DEPARTMENT OF DENTAL MEDICINE

Research paper
 Brisa lala
What is a Dental Caries?
Dental Caries is a global health problem and has a direct impact on the quality of life, particulary
on children’s health and development. Dental caries is probably a disease of modern civilization.

Dental caries
Apparently the carious lesions were found at or just below the contact areas and an increased
frequency of caries at the cementoenamel junction was noted.
Below is a very important information regarding dental caries. We all need to be aware and
prevent this problem. Dental Caries causes:
-tooth pain
-discomfort eating impairment
-loss of tooth and delay language development.
Although dental caries are largely preventable, they remain the most common chronic disease of
children aged 6 to 11 years and adolescents aged 12 to 19 years. Tooth decay is four times more
common than asthma among adolescents aged 14 to 17 years. Dental caries also affects adults,
with 9 out of 10 over the age of 20 having some degree of tooth-root decay .
It has been increasing among school children due to unlimited consumption of sugary
substances, poor oral care practices and inadequate health services utilization.
Although effective methods are known for prevention and management of dental caries, it is a
major health problem with manifestations persisting throughout life despite treatment. It
is seen in all geographic areas in the world and affects persons of both genders in all races, all
socioeconomic strata, and every age group. Dental caries forms through a complex interaction
over time between acid-producing bacteria and fermentable carbohydrate, and many host factors
including teeth and saliva. 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 for caries 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.
In early tooth decay, there are not usually any symptoms. As tooth decay advances, it can cause a
toothache (tooth pain) or tooth sensitivity to sweets, hot, or cold. If the tooth becomes infected,
an abscess, or pocket of pus, can form that can cause pain, facial swelling, and fever.
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. Dentists commonly treat cavities by filling them. A dentist will remove the decayed
tooth tissue and then restore the tooth by filling it with a filling material.
CAUSES
Cavities are caused by tooth decay — a process that occurs over time. Here's how tooth decay
develops:
Plaque forms. Dental plaque is a clear sticky film that coats your teeth. It's due to eating a lot of
sugars and starches and not cleaning your teeth well. When sugars and starches aren't cleaned off
your teeth, bacteria quickly begin feeding on them and form plaque. Plaque that stays on your
teeth can harden under or above your gum line into tartar (calculus). Tartar makes plaque more
difficult to remove and creates a shield for bacteria.
Plaque attacks. The acids in plaque remove minerals in your tooth's hard, outer enamel. This
erosion causes tiny openings or holes in the enamel — the first stage of cavities. Once areas of
enamel are worn away, the bacteria and acid can reach the next layer of your teeth, called dentin.
This layer is softer than enamel and less resistant to acid. Dentin has tiny tubes that directly
communicate with the nerve of the tooth causing sensitivity.
Destruction continues. As tooth decay develops, the bacteria and acid continue their march
through your teeth, moving next to the inner tooth material (pulp) that contains nerves and blood
vessels. The pulp becomes swollen and irritated from the bacteria. Because there is no place for
the swelling to expand inside of a tooth, the nerve becomes pressed, causing pain. Discomfort
can even extend outside of the tooth root to the bone.

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

 Tooth location.
 Certain foods and drinks.
 Frequent snacking or sipping.
 Bedtime infant feeding.
 Inadequate brushing.
 Not getting enough fluoride.
 Younger or older age.
 Dry mouth.
 Heartburn.
 Eating disorder

SYMPTOMS
The signs and symptoms of cavities vary, depending on their extent and location. When a cavity
is just beginning, you may not have any symptoms at all. As the decay gets larger, it may cause
signs and symptoms such as:
 Toothache, spontaneous pain or pain that occurs without any apparent cause
  Tooth sensitivity
 Mild to sharp pain when eating or drinking something sweet, hot or cold
 Visible holes or pits in your teeth
 Brown, black or white staining on any surface of a tooth
 Pain when you bite down

Classification Based on Rate of Progression

Acute Dental Caries.

