Tooth Decay

Dental caries is a common infectious disease characterized by demineralization and loss of organic material in tooth hard tissues due to microbial interactions. This process begins when fermentable carbohydrates are converted into acids by bacteria in the mouth. The resulting acidic environment disrupts the mineral structure of tooth enamel and creates favorable conditions for caries development.

Various risk factors contribute to the development of dental caries:

• Tooth Structure: Anatomically concave and irregular surfaces are more prone to plaque accumulation and caries formation.
• Microorganisms: Cariesogenic bacteria such as Streptococcus mutans and species of Lactobacillus play a significant role in caries development.
• Carbohydrate Consumption: Frequent and excessive intake of sugary foods increases acid production and elevates caries risk.
• Saliva: Saliva cleanses tooth surfaces and neutralizes acids. Reduced salivary flow can increase caries risk.
• Oral Hygiene: Inadequate oral hygiene facilitates plaque accumulation and consequently promotes caries formation.
• Socioeconomic Factors: Low socioeconomic status may limit access to oral health services and increase caries risk.

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Dental caries can be classified according to various criteria:

• By Location: Caries are classified as pit and fissure caries, smooth surface caries and root caries.
• By Lesion Depth: Caries are classified according to involvement of enamel, dentin and pulp.
• By Clinical Appearance: Caries are distinguished as active and inactive.
• By Progression Rate: Caries are classified as acute (rapidly progressing) and chronic (slowly progressing).

Various indices are used to evaluate dental caries at the population level:

• DMFT/DMFS Index: Used to determine the number of decayed, missing and filled teeth or surfaces.
• ICDAS (International Caries Detection and Assessment System): Developed for more detailed evaluation of caries lesions.
• PUFA Index: Assesses the presence of pulp involvement, ulceration, fistula and abscess.

These indices are used to determine the prevalence and severity of dental caries.

The methods used for diagnosing dental caries have diversified with technological advancements:

• Visual and Tactile Examination: The most commonly used method in clinical settings; however, it has limitations in detecting early-stage caries.
• Radiography: Supports visual examination but may be insufficient for detecting early lesions.
• Fiber Optic Transillumination (FOTI): Aids in detecting caries by examining the internal structure of the tooth with light.
• Digital Imaging Techniques: Digital radiography and other advanced imaging methods enable more sensitive detection of caries.

These methods enable early diagnosis of caries, facilitating more effective treatment planning.