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Tuesday, September 20, 2011

Dental Caries

Dental caries, is known as tooth decay or a cavity.
It is one of the most prevalent chronic diseases of people worldwide; individuals are susceptible to this disease throughout their lifetime.It is a disease where bacterial processes change carbohydrate like sugar in food left on teeth to acid that demineralises hard tooth structure (enamel, dentin, and cementum). If demineralisation exceeds saliva and other remineralisation like from calcium, these tissues progressively break down, producing dental caries (cavities, holes in the teeth).  The disease develops in both the crowns and roots of teeth, and it can arise in early childhood as an aggressive tooth decay that affects the primary teeth of infants and toddlers.

Risk factors leading to dental caries
It includes physical, biological, environmental, behavioural, and lifestyle-related factors such as high numbers of cariogenic bacteria, inadequate salivary flow, insufficient fluoride exposure, poor oral hygiene, inappropriate methods of feeding infants, and poverty.
* Reduced saliva  : Saliva have a buffering capability to counterbalance the acidic environment created by certain foods , so reduced saliva is associated with increased caries.
* The use of tobacco may also increase the risk for caries formation.Some brands of smokeless tobacco contain high sugar content, increasing susceptibility to caries.
The approach to primary prevention should be based on common risk factors. Secondary prevention and treatment should focus on management of the caries process over time for individual patients, with a minimally invasive, tissue-preserving approach.

Complication of dental caries
Untreated dental caries can lead to pain, , infection, and  tooth loss.

Cariology is the study of dental caries.

In general, there are two types of caries when separated by location: caries found on smooth surfaces and caries found in pits and fissures.

1 - Pit and fissure caries (class I dental caries)
Pits and fissures are anatomic landmarks on a tooth where the enamel folds inward. Fissures are mostly located on the occlusal (chewing) surfaces of posterior teeth and palatal surfaces of maxillary anterior (front) teeth. Pits are small, pinpoint depressions that are most commonly found at the ends or cross-sections of grooves.
2 - Smooth-surface caries
There are three types of smooth-surface caries. Proximal caries, also called interproximal caries, form on the smooth surfaces between adjacent teeth. Root caries form on the root surfaces of teeth. The third type of smooth-surface caries occur on any other smooth tooth surface.Proximal caries are the most difficult type to detect.

Signs and symptoms
 The earliest sign of a new carious lesion is the appearance of a chalky white spot on the surface of the tooth, indicating an area of demineralization of enamel.  As the lesion continues to demineralize, it can turn brown but will eventually turn into a cavitation ("cavity"). Before the cavity forms, the process is reversible, but once a cavity forms, the lost tooth structure cannot be regenerated.
The affected areas of the tooth change color and become soft to the touch. Once the decay passes through enamel, the dentinal tubules, which have passages to the nerve of the tooth, become exposed and causes pain in the tooth. The pain may worsen with exposure to heat, cold, or sweet foods and drinks.
Dental caries can also cause bad breath and foul tastes. In highly progressed cases, infection can spread from the tooth to the surrounding soft tissues. Complications such as cavernous sinus thrombosis and Ludwig's angina can be life-threatening.

Early treatment is less painful and less expensive than treatment of extensive decay
Treatment of dental caries is done by the dentist.
A simple dental examination can identify dental caries, and an X-ray may help your dentist to determine the extent of the caries.
For the small lesions, topical fluoride is sometimes used to encourage remineralization. For larger lesions, the progression of dental caries can be stopped by treatment. The goal of treatment is to preserve tooth structures and prevent further destruction of the tooth.The dentist will restore your tooth to its original morphology( shape) ,by cleaning the tooth and filling the cavity with the suitable restorative material  .
Restorative materials include dental amalgam, composite resin, porcelain, and gold.

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