Introduction:
Oral health is not merely maintained by regular brushing and proper rinsing. It involves thorough regular check-ups along with diet control. This diet control is crucial for preventing the initiation and progression of dental caries. Caries are the most typical and most rapidly progressing dental disease. It affects almost all the individuals of every age group, and there is no gender preference. In addition, it is accompanied by pain and sometimes inflammation. The incidence of dental caries is increased by refined and sticky food intake. The earlier signs need to be checked so that further progress can be stopped.
What Is Dental Caries?
Dental caries are solely responsible for more than 50 percent of tooth mortality. It starts mainly as a white or black lesion (the stage called incipient caries) and later spreads to form a dental cavity characterized by the destruction of enamel and dentin (the two coverings of the tooth crown). This disease is associated with mild pain during initiation, followed by spontaneous pain with a lingering response (irreversible pulpitis). Usually, the pain remains at a shallow threshold when the enamel or dentin is exposed, but the pain becomes unbearable on pulpal exposure. This disease affects almost every individual of any race, gender, or age.
What Are the Types of Dental Caries?
Based on progression, it can be classified as either rampant (early childhood) or nursing bottle caries. Both are rapidly progressive in nature found in small children. The primary difference lies in that rampant caries involve all the teeth, but nursing bottle caries spares mandibular incisors.
Caries can also be incipient or arrested. Incipient refers to starting lesion, while there is a stoppage of further caries in arrested caries.
Another variant is forward or backward caries. Forward caries involves a subsequent progression of enamel, dentin, and pulp with a sloping pyramid (in radiograph). Backward caries involves pulp, dentin, and enamel in subsequent progression with an inverted pyramid.
Lastly, it can be occlusal (pits and fissures), proximal (below two adjacent teeth’s contact point), or root caries. Occlusal caries is commonly found in children, while adults have proximal caries. Root caries are found in aged people having exposed root surfaces.
What Is the Microbiology of Dental Caries?
Dental caries occur due to the presence of microbes. Mainly two types of microbes are found. First are the initiators that start the infection. They include Streptococcus species (rattus, mitis, milleri, and mutans). These belong to the same genus that causes sore throat. It is then followed by Lactobacilli, which causes the progression of dental caries. They both are acidophilic (acid-loving) and aciduric (presence of acid).
What Are the Structural Changes in Tooth Structure?
A change in tooth structure characterizes dental caries. First, there is an exposure of the outermost covering, enamel. It is followed by dentin exposure, which involves the bulk of the tooth. The destruction of enamel and dentin characterizes cavity formation. The color of the cavity varies from yellow to dark brown to dark black. It depends upon the amount of invasion and vulnerability of the individual. Pulpal exposure is the most painful condition which must be avoided. The reason is that it paves the way for irreversible pulpitis and periapical abscesses. Hence, every effort should be made to prevent pulpal exposure of the tooth.
How Do We Diagnose Dental Caries?
Dental caries are easily diagnosed clinically with instruments such as explorer and probe and radiographically with X-rays. Cavitation is not always present, but catch can be present in caries-affected regions. Even RVG (radiovisiography) or CBCT (cone-beam computed tomography) can be used in advanced cases.
What Increases the Risk of Developing Dental Caries?
There are many factors responsible for dental caries. The first and most important is the diet. Refined and sticky foods, including sweets, cookies, fast food, and chocolates, are the most everyday foods that cause excess dental caries since they are not easily removed. After that comes individual vulnerability because rampant caries occur in those individuals who have weakened immunity.
In addition to these factors, dental plaque and negligence to maintain oral hygiene are other factors. Dental plaque is a prerequisite for tooth infection and mortality, and caries also helps this progression. Poor oral hygiene due to harmful habits is another reason for losing teeth. Hence all these risk factors need to be examined.
How Can We Treat Dental Caries?
It is always said that prevention is better than cure. Every effort should be made to prevent the progression of dental caries. If caries has progressed, restorations remain the gold standard. Early lesions are well treated with pit and fissure sealants. Systemic fluoridation helps control proximal caries in some countries through central or state water supply systems. If caries is associated with pain and discomfort with some loss of tooth structure, they are treated with dental filling materials like amalgams, glass ionomer cement (GIC), and composite. If the lesion is very deep or close to the pulp, we go for indirect pulp capping with an application of dentin forming agent and sandwich technique. Grossly decayed teeth are treated with crowns (core build-up, zirconia, and ceramic). Root canal treatment is the commonly used treatment option for severe pain and excess destruction. Post and core are also used in deep lesions, while pins provide strength. Antibiotics are usually given along with analgesics to control severe infection in the cases of dental abscesses and irreversible pulpitis.
What Are the Complications of Dental Caries?
The most typical complication is irreversible pulpitis and periapical abscess. Irreversible pulpitis does not occur spontaneously. First, there is a progression from caries to reversible pulpitis, and then later, it becomes irreversible pulpitis. However, in the case of trauma to the tooth, there can be the direct formation of irreversible pulpitis due to pulpal necrosis and strangulation.
Reversible pulpitis is characterized by pain in the presence of a stimulus only. It is the preliminary stage just next to the development of caries. If this condition is not treated, it extends to irreversible pulpitis, which exhibits severe pain even after removing the stimulus.
A periapical abscess usually develops from the extension of irreversible pulpitis or a long-standing open lesion (chronic hyperplastic pulpitis or pulp polyp), causing loss of vitality of the tooth. This pus sometimes causes noticeable swelling of the involved area.
What Are the Special Considerations During COVID-19?
COVID-19 pandemic has caused a lot of mortality in the world. Although dental diseases do not have any serious emergencies, they are associated with discomforts when there is irreversible pulpitis and periapical abscess. Pain due to both periapical abscess (excruciating) and acute irreversible pulpitis (spontaneous) is unbearable, especially at night. So in these conditions, it becomes sometimes necessary to do RCT (root canal treatment) or IPC (indirect pulp capping) in the involved tooth. Definitely, in this pandemic, people try avoiding dental visits, but these conditions cause a lot of pain and need intervention by a dental health professional. The pain may continue for 2 to 5 hours or more, both during the day and at night. Medications do provide temporary relief but not on a long-term basis. In my opinion, teledentistry can prove to be a valuable tool to at least relieve pain for a shorter duration. Hence, these conditions need to be addressed at the right time to avoid further dental problems.
Conclusion:
Dental caries is painful, especially when food lodges in the space formed by the cavity. It is acute, but a long-standing lesion becomes chronic, which damages the tooth and causes irreversible damage. Hence every effort should be made to prevent it, and if it has started, restorations or crowns should be given as early as possible to avoid tooth loss.
