<strong>CARIES</strong>
CARIES

Dental caries is a multifactorial disease that involves interactions between teeth, saliva and oral microbiota, which are considered individual factors, and diet, which is considered an external factor. In addition, genetic, biological and behavioural factors, etc. can be determinants.

Caries is a form of infection in which specific bacteria accumulate on the enamel surface, where they produce acid products that demineralise the surface and cause decay. Once damage is done to the enamel, the process spreads to more internal parts of the tooth, through the dentin and toward the pulp. If this process is not stopped, the teeth can be completely destroyed. Caries progression can be interrupted by mechanically removing infected dental tissue and replacing it with a synthetic material that is able to restore the normal shape and functions of teeth.

If caries is left untreated, the process will end up penetrating the innermost root channels of the teeth, toward the soft tissue, where a painful, inflammatory reaction will commence.

It is one of the most common oral diseases around the globe. It tends to occur in children and young adults, although it really can affect anyone, significantly impairing their quality of life.

ORIGIN

The essential role of microorganisms in the aetiology of caries was established by Miller in 1890. In recent years, Streptococcus mutans has been identified as the main microorganism responsible for dental caries. Other microorganisms participate, including Lactobacillus, Actinomyces and other types of Streptococcus, but their role is less important.

CAUSES

Dental caries is associated with the following causes: 

  • Intake of foods with a high sugar content and carbonated beverages (soft-drinks whose acids can harm teeth).
  • Improper oral hygiene techniques, such as a lack of toothbrushing, use of inadequate toothpaste or not using dental floss. It is also wise to note that some teeth, due to their special morphology or position, may retain more or less oral biofilm. Posterior teeth (molars and premolars) are more prone to the onset of caries, and therefore need to be more carefully brushed.
  • Reduction of pH in saliva affects the onset of caries.
  • A diet with high levels of fermentable carbohydrates.
  • Long periods between meals and brushing. The longer the period, the more likely it is that bacteria will attack and that acids will affect teeth.
  • Inherited genetic susceptibility. Some people are more prone to caries.
  • Sleeping with a bottle (in the case of younger children), because the nipple remains in contact with the palatal surfaces of the maxillary anterior teeth for more than 8 hours. Bottles and glasses with suction nozzle may also be a cause.
  • Some drugs alter oral biofilm composition and pH of the mouth, such that those who take them are more susceptible to getting caries. In addition, sugar is the main component of antacid tablets, syrups and cough drops, products often taken by children. Sweetened medications can be particularly problematic for those with chronic illnesses and who follow long-term therapies.
  • Other factors that influence caries formation are age, overall health, fluoride, proper instruction, socioeconomic level and a history of caries.

DIAGNOSIS (Common Diagnostic Methods)

  • History and nature of pain: these are related to the circumstances of its occurrence, such as the duration and type of sensation felt by the patient.
  • Reaction to temperature changes: done in the dental office by placing a cold or very hot object on teeth.
  • Reaction to electrical stimulation: Performed with a low voltage direct current. This test assesses the degree of excitability of the nerves of the inflamed pulp.
  • Reaction to the percussion of the tooth: a positive reaction to percussion indicates that there is apical periodontal tissue inflammation (supporting tissue around the root end of a particular tooth).
  • Radiographic Exploration: used to determine the extent of the carious lesion and to determine whether the inflammatory response has reached the periapical tissue.
  • Visual Exploration: used to determine the location and extent of the lesions.
  • Probing surrounding area: If probing the periapical area causes pain, this means that the inflammation has reached the tissue surrounding the tooth apex.

TREATMENT

The formation of biofilm on the surface of teeth is constant, so changes in pH caused by certain processes that occur in the oral cavity cannot be avoided, although their consequences can; in other words caries formation can be avoided.

Before planning treatment, an important prerequisite is to determine the individual risk for caries.

Disease control is accomplished by fighting oral biofilm formation. Controlling the disease by teaching patients how to best remove plaque through proper oral hygiene, by brushing every day, fluoride application (toothpastes, gels, etc..), modification of dietary habits, which can prevent or at least postpone the appearance of lesions.

  • Professional-use topical fluorides: 
Evidence on the effectiveness of fluoride in reducing the appearance of carious lesions and in slowing the progression rate of these lesions is well documented, however existing clinical trials on different forms of application and their effectiveness are not entirely consistent, with great differences depending on age and baseline caries risk. Therefore, the right pharmaceutical formulation is ever more important.
 
  • Fluoride for use at home: 
Toothpaste with fluoride concentrations that increase enamel resistance against the aggression of caries. Daily use of fluoride toothpaste provides teeth protection because it remineralises enamel and prevents caries. It is advisable, therefore, to brush teeth with fluoride toothpaste after every meal and especially before bed.

Other preventive measures include the use of:

  • Chlorhexidine: proven effective in reducing the appearance of carious lesions in high risk patients..
  • Pit and Fissure Sealants: preventive measures for both adults and children
  • Xylitol: Xilitol is a powerful non-caloric natural sweetener that is not consumable by cariogenic bacteria, because of its chemical structure with five carbons that cannot be recognised by Streptococcus mutans. It can reduce the rate of plaque formation, increase saliva flow and stimulate remineralisation.

Because children are very prone to developing caries, it is necessary to reinforce preventive measures. It is recommended to follow proper oral hygiene, even before the first teeth appear. And in the case of infants, it is advisable to take them to the paediatric dentist after the first month of life, and clean their mouth every day with clean, damp gauze. When deciduous or baby teeth begin to erupt, use a small brush with smooth rounded filaments three times a day.

The degree of cooperation of the patient is essential, so that anyone can learn to control the development and progression of caries through the control and preventive measures mentioned above.

It is advisable to visit your dentist once every 6 months or once per year to ensure proper oral health.

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