Dental carie

One names decays an infectious illness of the Dent which damages its structure. It is a lesion of the enamel and Dentine.

The dental carie is the most current lesion with the monde.

History

It would have appeared during the Neolithic time (approximately 7000 years ago in Europe), perhaps in connection with the consumption of flours of cereals and at the time when the populations sédentarisent and give up the predation for a saving in production. The human teeth going back to this period but pertaining to populations still living of hunting and the gathering (including sweetened bays) are not reached by decays.

For the majority of the other mammals, the decay testifies to a degraded general health and food deficiencies.

Factors etiologic

The formation of a decay requires the association of 4 factors:

of the bacteria . Any mouth has a Total colony count. This one can comprise several hundreds of species, variables from one individual to another.
of the substrates . The bacteria need nutritive substances to feed their metabolism.
the host = environment. We all are not identical. There exist internal variations (genetic) and external (smoker or not…). The principal difference is that of the Salive: pH, to be able plug, quantity…
the time . The evolution of the decay depends on the time during which the three preceding factors can interact.

The frequency of nibbling appears in fact more important than what is nibbled.

The factor etiologic is the Dental plaque, constituting a Biofilm (named " exogenic film acquise"). The bacteria composing this biofilm metabolize sugars in acids which dissolve enamel then the dentine.

Supporting factors the dental carie

bad oral hygiene . It is essential to remove the dental plaque progressively its formation to keep healthy teeth.
excessive consumption of sugars : a continuous contribution of nutrients makes it possible the bacteria to be active uninterrupted.
to smoke : the tobacco decreases vascularization, which makes less active local immunizing defenses.
local problem : Hyposyalie (lack of saliva), being able to make following a local irradiation (following a Radiotherapy ORL); bad mineralization of the teeth.
general diseases: Diabetes sweetened, Hyperthyroïdie, Hyperparathyroïdie

Zones of predilection

The decay generally begins in certain zones, less accessible to cleaning.

Furrows . The furrow is the zone at the bottom of the pit. Even with a good brushing, this zone is difficult to reach to the brush with teeth. To delay these decays, one can make a sealing of furrows (or sealent): one seals these hollows before formation of the decay.
Contact point . The zone of contact between two teeth cannot be cleaned with the brush with teeth. If the dental floss or an interdental brossette did not pass regularly, a decay can be formed on this level.
Collet . The brush with flexible tooth is necessary for good capacity to pass on the level of the collet, zone slightly in withdrawal.

Symptoms

The first signs can appear once the decay reached the dentine. But sometimes the pain only occurs very tardily. This is why it is highly advised not to wait to have badly to consult a Dentiste.

cold pains and with sweetened generally signs an active decay, which it is urgent to make treat
pains with the heat or with the pressure generally sign a resumption of decay under an obturation which evolved/moved with low noise and caused necroses it tooth concerned.

visible damage: initially white spot (not always very visible). A spot chestnut (more or less dark) sign an old decay, remineralized, which is not active any more.

When one notices a hole in the tooth, the decay is already advanced; the tooth is likely to have to be devitalized.

Evolution and forecast

Bactérie S develop thanks to the presence of Glucide S on the tooth. The bacteria using simple sugars in aerobic condition consume it whereas in anaerobic condition (when they are isolated from oxygen), they carry out a fermentation. The Métabolisme of these bacteria then generates Acide S which corrode the tooth progressively. Acidity causes the demineralization of the tooth.

An attack of surface of enamel can reminéraliser using the calcium of saliva or fluorine contained in the toothpaste; But a nonsurface decay will be able to never cure only. It is necessary obligatorily to make it treat by a Dentiste.

In the absence of care or adapted treatments, the carieuse disease develops towards the Pulpite then the Nécrose pulp (the " nerf" ), following the colonization of pulp by the pathogenic micro-organisms. This necroses is generally very painful, and can diffuse by endodontical way and become complicated by a Infection extending to the bone.
This infection can be chronic: granulome perish-apical chronicle or cyst (or desmodontite apical chronicle). The infection evolves/moves then often with low noise during several months even several years, and is sometimes detected only by one x-ray inspection of routine. This infection can also be acute: acute perish-apical abscess (or desmodontite apical acute). ( to see : Endodontics)
If a treatment is still not undertaken, the infection continues to be propagated. The ostéites and Cellulite S can be a prelude to a general bacterial invasion by blood way: it is septicaemia. The vital prognosis is then committed.

The demineralization of the dentine can lead to a complete destruction of the dental crown.

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