Dental caries
From Wikipedia, the free encyclopedia
- This article is about dental caries in humans. To read about dental caries in animals, please see dental caries (non-human).
| Destruction of a tooth by cervical decay from dental caries | |
| ICD-10 | K02. |
| ICD-9 | 521.0 |
| DiseasesDB | 29357 |
| MedlinePlus | 001055 |
Dental caries, also known as tooth decay or dental cavities, is a disease which damages the structures of teeth.<ref name="medline">Dental Cavities, MedlinePlus Medical Encyclopedia, page accessed August 14, 2006.</ref> The occurrence of dental caries is globally widespread, and the disease can lead to pain, tooth loss, infection, and, in severe cases, death. An estimated 90% of schoolchildren worldwide and most adults have had cavities, with the disease being more severe in Asian and Latin American countries and least in African countries.<ref>The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century – the approach of the WHO Global Oral Health Programme, released by the World Health Organization. (File in pdf format.) Page accessed on August 15, 2006.</ref> In the United States, dental caries is the most common chronic childhood disease; at least five times more common than asthma.<ref>Healthy People: 2010. Html version hosted on Healthy People.gov website. Page accessed August 13, 2006.</ref> It is the most significant cause of tooth loss in children.<ref>Frequently Asked Questions, hosted on the American Dental Hygiene Association website. Page accessed August 15, 2006.</ref>
The number of cases has decreased in some developed countries, and the decrease is usually attributed to increasingly better oral hygiene practices and preventive measures such as fluoride exposure.<ref name="whostatement2">World Health Organization website, "World Water Day 2001: Oral health", page 2, page accessed August 14, 2006.</ref> Nonetheless, places which have seen an overall decrease of tooth decay continue to have a disparity in the distribution of the disease.<ref>"Dental caries", from the Disease Control Priorities Project. Page accessed August 15, 2006.</ref> In children aged 5 to 17, 80% of dental caries reside in 25% of the population.<ref>Kumar, Jayanth V. and Mark D. Siegel. "A Contemporary Perspective on Dental Sealants." Journal of the California Dental Association. 1998. Online version hosted on the California Dental Association. Page accessed on October 29, 2006.</ref>
Tooth decay is caused by acid-producing bacteria which cause the most damage in the presence of fermentable carbohydrates, such as sucrose and glucose.<ref name="Hardie1982">Hardie, J.M. (1982). The microbiology of dental caries. Dental Update, 9, 199-208.</ref> <ref name="holloway1983">Holloway, P.J. (1983). The role of sugar in the etiology of dental caries. Journal of Dentistry, 11, 189-213.</ref> The subsequent acidic pH levels in the mouth affect teeth because of their high mineral content. Depending on the extent of tooth destruction, various treatments can be used to restore teeth to proper form, function, and esthetics, but to date there is no known method to regenerate large amounts of tooth structure. Instead, dental health organizations advocate preventative measures, such as regular oral hygiene and dietary modifications, to avoid forming dental caries.<ref name="adaoralhealth">Oral Health Topics: Cleaning your teeth and gums. Hosted on the American Dental Association website. Page accessed August 15, 2006.</ref>
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[edit] Types
Caries are classified by location. Generally, there are two types of caries: caries found on smooth surfaces and caries found in pits and fissures.<ref name="summit30">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 30. ISBN 0-86715-382-2.</ref> The location, development, and progression of smooth-surface caries differ from pit and fissure caries.
[edit] General description of caries
Carious lesions are described by their location on a tooth's surface. Caries on a tooth's surface that are nearest the cheeks or lips are called "facial caries", and caries on surfaces facing the tongue are known as "lingual caries." Facial caries are further subdivided into buccal (when found on the surfaces of posterior teeth nearest the cheeks) and labial (when found on the surfaces of anterior teeth nearest the lips). Lingual caries are also described as palatal, because the lingual surfaces of maxillary teeth are beside the hard palate.
Caries near a tooth's cervix—the location where the crown of a tooth and its roots meet—are referred to as cervical caries. Occlusal caries are found on the chewing surfaces of posterior teeth. Incisal caries are caries found on the chewing surfaces of anterior teeth. Caries can also be described as "mesial" or "distal." Mesial signifies a location on a tooth closer to the median line of the face, which is located on a vertical axis between the eyes, down the nose, and between the contact of the central incisors. Locations on a tooth further away from the median line are described as distal.
