Carries simply means “Decay”. Dental caries, therefore, is a combination of processes which leads to erosion and destruction of the hard dental tissues. Carries usually start from the enamel as a white chalky spot (lesion) and spread gradually in-depth thereby affecting dentin and develops in later stages to cause inflammation of the dental pulp (pulpitis). If left untreated, carries may cause significant damage to the dentition and other complications of periodontal diseases leading to tooth loss. At our dental clinics we offer affordable dental cavities treatment..
The normal tooth assumes a morphology where the enamel is continuous and intact covering the whole tooth. However, this status can be interfered with by acidic byproducts produced by the bacteria when they metabolize the remnant sugars left behind after eating. The acidic fluid dissolves the calcium/in-organic matter which is the hard part of the tooth eventually causing cavitation after the erosion of the organic matter.
Types of Dental carries
Carries are broadly classified as either Primary or Secondary carries.
Carries can occur on a healthy or a previously treated tooth. When dental caries occur as a primary affliction on a previously untreated (healthy) tooth, then it is known as Primary caries. Secondary caries affect teeth that are previously treated with a filling, a root canal or other prosthetic restorations. They do not occur directly on the fillings but on surfaces neighbouring the restorations. Carries can also occur under an existing filling thereby affecting the dentin that was left under the filling. This is called secondary caries.
Carries can also occur in the course of tooth development from childhood to adulthood. Acute caries spread through the shortest way towards the dental pulp. It occurs mainly in young persons and people suffering from systemic diseases. Chronic carries progress slowly. They can therefore be stopped temporarily or permanently through early intervention and treatment of caries. Arrested caries are the advanced stages of chronic caries.
Can I have caries after I have undergone restoration procedures?
After undergoing prosthetic restoration procedures, it is still possible to have dental cavities at the interface between the tooth and the prosthetic restoration site. This occurs when the conditions around the seal become acidic leading to demineralization of the prosthetic site. This is known as Secondary caries. Secondary caries are the main reason why prosthetic restorations fail despite the prosthetic material used. If secondary carries are detected early enough through clinical examination, it can be treated thus increasing the success of the prosthetic restoration. At Dr. Tim’s Dental Clinic in Nairobi we recommend regular dental visits for early diagnosis and dental cavity treatment. Early diagnosis makes dental clinic services cheap.
How do I know if I have dental Carries?
Depending on the depth of the cavity and its localization, you can detect dental caries through the main symptom which is pain. However, you are not likely to experience pain in the initial stages when the cavity is still very small. In this case, one can feel sensitivity which is caused by a reaction of the dentine to thermal or chemical stimuli changes. However, you may experience acute pain when you take hot or cold food items which go after eating. If the majority of the tooth is affected by decay towards the pulp, the pulp will experience irritation when exposed to thermal and or chemical changes.
This means that you will start experiencing severe pain which may last long after eating. In advanced cases of cavities, the pain becomes spontaneous and especially at night and can only be managed by analgesics.
2.What are the causes of dental caries?
Dental caries occur when a dental plaque exists on your gums or the tooth surface. A dental plaque is a deposit of food debris together with various components derived from saliva. Bacteria dwell within the plaque. When the bacteria metabolize carbohydrates, they produce acidic waste products which dissolves the dental hard tissues leading to dental caries or cavities. This occurs initially as a softened area of the enamel which progresses into a small cavity on the enamel surface. As the disease progresses, the cavity enlarges till it reaches dentino-enamel junction then spreads laterally due to increased organic material in this area. This affects the crown thereby leaving a fragile shell which may easily collapse under the strain of mastication (chewing). This may cause complete destruction of the tooth crown and subsequent infection of the pulp due to the exposure to the oral environment or via opened exposed dentinal tubules.
Infection of the pulp cavity may therefore lead to the formation of a dental abscess at the tooth supportive alveolar bone by extension of the infection along the root canal. An abscess is a collection of pus which is manifested through a smooth-walled cavity at the affected root apex. Pulp chamber infection persistent periradicular infection will eventually lead to tooth loss.
3.Clinical presentation of dental caries
The presentation of dental caries can be presented as cavities in pits and fissures or smooth surfaces without any pits or fissures; these are the surfaces which cannot self-clean during mastication due to their unfavorable positioning or contact with teeth.,
Cavities in pits and fissures on the other hand are mainly localized in pits of premolars and molars on the palatal facets of upper incisors, buccal surfaces of the lower molars and palatal surfaces of the upper molars.
4.Prevention of dental caries
Like many other dental diseases, dental caries can as well be prevented through early intervention. Some of the prevention measures may include brushing your teeth regularly by fluoridated toothpastes especially after meals, avoid frequent intake of sugary snacks, a regular visit to the dentist for dental checkups and also consider the use of sealants and fluoride therapy to protect developing carries.
5.Dental caries treatment
Since dental caries is a biofilm-mediated disease, its management is to target the dental plaque in order to restore the microbial dis-equilibrium within the oral biofilm. There are various clinical antimicrobial strategies which may include the use of chlorhexidine, fluoride among many others to manage tooth cavity development.
In cases of severe carries, the dentist will determine whether or not the pulp is likely to survive. If a pulp is likely to die, the dentist will carefully remove the pulp then seal the pulp canal with an inert tooth filling material, in a process called root canal treatment. If the tooth is not restorable, then a tooth extraction can be an option.
In reversible pulpitis, the dentist hopes to be able to preserve a healthy pulp through a plastic restoration. The clinical diagnosis of reversible pulpitis is made when the pain is evoked when the tooth is exposed to hot or cold food items but soon disappears. A times, the cavity is detected with no symptoms at all. Reversible pulpitis can be treated through restorative processes such as filling. Irreversible pulpitis on the other hand is diagnosed when the pain persists minutes or even hours after the removal of hot or cold food items. Irreversible pulpitis can be treated by a root canal treatment process or extraction of the tooth.
Acutely inflamed pulps are always painful. Necrotic pulps on the other hand are painless since there are no viable nerves to transmit pain. However, another set of symptoms may develop once the periapical tissues are involved. Chronical periapical inflammation may be painless but acute periapical inflammation is often very uncomfortable.
It is paramount for the dentist to make an accurate diagnosis when managing dental caries. Appropriate investigations such as bilateral bitewigs radiographs for detecting interproximal caries, tests and intra-oral periapical incase of pulpitis are key in dental caries management.