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Definition
Dental caries is a multifactorial disease of the hard substance of the tooth, which when untreated increasingly destroys the structure and function of the teeth and leads to tooth loss.
Epidemiology
Approximately 98% of the population in Europe is afflicted with dental caries. So, caries is by far the most prevalent disease in industrial countries.
Causes
Dental caries is caused by a disturbance in the balance of demineralization and remineralization of the teeth. According to Koenig (1971), 4 factors interact in the development of caries. These must come together at the same time in order to initiate the disease:- Substance (= tooth)
- Cariogenic microorganisms (= bacteria)
- Substrate (= Carbohydrate)
- Time
Pathogenesis
The cariogenic microorganisms (primarily streptococci) produce organic acids as metabolic degradation products out of low-molecular carbohydrates (sugar), which disrupt the mineral salts (hydroxyapatite) of the hard substance of the tooth. This process is designated as "demineralization". It is reversible as long as the organic matrix of the hard substance of the tooth is not damaged. If the matrix itself is decomposed by the bacteria, there develop structural defects (cavities) that are irreversible.
Risk factors
The development and/or progression of dental caries are influenced by many different factors. They are:- Lack of dental hygiene
- Tooth formation (cramped and defective positioning)
- Teeth status (e.g. missing teeth)
- Chewing habits
- Dietary composition and consistency
- Tongue and cheek activity
- Salivary characteristics and quantity (xerostomia)
- Restoration (e.g. defective fillings)
- Fluoride content in the enamel
- Intake of medicines
- And many others.
Classification
Dental caries can be divided into 4 or 5 stages:- Initial caries: Demineralization without structural defect. This stage can be reversed by fluoridation and enhanced mouth hygiene.
- Superficial caries (Caries superficialis): Enamel caries, wedge-shaped structural defect. Caries has affected the enamel layer, but has not yet penetrated the dentin.
- Moderate caries (Caries media): Dentin caries. Extensive structural defect. Caries has penetrated up to the dentin and spreads two-dimensionally beneath the enamel defect where the dentin offers little resistance.
- Deep caries (Caries profunda): Deep structural defect. Caries has penetrated up to the dentin layers of the tooth close to the pulp.
- Deep complicated caries (Caries profunda complicata): Caries has led to the opening of the pulp cavity (pulpa aperta or open pulp).
A special type constitutes the so-called caries sicca.
Symptoms
The symptoms are dependent on the stage of the caries. Initial caries and enamel caries are basically without any symptoms. In advanced caries, besides the visible structural defects, the following troubles may occur:- Sensitivity to heat and cold
- Intermittent pain
- Continuous pain
- Pulling pain while consuming certain food
- Halitosis (fetid breath)
- Loosening of fillings
Diagnostics
The diagnosis of caries is mostly carried out clinically by inspection and probing of the affected teeth. Moreover, special x-rays ("teeth film"), transillumination of the teeth with cold light and teeth sensitivity test with the air syringe are used.
Prophylaxis
The most important caries prophylaxis measure is the properly conducted dental care with toothbrush and dental floss, as well as, if necessary, with an interdental brush. In addition, the caries resistance of the teeth can be improved by using fluoride toothpastes and by local fluoridation. Other potential steps for children are:- Systemic fluoride intake (fluoride tablets)
- Sealing of fissures.
Therapy
The therapy of caries is the purpose of conserving dentistry. It consists of the removal of the affected hard substance of the teeth by excavation and subsequent filling of the resulting cavity with plastic, cast or precast filling material. Another method is the minimal-invasive removal of caries by softening of the lesion with a special gel and subsequent curretting with hand instruments (Carisolv®).
