Background

Dental caries is one of the oldest diseases in humans, as well as one of the most common. It is still prevalent today and tends to affect people who are in the lower classes of society. Historically, the management of caries relied on a surgical approach: dead cells were stripped off and the voluminous space created was molded using an artificial substance in a geometrically correct manner. However, this approach allowed the creation of even a larger cavity as secondary caries began to form requiring repeated treatments and ultimately tooth loss. The transition from this surgical model of disease management to a medical model of disease has brought preventive strategies like the preservation of teeth and the prevention of caries. 

Epidemiology

• Prevalence: Communities of all ages are impacted, though more severe rates are found in children and families of low economic status. This is due to higher standards of living, increased use of preventive care and the use of fluoride. 
• Geographic Variation: Developing countries shows higher levels owing to poor access to dental care and use of fluoride, however developed countries although they have low prevalence still experience disparity. 
• Risk Factors: It can be defined by such factors as high sugar intake, low levels of oral hygiene, no access to fluorides, as well as low socio-economic status. 
• Trends: Caries remains a major concern in many areas with rates having declined slightly due to the measures that have been put in place to boost public health. 

Anatomy

Pathophysiology

• Plaque Formation: Dental caries starts with the development of dental plaque, a soft deposit which is made up of bacteria, food residues and saliva on the tooth. 
• Acid Production: Bacteria in plaque utilises fermentable carbohydrates (mostly sugars) in the diet and produce organic acids (for instance lactic acid as byproducts. 
• Demineralization: The acids found with the bacteria decrease the pH in oral environment and makes the pH to reach a level below the critical value of about 5.5. These changes in pH lower the PH level and cause dissolution of calcium and phosphate ions in the tooth enamel leading to demineralization. 

Etiology

It has been categorized as a polygenic or multifactorial disease involving host factors, agent factors and environmental factors. The key etiologic agent of dental caries is the organism known as Streptococcus mutans (MS). Streptococcus mutans are known to adhere to the dental pellicle and metabolize sugars to lactic acid; the acidification of the content of the oral cavity surrounding the tooth occurs. This results in the decalcification of both the inner most surface of the enamel and the outer surface of the dentine. Important etiologic factors of dental caries are the presence of bacteria going into dental plaque, the state of the tooth and the use of sugary products. It is necessary to mention that carries and its prevalence depend on the amount and quality of sugar and its frequency. 

Genetics

Prognostic Factors

The following are some of the major prognostic factors affecting the methods used in the prevention of dental caries. Daily oral cleanliness including brushing with fluoride containing toothpaste and flossing help lower caries risk. Water fluoridation and topical application of fluoride gel are preventive measures that facilitate the re-mineralization of enamel in relation to caries. It showed the relationship between dietary behavior where avoidance of sugar and acid promotes caries formation, along with the positive correlation between a balanced diet and oral health. Preventive measures benefit from dental care through check-up and applying professional dental sealants. Concerning the socio-economic status of the population, education level and income influence utilization of care and preventive measures.  

Clinical History

Age Groups: 

• Children and Adolescents: It manifests clinically through the presence of demineralized areas or definite cavious lesions involving the enamel most frequently on the occlusal surfaces of the molars. ECC is prevalent in young children due to the regular use of sugars in food and drinks and low levels of oral hygiene. Dental caries can occur in both primary and permanent dentition among adolescents due to their dietary choices and presence of orthodontic appliances. 
• Adults: In the adults; caries manifests themselves as cavitations or dark areas on the teeth, usually at the gum line because of the receding gums. It also affects areas surrounding existing restoration or between adjacent teeth. 
• Elderly: There is a high prevalence of caries in root surfaces due to gum retraction and decreased saliva production in seniors. It can also affect the remaining natural teeth and dental restorations including fillings and crowns. 

Physical Examination

• Visual Inspection 
• Radiographic Examination 
• Assessment of Oral Hygiene  
• Gum Health Evaluation 

Age group

Associated comorbidity

• Socio-economic Status 
• Dietary Habits 
• Medications 

Associated activity

Acuity of presentation

• Acute: Early signs and symptoms of active caries include sharp and severe localized pain, tenderness to hot, cold or sweet substances and routinely visible cavities. It is important to note that carious lesions progress rapidly and cause toothache and swelling. 
• Chronic: Toothache could be less severe in chronic caries and patients may first described sensitivity, discoloration of the affected teeth, and gradual formation of cavities. It can occur that the disease is not diagnosed at all and does not manifest clinically until the later stages. 

Differential Diagnoses

• Dental Erosion 
• Dental Abrasion 
• Dental Attrition 
• Gingivitis and Periodontitis 
• Tooth sensitivity 
• Dental hypoplasia 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

