7/5/17

Dental caries

   This include: Dental caries, acute viral parotitis(MUMPS), acute Necrotising Ulcerative Gingivitis(ANUG) and congenital diseases of children such as:
     1. Ankyloglosia.( tongue tie)
     2. Cleft lip and palate.
  Today we will only emphasize on most common diseases of child dental patient which is DENTAL CARIES only. Others we be emphasize upon later.

What does dental caries simply means?

  Dental caries is a progressive pathologic process of erupted tooth, it is of external organ and essentially softens hard tissue eventually causing cavity formation.

Aetiology - (CAUSES) of Dental caries

  a. Bacteria: Streptococcus mutans, Lactobacilus acidophilus, actinonyces species found in plaque

Common Diseases of Child dental patient
Source: " Dr Peter sennato DDS" - under creative commons license

  b. Diet: Refined sugars essentially sucrose, glucose, fructose.

  c. Susceptible tooth.

  d. Time.

Epidemiology of dental caries

Dental caries has been found to occur worldwide. Although it used to be more common in the western society because of refined sugar predominance in their diet.
  However,dental caries is also common in females than the male and also common in young Than in older generation. This is also common In the people of high socioeconomic group.
Caries affects teeth with pits and fissure more than incisal I.e. posterior teeth more than anterior.

READ: Other common diseases of child dental patient - Acute Necrotising Ulcerative Gingivitis(ANUG)
   
Others are reading: Preventive Child Dental Care

Pathogenesis of dental caries

The commonest theory of caries formation is the acidogenic theory this is because of action of acid forming bacteria as mentioned before on refined sugar which leads to the reduction of the PH of the mouth from 7 to 3.5 within 10 minutes and may continue at the PH for about 30 minutes before it rises again.
  The critical PH for demineralization of enamel is 5.5. In people that is lasts for less than 30 minutes there is less chance of developing dental caries. The demineralisation of tooth eventually leads to caries formation are proteolytic theory, proteolysis chelation theory and auto immunity.

Clinical features

Enamel:

  - initially appears as opaque white.
  - Later develops a black spot.
  - Later breaks down to expose dentine
  - It may not present with any symptom until there is dentine exposure.
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Dentine:


  - There is cavity formation
  - On examination it sticks on probing.
  - Patients complain of pain on drinking cold water . It may be a 'shock' feeling.
  - Sensitivity when mastication food . When it has affects the pulp then there can be pain in response to both hot or cold drinks and may disturbed sleep pattern of the patient, in these case there is inflammation of the pulp ( pulpitis) or on inflammation of apical region of the tooth ( apical periodontitis) or apical abscess, granuloma or cyst.
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Investigations of Dental caries


  1. Periapical radiographs - area of infection present as radiohiscency and measure the extent of carious lesion.
  2. Transillumination

Classification of caries based on GV black

  1. Black's classification - This was designed by a man named black and it is useful in determining the type of cavity to be prepared.

Class I - Lesion on occlusal surface of posterior teeth I.e pits and fissures.

          II - Proximal caries.

          iii - Lesion of anterior teeth not affecting the incisal edge.

          IV - Affects incisal edge.

          v -   Lesions of gingival third of posterior teeth.

          vi -  Where two or more classes are found on the tooth.

Based on anatomy

     a. Enamel caries.
     b. Denture caries.
     c. Cementum caries I.e root caries.

Based on occurrence

     a. Incipient caries - Lesion occurring for the first time.
     b. Recurrent caries - on and off.
     c.  Residual caries - caries found below a restoration.
     d.  Arrested caries - Lesion that got reminerslised and hardens back e.g. Enamel caries.
     e.   Rampant caries - Affect many teeth in the mouth at the same time. Common in children.

Treatment of Dental Caries

Enamel caries

     - Apply fluoride - it hardens back
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Dentine

     -  Cut a cavity and restore it using zing oxide eugenol liner and fill with amalgam ,for posterior teeth and aesthetic material for anterior.

Pulp.  

     -  Temporary dressing if it has only affect coronal pulp - Pulpotomy ( formocresol ).
     -   Extraction, if other option fail.

Counseling and advice of dental caries to the patient

   1. Diet - patent should stop excess refined sugar.

   2. Oral hygiene - The patient should maintain food oral hygiene and make sure there is no plaque in the mouth - check up every 6 months,this reduces the amount of bacteria

   3. Time - if patient should take any refined sugar, he or she should rinse the mouth immediately, this restores the pH to neutral and reduces the time, Preventive caries function.

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