Prevention of dental caries
Dr Virginia Letebele | Tuesday March 29, 2022 06:00
Dental caries (tooth decay)
Dental caries, also referred to as cavities and tooth decay are both common and preventable. Globally it is estimated that two billion people suffer from caries of permanent teeth (the second set of teeth that follow after milk teeth that continue into adult age) and 520 million children suffer from caries of milk teeth (WHO)
Dr Virginia Letebele, a general dentist at Dental suite clinic in Gaborone states that tooth decay starts with formation of a dental plaque which basically is a sticky film that forms on the tooth surfaces if they are left for long without brushing especially after eating. There is really nothing wrong with dental plaque as everyone more or less has it, except if it if left for long without being removed. To check dental plaque, you can run your tongue over your teeth and that fuzzy feel is dental plaque. Tooth decay is brought about by bacteria in our mouths feeding on the dietary sugar from the plaque producing acids which affect teeth enamel causing loss of minerals.
This loss of minerals is known as demineralisation. Even this loss of minerals does not signal tooth decay as this is reversible when there is little to no sugar intake and teeth are brushed regularly with the use toothpaste containing fluoride. This practice is important as it replenishes the lost minerals, the process is known as remineralisation.
Once the demineralisation process occurs more than remineralisation, ‘white spots’ start to appear on teeth surfaces. This is an early stage of tooth decay. It is reversible when teeth are allowed to go through remineralisation.
If the process of tooth decay is allowed to continue the ‘white spot’ breaks down and the tooth darkens turning to a brownish color. As the enamel is weakened holes start to form on the tooth forming cavities. Cavities are not reversible therefore they need to be filled.
When they are not filled they grow to affect the second layer of teeth known as dentin. It is softer than enamel which makes it more sensitive as caries progress.
Dentin contains tubes that connect it to the nerve of the teeth. Because of this connection when the dentin is affected you may start to experience sensitivity particularly when having cold and sweet food or drinks. Caries that have progressed to dentine needs to be removed for teeth to be filled.
If dental fillings are not done, decay or caries progress and reach to the pulp of the tooth, the third deep layer of teeth. It contains nerves and blood vessels that help to keep teeth healthy. When the damage to the pulp happens, it may become inflamed, irritating and start to swell.
This can be experienced as pain that is spontaneous, intense pain, lingering and radiating to the jaw. Sensitivity can be felt to hot food and drinks. The pain can be severe to extent where is it even difficult to locate which tooth is painful. The severity of the pain can wake someone at night. This irreversible damage of the pulp requires treatment of the pulp by removing the infected pulp, known as root canal treatment. The other option is tooth extraction.
As tooth decay advances into the pulp, bacteria can invade and cause an infection. With increased inflammation in the tooth, pockets of pus can start forming at the bottom of the tooth forming an abscess.
Tooth abscess can cause severe pain and may radiate into the jaw. Symptoms that may be present include; swelling of the gums, face or jaw, fever, swollen lymph nodes in the head and neck area. A tooth abscess requires prompt treatment as the infection can spread into the bones as well as other areas of the head and neck. Treatment may involve removing the affected tooth and prescription of antibiotics.
Risk for developing dental caries The risk factors for caries development include; • frequent sugar intake • inadequate tooth brushing • inadequate use of fluoride containing toothpaste • lack of knowledge regarding oral health especially the importance of routine dental check ups at the dentist. • inappropriate bottle feeding • lack of proper oral hygiene and parental supervision for children when they brush
There is a lot that can be done to avoid dental caries. The main aim is to reduce the burden of plaque formation and where the decay process has started interventions are done to avoid caries progression, this includes; • Following a good oral care routine, that includes brushing teeth twice daily with a fluoride containing toothpaste. Cleaning between teeth with the use of interdental tooth brushes and dental floss on daily basis. • For children Ensure to start brushing their teeth as soon as the first teeth erupt. Use a soft toothbrush twice a day with a smear of toothpaste for children under two years of age and a pea size amount if they are between two and five years of age. • Reduce or eliminate sugar intake through Adopting a healthy balanced diet and avoiding sugary snacks and drinks • Avoid putting children to bed with a bottle filled with milk, juice or any other sweet liquids. Teach children to start drinking from a cup as early as possible, preferably before they turn one year of age. By drinking from a cup, the liquid is less likely to pool around the front teeth. • Scheduling regular visits with your dentist so any areas of decay can be identified while still small and far from the pulp. • Seek immediate attention if you experience pain or sensitivity from the dentist
Dr Virginia Letebele,(UWI) Dental Surgeon at Dental Suite Facebook @Dental suite Instagram@dental_suite