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81-445: The technique has an evidence base showing that it is acceptable to children, parents and dentists and it is preferred over standard filling techniques, due to the ease of application and overall patient comfort as young patients do not have to undergo traumatic injections. Preformed metal crowns are now recommended as the optimum restoration for managing carious primary molars. There are multiple randomised controlled trials that have shown

162-423: A causal relationship between smoking and coronal caries, but evidence does suggest a relationship between smoking and root-surface caries. Exposure of children to secondhand tobacco smoke is associated with tooth decay. Intrauterine and neonatal lead exposure promote tooth decay. Besides lead, all atoms with electrical charge and ionic radius similar to bivalent calcium , such as cadmium , mimic

243-439: A cavity. Since the carious process is reversible before a cavity is present, it may be possible to arrest caries with fluoride and remineralize the tooth surface. When a cavity is present, a restoration will be needed to replace the lost tooth structure. At times, pit and fissure caries may be difficult to detect. Bacteria can penetrate the enamel to reach dentin, but then the outer surface may remineralize, especially if fluoride

324-457: A child from a caretaker's kiss or through feeding pre-masticated food. Bacteria in a person's mouth convert glucose, fructose, and most commonly sucrose (table sugar) into acids, mainly lactic acid, through a glycolytic process called fermentation. If left in contact with the tooth, these acids may cause demineralization, which is the dissolution of its mineral content. The process is dynamic, however, as remineralization can also occur if

405-734: A clear band of dentine between the carious lesion and pulp for a Hall Technique to be suitable. Baby teeth are known as primary teeth or deciduous teeth . Biologically oriented strategies for managing dental decay are considered by their proponents to have advantages for child patients receiving dental care as the techniques are less invasive and often avoid having to use local anaesthesia and drilling. They are also less destructive and potentially damaging for primary teeth. Five randomised control trials with children, on decayed primary teeth, have been carried out looking at incomplete, or no removal of decay. These have looked at how much pain and infection or repeated treatment biological techniques (including

486-402: A constriction of the tubules, which is an attempt to slow the bacterial progression. In addition, as the acid from the bacteria demineralizes the hydroxyapatite crystals, calcium and phosphorus are released, allowing for the precipitation of more crystals which fall deeper into the dentinal tubule. These crystals form a barrier and slow the advancement of caries. After these protective responses,

567-433: A diet high in simple sugar is a risk factor. If mineral breakdown is greater than buildup from sources such as saliva , caries results. Risk factors include conditions that result in less saliva, such as diabetes mellitus , Sjögren syndrome and some medications. Medications that decrease saliva production include antihistamines and antidepressants . Dental caries are also associated with poverty , poor cleaning of

648-437: A few specific species of bacteria are believed to cause dental caries: Streptococcus mutans and Lactobacillus species among them. Streptococcus mutans are gram-positive bacteria which constitute biofilms on the surface of teeth. These organisms can produce high levels of lactic acid following fermentation of dietary sugars and are resistant to the adverse effects of low pH, properties essential for cariogenic bacteria. As

729-452: A greater risk for cavities. Molar incisor hypo-mineralization seems to be increasingly common. While the cause is unknown it is thought to be a combination of genetic and environmental factors. Possible contributing factors that have been investigated include systemic factors such as high levels of dioxins or polychlorinated biphenyl (PCB) in the mother's milk, premature birth and oxygen deprivation at birth, and certain disorders during

810-399: A low rate of salivary flow (molar fissures). Grooves on the occlusal surfaces of molar and premolar teeth provide microscopic retention sites for plaque bacteria, as do the interproximal sites. Plaque may also collect above or below the gingiva , where it is referred to as supra- or sub-gingival plaque, respectively. These bacterial strains, most notably S. mutans , can be inherited by

891-419: A mother's dental caries may decrease the risk in her children by decreasing the number of certain bacteria she may spread to them. Screening can result in earlier detection. Depending on the extent of destruction, various treatments can be used to restore the tooth to proper function, or the tooth may be removed . There is no known method to grow back large amounts of tooth. The availability of treatment

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972-410: A pH of 5.5. Dentin and cementum are more susceptible to caries than enamel because they have lower mineral content. Thus, when root surfaces of teeth are exposed from gingival recession or periodontal disease, caries can develop more readily. Even in a healthy oral environment, however, the tooth is susceptible to dental caries. The evidence for linking malocclusion and/or crowding to dental caries