[edit] Pit and fissure caries
Pits and fissures are anatomic landmarks on a tooth where tooth enamel infolds to create an appearance of pits and fissures. Fissures are the grooves located on the occlusal (chewing) surfaces of posterior teeth and lingual surfaces of maxillary anterior teeth. Pits are small, pinpoint depressions that are found at the ends or cross-sections of grooves.<ref>Ash & Nelson, "Wheeler's Dental Anatomy, Physiology, and Occlusion." 8th edition. Saunders, 2003, p. 13. ISBN 0-7216-9382-2.</ref> In particular, buccal pits are found on the facial surface of molars. For all types of pits and fissures, the deep infolding of enamel makes oral hygiene along these surfaces difficult, making dental caries common in these areas.
The occlusal surfaces of teeth represent 12.5% of all tooth surfaces but are the location of over 50% of all dental caries.<ref>Doniger, Sheri, B. "Sealed." Dental Economics, 2003. Page accessed August 13, 2006.</ref> Among children, pit and fissure caries represent 90% of all dental caries.<ref>Oral Health Resources - Dental Caries Fact Sheet. Hosted on the Centers for Disease Control and Prevention website. Page accessed August 13, 2006.</ref> Pit and fissure caries can sometimes be difficult to detect. As the decay progresses, caries in enamel nearest the surface of the tooth spreads gradually deeper. Once the caries reaches the dentin at the dentino-enamel junction, the decay quickly spreads laterally. The decay follows a triangle pattern, which points to the tooth's pulp. This pattern of decay is typically described as two triangles with their bases overlapping each other at the dentino-enamel junction.
[edit] Smooth-surface caries
There are three types of smooth-surface caries. Proximal caries, also called interproximal caries, are caries that form on the smooth surfaces between adjacent teeth. Root caries are caries that form on the root surfaces of teeth. The third type of smooth-surface caries is caries on any other smooth-surface of a tooth.
Proximal caries are the most difficult type of caries to detect.<ref name="summit31">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 31. ISBN 0-86715-382-2.</ref> Frequently, this type of caries cannot be detected visually or manually with a dental explorer. Proximal caries form cervically (toward the roots of a tooth) just under the contact between two teeth. As a result, radiographs are needed for early discovery of proximal caries.<ref>Heatlh Strategy Oral Health Toolkit, hosted by the New Zealand's Ministry of Health. Page accessed on August 15, 2006.</ref>
Root caries, which are sometimes described as a category of smooth-surfaces caries, are the third most common type of caries and usually occur when the root surfaces have been exposed due to gingival recession. When the gingiva is healthy, root caries is unlikely to develop because the root surfaces are not as accessible to bacterial plaque. The root surface is more vulnerable to the demeralization process than enamel because cementum begins to demineralize at 6.7 pH, which is higher than enamel's critical pH.<ref name="banting19">Banting, D.W. "The Diagnosis of Root Caries." Presentation to the National Institute of Health Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life, in pdf format, hosted on the National Institute of Dental and Craniofacial Research. Page 19. Page accessed on August 15, 2006.</ref> Regardless, it is easier to arrest the progression of root caries than enamel caries because roots have a greater reuptake of fluoride compared to enamel. Root caries are most likely to be found on facial surfaces, then interproximal surfaces, then lingual surfaces. Mandibular molars are the most common location to find root caries, followed by mandibular premolars, maxillary anteriors, maxillary posteriors, and mandibular anteriors.
