Tooth decay and cavities - causes, symptoms, diagnosis, treatment, pathology

Summary

This script offers an in-depth look at dental caries, explaining its causes, progression, and treatment. It details the tooth's structure, the role of bacteria and sugar in demineralization, and the importance of saliva in remineralization. The video emphasizes the balance between cariogenic and protective factors, the impact of diet, and preventive measures, including proper hygiene and fluoride use. It also discusses diagnostic methods and various treatment options, from remineralization to dental fillings and crowns, highlighting the need for addressing the root causes to prevent new caries.

Takeaways

• 📚 Learning medicine can be made easier with Osmosis, which offers personalized study plans including exclusive videos, practice questions, and flashcards.
• 🦷 Dental caries, also known as tooth decay, is caused by the demineralization or weakening of teeth due to the action of bacteria in the mouth.
• 🏥 The tooth structure includes the root, neck, crown, and is covered by cementum, enamel, and dentin, with the enamel being the hardest substance in the human body.
• 🌱 Enamel formation occurs before the tooth erupts and is produced by ameloblasts; once the tooth erupts, the ability to produce more enamel is lost.
• 🌐 The tooth's interior contains blood vessels and nerves that enter through the apical foramen and provide nutrition and sensation to the tooth.
• 🦷 Dentin is secreted by odontoblasts and contains sensory nerves that travel through tubules to the dentin enamel junction.
• 🤝 Saliva plays a crucial role in maintaining oral health by neutralizing acids, providing minerals for remineralization, and thickening to protect tooth surfaces.
• 🔄 Dental caries result from a balance between demineralization caused by bacteria and sugars, and remineralization aided by saliva and fluoride.
• 🦠 Dental plaque forms when bacteria attach to the tooth surface using adhesions and ferment sugars, leading to the production of lactic acid and potential enamel demineralization.
• ⚠️ Conditions that reduce saliva production or increase acidity in the mouth, such as Sjogren's syndrome or gastric reflux, can increase the risk of dental caries.
• 🛠️ Treatment of dental caries includes preventive measures like fluoride application and antibacterial rinses, as well as restorative treatments like fillings and crowns if the decay is advanced.

Q & A

What does Osmosis offer to make learning medicine easier?

Osmosis offers a personalized study plan that includes exclusive videos, practice questions, and flashcards, derived from lectures and notes.

What is dental caries disease, also known as tooth decay, characterized by?

Dental caries disease is characterized by the demineralization or weakening of the teeth, which can progress to cavitation or the formation of a hole, indicating tooth breakdown.

What are the two bones that support the teeth and how are they related to the teeth?

The mandible supports the bottom row of teeth and the maxilla supports the top row. Both have an alveolus or socket for each tooth, lined by a periodontal ligament and covered by gingiva or gums.

What is the hardest substance in the human body and how is it formed?

Enamel is the hardest substance in the human body, formed by ameloblasts before the tooth erupts into the mouth and cannot be regenerated once the tooth has erupted.

What is the function of the blood vessels and nerves that enter the tooth through the apical foramen?

The blood vessels and nerves provide nutrition and sensation to the tooth by entering the center of the root through the apical foramen and reaching the pulp.

What is the role of odontoblasts in the tooth structure?

Odontoblasts are cells that secrete dentin, a bone-like substance filled with proteins and minerals, and have long processes that lay within tiny tubules in the dentin for sensory nerve transmission.

What is the significance of saliva in the context of dental caries?

Saliva plays a crucial role in neutralizing acid in the mouth with bicarbonate ions, thickening with glycoproteins like mucin, and providing calcium and phosphate for remineralization of the tooth surface.

How does the formation of dental plaque contribute to dental caries?

Dental plaque is a sticky collection of bacteria, proteins from saliva, and dead cells that forms on the tooth surface. It allows bacteria to attach firmly and form a biofilm, which can lead to demineralization if the local pH drops below 5.5.

What factors can tip the balance towards caries progression?

Factors such as having less bicarbonate-rich saliva due to conditions like Sjogren's syndrome, radiation treatment, gastric reflux, or as a side effect of medication or recreational drugs can tip the balance towards caries progression.

How does the pH of the mouth environment affect the bacteria responsible for dental caries?

A lower pH environment favors bacteria like mutans streptococcus and lactobacillus, which thrive in low pH and contribute to tooth demineralization.