1053-543: A temporary restorative material may be used to build up the contact point to allow the effective placement of separators. However, temporary restorative material is not a common practice of the Hall Technique, and case selection appropriateness should be considered. The separators are generally placed 3–5 days prior to the placement of the stainless steel crown to space to be created. The clinician will provide advice on this procedure and how to proceed if these fall out prior to

1134-434: A tooth that is exposed to the oral cavity, but not the structures that are retained within the bone. Tooth decay is caused by biofilm (dental plaque) lying on the teeth and maturing to become cariogenic (causing decay). Certain bacteria in the biofilm produce acids, primarily lactic acid , in the presence of fermentable carbohydrates such as sucrose , fructose , and glucose . Caries occur more often in people from

1215-413: A zone of demineralized dentin due to acid and has no bacteria present. The zones of bacterial penetration and destruction are the locations of invading bacteria and ultimately the decomposition of dentin. The zone of destruction has a more mixed bacterial population where proteolytic enzymes have destroyed the organic matrix. The innermost dentin caries has been reversibly attacked because the collagen matrix

1296-427: Is a chronic condition that forms a large, shallow lesion and slowly invades first the root's cementum and then dentin to cause a chronic infection of the pulp (see further discussion under classification by affected hard tissue). Because dental pain is a late finding, many lesions are not detected early, resulting in restorative challenges and increased tooth loss. The presentation of caries is highly variable. However,

1377-519: Is a disease in which the enamel does not fully form or forms in insufficient amounts and can fall off a tooth. In both cases, teeth may be left more vulnerable to decay because the enamel is not able to protect the tooth. In most people, disorders or diseases affecting teeth are not the primary cause of dental caries. Approximately 96% of tooth enamel is composed of minerals. These minerals, especially hydroxyapatite , will become soluble when exposed to acidic environments. Enamel begins to demineralize at

1458-412: Is a significant risk factor for periodontal disease, which can cause the gingiva to recede . As the gingiva loses attachment to the teeth due to gingival recession, the root surface becomes more visible in the mouth. If this occurs, root caries is a concern since the cementum covering the roots of teeth is more easily demineralized by acids than enamel. Currently, there is not enough evidence to support

1539-463: Is an ecologic shift within the dental biofilm from a balanced population of microorganisms to a population that produces acids and can survive in an acid environment. Tooth enamel is a highly mineralized acellular tissue, and caries act upon it through a chemical process brought on by the acidic environment produced by bacteria. As the bacteria consume the sugar and use it for their own energy, they produce lactic acid. The effects of this process include

1620-458: Is an ongoing stem cell–based field of study that aims to find methods to reverse the effects of decay; current methods are based on easing symptoms. The cause of cavities is acid from bacteria dissolving the hard tissues of the teeth ( enamel , dentin and cementum ). The acid is produced by the bacteria when they break down food debris or sugar on the tooth surface. Simple sugars in food are these bacteria's primary energy source and thus

1701-418: Is being removed, which has been shown to reduce children’s reported discomfort. A Cochrane systematic review has compared biologically oriented strategies (stepwise, partial and no-caries removal), with complete caries removal for managing decay in both primary and permanent teeth. Eight trials of 934 patients (1372 teeth) with outcomes reported for 1191 teeth were included in the analyses. The conclusion of

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1782-437: Is characterized by demineralization of the tooth surface, altering the tooth's optical properties. Technology using laser speckle image (LSI) techniques may provide a diagnostic aid to detect early carious lesions. Caries can be classified by location, etiology, rate of progression, and affected hard tissues. These forms of classification can be used to characterize a particular case of tooth decay to more accurately represent

1863-453: Is in fact more cariogenic than a mixture of equal parts of glucose and fructose. This is due to the bacteria using the energy in the saccharide bond between the glucose and fructose subunits. S.mutans adheres to the biofilm on the tooth by converting sucrose into an extremely adhesive substance called dextran polysaccharide by the enzyme dextran sucranase. The frequency with which teeth are exposed to cariogenic (acidic) environments affects

