Misplaced Pages

#674325

100-569: Restorative dentistry aims to treat the teeth and their supporting structures. Many conditions and their consequences may be assessed and treated by a restorative dentist. Environmental causes may include as caries or maxillofacial trauma . Developmental issues may lead to the restorative dentist treating hypodontia , amelogenesis imperfecta , dentogenesis imperfecta or cleft palate . Multifactorial conditions with an environmental and genetic basis such as periodontitis , would be treated by restorative dentistry. Restorative dentists are part of

200-423: 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

300-439: 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

400-457: 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

500-402: 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,

600-585: A dentist may recommend dental implants for a patient, but that patient does not have enough upper jaw bone to accommodate a dental implant. In this case, the dentist will recommend a sinus lift. A sinus lift is a surgical procedure in which bone is grafted onto the upper jaw. The membrane of the maxillary sinus is lifted upward, making space for additional bone. Veneers are layers of dental resin or ceramic that are placed over existing teeth. As Dr. Aggarwal explains, veneers require "minimal removal of tooth structure" and provide an improved aesthetic appearance. While

700-437: 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

800-452: 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

900-450: A higher degrees of periodontal inflammation and often have difficulties with balancing their blood glucose level, owing to the constant systemic inflammatory state caused by the periodontal inflammation. Although no causal association was proven, there is an association between chronic periodontitis and erectile dysfunction , inflammatory bowel disease , and heart disease. A positive correlation between raised levels of glucose within

1000-399: 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

1100-419: 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

SECTION 10

#1732848241675

1200-426: 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 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

1300-410: 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

1400-420: A possible triggering of the aggravation of the stroke process. Other mechanisms have been suggested, PD is a known chronic infection. It can aid in the promotion of atherosclerosis by the deposition of cholesterol, cholesterol esters and calcium within the subendothelial layer of vessel walls. Atherosclerotic plaque that is unstable may rupture and release debris and thrombi that may travel to different parts of

1500-447: A regular healthy diet. Therefore, vitamin intakes (particularly vitamin C) and dietary supplements not only play a role in improving periodontal health, but also influence the rate of bone formation and periodontal regeneration. However, studies supporting the correlation between nutrition and periodontal health are limited, and more long-term research is required to confirm this. Periodontitis

1600-491: A significant role in the development and progression of gingivitis and periodontitis. Changes in hormone levels, particularly during puberty, menstruation, pregnancy, and menopause, can lead to increased sensitivity and inflammatory responses in the gums. For example, elevated oestrogen and progesterone during pregnancy can heighten the inflammatory response to dental plaque, making pregnant individuals more susceptible to gingival disease. As dental plaque or biofilm accumulates on

1700-434: 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

1800-760: A treatment planning service or provide shared care with the referring dentist. Restorative dentists manage complex cases that would be difficult to manage in general dental practice that include, but are not limited to: Dental crowns are tooth-colored restorations or metal restorations. They replace the essential structures of a missing tooth caused by root canals, decay, or fractures. Crowns also serve as full "caps" that restore normal tooth size, shape, and function. Dental fillings are often used to fill cavities or holes after root canal treatment. They can also be used to restore worn teeth or fill gaps between teeth. Fillings can be made of amalgam (a metal alloy) or materials such as composite resin and glass ionomer. Occasionally,

1900-413: 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

2000-427: 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,

2100-519: 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

SECTION 20

#1732848241675

2200-412: 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

2300-716: 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 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

2400-463: 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

2500-529: Is an inflammation of the periodontium , i.e., the tissues that support the teeth. The periodontium consists of four tissues: The primary cause of gingivitis is poor or ineffective oral hygiene , which leads to the accumulation of a mycotic and bacterial matrix at the gum line, called dental plaque . Other contributors are poor nutrition and underlying medical issues such as diabetes . Diabetics must be meticulous with their homecare to control periodontal disease. New finger prick tests have been approved by

2600-601: Is arguably the most important environmental risk factor for periodontitis. Research has shown that smokers have more bone loss, attachment loss and tooth loss compared to non-smokers. This is likely due to several effects of smoking on the immune response including decreased wound healing, suppression of antibody production, and the reduction of phagocytosis by neutrophils Ehlers–Danlos syndrome and Papillon–Lefèvre syndrome (also known as palmoplantar keratoderma) are also risk factors for periodontitis. If left undisturbed, microbial plaque calcifies to form calculus , which