What are the symptoms of dental caries and how is it diagnosed?

Symptoms of dental caries include tooth pain and sensitivity, especially when chewing or drinking hot, cold, or sweet substances. Diagnosis is made based on symptoms, visual inspection for discoloration or roughness, and dental radiographs.

What are the treatment and prevention strategies for dental caries?

Treatment and prevention strategies include stopping demineralization and promoting remineralization, reducing levels of harmful bacteria, restoring the tooth surface if needed, and using products that mimic saliva or contain fluoride.

Outlines

00:00

📚 Learning Medicine with Osmosis and Dental Caries Basics

This paragraph introduces the concept of personalized study plans for medical students using Osmosis, a platform that simplifies the learning process with videos, practice questions, and flashcards. It then delves into dental caries, also known as tooth decay, explaining the demineralization process and how it leads to cavitation. The structure of the tooth, including the mandible, maxilla, alveolus, and the protective para Donald ligament and gingiva, is described. The tooth's composition, including cementum, enamel, and dentin, is detailed, along with the role of ameloblasts in enamel formation and the importance of saliva in maintaining oral health by neutralizing acids and remineralizing teeth.

05:02

🦠 Dental Caries Progression and Treatment

This paragraph discusses the factors that contribute to the progression of dental caries, such as insufficient bicarbonate-rich saliva due to conditions like Sjogren's syndrome or side effects of medication. It explains how sugar fermentation by bacteria leads to lactic acid production, lowering the pH in the mouth and promoting demineralization. The paragraph describes the shift in bacterial populations towards those that thrive in acidic conditions and the formation of dental plaque. It also covers the process of demineralization and the eventual cavitation of the enamel, leading to bacterial invasion of the dentin. The importance of early diagnosis and treatment, including remineralization products and dental restorations, is emphasized, along with the prevention strategies such as risk assessment and improved oral hygiene practices.

10:09

🦷 Dental Caries Lesions: Diagnosis and Prevention

The final paragraph focuses on the diagnosis and prevention of dental caries lesions. It outlines the conditions that favor the formation of these lesions, such as a high sugar environment and low pH levels, which promote the growth of cariogenic bacteria. The importance of visual inspection and radiographic imaging in diagnosing caries is highlighted. The paragraph concludes with a summary of treatment options, which include halting demineralization, promoting remineralization, reducing harmful bacteria levels, and restoring tooth surfaces. It underscores the importance of a comprehensive approach to dental care to prevent the formation of new caries lesions.

Keywords

💡Osmosis

Osmosis is a learning platform that simplifies the process of studying medicine by providing personalized study plans, exclusive videos, practice questions, and flashcards. In the script, Osmosis is introduced as a tool to make the hard work of learning medicine easier, emphasizing its role in facilitating understanding and retention of complex medical concepts.

💡Dental caries

Dental caries, commonly known as tooth decay, is the focus of the video. It refers to the demineralization and weakening of teeth, which can eventually lead to cavitation or the formation of a hole in the tooth surface. The script explains that dental caries is a disease process that involves a tug of war between pathogenic factors promoting demineralization and protective factors promoting remineralization.

💡Demineralization

Demineralization is the process where minerals, such as calcium and phosphate, are lost from the tooth structure, leading to its weakening. The script describes how the balance of bacteria in the mouth and the presence of sugar can lead to the production of lactic acid, which in turn can cause demineralization of the enamel and dentin.

💡Enamel

Enamel is the outermost layer of a tooth and is the hardest substance in the human body due to its high mineral content. The script explains that enamel is formed by ameloblasts before the tooth erupts and that once the tooth is in the mouth, it cannot produce more enamel, making it crucial to protect it from demineralization.

💡Pellicle

The pellicle is a thin layer that covers the tooth and serves as the initial surface for bacterial colonization. In the script, it is mentioned that early colonizers, such as viridans group streptococci, attach to the pellicle, which is the starting point for the formation of dental plaque.

💡Sucrose

Sucrose is a type of sugar found in various foods and drinks, including table sugar. The script describes how bacteria in the mouth use sucrose to produce energy and create a sticky substance called glucan, which contributes to the formation of dental plaque and the subsequent demineralization process.

