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Dental Caries

Disease Details

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Description: Dental caries, also known as cavities, are caused by the demineralization of tooth enamel due to acids produced by bacteria in the mouth.
Type: Dental caries are not directly transmitted genetically. They result from a combination of factors including poor oral hygiene, diet, and the presence of bacteria that produce acids from dietary sugars. However, genetic predisposition can influence factors such as enamel strength, saliva composition, and susceptibility to bacteria, which could indirectly affect the likelihood of developing dental caries.
Signs And Symptoms: 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 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 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 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 the tooth to the surrounding soft tissues. Complications such as cavernous sinus thrombosis and Ludwig angina can be life-threatening.
Prognosis: Dental caries, commonly known as tooth decay, generally have a good prognosis when detected and treated early. Early-stage caries can be managed with fluoride treatments and improved oral hygiene. Advanced caries require restorative procedures like fillings, crowns, or root canals. However, untreated dental caries can lead to tooth loss and more severe infections, potentially affecting overall health. Early intervention and consistent dental care are key to a positive outcome.
Onset: Dental caries, commonly known as tooth decay or cavities, typically develop when plaque, a sticky film of bacteria, builds up on the teeth. If not properly cleaned, these bacteria produce acids that attack the enamel, leading to decay. The onset of dental caries can begin in early childhood, especially if poor oral hygiene practices and a diet high in sugars and starches are present. The progression can be slow or rapid depending on various factors, including oral hygiene, dietary habits, and genetic predisposition.
Prevalence: Dental caries, commonly known as tooth decay or cavities, is one of the most prevalent chronic diseases worldwide. It affects individuals of all ages, with particularly high rates among children and adolescents. Nearly 60-90% of school-aged children and almost 100% of adults have dental cavities globally.

Regarding novel antimicrobial nanoparticle (nan) treatments for dental caries, research is ongoing. Nanoparticles have shown promise due to their antibacterial properties, biocompatibility, and ability to target specific areas within the oral cavity, potentially leading to more effective prevention and treatment of dental caries.
Epidemiology: Worldwide, approximately 3.6 billion people have dental caries in their permanent teeth. In baby teeth it affects about 620 million people or 9% of the population. The disease is most common in Latin American countries, countries in the Middle East, and South Asia, and least prevalent in China. In the United States, dental caries is the most common chronic childhood disease, being at least five times more common than asthma. It is the primary pathological cause of tooth loss in children. Between 29% and 59% of adults over the age of 50 experience caries.Treating dental cavities costs 5–10% of health-care budgets in industrialized countries, and can easily exceed budgets in lower-income countries.The number of cases has decreased in some developed countries, and this decline is usually attributed to increasingly better oral hygiene practices and preventive measures such as fluoride treatment. Nonetheless, countries that have experienced an overall decrease in cases of tooth decay continue to have a disparity in the distribution of the disease. Among children in the United States and Europe, twenty percent of the population endures sixty to eighty percent of cases of dental caries. A similarly skewed distribution of the disease is found throughout the world with some children having none or very few caries and others having a high number. Australia, Nepal, and Sweden (where children receive dental care paid for by the government) have a low incidence of cases of dental caries among children, whereas cases are more numerous in Costa Rica and Slovakia.The classic DMF (decay/missing/filled) index is one of the most common methods for assessing caries prevalence as well as dental treatment needs among populations. This index is based on in-field clinical examination of individuals by using a probe, mirror and cotton rolls. Because the DMF index is done without X-ray imaging, it underestimates real caries prevalence and treatment needs.Bacteria typically associated with dental caries have been isolated from vaginal samples from females who have bacterial vaginosis.
Intractability: Dental caries, commonly known as tooth decay or cavities, is not considered intractable. It can be effectively prevented and managed through proper oral hygiene practices, regular dental check-ups, fluoride treatments, and restorative procedures such as fillings, crowns, and root canals. Prevention strategies include brushing and flossing regularly, reducing sugar intake, and using dental sealants.
Disease Severity: Dental caries, also known as tooth decay or cavities, can vary in severity based on the extent of the decay. Here's a brief overview of disease severity stages for dental caries:

1. **Initial Stage (Enamel Caries)**:
- White spots or lines on the enamel indicate early demineralization.
- No pain typically experienced.

2. **Moderate Stage (Dentin Caries)**:
- Decay progresses beyond the enamel into the dentin.
- Increased sensitivity to sweets, heat, or cold.

3. **Advanced Stage (Pulp Caries)**:
- Decay reaches the pulp, where nerves and blood vessels are located.
- Persistent pain and increased sensitivity.
- Possible formation of abscesses or infection.