Acute dental caries is that form of caries which runs a rapid clinical course and results in early
pulp involvement by the carious process. It occurs most frequently in children and young adults,
presumably because the dentinal tubules are open and show no sclerosis. The process is usually
so rapid that there is little time for the deposition of reparative dentin.
Rampant Caries.
A condition which is characterized by sudden, rapid and almost uncontrollable destruction of
teeth, affecting surfaces of teeth that are relatively caries free.
Nursing Bottle Caries.
Is also called nursing caries, baby bottle syndrome, and bottle mouth syndrome. This is an
unfortunate form of rampant caries affecting the deciduous dentition. It has been variously
attributed to prolonged use of:
- A nursing bottle containing milk or milk formula, fruit
juice or sweetened water
- Breastfeeding
- Sugar or honey-sweetened pacifiers.

Acute dental caries.

The disease presents clinically as widespread carious destruction of deciduous teeth, most
commonly the four maxillary incisors, followed by the first molars and then the cuspids if the
habit is prolonged.
Adolescent Caries.
There are two chronological periods when acute, rapidly progressing caries is commonly
observed. Acute exacerbations in caries rates are usually seen at 4–8 years of age and at 11–18
years of age. The acute caries attack in the latter period is usually characterized as adolescent
caries. These are usually seen in teeth and surfaces that are relatively immune to caries, with a
relatively small opening in enamel and with extensive undermining of enamel.
Chronic Dental Caries.
Chronic dental caries is that form which progresses slowly and tends to involve the pulp much
later than acute caries. It is most common in adults. The entrance to the lesion is almost
invariably larger. Because of this there is not only less food retention, but also greater access
of saliva. The slow progress of the lesion allows sufficient time for both sclerosis of the dentinal
tubules and deposition of reparative dentin in response to adverse irritation.
Recurrent Caries.
Recurrent caries is that type which occurs in the immediate vicinity of a restoration. It is usually
due to inadequate extension of the original restoration, which favors retention of debris, or to
poor adaptation of the filling material to the cavity, which produces a ‘leaky margin’.
Arrested Caries.
Arrested caries has been described as caries which becomes static and does not show any
tendency for further progression.
Radiation Caries. The development of rampant caries in patients undergoing radiation therapy
in the head and neck region is referred to as radiation caries. It differs from the other types of
caries by involving the cusp tips, incisal edges and the cervical areas. Rate of progression is
faster when compared to the former. It starts as a diffuse area of demineralization encircling the
entire crown of the tooth at the cervical portion and proceeds further to result in amputation of
the crown at the gingival margin.

Factors Affecting Caries Prevalence

Race. Some studies show remarkable differences in the caries experience between races.
American blacks and whites, living in the same geographic areas under similar conditions, offer
an excellent opportunity for comparison. Investigations indicate that the blacks have fewer
carious lesions than the whites. Most studies concerning other races have been relatively
unsatisfactory because of complicating factors such as differences in diet or exposure to fluoride,
which tend to mask any differences due to racial background. Nevertheless, there is some
evidence to indicate that blacks, Chinese, and East Indians have
considerably less caries than American Whites. The English have a higher caries incidence than
Italians, Russians, and Chinese.
Age. Carious lesions that result in cavitation are irreversible and therefore, cumulative with age.
There is a strong correlation between age. Several studies have shown that by the age of 6 years,
about 20% of children have experienced dental caries in their dentition and a DMFT of 0.5 can
be expected. By the age of 12 years, 90% of children would have experienced a DMFT of
approximately 5.5. The decayed, missing and filled surface (DMFS) accelerates at a greater rate
than the DMFT beyond the age of eight years. By the age 12, an average DMFS of 7.5 is seen in
most populations. In general, other reports of caries prevalence among children in various parts
of the world show rates that seem to be comparable to those cited here. Another common
element is that children from families in lower socioeconomic groups consistently have greater
caries prevalence than their peers from families at a higher socioeconomic level.
Gender. Studies indicate that the total caries experience in permanent teeth is greater in females
than in males of the same age. This is attributable largely to the fact that the teeth of girls erupt at
an earlier age. This time difference is particularly significant during the formative years because
teeth have been shown to be maximally susceptible to dentalcaries immediately after eruption
since, the chemical structure of teeth in the immediate post eruptive stage is suboptimal in terms
of caries resistance. As teeth are exposed to saliva and constituents in the diet, the outer layers of
the tooth take up additional minerals from the oral environment in a process known as
posteruptive maturation. This maturation process confers a greater resistance to dental caries on
the tooth.
Familial. Siblings of individuals with high caries susceptibility are also generally caries active,
whereas siblings of caries immune individuals generally exhibit low caries rates. Children of
parents with a low caries experience also tend to have low caries; the converse is true for
children whose parents have a high caries rate . Studies of the dental caries experience in
monozygotic and dizygotic twins indicate that concordance for carious sites in monozygotic
twins is much higher than in dizygotic twin pairs.