2700-570: Is associated with platelet and coagulation cascade activations, leading to thrombosis and thrombotic complications. Experimental animal studies have shown a link between periodontal disease, oxidative stress and cardiac stress. Oxidative stress favours the development and progression of heart failure as it causes cellular dysfunction, oxidation of proteins and lipids, and damage to the deoxyribonucleic acid (DNA), stimulating fibroblast proliferation and metalloproteinases activation favouring cardiac remodelling. During SARS Covid 19 pandemic, Periodontitis

2800-437: 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

2900-667: Is commonly called tartar. Calculus above and below the gum line must be removed completely by the dental hygienist or dentist to treat gingivitis and periodontitis. Although the primary cause of both gingivitis and periodontitis is the microbial plaque that adheres to the tooth surfaces, there are many other modifying factors. A very strong risk factor is one's genetic susceptibility. Several conditions and diseases, including Down syndrome , diabetes, and other diseases that affect one's resistance to infection, also increase susceptibility to periodontitis. Periodontitis may be associated with higher stress. Periodontitis occurs more often in people in

3000-497: Is considered the main cause of tooth loss for adults worldwide. In its more serious form, called periodontitis , the gums can pull away from the tooth , bone can be lost, and the teeth may loosen or fall out . Halitosis (bad breath) may also occur. Periodontal disease is generally due to bacteria in the mouth infecting the tissue around the teeth. Factors that increase the risk of disease include smoking , diabetes , HIV/AIDS , family history, high levels of homocysteine in

3100-412: Is crucial to maintaining periodontal health. Nutritional deficiencies can lead to oral manifestations such as those in scurvy and rickets disease. Different vitamins will play a different role in periodontal health: Nutritional supplements of vitamins have also been shown to positively affect healing after periodontal surgery and many of these vitamins can be found in a variety of food that we eat within

Restorative dentistry - Misplaced Pages Continue

3200-453: 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

3300-559: Is insignificant, although this may be a symptom of progressing periodontitis in that person. Periodontitis has been linked to increased inflammation in the body, such as indicated by raised levels of C-reactive protein and interleukin-6 . It is associated with an increased risk of stroke, myocardial infarction , atherosclerosis and hypertension . It is also linked in those over 60 years of age to impairments in delayed memory and calculation abilities. Individuals with impaired fasting glucose and diabetes mellitus have

3400-559: 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

3500-432: 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

3600-418: 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

3700-416: 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

3800-425: Is possible that there is a positive association by a shared genetic susceptibility in the two diseases. Due to the low incidence rate of oral cancer, studies have not been able to conduct quality studies to prove the association between the two, however future larger studies may aid in the identification of individuals at a higher risk. Periodontal disease (PD) can be described as an inflammatory condition affecting

3900-425: 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

4000-419: 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

4100-438: 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

Restorative dentistry - Misplaced Pages Continue

4200-413: 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

4300-418: 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

4400-519: The Food and Drug Administration in the US, and are being used in dental offices to identify and screen people for possible contributory causes of gum disease, such as diabetes. In some people, gingivitis progresses to periodontitis — with the destruction of the gingival fibers , the gum tissues separate from the tooth and deepened sulcus, called a periodontal pocket . Subgingival microorganisms (those that exist under

4500-527: 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

4600-443: 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

4700-461: 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

4800-573: The multidisciplinary team managing head and neck oncology cases, both before treatment and helping to rehabilitate the patient after surgery and/or radiotherapy . In the UK, restorative dentistry is legally recognized as a specialty under EU directive and the General Dental Council and is represented by several specialist societies including the British Society for Restorative Dentistry and

4900-408: The 1999 classification, the severity of chronic periodontitis is graded as follows: The "extent" of disease refers to the proportion of the dentition affected by the disease in terms of percentage of sites. Sites are defined as the positions at which probing measurements are taken around each tooth and, generally, six probing sites around each tooth are recorded, as follows: If up to 30% of sites in

5000-648: The Association of Consultants & Specialists in Restorative Dentistry. Restorative dentistry specialty training in the UK lasts five years, and upon successful completion, the dentist may be appointed as a consultant in restorative dentistry. Restorative dentistry combines the three dental monospecialties of endodontics, prosthodontics and periodontics. Restorative consultants work within dental hospital environments and receive referrals from other dental specialties and general dental practitioners. They may provide