4. **Severe Stage (Abscess and Tooth Loss)**:
- Severe infection can lead to abscess formation.
- Tooth structure may be extensively damaged, potentially requiring extraction.

Early detection and treatment are crucial to prevent progression and severe complications associated with dental caries.
Healthcare Professionals: Disease Ontology ID - DOID:216
Pathophysiology: 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 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 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.
Carrier Status: Dental caries, commonly known as tooth decay or cavities, is not a genetic disorder. There is no carrier status associated with it. Instead, dental caries result from a combination of factors including bacterial activity, sugary food intake, poor oral hygiene, and the inherent quality of the tooth enamel. Managing these factors can help prevent the development of dental caries.
Mechanism: Dental caries, commonly known as tooth decay, involves the demineralization of tooth enamel and dentin by acids produced from bacterial fermentation of dietary carbohydrates.

Mechanism:
1. **Bacterial Colonization**: Oral bacteria, primarily Streptococcus mutans, adhere to the tooth surface and produce a biofilm known as dental plaque.
2. **Fermentation**: When carbohydrates from food are consumed, these bacteria metabolize the sugars and produce organic acids, including lactic acid.
3. **Demineralization**: The acids lower the pH in the local environment of the tooth, leading to the dissolution of hydroxyapatite, the mineral component of enamel and dentin.
4. **Cavity Formation**: Continued demineralization without sufficient remineralization leads to the progressive breakdown of enamel and dentin, forming cavities.

Molecular Mechanisms:
1. **Glucan Formation**: Streptococcus mutans synthesizes glucans from sucrose via glucosyltransferase enzymes, which helps in bacterial adherence and biofilm formation.
2. **Acid Production**: Bacteria metabolize sugars through glycolysis, leading to the production of pyruvate, which is then converted to lactic acid by lactate dehydrogenase.
3. **pH Drop**: The localized production of acids results in a microenvironment with lowered pH (below 5.5), critical for the demineralization process.
4. **Enamel Demineralization**: At low pH, hydroxyapatite (Ca10(PO4)6(OH)2) in enamel and dentin dissolves, releasing calcium and phosphate ions into the surrounding environment.
5. **Proteases and Collagenase Activity**: Bacterial proteases and host-derived enzymes such as matrix metalloproteinases (MMPs) can further degrade the organic matrix of dentin, exacerbating cavity formation.

