Teeth

Dental Caries

search

Dental Caries, Tooth Decay, Dental Cavities

  • Epidemiology
  1. Early childhood carries are the most common chronic condition in children <6 years old
  • Pathophysiology
  1. Oral Bacteria present (Streptococcus mutans)
  2. Bacteria ferment dietary Carbohydrates (esp. Simple Sugars)
  3. Results in polymicrobial biofilm matrix
  4. Resulting acids are cariogenic
  5. Acids demineralize tooth enamel and dentine
  • Risk Factors
  • Children
  1. Enamel defects at time of Tooth Eruption
    1. Premature Infants
    2. Low Birth Weight Infants
    3. Low socioeconomic status
  2. Increased Mutans Streptoccal colonization
    1. Increased maternal levels of Mutans Streptococcus
    2. Second hand smoke exposure
  3. Increased sugar exposure (risk increases with frequency of exposure)
    1. Sucrose and other Simple Sugar exposure
    2. Propped baby bottles
    3. Sugar liquid (e.g. juice) in sippy cup
    4. Less associated with lactose and cow's milk
    5. Sweetened pastries may be higher risk
    6. Diet sodas also increase risk due to low pH
  4. References
    1. Garcia-Closas (1997) Am J Clin Nutr 66(5): 1257-63 [PubMed]
  • Risk Factors
  • Adults
  1. See child risk factors above
  2. Xerostomia (Dry Mouth)
    1. See Xerosotomia
    2. See Medication Causes of Dry Mouth
    3. Saliva helps remineralize teeth, decreases Bacterial load, and increases oral pH
  • Symptoms
  1. See Pulpitis
  2. Dental Erosions are initially painless
    1. Progresses from stimulation after hot or cold exposure to constant pain
  • Signs
  1. Pain when patient bites on Tongue blade
  2. Appearance
    1. Initial
      1. Pit or fissure in dental enamel (may be detected by dental probe)
      2. Appears as chalky white deposit in enamel surface of tooth
    2. Next
      1. Brown or Black Tooth Discoloration
      2. Softening and tooth cavitation
  • Imaging
  1. Dental XRays detect caries early
  2. Low-level lasers detect Dental Caries
  • Management
  1. See Pulpitis for dental management
  2. Evaluate for Pulpitis complications
  3. Analgesics
    1. NSAIDs or
    2. Vicodin or similar Opioid
  • Complications
  1. See Pulpitis
  2. Dental abscess (Periapical Abscess, Periodontal Abscess)
  3. Periodontal Cellulitis
  • Prevention
  1. See Oral Health
  2. See Oral Health in Children
  3. See Fluoride Supplementation
    1. Tooth Brushing with fluoride toothpaste (guidelines vary by age)
    2. Mouth rinses (e.g. ACT) for adults
  • References
  1. Douglass (2003) Am Fam Physician 67(3):511-16 [PubMed]
  2. Douglass (2004) Am Fam Physician 70(11):2113-22 [PubMed]
  3. Stephens (2018) Am Fam Physician 98(11): 654-60 [PubMed]