Lesions on other smooth surfaces of teeth are also possible. Since these occur in all smooth surface areas of enamel except for interproximal areas, these types of caries are easily detected and are associated with high levels of plaque and diets promoting caries formation.<ref name="summit31">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 31. ISBN 0-86715-382-2.</ref>
[edit] Other types of caries
In some instances, caries are described in other ways that might better depict the state of dental health of a person's teeth. "Recurrent caries" describes caries that recur at a location, while "incipient caries" describes decay at a location that has not experienced decay previously. "Baby bottle caries," "early childhood caries," or "baby bottle tooth decay" is a pattern of decay found in young children with their deciduous (baby) teeth. The teeth most likely affected are the maxillary anterior teeth, but all teeth can be affected.<ref>ADA Early Childhood Tooth Decay (Baby Bottle Tooth Decay). Hosted on the American Dental Association website. Page accessed August 14, 2006.</ref> The name for this type of caries comes from the fact that the decay usually is a result of allowing children to fall asleep with sweetened liquids in their bottles or feeding children sweetened liquids multiple times during the day. Another pattern of decay is "rampant caries," which signifies advanced or severe decay on multiple surfaces of many teeth.<ref>Radiographic Classification of Caries. Hosted on the Ohio State University website. Page accessed August 14, 2006.</ref> Rampant caries may be seen in individuals with xerostomia, poor oral hygiene, methamphetamine use, and/or large sugar intake.
[edit] Signs and symptoms
Until caries progresses, a person may not be aware of it.<ref>Health Promotion Board: Dental Caries, affiliated with the Singapore government. Page accessed on August 14, 2006.</ref> The earliest sign of a carious lesion is the appearance of a chalky white spot on the surface of the tooth, indicating an area of demineralization of enamel; professionally referred to as incipient decay. As the lesion continues to demineralize, it can turn brown but will eventually turn into a cavitation, a "cavity". The process before this point is reversible, but once a cavitation forms, the lost tooth structure cannot be regenerated. A lesion which appears brown and shiny suggests dental caries was once present but the demineralization process has stopped, leaving a stain. A brown spot which is dull in appearance is probably a sign of active caries.
As the enamel and dentin are destroyed further, the cavitation becomes more noticeable. The affected areas of the tooth change color and become soft to the touch. Once the decay passes through enamel, the dentinal tubules, which have passages to the nerve of the tooth, become exposed and cause the tooth to hurt. The pain can be worsened by heat, cold, or sweet foods and drinks.<ref name="medline">Dental Cavities, MedlinePlus Medical Encyclopedia, page accessed August 14, 2006.</ref> Dental caries can also cause bad breath and foul tastes.<ref>Tooth Decay, hosted on the New York University Medical Center website. Page accessed August 14, 2006.</ref> In highly progressed cases, infection can spread from the tooth to the surrounding soft tissues which may become life-threatening, as in the case with Ludwig's angina.<ref>Ludwig's Anigna, hosted on Medline Plus. Page accessed on August 14, 2006.</ref>
[edit] Diagnosis of caries
Primary diagnosis involves inspection of all visible tooth surfaces using a good light source, dental mirror and explorer. Dental radiographs, produced when X-rays are passed through the jaw and picked up on film or digital sensor, may show dental caries before it is otherwise visible, particularly in the case of caries on interproximal (between the teeth) surfaces. Large dental caries are often apparent to the naked eye, but smaller lesions can be difficult to identify. Unextensive dental caries was formerly found by searching for soft areas of tooth structure with a dental explorer. Visual and tactile inspection along with radiographs are still employed frequently among dentists, particularly for pit and fissure caries.<ref>Rosenstiel, Stephen F. Clinical Diagnosis of Dental Caries: A North American Perspective. Maintained by the University of Michigan Dentistry Library, along with the National Institutes of Health, National Institute of Dental and Craniofacial Research. 2000. Page accessed August 13, 2006.</ref>
Some dental researchers have cautioned against the use of dental explorers to find caries.<ref name="summit31">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 31. ISBN 0-86715-382-2.</ref> In cases where a small area of tooth has begun demineralizing but has not yet cavitated, the pressure from the dental explorer could cause a cavitation. Since the carious process is reversible before a cavitation is present, it may be possible to arrest the caries with fluoride to remineralize the tooth surface. When a cavitation is present, a restoration will be needed to replace the lost tooth structure. A common technique used for the diagnosis of early (uncavitated) caries is the use of air blown across the suspect surface, which removes moisture, changing the optical properties of the demineralised enamel. This produces a white 'halo' effect detectable to the naked eye. Fiberoptic transillumination, lasers and disclosing dyes have been recommended for use as an adjunct when diagnosing smaller carious lesions in pits and fissures of teeth.