5100-420: 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,

SECTION 50

#1732848241675

5200-629: The blood and certain medications. Diagnosis is by inspecting the gum tissue around the teeth both visually and with a probe and X-rays looking for bone loss around the teeth. Treatment involves good oral hygiene and regular professional teeth cleaning . Recommended oral hygiene include daily brushing and flossing . In certain cases antibiotics or dental surgery may be recommended. Clinical investigations demonstrate that quitting smoking and making dietary changes enhance periodontal health. Globally, 538 million people were estimated to be affected in 2015 and has been known to affect 10–15% of

5300-430: The blood and the onset or progression of periodontal disease has been shown in the current literature. Data has also shown that there is a significant increase in the incidence or progression of periodontitis in patients with uncontrolled diabetes compared to those who do not have diabetes or have well-controlled diabetes. In uncontrolled diabetes, the formation of reactive oxygen species can damage cells such as those in

5400-425: 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

5500-423: 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

5600-428: The calcium comes from saliva; for plaques below the gumline, it comes from blood via oozing of inflamed gums. The damage to teeth and gums comes from the immune system as it attempts to destroy the microbes that are disrupting the normal symbiosis between the oral tissues and the oral microbe community. As in other tissues, Langerhans cells in the epithelium take up antigens from the microbes, and present them to

5700-667: 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

5800-408: 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,

5900-437: The circulatory system causing embolization and therefore, an ischemic stroke. Therefore, PD has been suggested as an independent risk factor for stroke. A variety of cardiovascular diseases can also be associated with periodontal disease. Patients with higher levels of inflammatory markers such as TNF, IL-1, IL-6 and IL-8 can lead to progression of atherosclerosis and the development and perpetuation of atrial fibrillation, as it

6000-422: 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

6100-806: The connective tissue of the periodontal ligament, resulting in cell necrosis or apoptosis . Furthermore, individuals with uncontrolled diabetes mellitus who have frequent exposure to periodontal pathogens have a greater immune response to these bacteria. This can subsequently cause and/or accelerate periodontal tissue destruction leading to periodontal disease. Current literature suggests a link between periodontal disease and oral cancer. Studies have confirmed an increase in systemic inflammation markers such as C-Reactive Protein and Interleukin-6 to be found in patients with advanced periodontal disease. The link between systemic inflammation and oral cancer has also been well established. Both periodontal disease and cancer risk are associated with genetic susceptibility and it

SECTION 60

#1732848241675

6200-423: The damage is essentially irreversible. The seven categories are as follows: Moreover, terminology expressing both the extent and severity of periodontal diseases are appended to the terms above to denote the specific diagnosis of a particular person or group of people. The "severity" of disease refers to the amount of periodontal ligament fibers that have been lost, termed "clinical attachment loss". According to

6300-444: 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

6400-448: 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

6500-436: 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

6600-635: 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

6700-410: 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

6800-440: 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

6900-413: 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

7000-408: 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

7100-408: 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

7200-419: 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

7300-416: 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

7400-476: 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

7500-468: The gap where natural teeth once were. In the United States, the American Academy of Pediatric Dentistry (AAPD) has published the following guidelines: This dentistry article is a stub . You can help Misplaced Pages by expanding it . Tooth decay Tooth decay , also known as cavities or caries , is the breakdown of teeth due to acids produced by bacteria . The cavities may be

7600-445: The gum line) colonize the periodontal pockets and cause further inflammation in the gum tissues and progressive bone loss. Examples of secondary causes are those things that, by definition, cause microbic plaque accumulation, such as restoration overhangs and root proximity. Smoking is another factor that increases the occurrence of periodontitis, directly or indirectly, and may interfere with or adversely affect its treatment. It

7700-731: The immune system, leading to movement of white blood cells into the affected tissues. This process in turn activates osteoclasts which begin to destroy bone, and it activates matrix metalloproteinases that destroy ligaments. So, in summary, it is bacteria which initiates the disease, but key destructive events are brought about by the exaggerated response from the host's immune system. There were several attempts to introduce an agreed-upon classification system for periodontal diseases: in 1989, 1993, 1999, and 2017. The 1999 classification system for periodontal diseases and conditions listed seven major categories of periodontal diseases, of which 2–6 are termed destructive periodontal disease, because

