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16.2 Dental Caries

Table of Contents

Dental caries are caused by bacteria of the dental plaque which feed on sugary food substrates producing acid as by-products which dissolve the minerals of the tooth surface.

Diagnostic criteria

  • Early stage–asymptomatic
  • Intermediate stage: black/brown spot which may be visible on any surface of tooth
  • Cavities developing on tooth surface
  • Pain/toothache elicited by hot, cold or sweet foods/drinks
  • Late stage: pain may be spontaneous, intermittent, sharp and severe, even interfering with sleep.
  • Tenderness on percussion of the tooth

Investigation: Periapical x-ray of tooth/teeth may need to be done especially to confirm extent of caries for treatment decision e.g. the caries contained in the dentine can be distinguished from pulpal caries.

Prevention

  • Proper counseling to avoid frequent use of sugary foods and drinks
  • Use fluoridated toothpaste to brush teeth at least twice a day
  • Provide preventive measures to early lesions presenting as a spot on enamel without cavitation and softening

Non-pharmacological treatment.

  • Lesion with cavitation but confined to dentine–filling/restoration of teeth with suitable filling materials (e.g. amalgam, composite, glass ionomer)
  • Lesion involving the pulp (with or without periapical abscess), perform advanced tooth restoration by endodontic treatment wherever possible otherwise tooth extraction is done

Pharmacological treatment

Analgesics: for toothache

A: Paracetamol (PO) 1gm 8 hourly for 3 days

OR

A: Ibuprofen (PO) 400 mg 8 hourly for at least 3 days

OR

C: Diclofenac (PO) 50 mg 8 hourly for at least 3 days

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