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Dental Caries: A Review

Dental caries, a chronic disease is unique among human and is one of the most
common important global oral health problems in the world today. It is the destruction
of dental hard acellular tissue by acidic by-products from the bacterial fermentation of
dietary carbohydrates especially sucrose. It progresses slowly in most of the people
which results from an ecological imbalance in the equilibrium between tooth minerals
and oral biofilms which is characterised by microbial activity, resulting in fluctuations in
plaque pH due to bacterial acid production, buffering action from saliva and the
surrounding tooth structure. The microbial community of caries is diverse and contains
many facultatively and obligately-anaerobic bacteria. S. mutans is the most primary
associated with it. Dental caries can affect the human in various ways i.e. presence of
tooth pain, infection or dysfunction of the stomatognathic system can limit the
necessary ingestion of energetic foods, affecting the growth in children and adults as
well as their learning, communication skills and recreational activities. Moreover, oral
and pharyngeal cancers and oral tissue lesions are also significant health concern.
Cavernous sinus thrombosis and Ludwig angina can be life-threatening. Due to this,
treatment is needed for dental diseases which cost is normally high and is not feasible
for all community due to limited resources such as time, person and money. Therefore,
prevention is more affordable. Personal hygiene cares and dietary modification should
be recommended.

Author(s): Yadav K, Parakash S

The purpose of this review was to assess the scientific and clinical bases for the
proposed classification of periodontitis. The clinical and histopathological signs and
the etiology of periodontitis were described. Cross-sectional studies were analyzed
to determine when onset of periodontitis most frequently occurs in adults. In
addition, the progression rates of periodontitis have been assessed from
longitudinal studies. No clinical, histopathological, or microbiological features could
be identified that would characterize different disease entities of chronic
periodontitis. The prevalence, extent, and severity of periodontitis were found to
increase continually with higher age and there was no age when onset of disease
would most likely occur. The rate of periodontitis progression varies largely
between patients and there is no natural threshold for distinguishing various rates
of disease progression. The incidence of periodontitis unresponsive to treatment
depends on pretreatment progression rate, extent and severity of disease, tooth
type, smoking, high levels of putative periodontal pathogens, a deficient immune
response, and the type of therapy provided. There is no scientific basis for the
classification "adult periodontitis" and "refractory adult periodontitis." Extensive
clinical examinations are required for the diagnosis of "rapidly progressive adult
periodontitis." It appears unrealistic that these examinations can be performed
routinely in clinical practice. Therefore, the classification proposed by the
Organizing Committee to define adult, rapidly progressive, and refractory
periodontitis as specific disease entities was replaced with a simplified classification
of periodontitis based on the scientific data available.
Halitosis, or bad breath, is caused by mainly volatile sulfur compounds (VSC) as a
result of bacterial breakdown of protein and can be quantitatively and qualitatively
measured in the expired oral breath. In eight to ninety percent of cases, halitosis
originates in the mouth due to inadequate plaque control, periodontal disease, dry
mouth, faulty restorations, and in particular due to excessive bacterial growth on
the posterior third of the dorsal surface of the tongue. In the remaining ten to twenty
percent of cases, bad breath is caused by systemic disorders such as hepatic,
pancreatic and nephritic insufficiencies, trimethylaminuria, upper and lower
respiratory tract infection, medication and cases where gastric content may
generate oral malodour. The methods of detecting or diagnosing halitosis are
organoleptic or human sense of smell, sulfide monitoring and gas chromatography.
All of these methods have limitations and disadvantages. A more accurate,
analytical system which will be able to precisely detect the volatile compounds in
the expired air and correlate the results to a specific cause is not yet available.
Dental professionals require a good knowledge on the subject of bad breath in
order to feel secure about counseling and managing patients suffering from this
condition. The management of halitosis involves maintenance of plaque control,
elimination of active periodontal disease and cleaning the tongue on a routine
basis. Oral rinsing with a mouthwash could be indicated in some instances, as a
temporary measure.