Sam Proof Medical

Dental Probe

Tooth Decay

Dental caries - An overview

 

Author:

Mr. Suhail Lato

Professor

Department of Oral Pathology and Microbiology,

Govt. Faculty of Dentistry, Sgr

Co-authors:

Prof. (Dr.) Riyaz Farooq

Chief

Department of Conservative Dentistry and Endodontics,

Govt. Dental College, Sgr.

Dr. Ajaz Shah A

Associate Professor and Chief

Department of Oral and Maxillofacial

Govt. Dental College, Sgr.

 

Dr. Amir Rashid Purr

Department of Dentistry Conservative and Endodontics,

Govt. Dental College, Sgr.

 

Mr. Kaul Rudra

Academic Graduate

Department of Conservative Dentistry and Endodontics,

Govt. Dental College, Sgr.

Mr. Ullah Shafai Khatib

Department of conservative dentistry and endodontics

Govt. Dental College, Sgr.

Dr. Shazia Qadir

Department of Oral and Maxillofacial

Govt. School of Dentistry, Sgr.

 

Mr. Babar Ali Shah

Department of Oral Surgery and maxillofacial

Govt. Dental College, Sgr

Altaf Malik H

Department Oral and Maxillofacial Surgery

Govt. Dental College, Sgr

Mr. Mubashir Mushtaq

Conservative Dentistry and Endodontics Department

Govt. Dental College, Sgr.

Dr. Ali Aashiq

Department Oral and Maxillofacial

Govt. Dental College, Sgr

Dental caries - An overview

Summary

Dental caries is a pandemic disease that affects people of almost all age groups. It is a multifactorial disease, irreversible microbial calcified tissues of teeth characterized by demineralization of the inorganic and the destruction of the organic substance of the tooth, which often leads to cavitation. It is complex and dynamic process with a multitude of factors that influence the progression and start the disease. Although there are effective methods of prevention and management of dental caries is a major problem health that affect humanity, that its manifestations persist throughout life despite treatment. In this presentation, we discuss etiopathogensis, the presentation, diagnostic tests and various modes of treatment of dental caries.

Introduction:

Dental caries (tooth decay) is one of the most common of all disorders, second only to colds. It usually occurs in children and young adults but can affect anyone. It is a common cause of tooth loss among young people.

The bacteria are usually present in the mouth. The bacteria convert all foods, especially sugar and starch, into acids. Bacteria, acid, food debris and saliva in the mouth combining to form a sticky substance called plaque that adheres to teeth. If plaque is not removed thoroughly and regularly, tooth decay will not only begin, but flourish. Acids dissolve the enamel of the tooth and create holes in the tooth (cavities). Cavities are usually painless until they reach very large and affect nerves or cause a tooth fracture. If it untreated, a tooth abscess can develop. Untreated tooth decay also destroys the internal structures of the tooth (pulp) and ultimately cause tooth loss.

The purpose of this review is to discuss etiopathogensis, presentation, diagnostic tests and various modes of treatment of dental caries.

 

Epidemiology:

In modern human populations, tooth decay has a characteristic appearance. For all types of injuries caries, the molars are the most affected, followed by premolars and anterior teeth. coronal caries is a disease of children, rising steadily fifteen or less, and then falling in early adulthood. It is more common among girls than boys, but in the eruption of teeth in early states girls at risk of their teeth longer. root surface caries also particularly affects the proximal surfaces of teeth of the cheek, but it is a disease of adults. The decay scheme is similar to members of the same family for several generations, perhaps due to factors hereditary, but environmental factors such as dental care and nutrition also plays a very important role (Hillson, 1996).

 

Etiopathogensis:

Tooth decay is caused by the interaction between oral bacteria and their access to fermentable carbohydrates and vulnerable parts of the tooth. Classical Chart and named Stephen, shows the rapid decrease plaque pH after rinsing glucose (Stephan and Miller, 1943). The pH decrease is a result of fermentation of carbohydrates by plaque bacteria. The gradual return is the result of buffer pH of plaque and saliva. Whenever the pH is at least 5.3 enamel remains intact, but below this critical level, the dissolution of apatite crystals. Fortunately, both plaque and saliva are saturated with calcium and phosphate ions, so that if the pH becomes very rapidly above the level of 5.3, the ions are mixed with varnish and recrystallize. This remineralization process takes more time in an acidic medium, but it is fast if the next fluid enamel is neutral or even alkaline. Decay is rare in some parts of the mouth close to the production of salivary glands as the lower incisors, where the teeth are constantly bathed in the sources and calcium ions concentrated saliva. If the total flow of saliva may be more, there is a greater possibility of the protection of all teeth in the arch. Some foods, like cheese, stimulate the flow of saliva. Jenkins (1970) found that the cheese after a meal is not only a good way to put end, but also a particularly good inhibitor of decay. Sugar is also a good stimulant of saliva, but of course also provides the most favored elements nutrients for plaque bacteria. However, sugar substitutes, Although no bacteria, are also effective stimulants of saliva, as just chewing (Hector, 1985), it is chewing gum with artificial sweetener has a biological sense, and has a role in the arrest decay (Kleinberg, 1985, Makinen et al, 1995).

