Dental Caries

Dental caries, commonly known as tooth decay or cavities, is a chronic, multifactorial disease characterized by the demineralization of tooth structure due to the action of acids produced by bacteria. It can lead to pain, infection, and tooth loss if not treated.

Causes

1. Bacterial Infection: The primary bacteria involved in caries are Streptococcus mutans and Lactobacillus species, which metabolize sugars to produce acids.
2. Diet: High sugar and carbohydrate intake, particularly from fermentable sugars, contributes to acid production.
3. Plaque Formation: Dental plaque, a biofilm of bacteria that forms on teeth, is essential for caries development. Poor oral hygiene leads to plaque accumulation.

Systemic Causes

1. Diabetes Mellitus: Individuals with uncontrolled diabetes may experience dry mouth (xerostomia) and increased susceptibility to infections, including dental caries.
2. Autoimmune Disorders: Conditions like Sjögren’s syndrome can lead to reduced saliva production, increasing the risk of caries. (in sjogren’s look for Anterior dental caries)
3. Hormonal Changes: Fluctuations in hormones during pregnancy or menopause can affect oral health and increase caries risk.
4. Nutritional Deficiencies: Deficiencies in essential nutrients, particularly calcium and vitamin D, can weaken tooth structure and enamel, making teeth more susceptible to decay.
5. Medications: Certain medications, such as antihistamines, antidepressants, and diuretics, can cause dry mouth, reducing saliva’s protective effects against caries.

Risk Factors

1. Poor Oral Hygiene: Inadequate brushing and flossing allow plaque to build up.
2. Dietary Habits: Frequent consumption of sugary snacks and beverages increases caries risk.
3. Salivary Flow: Reduced saliva (xerostomia) can impair the mouth’s ability to neutralize acids and remineralize enamel.
4. Fluoride Exposure: Lack of fluoride, which helps strengthen enamel, increases susceptibility to caries.
5. Socioeconomic Factors: Limited access to dental care and education can contribute to higher caries rates.

Prevention

1. Oral Hygiene: Regular brushing with fluoride toothpaste and flossing to remove plaque.
2. Dietary Modifications: Reducing sugar intake and promoting a balanced diet rich in fruits, vegetables, and whole grains.
3. Fluoride Use: Utilizing fluoride toothpaste, mouth rinses, and professional fluoride treatments to strengthen enamel.
4. Regular Dental Visits: Routine check-ups and cleanings to monitor oral health and catch caries early.
5. Sealants: Application of dental sealants on molars to protect pits and fissures from decay.

Management

1. Fluoride Treatments: Professional fluoride applications can help remineralize early carious lesions.
2. Restorative Procedures: Fillings, crowns, or other restorative treatments for cavities.
3. Root Canals: Necessary for advanced decay that has reached the pulp of the tooth.
4. Extraction: In cases of severe decay where the tooth cannot be saved.

References

1. Featherstone JD. “The Science and Practice of Caries Prevention.” Journal of the American Dental Association. 2000;131(7):887-899.
2. Kassebaum NJ, et al. “Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990-2015: A Systematic Analysis for the Global Burden of Disease Study 2015.” Journal of Dental Research. 2017;96(4):380-387.
3. Marthaler TM. “Changes in Dental Caries 1953-2003.” Caries Research. 2004;38(3):173-181.
4. Scully C, et al. “Oral and Dental Health in Patients with Diabetes.” Diabetes Care. 2005;28(3): 1-7.