| | Dental Health | Teeth Cleaning
Tooth Decay (Caries): Causes, Prevention, and Treatment Options
Dental Caries: Pathophysiology and Management
Caries = localized destruction of dental hard tissues by acidic byproducts of bacterial metabolism of dietary carbohydrates.
Caries Triad (Keyes)
- Host: Tooth morphology, enamel quality, saliva (flow, buffering, antimicrobials).
- Microflora: S. mutans, S. sobrinus, lactobacilli, actinomyces – biofilm (plaque).
- Substrate: Fermentable carbs (sucrose > glucose/fructose > starches). Frequency > quantity.
Time (repeated cycles) completes the cycle.
Risk Factors
- High sugar frequency (snacking, sipping sweetened beverages).
- Poor oral hygiene (plaque retention).
- Xerostomia (medications, Sjögren's, radiation).
- GERD/eating disorders (acid erosion).
- Orthodontic appliances, prostheses.
- Low fluoride exposure.
- Socioeconomic barriers to care.
Prevention
- Fluoride: Toothpaste (1000-1500 ppm), water fluoridation, varnish (professional 2-4x/yr), supplements if water deficient.
- Oral hygiene: Brush 2x/day (2 min), floss/interdental clean daily.
- Diet: Limit free sugars <10% energy (WHO); avoid sticky/liquid sugars between meals.
- Sealants: Pit/fissure sealants on molars (children/adolescents).
- Xylitol: Gum/mints 5-10g/day – inhibits S. mutans.
- Regular dental visits: Risk-based recall (6-12 mo).
Treatment by Stage
| Stage | Appearance | Treatment |
|---|---|---|
| Initial (white spot) | Chalky white, non-cavitated | Fluoride remineralization, sealant, hygiene |
| Enamel caries | Cavitation in enamel | Resin infiltration (ICON) or composite |
| Dentin caries | Cavitation into dentin | Composite/amalgam/glass ionomer restoration |
| Pulpal involvement | Deep, near pulp | Indirect/direct pulp cap, pulpotomy, RCT |
| Periapical | Abscess, radiolucency | RCT or extraction |