[edit] Causes
There are four factors in the formation of caries: a tooth surface (enamel or dentin); cariogenic (or potentially caries-causing) bacteria; fermentable carbohydrates (such as sucrose); and time.<ref>Soames, J.V. and Southam, J.C. (1993). Oral Pathology, second edition, chapter 2 - Dental Caries.</ref> The caries process does not have an inevitable outcome, and different individuals will be susceptible to different degrees depending on the shape of their teeth, oral hygiene habits, and the buffering capacity of their saliva.
Dental caries can occur on any surface of a tooth that is exposed to the oral cavity, but not the structures which are retained within the bone.<ref>Kidd, E.A.M. and Smith, B.G.N. (1990). Pickard's Manual of Operative Dentistry, Sixth Edition. Chapter 1 - Why restore teeth?.</ref>.
[edit] Teeth
Having "soft teeth" is usually not the cause of caries, despite commonly held belief to the contrary. There are certain diseases and disorders, however, that affect teeth that can leave an individual at greater risk for caries. Amelogenesis imperfecta, which occurs between 1 in 718 and 1 in 14,000 individuals, is a disease in which the enamel does not form fully or in insufficient amounts and can fall off a tooth.<ref name="neville89">Neville, B.W., Douglas Damm, Carl Allen, Jerry Bouquot. "Oral & Maxillofacial Pathology." 2nd edition, 2002, page 89. ISBN 0-7216-9003-3.</ref> Dentinogenesis imperfecta is a similar disease. In both cases, teeth may be left more vulnerable to decay because the enamel is not as able to protect the tooth as it would in health.<ref name="neville94">Neville, B.W., Douglas Damm, Carl Allen, Jerry Bouquot. "Oral & Maxillofacial Pathology." 2nd edition, 2002, page 94. ISBN 0-7216-9003-3.</ref>
In most people, disorders or diseases affecting teeth are not the primary cause of dental caries. Ninety-six percent of tooth enamel is composed of minerals.<ref>Cate, A.R. Ten. "Oral Histology: development, structure, and function." 5th edition, 1998, p. 1. ISBN 0-8151-2952-1.</ref> These minerals, especially hydroxyapatite, will become soluble when exposed to acidic environments. Enamel begins to demineralize at a pH of 5.5.<ref>Dawes, Colin. "What Is the Critical pH and Why Does a Tooth Dissolve in Acid?." Journal of the Canadian Dental Association. Volume 69, Number 11, pages 722 - 724. December 2003. Hosted online. Page accessed August 14, 2006.</ref> Dentin and cementum are more susceptible to caries than enamel because they have lower mineral content.<ref>Mellberg, J.R. (1986). Demineralization and remineralization of root surface caries. Gerodontology, 5, 25-31.</ref> Thus, when root surfaces of teeth are exposed from gingival recession or periodontal disease, caries can develop more readily. Even in a healthy oral environment, the tooth is susceptible to dental caries.
The anatomy of teeth may affect the likelihood of caries formation. In cases where the deep grooves of teeth are more numerous and exaggerated, pit and fissure caries are more likely to develop. Also, caries are more likely to develop when food is trapped between teeth.
[edit] Bacteria
The mouth contains a wide variety of bacteria, but only a few specific species of bacteria are believed to cause dental caries: Streptococcus mutans and Lactobacilli among them.<ref name="Hardie1982">Hardie, J.M. (1982). The microbiology of dental caries. Dental Update, 9, 199-208.</ref> Particular for root caries, the most closely associated bacteria frequently identified are Lactobacillus acidophilus, Actinomyces viscosus, Nocardia spp., and Streptococcus mutans. Bacteria collect around the teeth and gums in a sticky, creamy-coloured mass called plaque. Some sites collect plaque more commonly than others. The grooves on the biting surfaces of molar and premolar teeth provide microscopic retention, as does the point of contact between teeth. Plaque may also collect along the gingiva. In addition, the edges of fillings or crowns can provide protection for bacteria, as can intraoral appliances such as orthodontic braces or removable partial dentures.
