Dental Caries Management and Prevention

Describing Dental Caries

• Dental caries is a dynamic process of demineralization and remineralization.
• It's initiated by acids produced when bacteria in the mouth digest carbohydrates on the tooth surface.
• These acids demineralize the tooth surface, leading to destruction of the dental tissues.
• This process is initially reversible but can become irreversible.

GDC Learning Outcomes

• Describe oral diseases and their relevance to prevention, diagnosis, and treatment.
• Explain the etiology and pathogenesis of oral disease.
• Assess and manage caries, occlusion, and tooth wear, and, where appropriate, restore the dentition using minimal intervention maintaining function and aesthetics.

Intended Learning Outcomes

• Explain worldwide healthcare issues associated with dental caries.
• Describe dental caries based on its causative factors.
• Describe dental caries based on its anatomical location.
• Describe dental caries based on its stage of progression.
• Explain how the basic management principles may vary for different clinical presentations of dental caries.

Aetiology of Dental Caries

• Dental caries involves susceptible tooth surface, time, fermentable carbohydrate, and plaque bacteria.

Histopathology of Enamel and Dentine Caries

• Histopathology of enamel and dentine caries lectures are recommended for further reading.

Types of Dental Caries

• Arrested/Inactive Caries: When the balance between demineralization and remineralization favors remineralization, carious lesions may heal. This might leave a scar on the tooth surface. Improved oral hygiene and fluoride can favor remineralization.
• Root Caries: This affects cementum, rapidly followed by dentine, when the root surface is exposed to the oral environment due to recession. Bacterial colonization follows, and the cementum being softer than the enamel means root caries can progress faster. Decreased salivary flow/xerostomia reduces the clearing of sugars and reduces the reservoir of minerals on the tooth surface for remineralization. Radiotherapy can damage the salivary glands, leading to xerostomia and trismus.
• Early Childhood Caries: Defined by the presence of one or more decayed tooth surfaces in preschool-age children (ages 0-71 months) and possibly includes "bottle caries" or "nursing caries."
• Rampant Caries: An extensive form of caries affecting multiple teeth with rapid progression, sometimes in teeth that are usually more resistant to decay (e.g. mandibular incisors). This might be due to early childhood, xerostomia, or radiation.
• Smooth Surface Caries: Caries that occurs on the tooth surface.
• Pit and Fissure Caries: Caries that occurs in pits and fissures of the teeth.
• Interproximal Caries: Caries that occurs between teeth.
• Primary Caries: Caries affecting a tooth surface that has not previously been treated.
• Secondary Caries: Caries that affects previously treated tooth surfaces.
• Residual Caries: Caries that remains after a restoration. This might be intentional (e.g. close to the pulp) or unintentional (e.g. missing caries prior to restoring the tooth).
• White Spot Lesions/Incipient Caries: The first evidence of carious activity that hasn’t extended to the amelodentinal junction. These lesions can be remineralized.

Treatment for Dental Caries

• Arrested/Inactive Caries: Fluoride application and restoration with composite or glass ionomer cement to address aesthetic concerns. Continued prevention is key.
• Root Caries: Preventative measures include oral hygiene instructions, diet advice (sugar-free sweets), fluoride use (varnish, toothpaste, mouthwash) and addressing poor oral hygiene in elderly patients. Treatment may include restorations with glass ionomer cement (fluoride releasing) or composite resins. Saliva substitutes, medication (pilocarpine) and tooth mousse. Also review the restoration process in the context of conventional caries management.
• Rampant Caries: Extensive prevention plans. Stabilization with temporary restorations to assess response to prevention prior to definitive restorations. Review treatment alongisde conventional caries management.
• Other types: Management of other types of caries need to be evaluated in conjunction with general caries management.

Additional Notes

• Multiple descriptions of caries can be used for the same lesion.
• Review root caries, rampant caries treatment, and other types of caries alongside conventional management of caries lectures.
• Further reading on detection, prevention, and management of dental caries is recommended.