If the flow of saliva is reduced because it is every night, the oral environment is particularly susceptible to plaque acids. Bedtime candy thus have a greater impact on the production of acid overnight, what to do during the day. Stephan curve can also be used to demonstrate the effect of brushing on plaque pH achieved by rinsing the mouth after the second glucose.

A piece of plaque pH before and after mouthwash with glucose. In (a), the pH drops because of the acid produced by bacterial fermentation of sucrose. At pH 5.3 the enamel begins to dissolve. In (2), pH increases due to the effect buffering capacity of saliva and plaque. In (3), one side of the arch is brushed and the pH rises to a neutral value of 7.0. In (4), rinsing glucose pH is the second plate on the side without brushing to fall below 5.3. The side brush also reduced, but not below the critical pH (after Stephan and Miller, 1943)

Reducing the mass of the plate increases the pH of rest and reduce the downward inclination of the curve glucose after rinsing seconds. The mass of the plate can also be reduced with antibacterial mouthwash, as chlorhexidene (Joyston-Bechaler et al, 1992).

In summary, an ebb and flow of minerals into and out of the enamel. Tooth decay occurs when the process of remineralization slower than the process of demineralization and there is a net loss of minerals in the environment. It can be avoided by limiting the consumption of sugars food and plaque removal, at least these are the methods promoted by dentists in their own families (McDonald, Cowell and Sheiham, 1981). These simple habits seem have worked, because children have less tooth decay than the general population (Ainamo and Holmberg, 1974).

the caries diagnosis:

Dental caries should be diagnosed and managed as a disease dynamics of enamel and dentin. Process the disease is triggered each time a tooth surface is exposed to the acid produced by fermentation of carbohydrates in cariogenic bacteria.

In the enamel, calcium and phosphate lost enamel crystals on the surface and subsurface layers after the fall of pH in the oral fluid less than 5.5. This loss usually occurs when the defense mechanisms in the oral cavity are not enough to protect the enamel of the effects frequent harmful acid attacks. If the loss of calcium and phosphate crystals remaining large areas of microporous expanded. These areas are visually identified as "white spots" where the tooth is dry or are perceived visually, without drying where large areas of microporous develop in the enamel. If the loss of tooth structure remains, a cavity develops.

In roots, early carious lesions have generally softened dentin and yellow. These characteristics result from the loss of organic and inorganic components of dentin at the root.

The purpose of examining a patient at presence of dental caries is to detect early signs of this disease in the enamel and root surfaces. If the early signs are demineralization detected, inform patients and provide preventive care to reverse the process of decomposition.

First enamel caries:

The enamel is almost entirely mineral by weight (96%), but only 87% mineral by volume. Thus, 13% of the space in enamel is water soluble and insoluble proteins (The Gerosa, 1991). The organic component of enamel water and allow the diffusion of ions in plaque and saliva in and out of the enamel. The mineral part of enamel is mainly composed of varieties biological apatite. An enamel lesion early seen in polarized light reveals four different areas mineralization.

The enamel lesion consists of four zones beginning of alternating levels of mineralization. It illustrates the dynamic nature of the process of decay. The blocks the surface of the passage of calcium ions in the body of the lesion and can be removed to allow the wound to be stopped (after Kidd and Joyston-Bechaler, 1987).

The outer surface is mineralized by ion replacement plaque and saliva. But the body of the lesion is poorly mineralized. Deeper than the body of the lesion, a darker area represents about remineralization, while the deep zone, is once more deionized water (Kidd and Joyston-Bechaler, 1987). These regions illustrate the dynamics of the series of events taking place in the early lesion. Tooth decay is not simply a process of demineralization continued.