Controlling these processes involves maintaining good oral hygiene, reducing carbohydrate intake, and enhancing remineralization through agents like fluoride.
Treatment: Most importantly, whether the carious lesion is cavitated or non-cavitated dictates the management. Clinical assessment of whether the lesion is active or arrested is also important. Noncavitated lesions can be arrested and remineralization can occur under the right conditions. However, this may require extensive changes to the diet (reduction in frequency of refined sugars), improved oral hygiene (toothbrushing twice per day with fluoride toothpaste and daily flossing), and regular application of topical fluoride. More recently, Immunoglobulin Y specific to Streptococcus mutans has been used to suppress growth of S. mutans. Such management of a carious lesion is termed "non-operative" since no drilling is carried out on the tooth. Non-operative treatment requires excellent understanding and motivation from the individual, otherwise the decay will continue.
Once a lesion has cavitated, especially if dentin is involved, remineralization is much more difficult and a dental restoration is usually indicated ("operative treatment"). Before a restoration can be placed, all of the decay must be removed otherwise it will continue to progress underneath the filling. Sometimes a small amount of decay can be left if it is entombed and there is a seal which isolates the bacteria from their substrate. This can be likened to placing a glass container over a candle, which burns itself out once the oxygen is used up. Techniques such as stepwise caries removal are designed to avoid exposure of the dental pulp and overall reduction of the amount of tooth substance which requires removal before the final filling is placed. Often enamel which overlies decayed dentin must also be removed as it is unsupported and susceptible to fracture. The modern decision-making process with regards the activity of the lesion, and whether it is cavitated, is summarized in the table.Destroyed tooth structure does not fully regenerate, although remineralization of very small carious lesions may occur if dental hygiene is kept at optimal level. For the small lesions, topical fluoride is sometimes used to encourage remineralization. For larger lesions, the progression of dental caries can be stopped by treatment. The goal of treatment is to preserve tooth structures and prevent further destruction of the tooth. Aggressive treatment, by filling, of incipient carious lesions, places where there is superficial damage to the enamel, is controversial as they may heal themselves, while once a filling is performed it will eventually have to be redone and the site serves as a vulnerable site for further decay.In general, early treatment is quicker and less expensive than treatment of extensive decay. Local anesthetics, nitrous oxide ("laughing gas"), or other prescription medications may be required in some cases to relieve pain during or following treatment or to relieve anxiety during treatment. A dental handpiece ("drill") is used to remove large portions of decayed material from a tooth. A spoon, a dental instrument used to carefully remove decay, is sometimes employed when the decay in dentin reaches near the pulp. Some dentists remove dental caries using a laser rather than the traditional dental drill. A Cochrane review of this technique looked at Er:YAG (erbium-doped yttrium aluminium garnet), Er,Cr:YSGG (erbium, chromium: yttrium-scandium-gallium-garnet) and Nd:YAG (neodymium-doped yttrium aluminium garnet) lasers and found that although people treated with lasers (compared to a conventional dental "drill") experienced less pain and had a lesser need for dental anaesthesia, that overall there was little difference in caries removal. Another alternative to drilling or lasers for small caries is the use of air abrasion, in which small abrasive particles are blasted at decay using pressurized air (similar to sand blasting). Once the cary is removed, the missing tooth structure requires a dental restoration of some sort to return the tooth to function and aesthetic condition.
Restorative materials include dental amalgam, composite resin, glass ionomer cement, porcelain, and gold. Composite resin and porcelain can be made to match the color of a patient's natural teeth and are thus used more frequently when aesthetics are a concern. Composite restorations are not as strong as dental amalgam and gold; some dentists consider the latter as the only advisable restoration for posterior areas where chewing forces are great. When the decay is too extensive, there may not be enough tooth structure remaining to allow a restorative material to be placed within the tooth. Thus, a crown may be needed. This restoration appears similar to a cap and is fitted over the remainder of the natural crown of the tooth. Crowns are often made of gold, porcelain, or porcelain fused to metal.
For children, preformed crowns are available to place over the tooth. These are usually made of metal (usually stainless steel but increasingly there are aesthetic materials). Traditionally teeth are shaved down to make room for the crown but, more recently, stainless steel crowns have been used to seal decay into the tooth and stop it progressing. This is known as the Hall Technique and works by depriving the bacteria in the decay of nutrients and making their environment less favorable for them. It is a minimally invasive method of managing decay in children and does not require local anesthetic injections in the mouth.

In certain cases, endodontic therapy may be necessary for the restoration of a tooth. Endodontic therapy, also known as a "root canal", is recommended if the pulp in a tooth dies from infection by decay-causing bacteria or from trauma. In root canal therapy, the pulp of the tooth, including the nerve and vascular tissues, is removed along with decayed portions of the tooth. The canals are instrumented with endodontic files to clean and shape them, and they are then usually filled with a rubber-like material called gutta percha. The tooth is filled and a crown can be placed. Upon completion of root canal therapy, the tooth is non-vital, as it is devoid of any living tissue.
An extraction can also serve as treatment for dental caries. The removal of the decayed tooth is performed if the tooth is too far destroyed from the decay process to effectively restore the tooth. Extractions are sometimes considered if the tooth lacks an opposing tooth or will probably cause further problems in the future, as may be the case for wisdom teeth. Extractions may also be preferred by people unable or unwilling to undergo the expense or difficulties in restoring the tooth.
Compassionate Use Treatment: Dental caries, commonly known as tooth decay, typically require standard treatments such as fillings, crowns, or root canals. However, in terms of off-label or experimental treatments:

1. **Silver Diamine Fluoride (SDF)**: Approved for reducing tooth sensitivity, SDF is increasingly used off-label for arresting active caries.

2. **Ozone Therapy**: Experimental treatment involves using ozone gas to reduce bacterial load in decayed teeth.

3. **Photodynamic Therapy**: Experimental approach using light-activated compounds to selectively target and kill cariogenic bacteria.

Compassionate use is not typically applicable for dental caries, as standard treatments are generally effective and accessible.
Lifestyle Recommendations: **Lifestyle Recommendations for Dental Caries:**

1. **Oral Hygiene:**
- Brush teeth at least twice a day with fluoride toothpaste.
- Floss daily to remove food particles and plaque between teeth.
- Use an antiseptic or fluoride mouthwash to help reduce bacteria and strengthen enamel.

2. **Diet:**
- Limit sugary and acidic foods and beverages, such as candy, soda, and fruit juices.
- Consume a balanced diet rich in fruits, vegetables, whole grains, and lean proteins.
- Drink plenty of water, especially fluoridated water, to help wash away food particles and bacteria.

3. **Regular Dental Visits:**
- Schedule and attend regular dental check-ups and cleanings, typically every six months.
- Seek professional fluoride treatments or dental sealants if recommended by your dentist.