TREATMENT
Regular checkups can identify cavities and other dental conditions before they cause troubling
symptoms and lead to more-serious problems. The sooner you seek care, the better your chances
of reversing the earliest stages of tooth decay and preventing its progression. If a cavity is treated
before it starts causing pain, you probably won't need extensive treatment.
Treatment of cavities depends on how severe they are and your particular situation. Treatment
options include:
Fluoride treatments. If your cavity just started, a fluoride treatment may help restore your
tooth's enamel and can sometimes reverse a cavity in the very early stages. Professional fluoride
treatments contain more fluoride than the amount found in tap water, toothpaste and mouth
rinses. Fluoride treatments may be liquid, gel, foam or varnish that's brushed onto your teeth or
placed in a small tray that fits over your teeth.
Fillings. Fillings, also called restorations, are the main treatment option when decay has
progressed beyond the earliest stage. Fillings are made of various materials, such as tooth-
colored composite resins, porcelain or dental amalgam that is a combination of several materials.
Crowns. For extensive decay or weakened teeth, you may need a crown — a custom-fitted
covering that replaces your tooth's entire natural crown. Your dentist drills away all the decayed
area and enough of the rest of your tooth to ensure a good fit. Crowns may be made of gold, high
strength porcelain, resin, porcelain fused to metal or other materials.
Root canals. When decay reaches the inner material of your tooth (pulp), you may need a root
canal. This is a treatment to repair and save a badly damaged or infected tooth instead of
removing it. The diseased tooth pulp is removed. Medication is sometimes put into the root canal
to clear any infection. Then the pulp is replaced with a filling.
Tooth extractions. Some teeth become so severely decayed that they can't be restored and must
be removed. Having a tooth pulled can leave a gap that allows your other teeth to shift. If
possible, consider getting a bridge or a dental implant to replace the missing tooth.

CONCLUSION

So, dental caries or cavities, more commonly known as tooth decay, are caused by a breakdown
of the tooth enamel. This breakdown is the result of bacteria on teeth that breakdown foods and
produce acid that destroys tooth enamel and results in tooth decay.
Although dental caries are largely preventable, they remain the most common chronic disease of
children and adolescents. Water fluoridation, named by CDC as one of the ten great public
health achievements of the 20th century, has been a major contributor to the decline of the rate of
tooth decay. Studies have shown that water fluoridation can reduce the amount of decay in
children’s teeth by 18-40%.
In addition to fluoridated water, good oral hygiene can help prevent tooth decay:

Brush twice a day with a fluoride toothpaste.

Clean between your teeth daily with floss or interdental cleaner.
Eat nutritious and balanced meals and limit snacking.
Visit your dentist regularly for professional cleanings and oral examination.
Check with your dentist about use of supplemental fluoride, which strengthens your teeth, and
about use of dental sealants (a plastic protective coating) applied to the chewing surfaces of the
back teeth to protect them from decay.

REFERNCES:

https://en.wikipedia.org/wiki/Tooth_decay

https://www.mayoclinic.org/diseases-conditions/cavities/diagnosis-treatment/drc-20352898

https://www.mayoclinic.org/diseases-conditions/cavities/symptoms-causes/syc-20352892

https://www.cdc.gov/healthywater/hygiene/disease/dental_caries.html#:~:text=Dental%20caries
%20or%20cavities%2C%20more,and%20results%20in%20tooth%20decay.

Shafer’s Textbook of ORAL PATHOLOGY