| | Dental Health | Teeth Cleaning
Tooth Decay (Caries): Pathogenesis, Stages, and Prevention
Caries Process (Dynamic Demineralization/Remineralization)
- Plaque biofilm: Streptococcus mutans, S. sobrinus, lactobacilli adhere to pellicle.
- Sugar metabolism: Bacteria ferment sucrose → organic acids (lactic, formic, acetic) → pH drops below critical (5.5 for enamel).
- Demineralization: Calcium/phosphate diffuse out of hydroxyapatite → subsurface lesion (white spot).
- Remineralization: Saliva (Ca²⁺, PO₄³⁻, fluoride) + pH recovery → mineral redeposition. Balance determines progression.
- Cavitation: Repeated cycles → surface collapse → frank cavity (irreversible without restoration).
- Dentin involvement: Softer, tubular; faster spread; sensitivity.
- Pulpitis: Bacterial toxins → inflammation → irreversible pulpitis → necrosis.
- Periapical abscess: Infection spreads to bone → swelling, fistula, systemic risk.
Prevention (Evidence-Based)
- Fluoride: Water fluoridation, toothpaste (1000–1500 ppm), varnish (professional 2–4×/year).
- Diet: Limit frequency of fermentable carbs; avoid sticky/sipping sugars.
- Oral hygiene: Brush 2×/day (fluoride toothpaste), floss/interdental daily.
- Sealants: Pit-and-fissure sealants on molars (children/adults).
- Regular dental visits: Risk-based recall (6–12 months); early detection of white spots → non-invasive arrest (SDF, high-fluoride).
Treatment by Stage
| Stage | Intervention |
|---|---|
| White spot (non-cavitated) | Fluoride varnish, SDF, resin infiltration (Icon), MI paste |
| Enamel/dentin cavity | Composite restoration (bonded) |
| Deep caries (near pulp) | Indirect pulp cap, stepwise excavation, vital pulp therapy |
| Irreversible pulpitis/necrosis | Root canal treatment or extraction |
| Abscess | Incision/drainage + RCT/extraction + antibiotics if systemic |