Dental caries (caries)

At a Glance

Dental caries is a disease in which acids produced by oral bacteria damage the tooth surface, potentially progressing to cavities.

Representative manifestations include early white spots, followed by brown discoloration, sensitivity, toothache, and cavities; progression may lead to infection or abscesses.

How the disease works

Key related factors include acid production by bacteria in plaque, intake of sugars and starches, insufficient oral care, low fluoride exposure, and reduced saliva secretion.

On the tooth surface, mineral loss and remineralization occur repeatedly; if acid-induced demineralization continuously outpaces remineralization, the enamel weakens, leading to the formation of lesions and cavities.

Variations in presentation among individuals

Risks can be increased by prolonged bottle feeding in children, exposed tooth roots due to gum recession in the elderly, and oral dryness resulting from medications, diseases, or cancer treatment.

The broad framework of diagnosis and management

There may be no symptoms in the early stages, but if left untreated, damage can spread into the interior of the tooth, leading to pain, abscesses, facial swelling, fever, and, in severe cases, tooth loss.

Diagnosis is primarily based on direct observation of teeth, evaluation with instruments, and confirmation of symptoms, with dental X-rays added if necessary.

Current status of treatment

Early lesions may be asymptomatic, and not all lesions require X-rays; therefore, examination results and the need for treatment must be interpreted by considering the lesion's location, depth, and symptoms together.

Management includes using fluoride toothpaste, regular brushing and flossing, limiting sugar, starch, and frequent snacking, regular check-ups, professional cleaning, and dental sealants if necessary.

For early caries, fluoride treatment is considered; formed cavities are restored after removal of decayed tissue, root canal treatment is performed when the pulp is involved, and extraction is considered if recovery is impossible.

How to read clinical trials

In follow-up observations, new lesions, the status of existing lesions and restorations, and changes in symptoms are regularly checked; the existence of a registered study does not imply efficacy, approval, or standard treatment, and the status and results of such records must also be interpreted with limitations.

Points to verify during clinical consultations

In clinical practice, it is important to check the onset and triggers of pain/sensitivity, dietary habits and oral care, fluoride use, medications/diseases that can cause dry mouth, and past dental treatments, and to report swelling/fever immediately.