Caries Definition
Tooth caries is pathological process of local destruction in the tooth tissue which is caused by microorganism. Caries is infectious disease, pathological process in the hard tissue of tooth which happened bacuse of multifactor interactions in the mouth, and is signed by loses of mineral ions chronically and continuously on the email crown though root surfaces. This process is stimulated by certain flora bacteria and its products. The beginning lesion will only seen microscopic, but later it will be seen clearly in the email as White Spot lesion or like soft cementum. The next step of this White Spot is the improvement that can add the amount of stain and will be browish. This shift will be increased with coffee or tea consumption. If it is continous, cavity will be formed, and later pulp damage will be irreversible.
Here is few bacteria which cause caries and change sugar into acid:
1. Streptococcus Mutans à The most dangerous one
2. Lactobacillus Acidophilus
3. Steptococcus Sanguish
4. Streptococcus Salivarius
These bacteria could be seen microscopicly in saliva. Food with sucrose is the fastest food which transform into acid where can be found in soft drinks and meals. The sucrose can reduce the value of pH that makes caries process faster.
Caries Prevention
The primary goal of a caries prevention program should be to reduce the numbers of cariogenis bacteria. Prevention should start with a consideration of the overall resistance of the patient to infection by the cariogenic bacteria. Preventive treatment methods are designed to limit tooth demineralization caused by cariogenic bacteria, preventing cavitated lesions. These methods include:
1. Limiting pathogen growth and metabolism and
2. Increasing the resistance of the tooth surface to demineralization.
Caries-control methods are operative procedures used to stop the advance of individual lesions and to prevent the spread of pathogenic bacteria to other tooth surface, and in this sense, they are preventive procedures. Caries-control methods are most effective if all active, cavitated lesions can be treated in a short time, even in a single appoinment. New restorative treatment methods have rendered the distinction between preventive and control of rondering tooth surfaces more acid-resistant and in some circumstances may arrest active caries. Patient’s caries risk:
1. General Healt
It has a significant impact on overall caries risk. Every patient has an effective surveillance and destruction system for “foreign” bacteria. The effectiveness of a patient’s immunologic system depends on overall health status. Patients undergoing radiation or chemotherapy treatment have significantly decreased immunocompetence and are at risk for increased caries. Medically compromised patients should be examined for changes in the following: plaque index, salivary flow, oral mucosa, gingiva, and teeth. Early signs of increased risk include increase plaque; puffy (bengkak), bleeding gingiva; dry mouth with red, glossy mucose; and demineralization of the teeth. Decreased saliva flow is common during acute and chronic system ilnesses and is responsible for the dramatic increase in plaque. The saliva should be tested for flow and buffering capacities when changes are detected from an oral examination.
2. Fluoride Exposure
Fluoride in trace amounts increases the resistance of tooth structure to demineralization and is a particularly important consideration for caries prevention. When fluoride is available during cycles of tooth demineralization, it is the major factor in reduced caries activity. It seems to be essential nutrient for humans that is required only in very small quantities. The availability of fluoride to reduce caries risk is primarily achieved by fluoridated community water systems, but also may occur from fluoride in the diet, toothpastes, mouthrinses, and profeissional topical applications. The optimal fluoride level for public water supplies is about 1 (0.7-1.2) part per million (ppm). The percentage of the U.S. population with public fluoridated community water system has increased from 62% (140 million) in 1999 to 66% (162 million) in 2000. Public water fluoridation has been one of the most successful public health measures instituted in the United States. Excessive fluoride exposure (≥10ppm) results in fluorosis, which is initially white but may become brownish discoloration of enamel, termed mottled enamel.
3. Immunization
Certain T and B cells in Peyer’s patches become sensitized to the new bacteria. The sensitized T and B cells migrate through the lympatic system to the bloodstream and eventually settle in glandular tissues, including the salivary glands in the oral cavity. There, these sensitized cells produce IgA class immunoglobulins that are secreted in the saliva. These IgA anti-bodies are capable of agglutination (clumping) of oral bacteria. It prevents adherence to the teeth and other oral structures, and the bacteria are more easily cleared from the mouth by swallowing. Appoint for patients with high concentrations of MS, agglutinating IgA may have an important anticaries effect. This immunologic occurence promotes the possibility of further vaccination against caries.
4. Salivary Functioning
Saliva is crucial in the prevention of caries. Although xerostomia may occur because of aging, it is more commonly a result of a medical condition or medication. Lack of saliva greatly increase the incidence of caries. Saliva stimulants (gums, paraffin waxes, or saliva subtitutes such as Sialogen or cevimeline [Evoxac] also may be prescribed for patients with impaired salivary functioning.