1944-559: Is not present to counterbalance the acidic environment created by certain foods. As a result, medical conditions that reduce the amount of saliva produced by salivary glands , in particular the submandibular gland and parotid gland , are likely to lead to dry mouth and thus to widespread tooth decay. Examples include Sjögren syndrome , diabetes mellitus , diabetes insipidus , and sarcoidosis . Medications, such as antihistamines and antidepressants, can also impair salivary flow. Stimulants, most notoriously methylamphetamine , also occlude

2025-432: Is not severely damaged, giving it potential for repair. The structure of dentin is an arrangement of microscopic channels, called dentinal tubules , which radiate outward from the pulp chamber to the exterior cementum or enamel border. The diameter of the dentinal tubules is largest near the pulp (about 2.5 μm) and smallest (about 900 nm) at the junction of dentin and enamel. The carious process continues through

2106-418: Is often diagnosed by blowing air across the suspect surface, which removes moisture and changes the optical properties of the unmineralized enamel. Some dental researchers have cautioned against the use of dental explorers to find caries, in particular sharp ended explorers. In cases where a small area of tooth has begun demineralizing but has not yet cavitated, the pressure from the dental explorer could cause

2187-416: Is often poor in the developing world. Paracetamol (acetaminophen) or ibuprofen may be taken for pain. Worldwide, approximately 3.6 billion people (48% of the population) have dental caries in their permanent teeth as of 2016. The World Health Organization estimates that nearly all adults have dental caries at some point in time. In baby teeth it affects about 620 million people or 9% of

2268-425: Is present until the loss of tooth structure results in a cavitation. Unlike enamel, the dentin reacts to the progression of dental caries. After tooth formation , the ameloblasts , which produce enamel, are destroyed once enamel formation is complete and thus cannot later regenerate enamel after its destruction. On the other hand, dentin is produced continuously throughout life by odontoblasts , which reside at

2349-419: Is present. These caries, sometimes referred to as "hidden caries", will still be visible on X-ray radiographs, but visual examination of the tooth would show the enamel intact or minimally perforated. The differential diagnosis for dental caries includes dental fluorosis and developmental defects of the tooth including hypomineralization of the tooth and hypoplasia of the tooth. The early carious lesion

2430-438: Is still unknown if the identification of high-risk individuals can lead to more effective long-term patient management that prevents caries initiation and arrests or reverses the progression of lesions. Saliva also contains iodine and EGF . EGF results effective in cellular proliferation, differentiation and survival. Salivary EGF, which seems also regulated by dietary inorganic iodine, plays an important physiological role in

2511-413: Is the first visible sign of caries and coincides with a one to two percent loss of minerals. A slight remineralization of enamel occurs in the dark zone, which serves as an example of how the development of dental caries is an active process with alternating changes. The area of greatest demineralization and destruction is in the body of the lesion itself. The surface zone remains relatively mineralized and

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2592-418: Is weak; however, the anatomy of teeth may affect the likelihood of caries formation. Where the deep developmental grooves of teeth are more numerous and exaggerated, pit and fissure caries is more likely to develop (see next section). Also, caries is more likely to develop when food is trapped between teeth. Reduced salivary flow rate is associated with increased caries since the buffering capability of saliva

2673-527: The cells in salivary glands, somewhat increasing the likelihood of caries formation. Susceptibility to caries can be related to altered metabolism in the tooth, in particular to fluid flow in the dentin. Experiments on rats have shown that a high-sucrose, cariogenic diet "significantly suppresses the rate of fluid motion" in dentin. The use of tobacco may also increase the risk for caries formation. Some brands of smokeless tobacco contain high sugar content, increasing susceptibility to caries. Tobacco use

2754-443: The cementum of root surfaces is more easily demineralized than enamel surfaces, a wider variety of bacteria can cause root caries, including Lactobacillus acidophilus , Actinomyces spp. , Nocardia spp. , and Streptococcus mutans . Bacteria collect around the teeth and gums in a sticky, creamy-coloured mass called plaque , which serves as a biofilm . Some sites collect plaque more commonly than others, for example, sites with

2835-461: The dental plaque . However, these four criteria are not always enough to cause the disease and a sheltered environment promoting development of a cariogenic biofilm is required. The caries disease process does not have an inevitable outcome, and different individuals will be susceptible to different degrees depending on the shape of their teeth, oral hygiene habits, and the buffering capacity of their saliva. Dental caries can occur on any surface of

