Dental caries

Dental caries is a chronic, progressive infectious disease characterized by destruction of tooth enamel, dentine, and eventually pulp tissue due to acid production from bacterial fermentation of dietary carbohydrates.

It remains one of the most prevalent oral health conditions worldwide affecting children and adults and represents a major cause of tooth loss if untreated.

Dental caries results from interaction between tooth surface, oral bacteria, fermentable carbohydrates, and time.

Epidemiology

• Highly prevalent worldwide affecting nearly all populations

• Common among school-aged children and young adults

• Increased burden in low- and middle-income countries

• Associated with poor oral hygiene and high sugar consumption

Risk Factors

• Frequent intake of sugary foods and beverages

• Poor oral hygiene practices

• Inadequate fluoride exposure

• Reduced salivary flow (xerostomia)

• Malnutrition

• Deep pits and fissures of teeth

• Orthodontic appliances

• Low socioeconomic status

• Lack of regular dental visits

Pathophysiology

Dental plaque contains cariogenic bacteria mainly:

• Streptococcus mutans

• Lactobacillus species

These microorganisms metabolize dietary sugars producing organic acids (mainly lactic acid).

The acids cause:

1. Demineralization of enamel.

2. Progression into dentine.

3. Bacterial invasion of pulp tissue.

4. Pulpitis and periapical infection if untreated.

Repeated acid exposure without remineralization leads to irreversible cavitation.

Classification

Dental caries may be classified as:

According to Location

• Pit and fissure caries

• Smooth surface caries

• Root caries

According to Progression

• Early (incipient) caries

• Moderate dentinal caries

• Advanced caries involving pulp

Signs and Symptoms

• Tooth sensitivity to cold, hot, or sweet foods

• Visible white chalky lesion (early stage)

• Brown or black discoloration of tooth surface

• Cavitation or hole in tooth

• Food impaction between teeth

• Toothache increasing with chewing

• Spontaneous pain in advanced disease

• Bad breath (halitosis)

Diagnostic Criteria

• Early stage: asymptomatic enamel lesion

• Visible black or brown spot on tooth surface

• Presence of cavitation

• Pain triggered by thermal or sweet stimuli

• Tenderness on percussion in advanced disease

• Clinical evidence of tooth structure destruction

Investigations

• Clinical oral examination (primary diagnostic method)

• Periapical dental X-ray

  • Determines depth of lesion

  • Detects hidden proximal caries

  • Assesses pulpal involvement

• Bitewing radiographs where available

Management

Treatment Principles

Management depends on:

• Depth of lesion

• Pulp involvement

• Tooth restorability

• Patient age and oral condition

Non-Pharmacological Management

Early Non-Cavitated Lesions

• Fluoride therapy

• Oral hygiene reinforcement

• Dietary modification

• Remineralization therapy

Cavitated Lesions Confined to Dentine

Restoration using:

• Dental amalgam

• Composite resin

• Glass ionomer cement

Pulp Involvement

• Root canal treatment (endodontic therapy) where feasible

OR

• Tooth extraction if restoration is not possible

Pharmacological Management

Analgesics (For Tooth Pain)

• Paracetamol 1 g orally every 8 hours for 3 days

OR

• Ibuprofen 400 mg orally every 8 hours for 3 days

OR

• Diclofenac 50 mg orally every 8 hours for 3 days

(According to Tanzania Standard Treatment Guidelines)

Antibiotics

Antibiotics are NOT routinely indicated unless there is:

• Systemic infection

• Facial swelling

• Cellulitis

• Associated abscess

Complications

• Pulpitis

• Periapical abscess

• Facial cellulitis

• Osteomyelitis of jaw

• Tooth loss

• Malocclusion

• Nutritional impairment

• Systemic infection in severe untreated cases

Prevention

Individual Preventive Measures

• Brush teeth at least twice daily using fluoridated toothpaste

• Reduce frequency of sugary snacks and drinks

• Regular dental check-ups every 6 months

• Use dental floss regularly

• Professional fluoride application in high-risk individuals

Community Preventive Measures

• Oral health education programs

• School dental screening

• Water fluoridation where applicable

Patient Education

• Avoid frequent sugar exposure between meals

• Maintain proper tooth brushing technique

• Seek dental care early when sensitivity begins

• Do not ignore early tooth discoloration or pain

• Encourage supervised brushing in children

Prognosis

Good prognosis when detected early and treated promptly. Advanced untreated caries may result in irreversible tooth destruction and systemic complications.