Dental Caries

Plaque forms even in the absence of any type of nutrition, however, the type of food that a person assumes can modify both the AMOUNT of plaque and its COMPOSITION.
As regards the amount of plaque, food that requires rigorous chewing, can help to clean teeth, directly by friction, and indirectly through the action of saliva, tongue and the cheeks; however, it is necessary to bear in mind that the gingival margin of teeth and the interdental spaces are not subject to friction by food during chewing.
Regarding the composition of plaque, a diet rich in sugars can favor the selection and the proliferation of those micro organisms (Streptococcus Mutans, Gram+, that utilize glucose as a source of energy, thus provoking a series of chemical reactions that produce ACIDS.
Although dental Caries are caused directly by specific bacteria in the plaque accumulated on teeth, the moment that triggers the pathology is brought about by the interaction of different factors that are involved in the process: predisposition of teeth, bacteria, sugars and frequency of intake. The formation of Caries will be impeded if one of these factors is lacking or notably reduced.
The quantity of sugar eaten is not so important, but rather the FREQUENCY OF INTAKE in the oral cavity.
Demineralization is When sugar and other fermentable carbohydrates reach the bacteria in the plaque, they release acids which start to dissolve the Enamel.
The initial phase of a Caries lesion occurs due to loss of Calcium and Phosphates.
Remineralization: The saliva can wash away sugars and buffer the acids and this process is facilitated by fluorides that enable the Calcium and Phosphates to re-enter the tooth to remineralize the Enamel.
The Fluoride that enters reinforces the superficial layer of the Enamel.
This is the principal reason for which the presence of Fluoride is so important in this phase; it fortifies the phase of remineralization. Naturally, the plaque must be removed.

CARIES occur if the Demineralization is more rapid than the Remineralization

The possibility of preserving teeth affected by CARIES depends principally on the combined ability of the patient and the dental team to keep bacteria under control and to keep in check the excess and frequency of the daily consumption of sugar (above all saccharose), not followed by adequate procedures of oral hygiene.

The process of the Caries

Caries is a disease process that changes over time, it can continue to worsen, it can stabilize, or signs can even improve following remineralization.
Caries is the phase at which the process of bacterial demineralization is stronger than the patients ability to remineralize tooth structure.
This process begins long before the cavity forms and the factors involved are bacteria and sugar levels (offence), salivary flow, Fluoride, home care and antimicrobial agents (defense).
The bacteria on the intact tooth surface metabolize the available sugar and produce acid, that penetrates the solid tooth surface, driving calcium and phosphate out of Enamel, demineralizing it.
In the early stages, the lesion appears as a whitespot lesion, rough and chalky, with no cavity.
It can be reversible (Featherstone 2000) and it is in ideal condition for remineralization therapy.
When, instead, the lesion is inactive, the surface is dark, shiny, smooth and nonporous.
Saliva can buffer the acid pH in the oral cavity, and with the increase in the pH, calcium and phosphate are deposited, remineralizing the tooth.
But the lesion can progress and after the cavity has formed, remineralization is unlikely.
Therefore, the possibility of preserving teeth affected by Caries depends principally on the ability of the patient and the dental team to keep bacteria, and the excess and the frequency of the daily intake of sugar (above all sucrose) under control.
The intake of sugar is particularly harmful if it is not followed immediately by adequate procedures of oral hygiene.
Consequently, the goal of treatment of patients who are susceptible to Caries, is to create an environment that impedes the formation of new Caries in the oral cavity.
Then the aetiological factors must be eliminated and subsequently periodic recalls must be performed in order to maintain the status of dental health.

CLINICAL CHARACTERISTICS OF CARIES

The clinical characteristics of Caries are more or less widespread signs of demineralization of the Enamel, and infiltration of existing fillings.
The advanced phases of the disease are frequently associated with partial or total destruction of the crowns of the teeth.
An accurate analysis of the status of Caries is made possible through x-rays.
Very often, marginal inflammation of the gingiva (Gingivitis) is also present together with the pathology of Caries.
During the first appointment, after the clinical examination of the oral cavity and the radiographic examination, the dentist formulates a diagnosis and defines the treatment plan, giving due consideration to two important aspects:

• Caries activity, which refers to the process on an individual tooth surface (Featherstone 2000, Young 2002);
• Caries risk, which describes the general status of the patient, defined as the likelihood that the patient will contract new Caries.

In defining the individual risk factor of each patient, the dentist assesses the teeth that are already decayed, missing, or filled (DMF), the patient’s medical history and he may receive further information following salivary tests (Reich 1999, Jenson 2006).
The hygienist can help the dentist to effect these salivary tests, which make it possible to assess:
• the quantity of salivary flow in a unit of time
• the buffer capacity of the saliva, which is its capacity to prevent the process of demineralization and to promote the processes of remineralization.
• the presence and the quantity of Streptococcus Mutans and Lactobacillus.