Caries Tooth
Author : Dr.P.Shenbakam B.D.S
Definition
Is a process of irreversible demineralisation of calcified structures and breakdown of organic substances of the tooth structure.
Causes
mutltifactorial
1. Microorganisms : streptococcus mutants, Lactobacillus
2. Host: genetics,teeth anatomy, Poor dental hygiene - lack of tooth brushing, Increased exposure of teeth by receding gums
3. Evironment: food -nature,quantity,quality,duration, frequent meals. Scanty saliva Decreasing buffering capacity of the saliva
Bacteria may be from a caretaker's kiss or thru feeding premasticated food
Sucrose, fructose, glucose
Clinical Features
Pain in the tooth
Sensitivity to cold, hot or sweet food/drinks
Bad breath
the initial leisons appear as white leisons.they may be yellow to brown /black spots to cavities in the crown.the caries can start in root also in older peopl.
Complications
Inflamation of the tissue around the tooth
Loss of tooth
Infection or abscess formation
Cavernous sinus thrombosis
Ludwig angina
Pathophysiology
Plaquaes contain bacteria
Bacteria breakdown carbohydrates and produce acids
Acids breakdown enamel by demineralization of enamel dentine and cementum
Reach pulp and nerve endings and perodontal structures.
Risk Factors
Conditions that result in less saliva such as diabetes mellitus, Sjogren's syndrome, medications such as antihistamines and anti depressants
Poverty
Poor dental/oral hygiene
Receding gums resulting in exposure of the roots of the reeth
Prevention
The carious process is reversible before a cavity is formed
Regular cleaning of the teeth
Regular dental checkup - dental flossing
diet low in sugar
Fluoride
Bresh the teeth twice per day
Flossing between the teeth once a day
Screening
Chewing gum containing xylitol
Dental sealants
Children should not be allowed to fall asleep with sweetened liquids in their bottles and should not be fed sweetened food frequently.
Investigations
Dental radiograph - may show caries even before is visible to the eye
Treatment
Depends on the extent of destruction
Paracetamol or ibuprofen
Removal of the carious portion
Dental restoration with dental amalgam, composite resin, porcelain and gold
A crwon is placed - stainless steel - Hall Technique
Endodontic therapy = Root Canal treatment - the pulp including the nerve and vascular tissues is removed along with decayed portions of the tooth. fille with gutta percha - a crwon is fitted - after root canal treatment the tooth devoid of any living tissue
signs and symptoms:
the clinician may note a spot or discolouration on the crown of teeth.radiographially there will be radiolucency in the crown.the patient ay complain of food lodgement ,sensitivity to hot or cold,or pain .
disease outcome: when the lesion is small it is easily removed and replaced with some composite restoration or fillings. when it becomes large it may even leads to breaking of tooth structure leading to missing tooth.when not treated for a very long time the nfection may spreadto the mastigatory spaces leading to difficulty in breathing to death in very severe cases.
treatment modaities:
initial leisons - remineralisation with topical fluorides in children.small restorations.
moderate leisons-large restorations or crowns
large leisons-root canal treatment when root infected ,extraction and crown placement.
mastigatory spaces involvement- airway maintenece,and sepsis treatment.