• Oral Hygiene: Choose a fluoride toothpaste and brush your teeth for at least two minutes twice a day to start and ensure you are cleaning the plaque from your teeth. It is usually advised that a soft bristle toothbrush be used. Flossing is the process of cleaning between the teeth and down to the gum line, and when done daily, it dislodges and reduces the formation of plaque and debris. 
• Fluoride Use: Use topical applications of fluoride varnish or gels in dental checkups to increase the hardness of the teeth enamel surfaces and their resistance to the corrosive effect of acids. Fluoride supplement can help in the remineralization of the enamel surface when one consumes fluoridated water. 
• Dietary Modifications: Avoid foods and drinks that are high in sugar and high in acids as they are areas where bacteria thrive and that erode the teeth. Promote non-cariogenic foods that should be taken in between meals, these include fruits, vegetables and cheese. 
• Dental Sealants: Use dental sealants on the occlusal surfaces of the posterior teeth, molars, preventing caries, especially for children and teenagers. 
• Regular Dental Check-ups: Dental checkups for cleaning, examination and early X-ray, fluoride treatment, and fissure sealant application should be planned periodically. As required, perform an X-ray to diagnose caries that cannot be seen clinically. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

use-of-a-non-pharmacological-approach-for-treating-dental-caries-prevention

• Oral Hygiene: It is recommended that one should brush his teeth at least twice a day using fluoride toothpaste, and flosses daily. 
• Dietary Modifications: Reduce the intake of sweets; develop sound eating habits and include foods high in calcium in your diet. 
• Dental Sealants: To prevent decay on molars, they should be sealed. 

Role of fluoride components

• Fluoride Toothpaste: Fluoridated toothpaste must be used by all children with an aim of avoiding dental caries. For children under 6 years: 
• Low caries risk: Consume toothpaste with fluoride content of up to 600 ppm. 
• High caries risk: Apply fluoride in the toothpaste in a concentration of 1000 ppm. 
• For children over 6 years old, the use of toothpaste containing fluoride of not less than 1,000 ppm should be encouraged. The parents should observe the brushing process closely especially for children below seven years and should use a smear of toothpaste for children below 2 years and a pea-sized amount for children aged between 2 to 6 years. Kids should be educated to rinse their mouth with water, then chew and spit the toothpaste. 
• Fluoride Varnish: It is a technique that has been used professionally and involves cementation of teeth permanently but in this case for a short period to release fluid to the teeth that hardens the enamel. Frequently it contains 5% sodium fluoride, and it is useful in the case of a primary prevention of latest caries and secondary prevention of infected ones. ESKA is especially prescribed for high-risk children and is used topically on the skin by painting on the skin. 
• Fluoride Mouth rinse: They are considered most unsuitable for children under the age of six, or in areas where fluoridated water is used, due to the obvious dangers of eating the material. 
• Fluoride Gel: Fluoride gels are special solutions of fluoride which enhances the degree of prevention of caries by approximately 28%. The most conventional gel comes with 12,300 ppm of fluoride as Acidulated Phosphate Fluoride (APF) and is applied using a tray method. It comes with a cautionary note for those under the age of six because it may be ingested. 
• Fluoride Supplements: They are available in the form of tablets, lozenges, drops and in combination with fluorides and vitamin preparations. They are often applied where other sources of fluorides are lacking and are prescribed only after evaluating caries potential to avoid the risk of toxicity and fluorosis. Supplements have a topical effect in that they create an elevated concentration of fluoride in saliva and plaque. 

Role of Antimicrobials

• Chlorhexidine: These are anti-bacterial agents that are useful in the prevention of dental caries through the decrease in the prevalence of mutans streptococci. It is thought to be the best of the batch when it comes to antiplaque agents.It may be obtained in the form of gel, solution and mouth rinse varying in concentration as a counter sale product or prescription. These include toothpaste, mouth wash, varnish, gel, gum, and aerosols which include spray. 
• Xylitol: It is a natural non-caloric sweetener that has been shown to decrease concentrations of cariogenic bacteria such as mutans streptococci in plaque and saliva. For children, it could be given in the syrup form or through wipes applied on the child’s skin. When it comes to its administration in older children, xylitol can be given in the form of gum, lozenges, or even high-fibre snack foods. 

use-of-intervention-with-a-procedure-in-treating-dental-caries-prevention

Fluoride Application: 

• Topical Fluoride: This is done by placement of fluoride varnish or gels to the teeth and is believed to assist in building up the enamel, thus resisting any acid attack. 
• Fluoridated Water: Safe water for drinking that has been fluoridated will lower the prevalence of caries among individuals in the population. 

Dental Sealants: 

• Sealant Placement: Applying a coating on the reverse side of the molars and premolars will prevent the teeth from being in contact with bacteria and foods that cause cavities. This is especially true in children and teenagers since these attainers are more prone to cavities. 

Professional Cleanings: 

• Scaling and Polishing: Cleaning the teeth prevents the accumulation of plaque and tartar which is causes of Tooth Decay. This also includes the shaping and refining of the teeth so that their surfaces are devoid of roughness that would enhance formation of plaque. 

Dietary Counseling: 

• Reducing Sugars: Recommendations on avoiding the consumption of foods and drinks that are high in sugar and acid, that can cause harm to teeth. 
• Healthy Eating Habits: Promoting the consumption of healthy diet that will lead to enhancement of the health of our teeth. 

use-of-phases-in-managing-dental-caries-prevention

• Preventive Interventions: Administer application of fluoride, provision of sealants and cleaning of the teeth. 
• Monitoring and Follow-Up: Have control measures and preventive procedures carried out periodically, review the degree of risk, and perhaps modify it. 
• Intervention (if necessary): Apply preventive measures on early carious lesions and restore the tooth if it gets involved in the decay. 
• Long-Term Maintenance: Promote maintenance of other preventive measures and constant employ of learning. 

Medication

Future Trends

Media Gallary

References

Diagnosis and Prevention Strategies for Dental Caries – PMC (nih.gov) 

Dental Caries – StatPearls – NCBI Bookshelf (nih.gov) 

Application of Antibiotics/Antimicrobial Agents on Dental Caries – PMC (nih.gov)