[edit] Fermentable carbohydrates
Bacteria in a person's mouth converts sugars (most commonly sucrose - or common sugar, glucose and fructose) into acids such as lactic acid through fermentation processes.<ref name="holloway1983">Holloway, P.J. (1983). The role of sugar in the etiology of dental caries. Journal of Dentistry, 11, 189-213.</ref> If left in contact with the tooth, these acids cause demineralization, which is the dissolution of its mineral content. The process is dynamic, however, as remineralization can also occur if the acid is neutralized and suitable minerals are available in the mouth from saliva but also from preventative aids such as fluoride toothpaste, varnish or mouthwash.<ref>Silverstone, L.M. (1983). Remineralization and dental caries: new concepts. Dental Update, 10, 261-273.</ref> Caries may be arrested at this stage. If sufficient acid is produced over a period of time to the favor of demineralization, caries will progress and may then result in so much mineral content being lost that the soft organic material left behind will disintegrate, forming a cavity or hole.
[edit] Time
The frequency of which teeth are exposed to cariogenic (acidic) environments affects the likelihood of caries development.<ref>"Dental Health", hosted on the British Nutrition Foundation website, 2004. Page accessed August 13, 2006.</ref> After meals or snacks containing sugars, the bacteria in the mouth metabolize them resulting in acids as by-products which decreases pH. As time progresses, the pH returns to normal due to the buffering capacity of saliva and the dissolved mineral content from tooth surfaces. During every exposure to the acidic environment, portions of the inorganic mineral content at the surface of teeth dissolves and can remain dissolved for 2 hours.<ref>Dental Caries, hosted on the University of California Los Angeles School of Dentistry website. Page accessed August 14, 2006.</ref> Since teeth are vulnerable during these periods of acidic environments, the development of dental caries relies greatly on the frequency of these occurrences. For example, when sugars are eaten continuously throughout the day, the tooth is more vulnerable to caries for a longer period of time, and caries are more likely to develop than if teeth are exposed less frequently to these environments and proper oral hygiene is maintained. This is because the pH never returns to normal levels, thus the tooth surfaces cannot remineralise, or regain lost mineral content.
The carious process can begin within days of a tooth erupting into the mouth if the diet is sufficiently rich in suitable carbohydrates, but may begin at any other time thereafter. The speed of the process is dependent on the interplay of the various factors described above but is believed to be slower since the introduction of fluoride.<ref name="summit75">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 75. ISBN 0-86715-382-2.</ref> Compared to coronal smooth surface caries, proximal caries progress quicker and take an average of 4 years to pass through enamel in permanent teeth. Because the cementum enveloping the root surface is not nearly as durable as the enamel encasing the crown, root caries tends to progress much more rapidly than decay on other surfaces. The progression and loss of mineralization on the root surface is 2.5 times faster than caries in enamel. In very severe cases where oral hygiene is very poor and where the diet is very rich in fermentable carbohydrates, caries may cause cavitation within months of tooth eruption. This can occur, for example, when children continuously drink sugary drinks from baby bottles. On the other hand, it may take years before the process results in a cavity being formed, if at all.
[edit] Treatment
Destroyed tooth structure does not fully regenerate, although remineralization of very small carious lesions may occur if dental hygiene is kept at optimal level.<ref name="medline">Dental Cavities, MedlinePlus Medical Encyclopedia, page accessed August 14, 2006.</ref> For the small lesions, topical fluoride is sometimes used to encourage remineralization. For larger lesions, the progression of dental caries can be stopped by treatment. The goal of treatment is to preserve tooth structures and prevent further destruction of the tooth.
Generally, early treatment is less painful and less expensive than treatment of extensive decay. Anesthetics -- local, nitrous oxide ("laughing gas"), or other prescription medications -- may be required in some cases to relieve pain during or following treatment or to relieve anxiety during treatment.<ref>Oral Health Topics: Anesthesia Frequently Asked Questions, hosted on the American Dental Association website. Page accessed August 16, 2006.</ref> A dental handpiece is used to remove large portions of decayed material from a tooth. A spoon is a dental instrument used to remove decay carefully and is sometimes employed when the decay in dentin reaches near the pulp.<ref name="summit128">Summit, James B., J. William Robbins, and Richard S. Schwartz. "Fundamentals of Operative Dentistry: A Contemporary Approach." 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 128. ISBN 0-86715-382-2.</ref> Once the decay is removed, the missing tooth structure requires a dental restoration of some sort to restore the tooth to function and esthetics.
