DENTAL PLAQUE AND CARIES

OVERVIEW OF DISEASE

Dental caries is a general term applied to the decalcification of mineral

components and dissolution of the organic matrix o the teeth. Although there has been a

marked decline in dental caries in recent years, it remains a problem that affects millions

of individuals, particularly those from lower socioeconomic group.

According to Department of Health 2013, oral disease continues to be a serious

public health problem in the Philippines. The prevalence of dental caries on permanent

teeth has generally remained above 90% throughout the years. About 92.4% of Filipinos

have tooth decay (dental caries) and 78% have gum diseases (periodontal diseases).

Although preventable, these diseases affect almost every Filipino at one point or another

in his or her lifetime. The oral health status of Filipino children is alarming. The 2006

National Oral Health Survey (Monse B. et al, NOHS 2006) investigated the oral health

status of Philippine public elementary school students. It revealed that 97.1% of six-year-

old children suffer from tooth decay. More than four out of every five children of this

subgroup manifested symptoms of dentinogenic infection. In addition, 78.4% of twelve-

year-old children suffer from dental caries and 49.7% of the same age group manifested

symptoms of dentinogenic infections. The severity of dental caries, expressed as the

average number of decayed teeth indicated for filling/extraction or filled permanent teeth

(DMFT) or temporary teeth (dmft), was 8.4 dmft for the six-year-old age group and 2.9

DMFT for the twelve-year-old age group (NOHS 2006).

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According to New York Times 2015, there may be no symptoms. If symptoms

occur, they may include:

 Tooth pain or achy feeling, particularly after sweet, hot, or cold foods and drinks

 Visible pits or holes in the teeth

Exams and Tests

Most cavities are discovered in the early stages during routine dental checkups.

A dental exam may show that the surface of the tooth is soft.

Dental x-rays may show some cavities before they are visible to the eye.

ASSESSMENT

Interview

The patient should be asked questions regarding dental care and frequency of dental

examinations.

Inspection and Palpation

The patient’s mouth should be assessed for tooth caries, missing teeth and dental

appliances such as dentures, bridges and crowns. The face should be examined for

symmetry and jaw should be palpated for lamps. The gingivae should be assessed for

redness, pallor, bleeding, recessions and ulcers.

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PATHOPHYSIOLOGY

Predisposing factors: Precipitating factors:

Age Tooth location

Bedtime infant feeding

Inadequate brushing

Intake of acidic beverages such as soda and

alcohol

Intake of anticholinergics

Present disorders such as Heartburn, anorexia and

bulimia

Having worn fillings and dentals devices

Plaque consist of bacteria, saliva and epithelial

cells builds up and adheres to teeth

Within 30 minutes after eating, bacteria produces

lactic acid from the break down from sugar
consumed by bacteria

Lactic acid destroys outer enamel and

underlying dentin of the tooth

Tooth decay

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TREATMENT

Treatment can help prevent tooth damage from leading to cavities.

Treatment may involve:

 Fillings

 Crowns

 Root canals

Dentists fill teeth by removing the decayed tooth material with a drill and replacing it

with a material such as silver alloy, gold, porcelain, or composite resin. Porcelain and

composite resin more closely match the natural tooth appearance, and may be preferred

for front teeth. Many dentists consider silver amalgam (alloy) and gold to be stronger,

and these materials are often used on back teeth. There is a trend to use high strength

composite resin in the back teeth as well.

Crowns or "caps" are used if tooth decay is extensive and there is limited tooth structure,

which may cause weakened teeth. Large fillings and weak teeth increase the risk of the

tooth breaking. The decayed or weakened area is removed and repaired. A crown is fitted

over the remainder of the tooth. Crowns are often made of gold, porcelain, or porcelain

attached to metal.

A root canal is recommended if the nerve in a tooth dies from decay or injury. The center

of the tooth, including the nerve and blood vessel tissue (pulp), is removed along with

decayed portions of the tooth. The roots are filled with a sealing material. The tooth is

filled, and a crown is usually needed.

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Prevention

Oral hygiene is necessary to prevent cavities. This consists of regular professional

cleaning (every 6 months), brushing at least twice a day, and flossing at least daily. X-

rays may be taken yearly to detect possible cavity development in high risk areas of the

mouth.

Chewy, sticky foods (such as dried fruit or candy) are best if eaten as part of a meal

rather than as a snack. If possible, brush the teeth or rinse the mouth with water after

eating these foods. Minimize snacking, which creates a constant supply of acid in the

mouth. Avoid constant sipping of sugary drinks or frequent sucking on candy and mints.

Dental sealants can prevent some cavities. Sealants are thin plastic-like coatings applied

to the chewing surfaces of the molars. This coating prevents the accumulation of plaque

in the deep grooves on these vulnerable surfaces. Sealants are usually applied on the teeth

of children, shortly after the molars erupt. Older people may also benefit from the use of

tooth sealants. Fluoride is often recommended to protect against dental caries. It has been

demonstrated that people who ingest fluoride in their drinking water or by fluoride

supplements have fewer dental caries. Fluoride ingested when the teeth are developing is

incorporated into the structure of the enamel and protects it against the action of acids.

Topical fluoride is also recommended to protect the surface of the teeth. This may

include a fluoride toothpaste or mouthwash. Many dentists include application of topical

fluoride solutions (applied to a localized area of the teeth) as part of routine visits.

(New York Times, 2015)

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