A.

Understanding Dental Caries

Caries or cavities is a disease in the oral cavity caused by the activity of
bacterial destruction of hard tissue of teeth (enamel, dentin and cementum). This
damage if not treated immediately will soon spread and spread. If left unchecked,
cavities will cause pain, tooth loss, infection, and even death (Sandira, 2009).
Dental caries (cavitation) is a decaying area inside the tooth that occurs due
to a process that gradually dissolves enamel (the hard outer surface of the tooth)
and continues to develop into the inside of the tooth (Hamsafir, 2010).
B. Factors Causing Dental Caries
The cause of caries is Streptococcus mutans and Lactobacilli . These
specific bacteria convert glucose and carbohydrates in food into acids through the
fermentation process. Acid continues to be produced by bacteria and eventually
damage the tooth structure little by little. Then plaque and bacteria start working
20 minutes after eating (Pratiwi, 2007).
a. Factors in the Mouth
1) Host Factor (Teeth and Saliva)     
a) Tooth      
Tooth composition can be seen from enamel and dentin. Dentin is the
layer below the email. The structure of email is very crucial in the process
of caries. Strong or weak tooth structure to the caries damage process can
be seen from the color, blurring and slippage of the tooth surface and the
thickness of the enamel (Suwelo, 1992).
b) Saliva     
Saliva is a complex oral fluid that consists of a mixture of secretions from
large and small salivary glands in the oral mucosa. Saliva is able to
liberalize early caries because it still contains a lot of calcium and
phosphate ions. The ability of saliva to remineralize increases with
fluorine ions . Besides affecting the pH, therefore, if salivary flow
decreases or disappears, caries may not be controlled (Kidd, et al, 2002).
2) Microorganism Factors     
The presence of oral bacterial flora in the form of plaque is a major cause for
caries formation. In teeth that have not been erupted and have not been
associated with oral flora no caries is formed, but once the teeth are erupted
they can be attacked by caries. Furthermore, it can be proven that certain
 types of oral bacteria in vitro can produce carious lesions in enamel and
dentin. Finally, this type of bacteria in large numbers can be demonstrated and
isolated from lesions in vivo , and it is also shown that the presence of certain
types of bacteria in relatively large numbers precedes tooth decay. The types
of bacteria that can cause caries are Streptococcus mutans, several types of
Streptococcus mitis, Streptococcus sanguis, Streptococcus miller , and many
Lactobacillus and several species of Actinomyces (Schuurs, 2007).
3) Substrate factor (leftovers)     
Very fast plaque formation occurs in feeding by mouth. Some of the food that
is given combines and is suitable as a substrate of plaque bacteria. Subtracted
from food, the opposite of saliva is only found a few moments each day, but
at high concentrations polysaccharides are synthesized in plaque and large
amounts of acid are formed from sugar. During the period of food supply,
there was a distorted selection, the use of sugar repeatedly increased the
growth of plaque and increased the number of streptococcus mutans in it
(Schuurs, 2007).
Substrate is a mixture of refined food and drinks eaten everyday that sticks to
the surface of the teeth. Human staple foods are carbohydrates, fats and
proteins. Basically, nutrition is very necessary for the growth and
development of teeth when forming the enamel and calcification matrix.
Nutrition plays a role in reshaping the oral tissues and forming resistance to
infections as well as caries . Nutrition is related to the growth and
development of teeth in the structure, size, composition, eruption and tooth
resistance to caries (Suwelo, 1992).
4) Time Factor     
The ability of saliva to deposit back minerals during the caries process,
indicates that the caries process occurs over a period of destruction and repair
that successively. Therefore, if saliva is in the dental arch, caries does not
destroy in a matter of days or weeks, but in months or years (Kidd, 2002).
C. Causes of Dental Caries
1. The main cause of dental caries is plaque that has accumulated on the surface
of the teeth. Plaque is formed from food scraps, dirt, bacteria in the mouth.
2. Rarely brush your teeth and often eat sweet foods can accelerate the growth
of plaque. When you eat sweet foods , bacteria in your mouth will produce
 acids. The acid in the plaque erodes the minerals in the hard tooth's outer
enamel.
3. Enamel erosion process is called the enamel erosion. Over time the erosion
process this can cause holes in small to tooth enamel. Well, the hole is called
the caries.
D. Characteristics and symptoms of dental caries are:
1. Tooth ache
2. Sensitive teeth
3. Mild to sharp pain when consuming sweet, hot, or cold foods
4. The hole seen in the tooth
5. Brown, black or white stains on the surface of the teeth
6. Pain when you bite food.
E. Types of Dental Caries
Based on the location of dental caries, can be distinguished as follows:
1. Caries Inspiens Namely caries occur on the surface of the tooth enamel (the
outer layer and the hardest on the teeth), and not to hurt, there is only black
or brown staining on the enamel.
2. Caries superficial Namely caries has reached the inside of the enamel and
sometimes hurt.
3. Caries Media Namely caries that has reached the dentin ( tooth bone ) or the
middle part between the surface of the tooth and pulp, but not more than half
of the dentin, teeth usually feel painful when exposed to cold stimulation,
sour and sweet foods.
4. Caries Profunda caries which hit more than half of dentin or has reached the
pulp. Usually it hurts when eating and pain suddenly without stimulation.
F. Process of Dental Caries
In our mouth there are various kinds of bacteria. One of these bacteria is
Streptococus. These bacteria gather to form a soft and sticky layer called plaque
that sticks to the teeth. Some of the plaque in the teeth convert sugar and
carbohydrates derived from food and drinks that are still attached to the teeth into
acids that can damage teeth by dissolving minerals that are in the teeth. The
process of disappearing minerals from the tooth structure is called
demineralization, while the addition of minerals in the tooth structure is called
remineralization. Dental caries occurs because the process of demineralization is
 greater than remineralization. In the early stages of the formation of dental caries is
the formation of dark spots that do not bias a cleaned with a toothbrush. If this spot
is left, it will get bigger and deeper. If the caries does not reach the tooth enamel, it
will not feel anything. However, if it has penetrated the tooth enamel, it will hurt
(Ramadan, 2010).
G. Clinical Manifestations
According to Kliegman and Arvin (2000) signs and symptoms of dental
caries include:
1. There is a lesion.
2. There is a hole in the teeth.
3. Black spots in the early caries stage.
4. Tooth decay (in milk bottle caries).
5. Often feels painful if the hole gets to the dentil.
6. A throbbing pain in the teeth to the head.
7. Incurred pain when exposed to cold water, and food intake, especially at night.
8. If it is severe there will be inflammation and pus develops.
H. Prevention and Management
There are several ways to prevent dental caries (Ramadan 2010) among
others, brushing with toothpaste that contains fluoride , dental hygiene by brushing
teeth properly, fissure sealant or closing the gap teeth. The management of other
dental caries between figs is as follows:
1. Dental cavities (dental fillings)
2. Tooth Extraction
3. Pulp capping or administration of calcium hydrogside to thicken the dentile
layer (Ramadhan, 2010)
4. Endodontic or treatment to overcome and treat cavities that have infections
(Ramadhan, 2010).