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Dental Caries

October 3, 2019 by admin0
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Dental caries is an infectious microbiological disease of the teeth that results in localized dissolution and destruction of the calcified tissues. It is the second most common cause of tooth loss and is found universally, irrespective of age, gender, caste, creed or geographic location. It is considered to be a disease of civilized society, related to lifestyle factors, but heredity also plays a role. In the late stages, it causes severe pain, is expensive to treat and leads to loss of precious man-hours. However, it is preventable to a certain extent. The prevalence of dental caries in India is 50% –60%.

Prevention and control of dental caries

  1. Increase the resistance of the teeth.
  • Systemic use of fluoride: (i) Fluoridation of water, milk and salt; (ii) fluoride supplementation in the form of tablets and lozenges; and (iii) consuming a fluoride-rich diet such as tea, fish, etc.

 

  • Topical: (i) Use of fluoridated toothpaste and mouth wash; (ii) use of fluoride varnishes (in-office application, longer duration of action, high fluoride content); (iii) use of casein phosphor peptide–amorphous calcium phosphate(CPP–ACP), which is available as tooth mousse, helps tore mineralize the soft initial carious, demineralized areas of the teeth.
  1. Combat the microbial plaque by physical and chemical methods.

(i) Physical methods

The correct method and frequency of brushing should be followed—in the morning and before going to bed and preferably after every major meal.

Tongue cleaning and the use of indigenous agents such as the bark of neem or mango (where toothbrush and paste are unaffordable) should be encouraged. The use of course toothpowder and tobacco-containing dentifrices should be avoided.

The use of various interdental cleaning aids such as dental floss, interdental brush, water pick, etc.  Supplements the cleansing effect   of a   toothbrush.  Use of an electronic toothbrush in children and persons with decreased manual dexterity is recommended.

 

(ii) Chemical methods

These include the use of a fluoride-containing toothpaste mouth rinses and 0.2% chlorhexidine and povidone–iodine mouthwash. These should be used on prescription of a dental surgeon.

  1. Modify the diet.

Reduce the intake and frequency of refined carbo-hydrates. Avoid sticky foods and replace refined with unrefined natural food. Increase the intake of fibrous food to stimulate salivary flow, which is protective against caries. Consume caries-protective foods such as cheese, nuts, raw vegetables, fruits, etc. Stimulate salivary flow with sugar-free chewing gum. Xylitol (a sugar substitute)-containing chewing gum, if chewed between meals, produces an anti-caries effect by stimulating salivary flow.

 

Treatment of dental caries

Treatment comprises removal of decay by operative procedures and resto rat ion with appropriate materials such as silver fillings, gold inlays, composite resin, glass ionomer cement, full metal or porcelain crow ns, etc. In advanced cases, where the pulp of the tooth is involved, endodontic treatment may be required. Where there is extensive destruction of the tooth structure or when endodontic treatment is not feasible, extraction of the tooth and replacement by an artificial prosthesis may be required.

Miscellaneous measures

These include the following:

  • Prevention of malocclusion (especially crowding of the teeth)
  • Prevention of premature loss of deciduous teeth
  • Restoration of missing permanent teeth by prostheses (dentures)
  • Making sugar-free chewing gum freely available and affordable in the country

Miscellaneous measures

These include the following:

  • Prevention of malocclusion (especially crowding of the teeth)
  • Prevention of premature loss of deciduous teeth
  • Restoration of missing permanent teeth by prostheses (dentures)
  • Making sugar-free chewing gum freely available and affordable in the country
  • Using sugar substitutes such as saccharine, xylitol mannitol, aspartame, etc. in paediatric medicinal syrups, bakery products, jams, marmalade, etc.
  • Making toothbrushes and fluoridated toothpaste available to the masses at low cost. Regular use of fluoridated toothpaste is proven to reduce the incidence of dental caries by 3 0%.

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