7800-523: 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,

7900-446: The low invasiveness of veneers may be attractive, they are more susceptible to damage than other treatments because they are so fragile. In addition, veneers may require multiple sessions to be placed. They are also more expensive, and insurance may not cover their costs Bridges are used to replace one or more missing teeth by placing artificial teeth between two natural teeth using crowns as supports on either side - effectively "filling"

8000-430: The lower classes than people in the upper classes. Genetics appear to play a role in determining the risk for periodontitis. It is believed genetics could explain why some people with good plaque control have advanced periodontitis, whilst some others with poor oral hygiene are free from the disease. Genetic factors which could modify the risk of a person developing periodontitis include: Diabetes appears to exacerbate

8100-453: 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

8200-413: 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

8300-401: 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

8400-480: The mouth are affected, the manifestation is classified as "localized"; for more than 30%, the term "generalized" is used. The 2017 classification of periodontal diseases is as follows: Periodontal health, gingival disease and conditions Periodontitis Other conditions affecting the periodontium (Periodontal Manifestations of Systemic Diseases and Developmental and Acquired Conditions) Peri-implant diseases and conditions The goals of staging periodontitis

8500-430: The onset, progression, and severity of periodontitis. Although the majority of research has focused on type 2 diabetes , type 1 diabetes appears to have an identical effect on the risk for periodontitis. The extent of the increased risk of periodontitis is dependent on the level of glycaemic control . Therefore, in well managed diabetes there seems to be a small effect of diabetes on the risk for periodontitis. However,

8600-531: The population generally. In the United States, nearly half of those over the age of 30 are affected to some degree and about 70% of those over 65 have the condition. Males are affected more often than females. In the early stages, periodontitis has very few symptoms, and in many individuals the disease has progressed significantly before they seek treatment. Symptoms may include: Gingival inflammation and bone destruction are largely painless. Hence, people may wrongly assume painless bleeding after teeth cleaning

8700-414: 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

8800-421: 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

8900-457: 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

9000-491: 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

9100-401: The risk increases exponentially as glycaemic control worsens. Overall, the increased risk of periodontitis in diabetics is estimated to be between two and three times higher. So far, the mechanisms underlying the link are not fully understood, but it is known to involve aspects of inflammation, immune functioning, neutrophil activity, and cytokine biology. Hormonal fluctuations can also play

9200-434: The risk of an episode of stroke in an acute or chronic phase. Inflammatory markers, CRP, IL-6 are known risk factors of stroke. Both inflammatory markers are also biomarkers of PD and found to be an increased level after daily activities, such as mastication or toothbrushing, are performed. Bacteria from the periodontal pockets will enter the bloodstream during these activities and the current literature suggests that this may be

9300-449: The self-destruction of roots and whole tooth resorption when new teeth erupt or later from unknown causes. Children at 6–12 months are at increased risk of developing dental caries. Periodontal disease Periodontal disease , also known as gum disease , is a set of inflammatory conditions affecting the tissues surrounding the teeth . In its early stage, called gingivitis , the gums become swollen and red and may bleed. It

9400-454: The supporting structures of the teeth. Studies have shown that PD is associated with higher levels of systemic inflammatory markers such as Interleukin-6 (IL-6), C-Reactive Protein (CRP) and Tumor Necrosis Factor (TNF). To compare, elevated levels of these inflammatory markers are also associated with cardiovascular disease and cerebrovascular events such as ischemic strokes. The presence of a wide spectrum inflammatory oral diseases can increase

9500-508: 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

9600-434: 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

9700-647: The teeth near and below the gums there is some dysbiosis of the normal oral microbiome . As of 2017 it was not certain what species were most responsible for causing harm, but gram-negative anaerobic bacteria, spirochetes, and viruses have been suggested; in individual people it is sometimes clear that one or more species is driving the disease. Research in 2004 indicated three gram negative anaerobic species: Aggregatibacter actinomycetemcomitans , Porphyromonas gingivalis , Bacteroides forsythus and Eikenella corrodens . Plaque may be soft and uncalcified, hard and calcified, or both; for plaques that are on teeth

9800-557: 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

9900-408: 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

10000-409: Was significantly associated with a higher risk of complications from COVID‐19, including ICU admission, need for assisted ventilation and death and increased blood levels of markers such as D‐dimer, WBC and CRP which are linked with worse disease outcome. Periodontal disease is multifactorial, and nutrition can significantly affect its prognosis. Studies have shown that a healthy and well-balanced diet

#674325