger or older age. In the USA, cavities are common in young children and teenagers. Older adults are at higher risk too. Within time, teeth can be worn down and gums recession occurs, making teeth more liable to root caries. Older adults usually uses more medications which reduce the salivation, increasing the risk of tooth caries.

Dry mouth. Dry mouth is occurs by a lack of salivation. Lack of salivation help in preventing tooth caries by washing away food and plaque on the teeth. Molecules found in saliva help in countering of the acidity produced by bacteria. Certain medications, some medical conditions, radiation to head or neck, or certain chemotherapeutic drugs can increase the risk of caries by reduction of saliva secretion.

Worn fillings or dental devices. Over the years, dental fillings become weak, begin to be broken down or rough surfaces may be developed. This makes plaque to be formed more easily and makes it very difficult to remove. Dental devices can stop fitting well, making caries to begin below them.

Heartburn. Heartburn or gastro esophageal reflux disease (GERD) can lead to stomach acid to flow into mouth (reflux) making the enamel of your teeth worn down and causing significant tooth destruction. This exposes more of the dentin surfaces to be attacked by bacteria, creating tooth caries. In this time you can consult your doctor to find if gastric reflux is the cause of your enamel loss.

Eating disorders. Anorexia and bulimia can lead to eroded teeth and cavities. Stomach acidity from repeated vomiting washes over the teeth and begins dissolving of your enamel. Eating disorders also can interfere with saliva secretion.

 

Complications:

• Mild to moderate pain (sometimes violent) in the teeth and jaw.
• Abscess, sometimes accompanied by fever and swelling of the face.
• Bad odor of breath.
• Loss of the carious tooth.
• Difficulty in chewing of food.
• Difficulty with pronunciation.

Prevention:

Prevention of dental caries includes cleaning of teeth regularly, low sugar in diet , and using of little amount of fluoride .Brushing of teeth twice per day and flossing between the teeth once a day especially before bedtime directly .Fluoride may be acquired from water, salt or toothpastes or other sources .Treating a mother's dental caries will decrease the transmission of caries to her children by reducing the number of certain bacteria she may spread to them .Screening will lead to earlier detection .According to the extent of decay, various treatments can be done to restore the tooth to suitable function or the tooth may be extracted .There is no known method to get back large amounts of tooth .The availability of treatment is often poor in the developing world .Paracetamol or ibuprofen may be taken for decreasing of pain.

 

How dentist can diagnose:

Visual-tactile examination of carious lesions is not accurate for assessment of interproximal or outer surfaces. Therefore, radiography is most common method used to assess and detect caries, as it gives the dentist more information about the clinical progression.

 
Treatment options of dental caries:

Fluoride treatments. If your cavity just started, a fluoride treatment may help restore the enamel of the teeth and can sometimes make a reservation for cavities at early stages.

Restorations. Intermediate option of treatment between fluoride treatment and crowns when dental caries progressed beyond first stages.

Laboratory restorations (Crowns):

We use this option when we see severe decayed tooth especially after root canal treatment as the tooth is brittle at this time because of removing its pulp.

Root canals treatment:

This option of treatment we use when dental caries reach to dental pulp .And it is very important to prepare for crown restoration after root canal treatment and the cause we have mentioned above.

Tooth extraction:

This is the last option of treatment but we use when the tooth is very decayed and there is a difficulty to restore it by any options of treatment we have mentioned above .And it is very important to replace the missed tooth by dental implant or bridge after its extraction.

Summary:

To summarize, you can watch this video for Dr. Pardinas Lopez: