Dental Caries

 

Dental caries, also known as tooth decay or cavity.

It is a disease wherein bacterial processes damage hard tooth structure

These tissues progressively break down, producing dental caries or in simple words cavities, holes in the teeth..

If left untreated, the decay or caries can lead to pain, tooth loss, infection.

Signs and symptoms

The earliest sign of a new carious lesion is the appearance of a chalky white spot on the surface of the tooth, which indicate the area of demineralization of enamel. This is nothing but the incipient decay.

Lesion if continue to decay or demineralize it can turn brown but will eventually turn into cavity or cavitations.

Once the decay passed through the enamel, dentinal tubules it the then reaches to pulp or nerve of the tooth which then causes pain in the tooth.

Pain may worsen with exposure to heat, cold, drinks and sweet foods.

Caries may also cause bad breath and foul smell.

The tip of a dental explorer, which is used for caries diagnosis.

Causes

There are four main criteria required for caries formation: a tooth surface (enamel,  or dentin); caries-causing bacteria; fermentable carbohydrates (such as sucrose)  and time.

The caries process does not have an inevitable outcome, and different individuals will be susceptible to different degrees depending on the shape of their teeth, oral hygiene habits, and the buffering capacity of their saliva

Diagnosis

Primary diagnosis involves inspection of all visible tooth surfaces using a good light source, dental mirror and explorer.

Dental radiographs (x-rays) may show dental caries before it is otherwise visible, particularly caries between the teeth.

Large dental caries are often apparent to the naked eye, but smaller lesions can be difficult to identify.

Visual and tactile inspections along with radiographs are employed frequently among dentists, particularly to diagnose pit and fissure caries.

When a cavity is present, a restoration will be needed to replace the lost tooth structure.

Treatment

Destroyed tooth structure does not fully regenerate.

For the small lesions, topical fluoride is sometimes used to encourage remineralization.

For larger lesions, the progression of dental caries can be stopped by treatment. The goal of treatment is to preserve tooth structures and prevent further destruction of the tooth.

Generally, early treatment is less painful and less expensive than treatment of extensive decay.

Anesthetics—local, nitrous oxide (“laughing gas”), or other prescription medications—may be required in some cases to relieve pain during or following treatment or to relieve anxiety during treatment.

A dental hand piece (“drill”) is used to remove large portions of decayed material from a tooth. A spoon is a dental instrument used to remove decay carefully and is sometimes employed when the decay in dentin reaches near the pulp. Once the decay is removed, the missing tooth structure requires a dental restoration of some sort to return the tooth to functionality and aesthetic condition.

Restorative materials, include

Dental amalgam

Composite resin,

Porcelain, and gold..

When the decay is too extensive, there may not be enough tooth structure remaining to allow a restorative material to be placed within the tooth. Thus, a crown may be needed. This restoration appears similar to a cap and is fitted over the remainder of the natural crown of the tooth. Crowns are often made of gold, porcelain, or porcelain fused to metal.

In certain cases especially, endodontic therapy may be necessary for the restoration of a tooth.

Endodontic therapy, also known as a “root canal”, is recommended if the pulp in a tooth dies from infection by decay-causing bacteria or from trauma. During a root canal, the pulp of the tooth, including the nerve and vascular tissues, is removed along with decayed portions of the tooth. The canals are instrumented with Endodontic files to clean and shape them, and they are then usually filled with a rubber-like material called gutta percha. The tooth is filled and a crown can be placed. Upon completion of a root canal, the tooth is now non-vital, as it is devoid of any living tissue.

An extraction can also serve as treatment for dental caries. The removal of the decayed tooth is performed if the tooth is too far destroyed from the decay process to effectively restore the tooth. Extractions are sometimes considered if the tooth  with extensive caries eventually requiring extraction.

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