Understanding Dental Caries

What is Caries?

• Dental caries is a common bacterial infection characterized by gradual demineralization of tooth tissues.
• The infection is the main cause of tooth loss worldwide.

Initial Caries

• Appearance: White spots or opaque areas on tooth enamel indicate mineral loss.
• Location: Often found on smooth surfaces, near the gumline, in pits and fissures, or between teeth.
• Reversibility: Can be reversed with good oral hygiene, fluoride treatments, and diet changes.

Risk Factors

• Local: Existing caries, high S.mutans levels in saliva, low plaque pH, enamel defects.
• Systemic: Head and neck radiotherapy, diabetes mellitus, Sjogren's syndrome.

Oral Environmental Risk Factors

• Prior caries experience is a significant predictor of future decay.
• High levels of S.mutans bacteria in saliva are strongly associated with increased caries risk.
• Low plaque pH is a major risk factor because it creates an acidic environment that promotes tooth decay.
• Developmental enamel defects significantly increase caries risk, especially in early childhood.

Personal Behavior Risk Factors

• High sugar intake and frequent snacking increase caries risk.
• Poor oral hygiene is directly linked to high caries risk, periodontal disease, and tooth loss.
• Parents' oral health, socioeconomic status, and habits significantly influence a child's caries risk.

Systemic Risk Factors

• Radiotherapy to the head and neck, especially targeting salivary glands, significantly increases caries risk.
• Both Type 1 and Type 2 diabetes are associated with higher caries risk.
• Sjogren's syndrome, an autoimmune disorder, causes increased caries risk due to chronic dry mouth.

Preventive Factors

• Local: Saliva, fluoride, chewing gum, dental sealants.
• Systemic: Systemic fluoride, probiotics.

Local Factors

• Saliva protects against caries by neutralizing acids, containing antibacterial compounds, and diluting sugars.
• Fluoride reduces caries incidence through topical applications or mouth rinses.
• Sugar-free chewing gum, especially with xylitol, reduces S.mutans levels in saliva.
• Dental sealants offer effective protection against caries by acting as a physical barrier and preventing bacteria from penetrating.

Systemic Factors

• Probiotic supplements reduce S.mutans levels and prevent biofilm formation, lowering caries risk.
• Water fluoridation significantly reduces the incidence of dental caries.

Role of Saliva

• Saliva protects against caries by:
  • Diluting and eliminating sugars and other substances
  • Neutralizing acids with buffer capacity
  • Balancing demineralization and remineralization
  • Exhibiting antimicrobial action

Caries Detection and Diagnosis

• Tactile examination: Uses dental explorers and dental floss.
• Radiographic Examination: Caries attenuates less radiation than intact tooth surface, appearing darker on film.
  • Interproximal > Occlusal > Buccal > Lingual > Cemental
  • Conventional vs Digital

Light-Based Caries Detection

• Fluorescence-Aided Caries Excavation (FACE)
• Fiber-Optic Transillumination (FOTI)
• Quantitative Light-Induced Fluorescence (QLF)
• Laser fluorescence (DIAGNOdent)
• Photothermal Radiometry and Modulated Luminescence (The Canary System)

Fiber-Optic Transillumination (FOTI)

• FOTI transmits light through dental tissues to diagnose caries and other conditions.
• Applications: Identifying developmental defects, locating root canal orifices, detecting fractures.
• Advantages over radiographs: FOTI often has higher specificity and sensitivity.

Caries Indices

• DMFT/dmft Index (Decayed, Missing, Filled Teeth):
  • Purpose: Measures caries prevalence and severity in permanent (DMFT) and primary.
  • Components: D/d (decayed), M/m (missing), F/f (filled).
  • Application: Quantifies caries in populations and evaluates public health interventions.

Prevention

• Early screening is required from infancy, childhood, adolescence, and adulthood.
• Prevention approaches:
  • Community
  • Professional care
  • Individual preventative measures

This quiz explores the basics of dental caries, including its definition, stages, and risk factors. Learn about the initial appearance of caries and how they can be reversed with proper care. Test your knowledge about the causes and preventive measures related to tooth decay.