Restorative materials include dental amalgam, composite resin, porcelain, and gold.<ref name="DCPPtx">"Aspects of Treatment of Cavities and of Caries Disease" from the Disease Control Priorities Project. Page accessed August 15, 2006.</ref> Composite resin and porcelain can be made to match the color of a patient's natural teeth and are thus used more frequently when esthetics are a concern. Since composite restorations are not as strong as dental amalgam and gold, some dentists consider them as the only advisable restoration for posterior areas where chewing forces are great.<ref>Oral Health Topics: Dental Filling Options, hosted on the American Dental Association website. Page accessed August 16, 2006.</ref> When the decay is too extensive, there may not be enough tooth structure remaining to allow a restorative material to be placed within the tooth. Thus, a crown may be needed. This restoration appears similar to a cap and is fitted over the remainder of the natural crown of the tooth. Crowns are often made of gold, porcelain, or porcelain fused to metal.
In certain cases, root canal therapy may be necessary for the restoration of a tooth.<ref>What is a Root Canal?, hosted by the Academy of General Dentistry. Page accessed on August 16, 2006.</ref> Root canal therapy, also called "endodontic therapy", is recommended if the pulp in a tooth dies from infection by decay-causing bacteria or from trauma. During a root canal, the pulp of the tooth, including the nerve and vascular tissues, is removed along with decayed portions of the tooth. The canals are instrumented with endodontic files to clean and shape them, and they are then usually filled with a rubber-like material called gutta percha.<ref>FAQs About Root Canal Treatment, hosted on the American Association of Endodontists website. Page accessed August 16, 2006.</ref> The tooth is filled and a crown can be placed. Upon completion of a root canal, the tooth is now non-vital, as it is devoid of any living tissue.
An extraction can also serve as treatment for dental caries. The removal of the decayed tooth is performed if the tooth is too far destroyed from the decay process to effectively restore the tooth. Extractions are sometimes considered if the tooth lacks an opposing tooth or will probably cause further problems in the future, as may be the case for wisdom teeth.<ref>Wisdom Teeth, packet in pdf format hosted by the American Association of Oral and Maxillofacial Surgeons. Page accessed on August 16, 2006.</ref> Extractions may also be preferred by patients unable or unwilling to undergo the expense or difficulties in restoring the tooth.
[edit] Prevention
[edit] Oral hygiene
Personal hygiene care consists of proper brushing and flossing daily.<ref name="adaoralhealth">Oral Health Topics: Cleaning your teeth and gums. Hosted on the American Dental Association website. Page accessed August 15, 2006.</ref> The purpose of oral hygiene is to minimize any etiologic agents of disease in the mouth. The primary focus of brushing and flossing is to remove and prevent the formation of plaque. Plaque consists mostly of bacteria.<ref>Introduction to Dental Plaque. Hosted on the Leeds Dental Institute Website, page accessed August 14, 2006.</ref> As the amount of bacterial plaque increases, the tooth is more vulnerable to dental caries. A toothbrush can be used to remove plaque on most surfaces of the teeth except for areas between teeth. When used correctly, dental floss removes plaque from areas which could otherwise develop proximal caries.
It is best not to brush one's teeth within half an hour of eating because the surface is softened by the acid produced by the bacteria. After this, the saliva has rebuilt the surface and brushing will do little damage.
Professional hygiene care consists of regular dental examinations and cleanings. Sometimes, complete plaque removal is difficult, and a dentist or dental hygienist may be needed. Along with oral hygiene, radiographs may be taken at dental visits to detect possible dental caries development in high risk areas of the mouth.
