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Dental caries
History
It appeared during the Neolithic period (there are about 7000 years in Europe), perhaps related to the consumption of cereal flours and when populations abandon sédentarisent and predation for an economy of production. The human teeth dating from this period but belonging to people still living from hunting and gathering (including sweet berries) are not affected by caries.
For most other mammals, caries reflects a general deterioration of health and nutritional deficiencies.
Causative factors
The formation of a cavity requires the combination of 4 factors:
* Bacteria. Any mouth has a bacterial flora. The latter may include several hundred species, which vary from one individual to another.
* Substrates. Bacteria need nutrients to fuel their metabolism.
* Host = field. We are not all identical. There are genetic variations and related to lifestyle (mineralization of the tooth, malpositions, salivation, medications, dietary habits, smoking or not, degree of exposure to stress, etc. ...). The main difference is that the saliva: pH, buffered quantity ...
* Time. The evolution of decay depends on the time during which the three previous factors can interact.
The frequency of nibbling is actually more important than what is eroded by increasing the contact time (deterioration) food with dental surfaces.
The causative factor is the plaque is a biofilm (called "exogenous acquired film"). The bacteria present in this biofilm metabolize sugars acids that dissolve enamel then dentine.Cet organic coating, observable after two or three days without brushing, concentrating on both bacteria and substrates in the host, is highly cariogenic . Hence the importance of eliminating a daily hygiene.
Contributing factors dental caries
* Poor oral hygiene. It is essential to remove dental plaque as his training to keep teeth healthy.
* Excessive consumption of sugars: a continuous supply of nutrients allows the bacteria to be active continuously.
* Smoking: tobacco decreases vasculature, which makes them less active local immune defenses, including among children exposed to passive smoking parents.
* Local problem: hyposyalie (lack of saliva), which may be preceded by a local irradiation (following radiotherapy ENT); mouth respiration; mineralization bad teeth.
* General diseases: diabetes mellitus, hyperthyroidism, hyperparathyroidism, treatment with corticosteroids.
* Stress: many studies have highlighted a direct link between stress and the rate of caries. The holistic dentistry takes into account the dimension of stress.
Areas of choice
The decay begins most often in some areas, less accessible for cleaning.
* Sillons. The path is the area anfractueuse, negative relief, intaglio, any tooth surface. Even with a good brushing, this area is easily accessible to the toothbrush. To prevent these cavities, you can make a seal furrows (or sealent): filling these hollow before formation of cavities.
* Point of contact. The contact area between two teeth can be cleaned with toothbrushes. If the floss did not go regularly, a bunt can form this place.
* Collet. The flexible toothbrush is necessary to go well at the collar, slightly indented area.
Symptoms
The first signs may appear once the cavity has reached the dentin. But sometimes the pain occurs only very late. That is why it is strongly advised not to wait for trouble to consult a dentist.
* Pain to cold and sweet sign most often a bunt active or denudation dental crown, it is urgent to deal
* Hot pain or pressure generally sign a resumption of caries in a shutter that has evolved low noise and caused necrosis of the tooth concerned.
* Visible damage initially white patch (not always very visible). A brown stain (more or less dark) signs a bunt old reminéralisée, which is no longer active.
When we noticed a hole in the tooth decay is already advanced, the tooth may need to be devitalised.
Evolution and prognosis
Bacteria thrive thanks to the presence of carbohydrates on the tooth. The bacteria using simple sugars in the aerobic fitness consume while in anaerobic condition (when they are isolated from oxygen), they make a fermentation. The metabolism of these bacteria then generates acids that corrode as the tooth. Acidity causes demineralization of the tooth.
An infringement on the surface of the enamel can remineralize the help of calcium saliva or fluorine content in toothpaste; But not superficial cavities may never heal alone. It is mandatory to be handled by a dentist.
In the absence of care or treatment adapted, the disease progresses to the caries pulpitis then necrosis of the pulp (the "nerve"), following the colonization of the pulp by micro-organisms. This necrosis is usually very painful and can spread through endodontics and complicated by an infection spreading to the bone.
This infection can be chronic granuloma peri-apical or chronic cyst (desmodontite apical or chronic). The infection then moves often low noise for several months or several years, and is sometimes detected by a routine X-ray control. The infection can also be acute abscess peri-apical acute (or desmodontite apical acute). (see: endodontics)
If treatment is still not begun, the infection continues to spread. The osteitis cellulites and may herald a general bacterial invasion through blood is septicaemia. The prognosis is therefore vital engagé.En especially among vulnerable people.
Conservatives care
With rotary instruments (strawberries mounted against-angle or turbine), ultrasound or laser, the dentist carry out the eviction of a soft tissue decay.
He then fills the cavity created by the excision of tissue with a filling material, usually a composite or a combination.
See also: Conservative Dentistry, dental Erbium laser.
Devitalisation
When the cavity has reached an advanced stage, the dentist must dévitaliser tooth (pulpectomy), then plugging channels in which was the pulp to prevent bacterial infection (shutter canal). Once the bacteria have entered the pulp, the tooth must be devitalised.
The tooth devitalised being more fragile, the risk of fracture is increased.
See also: endodontic treatment
Prothese
If the decay has destroyed a large part of the tooth, it must be reconstituted with a crown.
See also: dentures.
When the tooth must be removed, new techniques make it possible to put in place of the tooth removed a wisdom tooth if it had not been removed and that the surgeons dentist judge that it can be accommodated. This technique is still not very répendue but tends to grow. Such intervention must be accompanied by a treatment to avoid rejection and failure cases are still important.
Vaccine
A vaccine cavity is regularly announced.
The main germ involved in the formation of caries is Streptococcus mutans. Others seem cariogenic (Lactobacillus, ...) But there are 300 species of bacteria that can colonize the oral cavity (approximately 50 to 150 species per individual). Not all are pathogens, far from it: they are commensal flora.
The danger is to try to eliminate all bacteria present. As in the rest of the digestive tract, the presence of bacteria is necessary. In addition, the elimination of all bacteria leaving a vacant ecological niche, which could be settled either by only pathogenic bacteria, or fungi (Candida albicans). We can observe this phenomenon in patients treated with massive doses of broad spectrum antibiotics (which should be used very sparingly).
Prevention
The prevention of dental caries requires above all:
* A good oral hygiene.
The regular and thorough brushing twice a day (morning and evening) is imperative. To do this we must use a soft toothbrush, non-aggressive, fluoride toothpaste and floss to prevent cavities interdental.
* Avoid snacks without food or drink sugary drinks: it increases the attacks against the teeth by increasing bacterial activity and thus acidifying the mouth.
* The soft drinks, syrups and fruit juices are very cariogenic: they are not only very sweet but also very acidic which will decrease further oral pH. The products "lights", flavoured waters, juices "natural" are no exception. The water must be drinking privileged, especially among young children.
* If you do not have access to his toothbrush, a sugar-free chewing gum can be used to make at least salivate heavily (to reduce the acidity of the mouth) until the next brushing mechanics.
* A diet adapted: focus on food compared to the full refined foods. To reduce foods containing sugar.
* The regular screening to the dentist: it will treat caries at an early stage. The dental injuries will be minimal. It does not cure a tooth decay, its progress was stopped by his curettage and plugged on the residual cavity. This screening will be ideally every 6 months, an annual visit will be sufficient adult who presents few problems of tooth decay or gum problems.
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