Dental Caries (Decay)

What is dental caries?

The current concept considers caries as a dynamic and reversible process, characterized by demineralisation and remineralisation occuring over time. Cavitation will occur only if dimineralisation predominates. Under favourable conditions, with the help of the modifiers, even an incipient lesion can become inactive and arrested. Arrested caries has a dark appearance.

Caries Risk

High-risk Groups

·       Malnourished children: malnutrition affects the development of salivary glands and the development of teeth

·       Socially deprived, especially those with less education and low knowledge about oral care

·       Some of the wealthy, who have easy access to refined foods and sugar products

·       Those who snack more frequently on sugary products

·       Medically compromised/handicapped: inadequate plaque control

xerostomia: all patients on medication like antidepressants, antihypertensives and                antipsychotics

                                          radiotherapy in salivary gland region

                                          rheumatoid arthritis

·     Infants who have prolonged, on-demand breast feeding beyond 42 months or infants who fed   with sugary fluids, especially at night

·       Residents of non-fluoridated water with no fluoride toothpaste or supplements

·       Clinical evidence: multiband orthodontics (due to stagnation of dental plaque) and partial dentures (increased plaque with greater risk of root caries on abutment tooth)

Caries risk can change throughout life. There can be change in diet due to change in lifestyle- loss of income, or bereavement or change in residence from fluoridated area to non-fluoridated area and vice-versa. 

What causes dental caries?

Dental caries is caused by plaque acids that gradually dissolve away the enamel and dentine of the tooth. Decay damages your teeth and may lead to the tooth needing to be filled or even taken out.

Why do my teeth decay?

Decay happens when sugars in food and drinks react with the bacteria in plaque, forming acids. Every time you eat or drink anything containing sugars, these acids attack the teeth and start to soften and dissolve the enamel. The attacks can last for an hour after eating or drinking, before the natural salts in your saliva cause the enamel to ‘remineralise' and harden again. It's not just sugars that are harmful: other types of carbohydrate foods and drinks react with plaque and form acids. (These are the ‘fermentable' carbohydrates: for example ‘hidden sugars' in processed food, natural sugars like those in fruit and cooked starches).

Always check the ingredients. Generally anything with ‘ose' in the name is a sugar, for example: sucrose, maltose and so on.

Having sugary or acidic snacks and drinks between meals can increase the risk of decay, because your teeth come under constant attack and do not have time to recover. It is therefore important not to keep having sugary snacks or sipping sugary drinks throughout the day.

What happens if I have a Caries (cavity)?

Once the cavity has reached the dentine your tooth may become sensitive, particularly when you have cold drinks, sweets and sour or hot foods. As the caries progresses near the dental pulp you may suffer from toothache.As the decay gets closer to the dental pulp the pain may last longer and you may need to take painkillers - paracetamol or ibuprofen - to control the pain.

Caries Management

Preventive Measures by modifying the causative agents

·       Tooth: make the tooth resistant to acid attack by use of fluorides

·       Plaque: remove plaque by brushing with fluoridated toothpaste, twice a day, after meals

·       Diet: have a nutritious diet with reduced frequency of sugars

 Operative Treatment

·       Restoration of teeth: Decayed teeth can be restored up to the reversible pulpitis stage. In case of irreversible pulpitis, root canal treatment is necessary, which requires special training, equipment, and multiple visits and is expensive.

·       Extraction of teeth: Badly decayed and broken down teeth need extractions.

Progression and Effect of Dental Caries

Initial lesion is visible as a white spot on the enamel. Continued acid attack changes the surface from smooth to rough. Enamel caries is painless. Under unfavorable conditions, as the lesion progresses, pitting and eventually cavitation occurs, extending into dentine.  At this stage (dental caries), there is slight pain, especially when eating sweet foods. If no treatment is done, pain increases and lasts longer as the cavity approaches the pulp. The initial stage of pulpal involvement is called reversible pulpitis.  The patient experiences sensitivity to hot and cold, which goes away when the stimulus is removed. Persistent pulpal inflammation leads to irreversible pulpitis, which causes spontaneous and persistent pain, which occurs especially at night. Spread of infection from the tooth to the periapical tissue results in periapical abscess.