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