Introductory Chapter: Dental Caries-General Considerations

1. Introduction

Dental caries, a most common chronic disease, affecting the global population, has been defined as: “a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues” [1].

Dental caries is currently considered the most prevalent chronic oral disease, with great influence on both oral and systemic health, as oral bacteria play specific roles in secondary infections of internal organs, with potentially serious consequences on the general health [2].

2. Dental caries-general considerations

Dental caries is primarily caused by the interaction of the oral biofilm with fermentable dietary carbohydrates on the tooth surface, but its etiology is, in fact, much more complex, involving the influence of numerous risk and protective factors, as well [3].

Dental caries is represented by the localized demineralization of the tooth structure, with progressive loss of its components. The main process involved in its initiation is the demineralization of the tooth, in the presence of a low salivary pH, further exposing the dental structures to the action of pathological agents.

Being the first body fluid coming in contact with oral pathogens, saliva is responsible for their neutralization, thus controlling the homeostasis of the oral environment. The flow rate, composition, and pH of the saliva are important variables for the initiation and progression of dental caries. It also plays an important role in controlling the mineral content of the tooth and protecting its integrity, being involved in the remineralization process [4].

Dietary habits are another important factor in developing dental caries. A frequent exposure to fermentable carbohydrates triggers modifications of the oral environment, which facilitate the growth of acidogenic bacteria and appearance of cariogenic biofilm. A retentive tooth anatomy, with steep pits and fissures or with gingival recession, exposing the root, represents favoring factors [5].

Basically, the cumulative action of all these factors, for a certain period of time, results in occurrence of dental caries. Characterized by a progressive evolution, dental caries is being reversible in early stages of the demineralization process [6].

A proper oral hygiene is crucial in preventing or arresting the process. Tooth brushing, flossing, and rinsing not only mechanically clean the teeth, and disrupt the biofilm, but also remove most of the bacteria and enable new colonization of the clean tooth surface. In cases of high risk of developing dental caries, topical fluoride agents are frequently recommended as a preventive method. However, rough surfaces restrict proper biofilm removal. In cases of steep pits and fissures, sealants play an important role in preventing and arresting initial lesions [1].

Caries detection in early stages of demineralization, when only enamel has been affected, is traditionally carried out by visual inspection and probing, appearing as white, chalky, and opaque spots, with unaltered surface texture, in case of non-cavitated lesions. As the lesion advances, a rough surface, softer than sound enamel, can be detected. Noncavitated lesions on proximal surfaces are visually undetectable. A cavitated enamel lesion is perceived as a surface breakdown, sensitive to probing. After passing the dentin-enamel junction, the carious process advances more rapidly, spreading in the less mineralized dentin, weaker to the acid attack. In this stage, pain and sensitivity usually occur. With the aid of currently available detection methods, such as fluorescence-based or light-based techniques, early detection of caries has become handy [7].

When caries progresses, causing tooth structure destruction, it requires repair, the main goal is preserving the vitality of the pulp. Conservative preparations, followed by small-size restorations, have a potentially less negative impact on tooth function and esthetics, also preserving the strength of the remnant hard tissue.

Materials choice and selection have to consider several factors, and the dentist has to present the available choices to the patient. Usually, patient’s decision is mainly focused on esthetic and price considerations, but, other important factors, such as the extent of the preparation and the possibility of proper isolation of the working field, should be taken into account.

The most common choice is composite restorations, adhesively bonded, which allow a conservative approach to the preparation, and also provide excellent esthetics [8].

However, untreated dental caries may result in complications, usually accompanied by severe pain, with an important impact on daily living. The ultimate consequences are acute or chronic pulpitis and apical periodontitis, which require much more complicated and expensive treatment. Extreme cases may even require tooth extraction, followed by undesired repercussions on local and general health.

3. Conclusion

The goal in the management of dental caries is to address its causative factors, and maintain a neutral oral pH.

Conflict of interest

The authors declare no conflict of interest.