Dental Caries (Tooth Decay)

Tooth Decay Definition

Dental caries, commonly known as tooth decay, is one of the most common dental diseases affecting the general population. It is caused by microbes infiltrating tiny cavities that form in the hard outer surface of the teeth. The bacteria casing dental caries lead to various chemical reactions on the surface of the tooth and some of these reactions cause localized demineralization of the tooth structures. Dental caries can severely compromise the tooth structure and eventually lead to loss of the tooth.

Symptoms of Tooth Decay

The earliest sign of caries is whitish spots on the surface of tooth, the hard outer layer known as the enamel. It is also known as incipient caries. Once the caries progresses towards the underlying dentin and enamel junction it causes cavitations of the tooth surface. The color of the visible indentation also changes from light brown to dark brown. As the dentin gets exposed to the environment within the mouth, tooth sensitivity may become evident. Hot and cold food or drinks, and cold air can elicit pain.

Picture of tooth decay from Wikimedia Commons

Types of Tooth Decay

In general dental caries are roughly classified in to there types depending on its location :

  • Pit and fissure type
  • Smooth surface type
  • Root caries

Pit and fissure caries affects the grinding surfaces of molars and premolars .This type of caries fans out as it penetrates enamel. It is a cone shaped defect with its base towards the junction of enamel and dentin and apex towards the pit. Caries starting on smooth surface has a broad area of origin and a conical extension towards the pulp. Root surface caries begins directly at dentin. It is a U-shaped lesion affecting the cementum covering the root of the teeth.

Causes of Tooth Decay

Streptococcus mutans is the important bacteria responsible for tooth decay .Other microorganisms like Lactobacillus acidophilus, Lactobacillus cassei, Actinomyces species and Streptococcus sanguis also have ability to produce caries. There are many different reasons why tooth decay may arise.

The three factors that are necessary for decay to form includes :

  1. A susceptible tooth.
  2. Microorganisms capable of causing decay.
  3. Food remnants, particularly fermentable carbohydrates, on the teeth.

The cariogenic bacteria accumulate son the susceptible tooth surfaces leading to chemical reactions in the presence of food remnants thereby altering the pH of the tooth. The process leads to destruction of crystals-forming enamel and dentin causing cavitations. Early childhood decay affects multiple teeth is often related to diet pattern and feeding habits of the child. Rampant decay may also be seen in teenagers. These contributing factors for the development of decay are largely due to poor dental hygiene. Sometimes decay can also arise as a result of radiation to the head or neck usually for the treatment of cancer.

Tooth Decay Treatment

The best treatment for dental caries is its prevention. Fluoride in toothpaste and mouthwash, application of fluoride in the clinic setting and procedures to address the decay are necessary in the treatment process.

As early childhood decay tends to cause rapid destruction of the teeth, prevention should be started at an early age. Maintenance of oral hygiene should start as soon as the first tooth erupts in the oral cavity. Feeding and diet patterns in children should be monitored.

Deep fissures and grooves on grinding surface of molars should be sealed with pit and fissure sealants. Tooth decay that has progressed further can be treated by drilling and filling. The entire decayed portion is excavated and refilled using material such as dental cements, dental amalgam and dental composites restorative materials.

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