There is ample evidence that the initial lesion by remineralization enamel can be reversed and if the plate is removed. Arrested enamel lesions are often on a surface some time after interproximal adjacent tooth is extracted. Simply cleaning the most self-help to reduce the mass of the plate. Fluoride accumulates in remineralizing enamel, which makes the enamel more resistant to acid attack later. In artificial caries-like, components of milk (which contains levels high calcium and phosphate ions) are able to spread within the lesion (Mor and Rodda, 1983). However, sometimes the injury is progressing despite the availability calcium ions and fluoride. Robinson et al, (1990) suggest that this may be due to the presence of a barrier in the surface region which limits the movement of calcium ions and fluoride demineralized area. This barrier may be due to obstruction of the spaces between the crystals of enamel with salivary proteins. minerals can not get the replacement at the damaged site, but if the surface of the enamel is treated with an agent-proteinising, remineralization occurs more easily.

Remineralization can also be obtained by removing the surface of the lesion. Of course, this is more destructive than-proteinising the surface, but there is evidence teeth wear can be an important process in the arrest of enamel lesions. If the return to normal looking white enamel lesions, or after removal of orthodontic band or attack seems to be due to abrasion the weakened enamel crystals by the Food and brushing (Holmen and Thylstrup Artun, 1987). It is unlikely that these defects on the surface are occupied by the Crystal Growth salivary minerals. In fact, the precipitation of calcium phosphate crystal growth can be effectively inhibited by protein Salivary statherin.

dentine caries:

Although enamel caries is clearly a dynamic process, it is a vital process in the sense that the reactions occur cellular life. The pulp and dentin is a living tissue quite capable of defending themselves. The essential relationship between pulp and dentin promoted at the end of the pulp-dentin as a structural and functional biological unit.

The process of dentin caries involves demineralization of the mineral component and decomposition of the organic collagen fibers. The process of disintegration of the dentin is approximately twice faster in the enamel. Advanced caries lesions in dentin consist of two distinct layers with different microscopic structures and chemical (Al Daculsi and 1987). The outer layer is heavily infected by bacteria found mainly in the tubular spaces. The collagen fibers were denatured and organic matrix No. remineralization. The inner layer is slightly infected but affected by the acid in plaque. It still contains high concentrations of minerals and can remineralization.

dentin caries consists of two main layers. On the outer layer, dentin is infected with the bacteria. Both mineral and organic matrix is lost and the dentin is irreparable. In layer deep dentin is affected by plaque and acids demineralized. The number of colony forming units (CFU) of bacteria decreases (100 times) that produces cavity preparation in dentin affected. Damage to this layer is reversible if the bacterial metabolism can be stopped. A translucent barrier (or mineralized) dentin may be formed before the accident progresses. Reactionary (secondary) forms of dentin to protect the pulp from irritation of the acid (After Kidd and Joyston-Bechaler, 1987).

Microbiology of caries dentine

Although many organizations were isolated from dental caries some genera are usually present and dominate. The most frequently isolated are members of the Streptococcus sp. and in particular s. mutans in occlusal caries on smooth surfaces. Actinomyces sp. are the dominant genre on the root surface caries (Calmes and Roth 1981). Deep dentine caries showed a predominance of Lactobacillus gram positive rods with several others and filaments.

Kidd-Joyston Bechaler and Beighton (1993) collected samples of carious dentin during cavity preparation, and culture samples in order to count the number of bacteria. As the sample, dentine has been assessed as low, medium or hard, dry or moist, pale or dark. The number of bacteria decreases considerably as the cavity became drier and harder and the cavity becomes deeper.

Reducing the number of bacteria, are not marginal, but the order of one hundred times less. There was no significant difference between the number of cultured organisms of the average difference dentin disk. The color of the sample was not associated with the number of bacteria recovered. This suggests that the elimination after removing soft and wet dentin dentin stained more than half drive can not contribute to the further reduction of infected material. Our traditional emphasis that the floor of the cavity must be blameless, hard material can be unnecessarily destructive of the tooth and lead to exposure of the pulp chamber. The question immediately arises out of the dentin a little soft, so one is left behind, and if it is a source of secondary caries.

The marginal leakage studies were the first indications that secondary caries was not due to cavity preparation forever incomplete. According Edwardsson (1987) The microflora left under restorations in general do not develop, but can survive for several months. Its viability is influenced mainly by the amount of sealed carious dentin and the extent to which they are isolated from the oral cavity.