4. **Avoid Tobacco and Limit Alcohol:**
- Avoid using tobacco products, which can contribute to oral health problems.
- Limit alcohol consumption as it can dry out the mouth and create an environment conducive to tooth decay.

5. **Chewing Gum:**
- Chew sugar-free gum after meals to stimulate saliva production, which helps neutralize acids and repair enamel.

Implementing these lifestyle recommendations can significantly reduce the risk of dental caries and promote overall dental health.
Medication: Dental caries, commonly known as tooth decay, primarily require treatments like fluoride treatments, dental fillings, crowns, root canals, and tooth extractions rather than medication. However, for associated pain or infection, over-the-counter pain relievers like ibuprofen or acetaminophen can be used. In cases of bacterial infection, a dentist may prescribe antibiotics such as amoxicillin.
Repurposable Drugs: Repurposable drugs for dental caries are not well-defined, as treatment typically focuses on preventative measures and direct dental interventions rather than pharmaceutical approaches. However, some substances, such as fluoride, have been extensively used to prevent and manage dental caries. Additionally, chlorhexidine is sometimes used as an antimicrobial mouth rinse to reduce bacterial load.

As for nanotechnology, there is growing research into nanomaterials for dental applications. For example, silver nanoparticles have shown potential due to their antimicrobial properties. Nanohydroxyapatite is also being explored for its ability to remineralize enamel and dentin. However, these are still largely in the experimental or early adoption phases and not yet standard treatments.
Metabolites: For dental caries (tooth decay), metabolites are compounds that are produced or consumed during metabolic reactions related to the disease process. The key metabolites involved in dental caries include:

1. **Lactic Acid**: Produced by the metabolism of sugars (e.g., glucose, fructose, and sucrose) by oral bacteria such as Streptococcus mutans and Lactobacilli.
2. **Acetic Acid, Propionic Acid, and Butyric Acid**: Other organic acids that can be generated by different bacterial species present in dental plaque.
3. **Formic Acid**: Another by-product of bacterial fermentation.
4. **Pyruvate**: An intermediate that can be diverted towards the production of lactic acid or other metabolic pathways.
5. **Ethanol and Acetaldehyde**: Occasionally produced by oral bacteria, though less commonly involved in caries development.

The production of these acidic metabolites leads to the demineralization of the tooth enamel and dentin, which is the hallmark of dental caries.
Nutraceuticals: Nutraceuticals, which are food products providing health and medical benefits, can play a role in the prevention and management of dental caries (tooth decay). Some commonly studied nutraceuticals for dental caries include:

1. **Probiotics:** Beneficial bacteria like Lactobacillus and Bifidobacterium can help balance the oral microbiota, reducing harmful bacteria that cause tooth decay.
2. **Xylitol:** A natural sweetener that inhibits the growth of Streptococcus mutans, the bacteria primarily responsible for dental caries.
3. **Green tea extract:** Contains catechins with antibacterial properties that help reduce plaque formation.
4. **Cranberry extract:** Has anti-adhesion properties that can prevent bacteria from sticking to the teeth and gums.
5. **Calcium and Phosphates:** Found in dairy products and supplements, they help remineralize tooth enamel.

Nanotechnology (nan) applications in dentistry offer innovative solutions for preventing and treating dental caries:

1. **Nano-Hydroxyapatite:** Used in toothpaste and dental treatments to remineralize and repair tooth enamel.
2. **Antimicrobial Nanoparticles:** Silver nanoparticles and other antimicrobial agents can be incorporated into dental materials to prevent bacterial growth.
3. **Drug Delivery Systems:** Nanoparticles can deliver anti-caries agents directly to the dental biofilm, increasing treatment efficacy.
4. **Nano-Fillers in Composites:** Improve the strength and durability of dental restorative materials.

Both nutraceuticals and nanotechnology are promising in enhancing dental care and managing caries more effectively.
Peptides: Research into peptides for dental caries prevention and treatment has shown promise. Antimicrobial peptides (AMPs), which are part of the innate immune system, can inhibit the growth of caries-causing bacteria like Streptococcus mutans. Some peptides work by disrupting bacterial cell membranes, while others interfere with biofilm formation.

Nanotechnology offers innovative approaches for dental caries management. Nanoparticles, such as silver, zinc oxide, and calcium phosphate, have been studied for their antimicrobial properties and ability to remineralize enamel. Combining peptides with nanoparticles can enhance the effectiveness of both, providing a dual-action approach to prevent and treat dental caries by targeting bacteria and promoting enamel repair.