Dental caries or otherwise known as the dental cavity is a very common chronic infectious disease resulting from tooth-adherent cariogenic bacteria, most prominently Streptococcus Mutans, which metabolizes the sugars to produce acid and demineralize the tooth structure over time. Dental caries is a major public health problem and is the most widespread non-communicable disease(NCD).
Dental Caries is also the most prevalent condition included in the year 2015 Global Burden of Disease Study, ranking first for the decay of permanent teeth (2.3 billion people) and 12th for deciduous teeth (560 million children). It became a major health issue in the world which is affecting people in developed countries as 10% of the health expenditure is related to dental health care.
Caries is a multifactorial, chronic disease that causes destruction and demineralization of the hard tissues of the tooth by producing acids that are produced from the bacterial fermentation of food.
Dental plaque and biofilm are mainly associated with the etiology of gingival and periodontal diseases. Dental plaque is a sticky film or coat of bacteria that forms constantly both on the surface of teeth and also under the gingiva on the teeth root portion and slowly breaks down the alveolar bone that surrounds the teeth. We can also define it as a structural entity in which bacteria or other microorganisms are embedded in a highly organized intercellular matrix. Dental plaque predominantly consists of Streptococcus mutans and other anaerobes which include fusobacterium and actinobacteria. S. mutans and anaerobes are the primary colonizers of the tooth surface and play an important role in the establishment of early biofilm formation. The bacteria use the enzyme glucan sucrase to convert sucrose into a sticky, dextran-based, extracellular polysaccharide that allows the bacteria to cohere, forming dental plaque. Maintaining poor oral hygiene combined with unhealthy eating habits can be a major factor in the formation of dental plaque which can lead to many dental problems.
Evaluation of Dental Caries
Various techniques are present to detect or evaluate dental caries which include dental radiographs, visual-tactile method, fiberoptic illumination(FOTI), and digital fiberoptic illumination(DIFOTI).
The most common and simplest method is a conventional visual-tactile method of detecting caries. Several dental radiographs that are used for the evaluation of caries are intraoral periapical radiographs(IOPA), bitewing radiographs for occluso-proximal caries, and orthopantomogram(OPG), etc. The International Caries Detection and Assessment(ICDAS) is a useful tool for recording dental caries. This system classifies carious lesions into six categories, where a higher score correlates with a more advanced lesion and it also tracks the progression of the carious lesion. Newer advanced diagnostic devices including laser fluorescence detection and light-induced fluorescence, provide extra information about the carious lesion. Laser-induced fluorescence devices detect the demineralization and demineralization cycles occurring in the affected portion of the tooth.
The management of dental caries should be aimed at the following -
- Detecting initial lesions
- Determining caries activity
- Preserving the dental tissues
- Preserving the tooth structure
- Performing caries assessment tests
- Preventing new carious lesions
Treatment options depend on the depth of the cavity, if the caries is within the enamel and dentinal layer they can be restored using dental restorative materials which include dental amalgam, glass ionomer cement, dental composites, etc. If the caries is deep but not yet reached the pulp cavity can be treated using procedures that will help in reparative dentin formation. If caries has invaded the pulpal tissue it can be treated with a root canal treatment procedure followed by crowns which depend on the amount of tooth structure damaged. If the prognosis of the affected tooth is very hopeless then it can be extracted followed by replacement of the extracted site with new artificial teeth.
The prognosis of dental caries mainly depends on the patient’s health condition, maintenance of oral hygiene, and the extent and severity of the carious lesion. If the patient reports early signs of caries, the lesion may be reversed using preventive methods. If dental caries progresses to the moderate stage it can be filled and rebuilt but beyond the moderate stage, there can be a loss of a tooth. Prognosis depends even on the patient’s frequent and subsequent dental checkups.
- Abscess with or without sinus tract opening
- Periapical abscess
- Periapical cysts
- Periapical granuloma
- Apical periodontitis