Dental Caries Overview

Dental Caries Overview

• Dental caries is a dynamic process of demineralization and remineralization.
• It is caused by acids produced when bacteria in the mouth digest carbohydrates on the tooth surface.
• These acids demineralize the tooth surface, leading to the destruction of dental tissues.
• Initially, the process is reversible, but prolonged exposure makes it irreversible.

GDC Learning Outcomes

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

Intended Learning Outcomes

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

Aetiology of Dental Caries

• Caries is influenced by the interplay of time, susceptible tooth surface, fermentable carbohydrates, and plaque bacteria.

Histopathology of Enamel and Dentine Caries

• This is a subject of pre-reading material.

Types of Dental Caries

• Arrested/Inactive Caries:

  • When the balance between demineralization and remineralization favors remineralization, the carious lesions may heal.
  • Reasons for the balance shift to remineralisation can include improved oral hygiene or prevention measures, removal of plaque retention factors.
  • Treatments may include fluoride application and restorations for cosmetic reasons.
  • Requires continued prevention as arrested caries indicate an increased risk of future caries.

• Root Caries:

  • Primary tissue affected (initial stage): cementum
  • Rapidly progresses to dentine.
  • Occurs when root surfaces are exposed due to recession.
  • Followed by bacterial colonization.
  • Progresses faster than enamel caries due to cementum's softer nature.
  • Etiology (causes): Decreased salivary flow (xerostomia) reduces sugar clearance and mineral reservoir on the tooth surface.
  • Treatment:
    • Preventative measures: oral hygiene, diet advice (sugar-free sweets), fluoride. Oral hygiene can be challenging for elderly patients due to physical impairments.
    • Treatment: restoring with glass ionomer cement (fluoride-releasing) or composite resin, saliva substitutes, medications like pilocarpine, and tooth mousse.
    • When to restore: Cavitated lesions posing a risk to pulp (nerves). Uncontrollable sensitivity. Inhibition of plaque control. If active and not arrested.
    • Treatment technique: Isolation (ideally rubber dam) if adequate enamel and isolation possible. If not possible composite or glass ionomer cement.

• Early Childhood Caries:

  • Defined by presence of one or more decayed, missing, or filled (due to decay) tooth surfaces in preschool-age children (birth to 71 months).
  • Primarily in primary teeth.
  • Previously termed bottle caries or nursing caries.
  • Essentially refers to any child under 6 who has decay.
  • Further information in paediatric dentistry lectures.

• Rampant Caries:

  • Extensive form of caries.
  • Impacts multiple teeth.
  • Characterized by rapid progression.
  • Often more immune to decay in select areas (e.g. mandibular incisors)
  • Subgroups include: early childhood rampant caries, xerostomia-induced rampant caries, and radiation-induced rampant caries.
  • Treatment:
    • Extensive prevention.
    • Stabilization: using temporary restorations to assess response to prevention prior to definitive restorations.
  • Review treatment with conventional management of caries lectures.

• Caries based on anatomical position:

  • Smooth surface caries: Described as caries on smooth surfaces.
  • Pit and fissure caries: Described as caries in pits and fissures.
  • Interproximal caries: Caries between teeth, typically below contact points where bacteria accumulate easily.
  • GV Black Classification: Used to technically classify restoration designs related to cavity preparation. Can also be used to describe caries locations for treatment purposes.
    • Class I, II, III, IV, V, and VI have different tooth and surface locations.

• Primary/Secondary Caries:

  • Primary caries: caries affecting a previously untreated tooth surface.
  • Secondary caries: caries affecting a previously treated tooth surface (e.g. after restoration or fissure sealant).

• Residual Caries:

  • Caries remaining after restoration.
  • May be intentional (e.g. close to pulp, sealants) or unintentional (e.g., missed decay before restoration).

• White spot lesions/Incipient Caries:

  • Initial evidence of carious activity not yet in the dentine.
  • Can be remineralized with preventative measures.
  • May also be termed reversible caries or present as white spot lesions.

Follow-up Reading

• Detection of dental caries lecture.
• Caries prevention lectures.
• Caries management lectures.