-IBIS-1.5.0-
tx
eyes/ears/nose/throat
dental caries/toothache
diagnoses

definition and etiology

definition: Bacterially induced gradual destruction and erosion of the tooth enamel and dentin, leading to involvement of the pulp if not properly treated. Usually leads to cavities.

etiology: This is the second most common human disorder after the common cold. Three factors interrelate to cause caries:
• a susceptible tooth surface
• the presence of caries-inducing bacteria
• a substrate capable of maintaining bacterial growth

The main bacteria responsible for caries is Streptococcus mutans, and the favorable environment for bacterial growth is acidic. Dental plaque (made of polysaccharides, bacteria and salivary glycoproteins) accelerates the development of caries by acid production as well as by resisting the buffering and remineralization attempts of the saliva. Sugary foods are implicated in causing caries (they lead to an acidic oral milieu) especially if they are sticky (e.g. caramels, taffy).

signs and symptoms

The patient may often remain unaware of the development of caries until the disease has significantly progressed.

signs and symptoms:
• intolerance to cold and sugary foods
• as the cavity deepens and leads to damage to the pulp of the tooth, heat sensitivity also develops
• pain on chewing or percussion if the lesion gets deep into the tooth

lab findings and dental exam:
• softening of the enamel and/or dentin when tested with a sharp object
• X-ray of the tooth will show radiolucent areas caries has developed

course and prognosis

Although caries development may be arrested, the damaged tooth will not regenerate. Usually, though, the lesion does not arrest and will continue to develop until severe disease occurs: periapical granuloma leading to periapical cyst or abscess. Complications of these include osteomyelitis, cellulitis and bacteremia.

The normal treatment is excavation and filling of damaged areas. Preventive and supportive measures are also important.

differential diagnosis

• maxillary sinusitis
• dental abscess
• periodontal disease
• TMJ syndrome
• other dental problems


footnotes