Management:

A traditional test of the decay of referral to the proper preparation of the cavity, the tone is a sharp probe on a hard surface of the dentin. Massler (1962) promoted the idea that it was unnecessarily destructive and often can lead to exposure of the pulp in deep cavities. He argued that the soft dentin was not necessarily affected, but it may be attacked by plaque acids. This concern is reversible and can therefore remineralizing dentin if given a proper environment. He proposed a cavity preparation is more conservative, requiring the elimination of only infected dentin, leaving behind soft, but not call dentin infected and affected. affected dentin remineralization may If acid production stopped. Although the ideas Massler supported by few experimental data about leaving behind soft dentin, and reviewing the tooth 6 weeks later, became an acceptable practice. It has been recently observed that within six weeks was too short to allow a significant amount of secondary dentin forms, but do allow an assessment of the dough to make (Schroder, 1985). Massler (1967) argued later, more data, it was an inflamed pulp is dead, and could recover if the irritation has been eliminated. He promoted the idea the repair of pulp dentin had great power and should not be neglected in the treatment of caries.

 

 

Arrested caries

Arrested in dentin caries is clinically defined by the hardness of the dentin surface and yellow to dark brown. Arrested carious lesions are most often found in lingual and labial aspects of the teeth and, less frequently in the interproximal area. In the decadence that became arrested dentinal tubules in the area between the soft and hard dentine has been shown to be blocked by large crystals. This process usually occurs in several stages.

First step: the acids produced by bacteria dissolve the state Progress in the minerals surrounding intertubular dentin. tubular fluid becomes saturated with calcium and magnesium phosphate. The lesion grew less that the level of metabolic activity of bacteria is reduced. If it is less acidic, then the second step can occur.

Phase II: saturated solution precipitates the production of large crystals of tricalcium phosphate. These crystals are relatively soluble, but block the tubules.

Third stage: The odontoblast process, protected by large crystals blocking the tube, collagen secret dentin tubules. The small plate-shaped crystals of hydroxyapatite are accumulated, which are less soluble than tricalcium phosphate, thus blocking the tubules more effectively. Over time growth of crystals even in the intertubular dentin.

The steps of forming a lesion in the dentin Order) The dentin tubule contains a high concentration of dissolved minerals. b) If the production of acid bacteria is reduced and increases the pH, salts are precipitated in large crystals of tricalcium phosphate temporarily block the tube. c) If more activity bacteria is removed, the odontoblasts secrete collagen and calcium salts. hydroxyapatite crystals and they become more effective blocking tube (After Daculsi et al, 1987)

Strategies to promote the arrest of caries

Fluoride

fluoride increases the resistance of enamel and dentin hydroxyapatite dissolution in acid of the plate. The source of fluoride ions for this role protection was mainly toothpastes. In fact, it is a fluoride toothpaste that has been thought responsible for the reduction Tooth decay that has occurred in many developed countries (Sheiham 1994). In developing countries, where the cost of toothpaste, places out of reach of water fluoridation for many, is a viable alternative. It becomes clear that the most powerful effect of water fluoridation not so much in preventing new lesions appear, but existing remineralization of carious lesions, and thus slow or even halt the process decay (Backer-Dirks, 1961; Lorenzo, Sheiham and Benn).

The main benefit of fluoride is achieved when there is a constant low level of remineralization. In vitro studies indicate that fluoride is still in concentrations above 2 ppm, significant remineralization occurs in the lesions artificially created (Arends et al, 1989). The levels required by the dentin, however, are much higher than enamel. Although enamel and remineralized less than 5 ppm of fluoride, dentin requires more than 100 ppm. fluoride release of restorative materials such as glass ionomer cements has been shown that fluoride release for up to six months. glass ionomer used to keep the hooks cause a significant increase in concentrations of Fluoride in plaque adjacent (Hallgren, and Oliveby Twetman, 1993).

Gluterdialdehyde

A daily application of 2 minutes of the GDA (gluterdialdehyde) was shown to reduce mineral loss in dentine caries, probably due to the determination of collagen, which reduces the diffusion of ions of the lesion and its antibacterial action (Dijkman, de Vries and Arends, 1992). These results suggest that GDA may be able to help stop tooth decay and dentin could use in institutions such as schools, where the GDA could be applied in Daily monitoring.

Sugar Substitutes

Chewing gum with sugar substitutes have been found effective to slow or stop the dentin caries. Makinen et al, (1995) used contains xylitol and sorbitol gum chewing gum monitored on a pilot basis in 40 months 510 children 6 years and 1277 aged 10 years. Rehardening of dentin caries more frequently observed in groups of chewing gum containing xylitol. The authors suggest that the flow of saliva is the increase resulting from the sweet gum that tends to interrupt the existing decay. supervised activities are costly in resources, but it may be possible to interest the private sector to subsidize the production of sugarless gum without its use could

 

Under the procedures of intervention stop decay.