2916-416: The Hall Technique crown will be assessed clinically and radiographically when required. The tooth will still be able to exfoliate naturally, and the tooth should exfoliate with the crown in place. However, if the patient experiences pain/discomfort after the initial few days, they should consult their dental professional. A dental professional should also be consulted if the crown falls off, as this will prevent

2997-417: The Hall Technique is indicated the following stages will be likely to occur. To enable the stainless steel crown to be placed on the tooth, there must be sufficient space between the teeth. If this space is not currently available, orthodontic separators may be placed between the tooth indicated for the Hall Technique and adjacent teeth (see image 1). If the placement is impaired due to interproximal breakdown

3078-561: The Hall Technique to be superior to other methods for managing decay in baby teeth, but there is a lack of evidence to conclude that the Hall Technique is superior to placing preformed metal crowns in a conventional manner. Initial fears over the potential problem with sealing caries (cavities) into teeth being that the caries process might only be slowed, rather than arrested and that the caries might still progress, leading to pain and infection later. This problem has not been realised with one study showing long-term data beyond five years, to when

3159-508: The Hall Technique) compare to other treatment techniques including complete caries removal. These " minimal intervention " approaches reduce some of the adverse consequences associated with carrying out restorative treatment: conservation of tooth structure and integrity, maintenance of maximum pulpal floor dentinal thickness, which reduces the impact on pulpal health; reduced pulp exposure, and less need for local anaesthesia if no vital dentine

3240-420: The acid is neutralized by saliva or mouthwash . Fluoride toothpaste or dental varnish may aid remineralization. If demineralization continues over time, enough mineral content may be lost so that the soft organic material left behind disintegrates, forming a cavity or hole. The impact such sugars have on the progress of dental caries is called cariogenicity. Sucrose, although a bound glucose and fructose unit,

3321-542: The baby teeth are lost, with fewer problems from the tooth with the crown. Crowns placed using the Hall Technique have better long term outcomes ( pain /infection and need for replacement) compared with standard fillings. The technique has been used and found particularly valuable in a developing country with little access to dental services, or resources to support such services. It is also utilized in modern dental practices, as many parents and patients prefer treatment options that are minimally invasive and that help eliminate

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3402-425: The border between the pulp and dentin. Since odontoblasts are present, a stimulus, such as caries, can trigger a biologic response. These defense mechanisms include the formation of sclerotic and tertiary dentin . In dentin from the deepest layer to the enamel, the distinct areas affected by caries are the advancing front, the zone of bacterial penetration, and the zone of destruction. The advancing front represents

3483-423: The calcium ion and therefore exposure to them may promote tooth decay. Poverty is also a significant social determinant for oral health. Dental caries have been linked with lower socio-economic status and can be considered a disease of poverty. Forms are available for risk assessment for caries when treating dental cases; this system using the evidence-based Caries Management by Risk Assessment (CAMBRA). It

3564-667: The cementum enveloping the root surface is not nearly as durable as the enamel encasing the crown , root caries tend to progress much more rapidly than decay on other surfaces. The progression and loss of mineralization on the root surface is 2.5 times faster than caries in enamel. In very severe cases where oral hygiene is very poor and where the diet is very rich in fermentable carbohydrates, caries may cause cavities within months of tooth eruption. This can occur, for example, when children continuously drink sugary drinks from baby bottles (see later discussion). There are certain diseases and disorders affecting teeth that may leave an individual at

3645-408: The child's first 3 years such as mumps , diphtheria , scarlet fever , measles , hypoparathyroidism , malnutrition , malabsorption , hypo-vitaminosis D , chronic respiratory diseases , or undiagnosed and untreated coeliac disease , which usually presents with mild or absent gastrointestinal symptoms. Amelogenesis imperfecta , which occurs in between 1 in 718 and 1 in 14,000 individuals,

3726-422: The condition to others and also indicate the severity of tooth destruction. In some instances, caries is described in other ways that might indicate the cause. The G. V. Black classification is as follows: Early childhood caries (ECC), also known as " baby bottle caries ," " baby bottle tooth decay" or "bottle rot," is a pattern of decay found in young children with their deciduous (baby) teeth. This must include

