Tooth decay is an infectious disease of the mouth. As a consequence of the fermentation of dietary sugars, the microorganisms in dental plaque produce acids that attack the inorganic component of tooth tissues. This produces a demineralization of these hard tissues that, if it advances and perpetuates itself over time, can cause its destruction, causing a 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 over time, as the lesion progresses. Those caries that are hidden on the surface between teeth are very difficult to identify with the naked eye, so on certain occasions it is necessary to perform intraoral radiographs in order to diagnose them in time.
Generally, we can distinguish between three types of caries:
Coronal caries: It is the most frequent, especially in children and young adults, and affects the parts of the tooth that perform the chewing function.
Root caries: it is normally associated with older patients with periodontal problems in which the root of the tooth is exposed. This type of caries is usually more dangerous (being closer to the nerve) and is more difficult to treat, which is why, in more advanced cases, tooth extraction is often required as restoration is not possible.
Recurrent caries: that that appears under the fillings or the covers that have been previously placed for the treatment of other caries or in other circumstances, such as reconstruction of fractured teeth, replacement of missing teeth, aesthetic restorative treatments, etc.
Caries, together with gum diseases, is one of the most frequent pathologies that affect humans and is more common as their age progresses.
Dental caries is estimated to affect 60-90% of the school-age child population and close to 100% of adults. In Spain, more than 90% of the population between 35-65 years old suffers or has suffered from cavities.
Dental chemical destruction is associated with the intake of sugars and acids present, for example, in certain drinks and foods, although they must act for a long time.
Other factors related to the appearance of caries are:
The dental anatomy itself: it can have a crucial role in the appearance of caries, since the complexity of the surface in molars, and its location (in posterior areas) makes these teeth retain more dental plaque. It is also important to keep in mind that if the teeth are poorly positioned or crowded there will be more plaque retentive areas, 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 cavities. It must be remembered that the optimal pH level 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 repeated vomiting or gastroesophageal reflux, can favor its appearance.
Intense dry mouth: it is another factor that favors the appearance of caries due to the lack of the protective role of saliva.
Caries appear due to the presence of bacteria and the rest are factors that favor it. Among many other aspects that influence its appearance, they 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 cavities.
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.
Having the teeth close together or mounted between them.
Having periodontitis: patients with this condition are at higher risk of root caries.
Caries usually begins at the level of the tooth enamel or the cement that covers the root of the tooth when the gum has retracted. In the event that caries progresses, it will affect the dentin (tooth tissue 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 (odontalgia) and sometimes it may even be associated with the appearance of phlegmon.
Other signs and symptoms that can be associated with the presence of cavities are:
Darkening of tooth color.
Presence of an unpleasant oral taste.
Caries diagnosis is based on a clinical and / or radiographic examination. The main determinant for considering that the disease is active is the presence of soft lesions within the tooth, lesions that the dentist will explore with a specific probe or instrument for this purpose.
Although caries and periodontal diseases are pathologies of infectious origin that occur in the same environment (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 who present retraction of the gums, as a consequence of periodontal disease, have a higher risk of experiencing cavities in the roots of the teeth and that these are more difficult to try.
After the destruction of the enamel, the caries attacks the dentin, and can even reach the dental pulp that is inside the dental organ and that surrounds the dentin. In these more advanced cases, inflammation of the nerve and its subsequent necrosis (pulp death) may occur.
If the tooth is not treated properly, an inflammation in the area around the apex (end of the root) can establish that leads to an infectious process at the bone level.
In both cases, and to maintain the natural tooth, it will be necessary to carry out root canal or root canal treatment.
For the prevention of caries, it is recommended to follow a series of oral health measures:
Perform 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 in regard to their frequency.
Chewing 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.
Placing fissure sealants in the mouth or teeth: used to cover the retentive areas of bacteria on the posterior teeth, in order to prevent cavities.
If there is dry mouth, use saliva substitutes and drink water.
Treatment for caries is usually based on:
Elimination of soft lesions caused by the advancement of caries.
Depending on the degree of involvement, it may be necessary to carry out an endodontic procedure and even have to put a cover on the tooth.
1. Brush your teeth at least 2 times a day for 2 minutes.
Good oral hygiene reduces the presence of gingivitis and the risk of developing caries lesions.
2. Use a paste that contains fluorine.
Fluorine prevents cavities and is also essential for the treatment and recovery of initial established injuries.
3. Don't forget about dental floss.
Use it on a daily basis to eliminate those bacteria located between your teeth and difficult to eliminate with your usual brush.
4. Complement your oral hygiene with an oral rinse.
Finish cleaning your mouth with a suitable mouthwash recommended by a healthcare professional.
5. Change your toothbrush every three months.
Sometimes, even before if it is very deteriorated and always to avoid the accumulation of bacteria on your brush, which originates over time.
6. Avoid consuming drinks and sugary foods.
The World Health Organization (WHO) advises reducing sugar consumption to less than 10% of the daily caloric intake in order to reduce the risk of dental caries.
7. Bet on a varied and balanced diet.
Diet plays a key role in preventing cavities. Consume vegetables, legumes, meat and fish regularly, without forgetting foods rich in vitamin C such as orange, kiwi or strawberries.
8. Drink water after meals.
Especially if you do not have the possibility of brushing, since you will help to eliminate the glucose particles deposited on the teeth.
9. Give up tobacco and alcohol.
Its consumption is not only harmful to your body but also favors the appearance of oral infections.
10. Visit your dentist regularly.
Proper maintenance of your mouth by dental professionals reduces dental plaque, gingival inflammation and carious lesions.
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30 Mar 2020