Introduction

• Organic decay of the dentine of a tooth following inorganic demineralization of enamel.
• Incidence: 40% - underdiagnosed because of difficulty of detection in conscious patient. Accounts for 10% of tooth loss.
• Cause: plaque Teeth: calculus.
• Signs: dysphagia, salivation, pain, behavioral changes.
• Diagnosis: visualization of cavities, radiography.
• Treatment: fill cavity with specialist dental materials +/- endodontic treatment or extraction.
• Prognosis: generally good - dependent on size and position of cavity and early treatment.

Pathogenesis

Etiology

• Chemicals released from bacteria (especiallyStreptococcus mutans Streptococcus spp ) in plaque accumulations.

Specific

• Malalignment of teeth causing plaque build-up.
• Fractures/damage to teeth exposing dentine.
• Exposed root structure (no enamel covering).
• Increased dietary refined carbohydrate level.

• Bad oral hygiene → accumulation of plaque.
• Food stagnation between teeth (uncommon, except posterior teeth).

• Congenitally defective enamel Teeth: enamel disease.

Pathophysiology

• Organic decay of the dentine of a tooth following inorganic demineralization of enamel.

• Poor oral hygiene → accumulation of food debris on teeth surface → microorganism colonization (bacterial plaque) → break down of refined carbohydrates, eg glucose, lactose → 'plaque acid' release → demineralization of enamel → exposed dentine → rapid organic decay = caries → pain.
• Pulp may be exposed → acute pain → pulpitis → pulp necrosis → periapical infection.
• Undermined enamel of teeth may fracture Dental fracture.

Timecourse

• Enamel demineralization is a slow process.
• Dentine decay is rapid.

Diagnosis

Treatment

Prevention

Outcomes