Clean up the cavities of the car:

The plaque removal of a carious lesion causing a change in the balance of factors that cause demineralisation. If the decay can be accessible for cleaning, the process of decomposition can be stopped. The potential minimum for the elimination representing the cavity clean enamel is probably higher in the smooth surface caries. This technique (1962) calls Massler was a real alternative saucerising shallow surface caries root before the arrival of resin bonding to dentin. Its value clearly depends on the patient's motivation to clean the cavity with special care.

 

Sealing caries:

The removal of infected dentin seems to be the minimum procedure to ensure the long-term recovery. But the unthinkable has become, as it has survived over ten years. Mertz-Fairhurst and colleagues (1995) Medical College of Georgia, cavities sealed with composites. The study involved more 120 patients. There were three methods used restorative. The first method was to build an ultra-conservative preparation in which no decay is eliminated, but the enamel margins were beveled. These cavities were filled with a composite post (curing only) and any solid surface and cracks around with a color sealer. After nine years the restorations were evaluated clinically and radiographically. Rate cumulative failure, especially in terms of marginal deterioration was 16% for composite restorations, compared with 17% of controls for amalgam. The authors indicate that the decay can be stopped by placing sealed composite restorations. However, these restorations have not been opened and examined, so that the degree of remineralization can not be accurately evaluated. radiographic evidence is that the lesions have not progressed.

 

Atraumatic Restorative Technique:

Following the same philosophy that the team Mertz-Fairhurst, described a technique that aims to avoid even mechanical, rotating in the cavity preparation. Frenck et al, (1994) report on a trial which took place in rural Thailand, where cavities were prepared using hand instruments to remove the enamel and soft dentine compromised. No anesthesia is necessary. The cavities were restored with glass ionomer cement glass both as material filling and sealing. The mobile dental units are used to provide a mix of traditional treatment of caries in another city. After one year 79% of ART restorations in primary teeth and permanent teeth 93% were successful. The authors found that two surface restorations were less successful. This technique pushes the material to the edge of his property and challenges the foundations of many clinical standards. The absence of rotary instruments is a major constraint in the preparation of margins that may be available and free to lose the enamel prisms. The use of glass ionomer has the advantage fluoride release and the union of excellence to dentin and enamel, but no resistance to wear and fracture of composites filled.

Each of these three rather unusual methods of dental caries are a direct interest in which treatment resources are limited. First, they could all be done without anesthesia. If dentin is sensitive should not be removed. The sensitivity of dentin is dependent transmission cut the flesh, the vibrations in the tubular fluid. If tubules are patent process described by Daculsi et al, (1979) should occur when a barrier mineral and collagen sheet profile arrest caries activity. Second could be performed by at least one full course in dental care. A thorough knowledge of the biology of the pulp, dentin is not necessary if the preparation is only to bevel the enamel margins.

risk assessment of caries

The decay is unlikely to be discontinued in individuals or groups who are at high risk of caries (Moss and Zero, 1995). It is not easy to identify these groups or individuals, but there are some obvious indications cons- use unusual methods of intervention to stop the decline. The first should be the level of awareness on the health of individuals and the level of motivation to implement effective practices of oral hygiene and eating habits. Procedures for the Treatment of caries not for the motivation. Unfortunately, often poor and uneducated, that target receptors on intervention techniques.

A known risk degradation after radiation which reduces the flow of saliva, and many patients have new caries lesions. These high-risk patients can be protected during radiotherapy and the salivary glands of damage, using a mouthwash twice daily with chlorhexidine and fluoride (Joyston-Bechaler et al, 1992). But this is not a group for the reduction of response procedures for the treatment of caries indicated. It is therefore necessary to ensure that programs consistent with public health management of disease risk.

Conclusion

repair capacity inherent pulp dentin must be recognized. Patient education is the first step towards creating an environment that promotes remineralization. As Kidd and Joyston-Bechaler (1987) Emergency Dentists are responsible for explaining to patients how to stop the disease in the mouth. "The selection patient restraint procedures for testing is appropriate is difficult. It would be difficult now to defend the limited procedures in the charge that second account to care for the underclass. procedures at the bottom of the first response should be carefully studied to whether it can actually be beneficial and low cost. Continued basic research on the dynamics of the tooth stop both contribute to strategies based on evidence. The need to develop solutions that are socially acceptable and scientifically valid is a challenge that requires attention urgent. However, the priority is to put in place health promotion, prevention measures and fluoridation of water is suitable for everyone. Otherwise, it sweeps sand, with no end in sight.

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About the Author

I fear the death of a dental procedure, because periodontal disease?

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