3807-444: The day. Another pattern of decay is "rampant caries", which signifies advanced or severe decay on multiple surfaces of many teeth. Rampant caries may be seen in individuals with xerostomia , poor oral hygiene, stimulant use (due to drug-induced dry mouth ), and/or large sugar intake. If rampant caries is a result of previous radiation to the head and neck, it may be described as radiation-induced caries. Problems can also be caused by

3888-448: The decay has progressed enough to allow the bacteria to overwhelm the pulp tissue in the center of the tooth, a toothache can result, and the pain will become more constant. Death of the pulp tissue and infection are common consequences. The tooth will no longer be sensitive to hot or cold but can be very tender to pressure. Dental caries can also cause bad breath and foul tastes. In highly progressed cases, an infection can spread from

3969-436: The demineralization of crystals in the enamel, caused by acids, over time until the bacteria physically penetrate the dentin. Enamel rods , which are the basic unit of the enamel structure, run perpendicularly from the surface of the tooth to the dentin. Since demineralization of enamel by caries follows the direction of the enamel rods, the different triangular patterns between pit and fissure and smooth-surface caries develop in

4050-635: The demineralization process has stopped, leaving a stain. Active decay is lighter in color and dull in appearance. As the enamel and dentin are destroyed, the cavity becomes more noticeable. The affected areas of the tooth change color and become soft to the touch. Once the decay passes through the enamel, the dentinal tubules , which have passages to the nerve of the tooth, become exposed, resulting in pain that can be transient, temporarily worsening with exposure to heat, cold, or sweet foods and drinks. A tooth weakened by extensive internal decay can sometimes suddenly fracture under normal chewing forces. When

4131-410: The dental caries, then the dentin produced is called "reactionary" dentin. If the odontoblasts are killed, the dentin produced is called "reparative" dentin. In the case of reparative dentin, other cells are needed to assume the role of the destroyed odontoblasts. Growth factors , especially TGF-β , are thought to initiate the production of reparative dentin by fibroblasts and mesenchymal cells of

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4212-440: The dentin is considered sclerotic. According to hydrodynamic theory , fluids within dentinal tubules are believed to be the mechanism by which pain receptors are triggered within the pulp of the tooth. Since sclerotic dentin prevents the passage of such fluids, pain that would otherwise serve as a warning of the invading bacteria may not develop at first. In response to dental caries, there may be production of more dentin toward

4293-413: The dentinal tubules, which are responsible for the triangular patterns resulting from the progression of caries deep into the tooth. The tubules also allow caries to progress faster. In response, the fluid inside the tubules brings immunoglobulins from the immune system to fight the bacterial infection. At the same time, there is an increase of mineralization of the surrounding tubules. This results in

4374-408: The development of dental caries relies heavily on the frequency of acid exposure. The carious process can begin within days of a tooth's erupting into the mouth if the diet is sufficiently rich in suitable carbohydrates. Evidence suggests that the introduction of fluoride treatments has slowed the process. Proximal caries take an average of four years to pass through enamel in permanent teeth. Because

4455-408: The direction of the pulp. This new dentin is referred to as tertiary dentin. Tertiary dentin is produced to protect the pulp for as long as possible from the advancing bacteria. As more tertiary dentin is produced, the size of the pulp decreases. This type of dentin has been subdivided according to the presence or absence of the original odontoblasts. If the odontoblasts survive long enough to react to

4536-419: The disease) are present in dental plaque, but they are usually in too low concentrations to cause problems unless there is a shift in the balance. This is driven by local environmental change, such as frequent sugar intake or inadequate biofilm removal (toothbrushing). If left untreated, the disease can lead to pain, tooth loss and infection . The mouth contains a wide variety of oral bacteria , but only

4617-416: The enamel because the orientation of enamel rods are different in the two areas of the tooth. As the enamel loses minerals, and dental caries progresses, the enamel develops several distinct zones, visible under a light microscope. From the deepest layer of the enamel to the enamel surface, the identified areas are the: translucent zone, dark zones, body of the lesion, and surface zone. The translucent zone

4698-568: The exclusive domain of techniques based on complete caries removal prior to tooth restoration. Norna Hall used pre-formed crowns and cemented over carious primary molars using a glass-ionomer luting cement , with no caries removal, tooth preparation, or local anaesthesia. The Hall Technique has been included in a guideline of the Scottish Dental Clinical Effectiveness Programme (SDCEP) and has helped to drive change in how dentists manage decay in primary teeth from