[edit] Dietary modification
For dental health, the frequency of sugar intake is more important than the amount of sugar consumed.<ref>"Dental Health", hosted on the British Nutrition Foundation website, 2004. Page accessed August 13, 2006.</ref> In the presence of sugar and other carbohydrates, bacteria in the mouth produce acids which can demineralize enamel, dentin, and cementum. The more frequently teeth are exposed to this environment, the more likely dental caries are to occur. Therefore, minimizing snacking is recommended, since snacking creates a continual supply of nutrition for acid-creating bacteria in the mouth. Also, chewy and sticky foods (such as dried fruit or candy) tend to adhere to teeth longer, and consequently are best eaten as part of a meal. Brushing the teeth after meals is recommended. For children, the American Dental Association and the European Academy of Paediatric Dentistry recommend limiting the frequency of consumption of drinks with sugar, and not giving baby bottles to infants during sleep.<ref>A Guide to Oral Health to Prospective Mothers and their Infants, hosted on the European Academy of Paediatric Dentistry website. Page accessed August 14, 2006.</ref> <ref>Oral Health Topics: Baby Bottle Tooth Decay, hosted on the American Dental Association website. Page accessed august 14, 2006.</ref>
It has been found that milk and certain kinds of cheese like cheddar can help counter tooth decay if eaten soon after the consumption of foods potentially harmful to teeth. Also, chewing gum containing xylitol (wood sugar) is widely used to protect teeth in some countries, being especially popular in the Finnish candy industry.<ref>"History", hosted on the Xylitol.net website. Page accessed October 22, 2006.</ref> Xylitol's effect on reducing plaque is probably due to bacteria's inability to utilize it like other sugars.<ref>Ly KA, Milgrom P, Roberts MC, Yamaguchi DK, Rothen M, Mueller G. Linear response of mutans streptococci to increasing frequency of xylitol chewing gum use: a randomized controlled trial. BMC Oral Health. 2006 Mar 24;6:6.</ref> Chewing and stimulation of flavour receptors on the tongue are also known to increase the production and release of saliva, which contains natural buffers to prevent the lowering of pH in the mouth to the point where enamel may become demineralised.<ref>Bots CP, Brand HS, Veerman EC, van Amerongen BM, Nieuw Amerongen AV. Preferences and saliva stimulation of eight different chewing gums. Int Dent J. 2004 Jun;54(3):143-8.</ref>
[edit] Other preventive measures
The use of dental sealants is a good means of prevention. Sealants are thin plastic-like coating applied to the chewing surfaces of the molars. This coating prevents the accumulation of plaque in the deep grooves and thus prevents the formation of pit and fissure caries, the most common form of dental caries. Sealants are usually applied on the teeth of children, shortly after the molars erupt. Older people may also benefit from the use of tooth sealants, but usually their dental history and likelihood of caries formation are taken into consideration.
Fluoride therapy is often recommended to protect against dental caries. It has been demonstrated that water fluoridation and fluoride supplements decrease the incidence of dental caries. Fluoride helps prevent dental decay by binding to the hydroxyapatite crystals in enamel.<ref>Cate, A.R. Ten. "Oral Histology: development, structure, and function." 5th edition, 1998, p. 223. ISBN 0-8151-2952-1.</ref> The incorporated fluoride makes enamel more resistant to demineralization and, thus, resistant to decay.<ref>Ross, Michael H., Gordon I. Kaye, and Wojciech Pawlina, 2003. "Histology: a text and atlas." 4th edition, p. 453. ISBN 0-683-30242-6.</ref> Topical fluoride is also recommended to protect the surface of the teeth. This may include a fluoride toothpaste or mouthwash. Many dentists include application of topical fluoride solutions as part of routine visits.
Furthermore, recent research shows that low intensity laser radiation of argon ion lasers may prevent the susceptibility for enamel caries and white spot lesions.<ref>In vitro caries formation in primary tooth enamel: Role of argon laser irradiation and remineralizing solution treatment. Journal of the American Dental Association, Volume 137, Number 5, p. 638-644. Page accessed August 18, 2006.</ref> Also, there is current active research to find a vaccine for dental caries, but no effective vaccine has been created yet.<ref>Panel on Caries Vaccine. National Institute of Dental and Craniofacial Research of the National Institute of Health, January 28, 2003. Page accessed August 18, 2006.</ref>
[edit] See also
[edit] References
<references/>
[edit] External links
- What causes cavities; an indepth look
- Links to tooth decay pictures (Hardin MD/Univ of Iowa)
- Caries Diagnosis - Coronal Caries from the University of Michigan, School of Dentistry
- Diet, Nutrition and the prevention of chronic diseases (including dental caries) by a Joint WHO/FAO Expert consultation (2003)
- Diet & Dental diseases — A summary for non specialists by GreenFacts of the above WHO/FAO report.
- Image showing various stages of dental cariesar:نخر الأسنان
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