A guide to common oral lesions

[drsnehamaheshwari]

Dental caries

DESCRIPTION: Caries ranks with gingivitis and periodontitis as one of the most common oral diseases. Treatment of these diseases and their sequelae constitutes the bulk of the practice of dentistry. Caries is the only disease that attacks that portion of the tooth exposed to the oral environment. Typical caries are most commonly located in the occlusal pits and fissures of molars and premolars, as well as beneath the contact points on the interproximal surfaces. Special consideration should be given to two types of caries, namely radiation type caries and early childhood caries (nursing bottle caries). Radiation type caries characteristically occur as multiple lesions in the cervical region of the teeth immediately adjacent to the gingival. These may completely encircle the tooth causing amputation at the gingival. Early childhood caries are multiple and rampant occurring in deciduous teeth of nursing infants and small children.

ETIOLOGY: Caries is caused by the decalcification of tooth enamel and destruction of the protein matrix. Acid produced by bacteria, mainly Streptococcus mutans, in dental plaque is the precipitating factor. After the enamel is destroyed bacteria enter the dentin and may extend to the pulp of the tooth. Radiation or cervical caries are usually related to xerostomia and/or chemical changes in saliva. Radiation therapy exceeding 4000 cGy to salivary glands is the most common cause. However, many common medications and systemic chemotherapy may also cause dry mouth and radiation type caries. Sjogren’s syndrome is a cause of xerostomia and a cause of radiation-type caries. Early childhood caries is due to frequent nursing with solutions containing high concentrations of sugar such as milk, soft drinks, and juices.

TREATMENT: Prevention is the best treatment. Caries can be prevented by brushing and flossing to remove plaque. A well-balanced diet without excessive sugars is also beneficial. Topical and systemic fluoride are highly effective in reducing caries, especially if given during the formative years of the teeth. Fluorides have significantly reduced the incidence of caries in the United States in the last several decades. Radiation type caries can also be prevented by a daily regime of topical fluoride. Fluoride applications applied with a custom mouth guard should begin as soon as radiation is started. Patients who have received head and neck radiation should continue daily treatments for life to prevent caries that could lead to extractions and possible osteoradionecrosis. Once caries have developed, dental restorative procedures are the only treatment, although there is now evidence that very early lesions, under intact surface enamel (white spots), may be remineralized with topically applied agents.

PROGNOSIS: Prognosis is good if the disease is treated early. If ignored, caries is a major cause of tooth loss and suffering from infection of bone and soft tissues.

DIFFERENTIAL DIAGNOSIS: None