4779-476: The flow of saliva to an extreme degree. This is known as meth mouth . Tetrahydrocannabinol (THC), the active chemical substance in cannabis , also causes a nearly complete occlusion of salivation, known in colloquial terms as "cotton mouth". Moreover, 63% of the most commonly prescribed medications in the United States list dry mouth as a known side-effect. Radiation therapy of the head and neck may also damage

4860-399: The following situations: Hall Technique stainless steel crowns are contraindicated in the following instances: The Hall Technique sometimes requires several appointments to allow separation of the teeth in order to place the preformed crown to be fitted with no additional tooth removal or anaesthetic. Diagnostics and radiographs will be required initially. Once it has been established that

4941-523: The likelihood of caries development. After meals or snacks , the bacteria in the mouth metabolize sugar, resulting in an acidic by-product that decreases pH. As time progresses, the pH returns to normal due to the buffering capacity of saliva and the dissolved mineral content of tooth surfaces. During every exposure to the acidic environment, portions of the inorganic mineral content at the surface of teeth dissolve and can remain dissolved for two hours. Since teeth are vulnerable during these acidic periods,

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5022-453: The lower end of the socio-economic scale than people from the upper end of the socio-economic scale, due to lack of education about dental care, and lack of access to professional dental care which may be expensive. The most common bacteria associated with dental cavities are the mutans streptococci, most prominently Streptococcus mutans and Streptococcus sobrinus , and lactobacilli . However, cariogenic bacteria (the ones that can cause

5103-413: The maintenance of oral (and gastro-oesophageal) tissue integrity, and, on the other hand, iodine is effective in prevention of dental caries and oral health. Teeth are bathed in saliva and have a coating of bacteria on them ( biofilm ) that continually forms. The development of biofilm begins with pellicle formation. Pellicle is an acellular proteinaceous film which covers the teeth. Bacteria colonize on

5184-443: The management of the decay. Caries Tooth decay , also known as cavities or caries , is the breakdown of teeth due to acids produced by bacteria . The cavities may be a number of different colors, from yellow to black. Symptoms may include pain and difficulty eating. Complications may include inflammation of the tissue around the tooth , tooth loss and infection or abscess formation. Tooth regeneration

5265-401: The mouth , and receding gums resulting in exposure of the roots of the teeth. Prevention of dental caries includes regular cleaning of the teeth, a diet low in sugar, and small amounts of fluoride . Brushing one's teeth twice per day, and flossing between the teeth once a day is recommended. Fluoride may be acquired from water , salt or toothpaste among other sources. Treating

5346-454: The need for sedation. Preformed metal crowns have been used for restoring primary molars since the 1950s. Literature suggests preformed crowns placed on carious primary molar teeth reduce risk of major failure or pain in the long term compared to fillings. There is also evidence to suggest that fitting crowns using the Hall Technique reduces patient discomfort at the time of treatment in comparison to conventional fillings. It can also help reduce

5427-414: The next appointment. The stainless steel crowns are selected by tooth type, location and size (see image 2). The tooth will be measured to identify the most suitable size of stainless steel crown. The clinician will try the stainless steel crown prior to its cementation, to ensure that it fits correctly, and establish if an alternative size or contouring of the stainless steel crown is required. When placing

5508-577: The overall time a patient spends in the dental chair due to the relatively simple and quick procedure when compared with traditional method of stainless steel crown (SSC) application. The Hall Technique is named after Dr. Norna Hall, a dentist working in Scotland, who has developed a simplified technique where the crown is simply cemented over the carious primary molar, with no local anaesthesia , caries removal, or tooth preparation of any kind. The traditional method for management of dental caries has evolved from

5589-414: The population. They have become more common in both children and adults in recent years. The disease is most common in the developed world due to greater simple sugar consumption, but less common in the developing world. Caries is Latin for "rottenness". A person experiencing caries may not be aware of the disease. The earliest sign of a new carious lesion is the appearance of a chalky white spot on

5670-421: The presence of at least one carious lesion on a primary tooth in a child under the age of 6 years. The teeth most likely affected are the maxillary anterior teeth, but all teeth can be affected. The name for this type of caries comes from the fact that the decay usually is a result of allowing children to fall asleep with sweetened liquids in their bottles or feeding children sweetened liquids multiple times during

