Caries is an infectious disease of the mouth.
Caries is an infectious disease of the mouth. As a consequence of the fermentation of sugars in the diet, the microorganisms in dental plaque produce acids that attack the inorganic component of tooth tissues. This produces a demineralization of these hard tissues which, if it advances and is perpetuated over time, can cause their destruction, which causes softening and the formation of a cavity.
Caries reduces the diversity of bacterial species present in the mouth. It is estimated that there are about 600 bacterial species in healthy dental plaque, while the number is reduced to 200 when the caries is located in the dentin (tooth tissue under the enamel) and to 125 species when we find an initial lesion in the enamel .
At the beginning, a white spot can be observed, which darkens with the passage of time, as the injury progresses. Those cavities that hide on the surface between the teeth are very difficult to identify with the naked eye, so on certain occasions it is necessary to perform intraoral X-rays to be able to diagnose them in time.
Generally, we can distinguish between three types of cavities:
Coronal caries: it is the most common, especially in children and young adults, and affects the parts of the tooth that perform the chewing function.
Root caries: it is usually associated with older patients with periodontal problems in which the root of the tooth is exposed. This type of caries is usually more dangerous (because it is closer to the nerve) and it is more difficult to treat, which is why, in more advanced cases, tooth extraction is often required as restoration is not possible.
Recurrent caries: one that appears under fillings or covers that have been previously placed for the treatment of another caries or in other circumstances, such as reconstruction of fractured teeth, replacement of absent teeth, aesthetic restorative treatments, etc.
Caries, along with gum diseases, is one of the most common pathologies that affect humans and is more common as they age.
Dental caries is estimated to affect 60-90% of the school-age child population and about 100% of adults. In Spain, more than 90% of the population between 35-65 years suffers or has suffered cavities.
Chemical dental destruction is associated with the intake of sugars and acids present, for example, in certain beverages and foods, although they must act for a long time.
Other factors related to the appearance of cavities are:
The dental anatomy itself: it can play a crucial role in the appearance of cavities, since the complexity of the surface in molars, and their location (in posterior areas) makes these teeth retain more dental plaque. It is also important to bear in mind that if the teeth are poorly positioned or crowded there will be more retentive areas of plaque, making it more difficult to perform good hygiene and, therefore, easier for cavities to appear.
Some oral bacteria: Streptococcus mutans and Lactobacillus acidophilus are more likely to cause cavities, since they are able to adhere to dental structures forming colonies (biofilm). Other microorganisms are also relevant, such as Bifidobacterium dentium and Scardovia wiggsiae (the latter associated with early childhood caries).
The influence of the pH of saliva: People with a low pH in the mouth are more prone to tooth decay. It must be remembered that the optimum level of pH in our saliva is around 7, so that a continuous decrease below 5.5 can favor the appearance of cariogenic bacteria.
Some diseases: anorexia nervosa or bulimia, due to repetitive vomiting or gastroesophageal reflux can favor its appearance.
Intense dry mouth: it is another factor that favors the appearance of cavities due to the lack of the protective role of saliva.
Cavities appear due to the presence of bacteria and the rest are factors that favor it. Among many other aspects that influence its appearance, include:
Frequent consumption of sugars, carbonated drinks (such as soft drinks, bottled juices, isotonic drinks) and abuse of foods rich in acids.
Poor oral hygiene: either due to poor brushing or insufficient dental care, especially related to the lack of use of interdental cleaning methods such as floss or interdental brushes.
Genetic inheritance: Although the contribution is low, genetics can increase susceptibility to tooth decay.
A low oral pH.
Certain medications: especially those that incorporate added sugars (sucrose) within their excipients or those that reduce salivary flow such as anxiolytics, antihistamines, etc.
Have the teeth very close together or mounted between them.
Suffering from periodontitis: Patients with this condition are at higher risk for root caries.
Caries generally begins at the level of the tooth enamel or the cementum that covers the root of the tooth when the gum has retracted. In the event that cavities progress, it will affect the dentin (tissue of the tooth under the enamel) and even reach the nerve of the tooth. At first they may feel discomfort when drinking or eating sweet and / or cold foods, and later also with hot ones. If it continues to evolve, it will cause pain (toothache) and can even sometimes be associated with the appearance of phlegmons.
Other signs and symptoms that can be associated with the presence of cavities are:
Darkening of tooth color.
Bad breath.
Presence of an unpleasant mouth taste.
The diagnosis of caries is based on a clinical and / or radiographic examination. The main determinant to consider that the disease is active is the presence of soft lesions within the tooth, lesions that the dentist will explore with a probe or specific instrument for this purpose.
Although tooth decay and periodontal diseases are pathologies of infectious origin that occur in the same environment (the mouth or teeth), there are important differential features that make them completely different pathologies. However, it has been seen, as we have commented, that patients with receding gums, as a consequence of periodontal disease, have a greater risk of experiencing cavities in the roots of the teeth and that these are more difficult to treat. try.
After the destruction of the enamel, caries attacks the dentin, and can even reach the dental pulp, which is the interior of the dental organ and what surrounds the dentin. In these more advanced cases, inflammation of the nerve and its subsequent necrosis (pulp death) can occur.
If the tooth is not properly treated, an inflammation can be established in the area around the apex (end of the root) leading to an infectious process at the bone level.
In both cases, and to maintain the natural tooth, a root canal or endodontic treatment will be necessary.
For the prevention of cavities, it is recommended to follow a series of oral health measures:
Carry out proper daily dental hygiene, insisting on the use of dental floss and / or interdental brushes.
Maintain a balanced diet, limiting the intake of sweets and soft drinks, especially regarding their frequency.
Chew gum without sugar and, if possible, containing xylitol, as it can help prevent cavities.
Use of specific fluoride treatments for high-risk patients under prescription and control by your dentist
Identify and treat certain diseases, such as anorexia nervosa, bulimia, or gastroesophageal reflux.
Place fissure sealants in the mouth or teeth: used to cover the retentive areas of bacteria in the posterior teeth, with the aim of preventing cavities.
If there is dry mouth, use salivary substitutes and drink water.
Treatment for cavities is usually based on:
Elimination of soft lesions caused by the advancement of caries.
Tooth restoration.
Depending on the degree of affectation, it may be necessary to practice a root canal and even have to put a cap on the tooth.
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