5. Antimicrobial Agents
A variety of antimicrobial agents also are available to help prevent caries. Fluoride has antimicrobial effects. Likewise, chlorhexidine use provides beneficial results. Chlorhexidine varnish enchances remineralization and decreases MS presence. Chlorhexidine is prescribed for home use at bedtime as a 30-second rinse. Clorhexidine may be used in combination with other preventive measures for high-risk patients. A popular mouthwash (Listerine; Proctor & Gambler; Cincinnati, Ohio) has been reported to be effective in plaque reduction when used specifically as directed.
6. Diet
Dietary sucrose has two important detrimental effects on plaque:
a. Frequent ingestion of foods containing sucrose provides a stronger potential for colonization by MS, enchancing the caries potential of the plaque.
b. Mature plaque exposed frequently to sucrose rapidly metabolizes it into organic acids, resulting in a profound and prolonged decline in plaque pH.
Caries activity is most strongly stimulated by the frequency, rather than the quantity, of sucrose ingested.
7. Oral Hygiene
Plaque-free tooth surfaces do not decay! Daily removal of plaque dental by dental flossing, tooth brushing, and rinsing is the best measure for preventing caries and periodontal disease.Pits and fissures are not accesible to toothbrush bristles of the small diameter of their orifices, and these areas are highly suspectible to caries.Obturation of pits and fissures by sealants is a highly effective method for caries prevention. Mechanical plaque removal by brushing and flossing has the advantage of not eliminating the normal oral flora. The oral flora on the teeth of patients with good plaque control has a high percentage of S. Sanguis or S. Mitis and is much less cariogenic than older, mature plaque communities, which have significantly higher percentage of MS. Rigid oral hygiene programs should be prescribed only to high-risk persons with evidence of active disease. Plaque removal in high-risk patients should be done frequently. Adults with a low caries experience probably require flossing, brushing, and rinsing only once a day, and the best time for this is in the evening before going to bed.
8. Xylitol Gums
Xylitol is a natural five-carbon sugar obtained from birch trees. It keeps sucrose molecule from binding with MS. MS cannot ferment (metabolize) xylitol. Xylitol reduces MS by altering their metabolic pathways and enchances remineralization and helps arrest dentinal caries. It is usually recommended that a patient chew a piece of xylitol for 5 to 30 minutes after eating or snacking. Chewing any sugar-free gum after meals reduces the acidogenicity of plaque because chewing stimulates salivary flow, which improves the buffering of the pH drop that occurs after eating. Reduction in caries rates are greater, howerver, when xylitol is used as the sugar subtite.
9. Pit-and-Fissure Sealants
Although fluoride treatments are most effective in preventing smooth-surface caries, they are less effective in preventing pit-and-fissures caries. Although occlusal surfaces account for only 12.5% of all tooth surfaces, they account for much of the caries in school-age children. Sealants have three important preventive effects:
1. Sealants mechanically fill pits and fissures with an acid-resistant resin
2. Because the pits and fissures are filled, sealants deny MS and other cariogenic organisms their preferred habitat.
3. Sealants render the pits and fissures easier to clean by toothbrushing and mastication.
If more children received sealants, caries prevelance would be reduced. Sealants have been shown to be effective, to have long-term retention, to cause regression of active lesions, and to be superior to amalgam restoration in terms of time requirements. Material of this sealant are unfilled resin and GIC. This sealant is important to prohibit demineralization. The negative effect of sealant is the existence of stain (noda), but it can be cleaned.
10.Restorations
The status of a patient’s existing restorations may have an important bearing on the outcome of preventive measures and caries treatment. Restoration defects, such as overhangs, open proximal contacts, and defective contours, contribute to plaque formation and retention. These defects should be corrected, usually by replacement of the defective restoration. Detection of secondary caries can be difficult around old restorations. Discoloration of the enamel adjacent to a restoration suggests secondary caries. Because metallic restorations are radiopaque, the radiolucency of secondary caries may be masked. The placement of a restoration into a cavitated carious tooth does not cure the carious process. Strict preventive measures for caries are not necesarry for all patients. Only caries-active patients and patients at high risk (who most likely would benefit from preventive measures) should be treated with comprehensive regimens. Preventive treatment is based on reducing the pathogen population size and increasing the resistance of the tooth to cariogenic attack. The cariogenicity of plaque can be controlled by denying the food supply, denying the habitat, using antimicrobial therapy, and stopping succession. The most successful preventive treatment regimen combines all of these treatments in a spesific program designed for an individual that considers caries and periodontal disease.
Reference : Studervant’s Art and Science of Operative Dentistry. 5th Ed. The Mosby Inc. St. Louis, 2006.