5751-457: The pulp. Reparative dentin is produced at an average of 1.5 μm/day, but can be increased to 3.5 μm/day. The resulting dentin contains irregularly shaped dentinal tubules that may not line up with existing dentinal tubules. This diminishes the ability for dental caries to progress within the dentinal tubules. The incidence of cemental caries increases in older adults as gingival recession occurs from either trauma or periodontal disease. It

5832-430: The review was that for symptomless and vital teeth, biologically oriented strategies had clinical advantages over complete caries removal in the management of dentinal caries. Not only were there no differences in restoration longevity or in the numbers of teeth (or patients) experiencing pulpal pathology (pain or infection), but there were significantly less pulp exposures. For partial caries removal in primary teeth, this

5913-491: The risk factors and stages of development are similar. Initially, it may appear as a small chalky area (smooth surface caries), which may eventually develop into a large cavitation. Sometimes caries may be directly visible. However other methods of detection such as X-rays are used for less visible areas of teeth and to judge the extent of destruction. Lasers for detecting caries allow detection without ionizing radiation and are now used for detection of interproximal decay (between

5994-434: The stainless steel crown within the mouth, the airways will generally be protected by placing gauze around the site, or the clinician may secure the stainless steel with tape/ Elastoplast . Once a correct size and fit is established, the crown may be adhered to the tooth. The stainless steel crown is secured to the tooth by partially filling the stainless steel crown with a self-curing glass ionomer cement and then placing over

6075-508: The surface of the tooth, indicating an area of demineralization of enamel . This is referred to as a white spot lesion, an incipient carious lesion, or a "micro-cavity". As the lesion continues to demineralize, it can turn brown but will eventually turn into a cavitation ("cavity").  Before the cavity forms, the process is reversible, but once a cavity forms, the lost tooth structure cannot be regenerated . A lesion that appears dark brown and shiny suggests dental caries were once present, but

6156-434: The teeth by adhering to the pellicle-coated surface. Over time, a mature biofilm is formed, creating a cariogenic environment on the tooth surface. The minerals in the hard tissues of the teeth – enamel, dentin and cementum – are constantly undergoing demineralization and remineralization. Dental caries result when the demineralization rate is faster than the remineralization, producing net mineral loss, which occurs when there

6237-557: The teeth). Primary diagnosis involves inspection of all visible tooth surfaces using a good light source, dental mirror and explorer . Dental radiographs ( X-rays ) may show dental caries before it is otherwise visible, in particular caries between the teeth. Large areas of dental caries are often apparent to the naked eye, but smaller lesions can be difficult to identify. Visual and tactile inspection along with radiographs are employed frequently among dentists, in particular to diagnose pit and fissure caries. Early, uncavitated caries

6318-408: The tooth to the surrounding soft tissues . Complications such as cavernous sinus thrombosis and Ludwig angina can be life-threatening. Four things are required for caries to form: a tooth surface (enamel or dentin), caries-causing bacteria, fermentable carbohydrates (such as sucrose ), and time. This involves adherence of food to the teeth and acid creation by the bacteria that makes up

6399-443: The tooth. The stainless steel crown should "click" securely into place. The patient is required to bite firmly onto a cotton roll or bite stick to secure it in the correct position whilst it sets. The excess of glass ionomer cement will be wiped off or removed with knotted floss from between the interproximal contact, and a sickle probe from the buccal gingival sulcus on the buccal and lingual/palatal surfaces. At follow-up appointments

6480-558: The traditional invasive surgical approach to the less-invasive biological management of decay. Clinical trials have shown the technique to be effective; however it is not an easy, quick-fix solution to the problem of carious primary molars. The technique is not suited to every tooth, child or clinician, but it can be an effective method of managing carious primary molars. The Hall Technique should not be used when there are clinical or radiographic signs and symptoms of irreversible pulpitis or dental abscess . Radiographically , there should be

6561-544: Was a risk ratio of 0.24 [0.06,0.90], when caries were not completely removed. The Hall technique can also be used with permanent first molars in some cases where prognosis is poor, such as where first permanent molars are hypomineralised, carious with poor prognosis but to be maintained until full eruption of second molars, or for cuspal coverage of endodontically treated teeth in minors with compliance issues preventing full coverage crown preparation. Hall Technique stainless steel crowns (SSC) are indicated for primary molars in

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