Dental caries – Causes, types, and treatment

Indians don’t bother about oral health?

A famous toothpaste maker made an advertisement on the importance of brushing twice a day. In this ad, school children sing urging other children to brush twice a day. This ad is set in a “child-friendly” background with cartoons, vibrant colors, and rhythmic music. Though this advertisement was a huge success, many parents know it very well that it’s not easy to make children brush their teeth twice a day and in the proper manner. The result is they develop multiple types of dental caries.

It is a stereotype that Indians and Chinese care two hoots for oral health but give their eyeteeth for consumer goods like smartphones, cars, and other gadgets.

Comparing oral health perspectives among Western and Asian people, a famous Asian dentist once said “Westerners would rather get into debt to protect their teeth, but Asians would patiently wait for their condition to progress to gum erosion and periodontitis.” Westerners get into debts due to high dental treatment costs, but what about Asians?

In many ways this rather sweeping statement seems to be very true and there are numbers to justify it. A recent exhaustive study conducted shows that the presence of dental caries or dental decay is around 50.84% to 62.41% among Indian children. This means more than half of Indian children have dental problems!

When it comes to Indian adults and elderly, among adults (35-44 years) 78% of them have dental caries, and among the elderly (65 -74 years) 84% of them have dental caries. While men are more prone to dental caries at younger ages, women are prone to it in their older ages.

So, why do we disregard oral health? What is the price we are paying?

Why worry about dental caries – We only regrow teeth once

There was once this famous question “alligators and sharks regrow teeth so why not humans?” To give a short answer to this, animals don’t get dental caries. And, our baby teeth and permanent teeth develop even before we are born plus our DNA does not support endless replacement like skin or facial hair.

Even though the enamel on teeth is the strongest material in our bodies and consists of over 90 minerals, it does not contain certain proteins in order to replace itself. This means that enamel on teeth can heal itself only to an extent. Beyond that, it is a downward spiral with many types of dental caries.

If you neglect visiting a dental clinic for tooth decay, it can lead to a variety of complications which can spoil your facial appearance, damage your jawbone, make you incapable of eating your favorite foods, and can even lead to cardiovascular diseases.

Complications of dental caries

Tooth decay or dental caries can lead to painful complications if you do not visit a dental clinic in the early stages. Here are a few complications that arise from dental caries.

• Damage to the root of the tooth
• Tooth breakage and loss of tooth
• Gum diseases like gingivitis & periodontitis
• Damage to periodontal ligament (tissues that connect the tooth and its socket)
• Damage to jawbone
• Damage to alveolar bone
• Dental abscesses with plaque, pus, and inflammation
• Gum infection with severe pain
• Dental sepsis
• Tooth pain
• Inability to eat foods
• Gum bleeding

So if you want to avoid these complications, more than herbage and home remedies like cloves, salt, meswak, cloves, licorice roots, tea or Galla chinensis, you need to visit a dental clinic for a periodical dental examination. You should also know the early signs and symptoms of dental caries so that you can act fast!

What are dental caries?

Dental caries or teeth decay is one of the most common dental problems. Dental caries are characterized by dental cavities caused by the destruction of tooth enamel due to bacterial infections. As dental caries progress after eroding the enamel, cavities spread into the dentin (inner layer of the tooth).

Humans have lot of bacteria in their mouths. Dental caries start with the breakdown of enamel due to the acids produced by oral bacteria. In the first stage, decay is only on the surface. In the next stage, the inner layer of the teeth called the dentin is also affected. Later, the inner pulp of the tooth is affected. In this stage, blood vessels and nerves of the tooth are infected and it leads to formation of pus and inflammation. This stage is also characterized by constant pain and difficulty to eat.

After the pulp, blood vessels, and nerves of the tooth are affected, it then progresses to abscess formation. This is very painful as the infection spreads to the tip of the tooth and starts to spread to the bone. In this stage, both the gums and tongue are swollen, there is severe pain, and it needs oral surgery.

Finally, dental caries lead to tooth loss, and spread of infection to adjoining teeth and the jawbone.

Classification of dental caries

Over the years, dentists have come up with numerous types of dental caries classifications; however, these are based on the type of teeth affected, location of the decay, and the severity of dental caries.

• Class I: Pit and fissure cavities – These occur on the molars and premolars, and lingual surfaces of maxillary incisors
• Class II: These occur on the proximal surfaces of premolars and molars
• Class III: Affecting the proximal surfaces of incisors and cuspids
• Class IV: These affect proximal surfaces and incisal angles of anterior teeth
• Class V: Affect the gingiva (gum) and lingual surfaces of either anterior or posterior teeth
• Class VI: These affect the cusp tips of premolars, molars, and cuspids

Though this classification of dental caries might look a little complicated to you, one takeaway from this is that as the infection progresses, cavity spreads into the pulp and tip of the tooth (backward caries). There is increased pain, discomfort, risk of tooth loss, and spreading of infection to other areas.

What causes dental caries?

There are many types of dental caries like incipient, occult or hidden, arrested caries, recurrent caries, acute caries, and forward and backward caries. Most of these are caused due to the presence of bacteria and plaque.

Dental caries arise due to acids secreted by bacteria in the mouth - bacteria like streptococcus mutans and lactobacilli. Bacterial acids erode the enamel and the infection spreads inside the tooth. Other causes of dental caries include:

• Poor oral hygiene
• Not brushing teeth properly
• Not flossing
• Not brushing teeth before 20 minutes of eating food
• Not using antibacterial mouthwash daily
• Not brushing before going to sleep
• Presence of dry mouth
• Having broken teeth or fractured teeth
• Disease conditions like HIV AIDS, diabetes mellitus, and osteoporosis
• Gastrointestinal disorders like GERD
• High blood pressure
• Kidney and liver problems
• Use of tobacco
• Improper nutrition
• Consuming certain foods

What food causes dental caries?

• Sugary foods like chocolates, candies, popsicles, caramel, lollipops
• Baked foods like bread, cookies, cakes, pasta, biscuits, crackers
• Carbohydrate-containing foods like potato chips, foods made of flour, starchy foods
• Sodas and fruit juices that contain added sugars
• Excess consumption of coffee, tea
• Excess consumption of citrus fruits and sticky foods like dried fruits
• Alcohol consumption

In order to avoid dental caries right from childhood, it is advisable to limit all foods that are guilty of causing tooth decay. Instead, opting for sugarless chewing gum, water, green or black tea, fiber-rich vegetables, dairy products that contain calcium and vitamin D, and fluoride-containing toothpaste are known to reduce the risk of dental caries. However, never forget to get an annual dental checkup at your nearest dental clinic!