💡Dental plaque

Dental plaque is a sticky film of bacteria, proteins, and other substances that can form on the surface of teeth. The script explains that plaque is a result of bacterial metabolism of sugars like sucrose and can lead to demineralization and dental caries if not removed.

💡Remineralization

Remineralization is the process by which minerals are redeposited into the tooth structure, helping to repair early signs of dental caries. The script mentions saliva as a source of minerals like calcium and phosphate, which are essential for remineralization and maintaining tooth health.

💡Cavitation

Cavitation refers to the formation of a hole or cavity in the tooth surface as a result of advanced dental caries. The script describes cavitation as the physical evidence of tooth breakdown, which occurs when the enamel surface collapses due to severe demineralization.

💡Restorative treatment

Restorative treatment in the context of dental caries involves procedures to repair the damage caused by the disease. The script mentions fillings, dental crowns, and root canal procedures as examples of restorative treatments that can help manage the effects of dental caries and restore tooth function.

💡Risk assessment

A risk assessment for dental caries involves identifying individuals at high risk for the disease. The script explains that factors such as previous caries lesions, problems with saliva production, and poor dietary habits can contribute to an increased risk of dental caries, and a risk assessment can help in early detection and prevention.

Highlights

Learning medicine is made easier with Osmosis, a platform that personalizes study plans with exclusive videos, practice questions, and flashcards.

Dental caries, also known as tooth decay, is the result of a demineralization process weakening the teeth.

An advanced caries lesion can lead to cavitation, which is a physical sign of tooth breakdown.

The mandible and maxilla are the bones that support the teeth, with alveoli housing the tooth roots.

The paragingival ligament and gingiva protect the alveolus and cover the tooth root surface.

The tooth is divided into the root, neck, and crown, with the crown being the hardest substance in the human body due to its enamel.

Ameloblasts are cells responsible for enamel formation before a tooth erupts into the mouth.

Blood vessels and nerves enter the tooth through the apical foramen and provide nutrition and sensation.

Odontoblasts secrete dentin, a bone-like substance filled with proteins and minerals.

Saliva plays a crucial role in neutralizing mouth acid and supplying minerals for tooth remineralization.

Dental caries involves a tug-of-war between demineralization and remineralization processes in the tooth.

Viridans group streptococci are early colonizers that attach to the tooth's pellicle layer using adhesions.

Sucrose is metabolized by bacteria to produce lactic acid, contributing to tooth demineralization.

A decrease in mouth pH can lead to the dominance of bacteria that thrive in low pH environments.

Dental plaque is a biofilm that forms on teeth and can lead to demineralization if the pH drops below 5.5.

If enamel demineralization continues, it can lead to cavitation and exposure of the dentin to bacteria.

Dental caries can cause pain and sensitivity, especially with hot, cold, or sweet stimuli.

Diagnosis of dental caries includes visual inspection, symptoms assessment, and dental radiographs.

Prevention and treatment of dental caries involve risk assessment, antibacterial measures, and remineralization products.

Restorative treatments like fillings and crowns address the symptoms but do not resolve the underlying cause of caries.

Carious lesions can form not only on the enamel but also on the cementum if gingival recession occurs.

Transcripts

learning medicine is hard work osmosis make it easy

Learning medicine is hard work osmosis makes it easy

It takes our lectures and notes to create a personalized study plan with exclusive videos practice questions and flashcards

and so much more

Try it free today

Dental caries disease also called tooth decay

Refers a demineralization or weakening of the teeth and the end result of caries diseases. It carries the lesion

An advanced caries lesion can progress to the point where the tooth surface forms a cavitation or a hole?

Which is the physical evidence of tooth breakdown?

Let's start by building a model of a tooth and its surrounding structures in the mouth the bone beneath

The bottom row of teeth is the mandible and the bone above the top row of teeth is the maxilla

Both bones have an alveolus or socket for each tooth

The socket is lined on the inside by a para Donald ligament

protecting the alveolus on the outside is a layer of soft supportive tissue called the gingiva or gums that

Sits on the top of the bone and covers the root surface from the bone to the cementoenamel junction

Where the cementum in the UNAM will come together

The tooth itself can be roughly divided into a few parts. The first part is the root and it sits within the alveolus

the root is covered by cementum, which is a bone like substance that the para donald ligaments fiber is attached to

Next there's the neck which is the transition between the root portion covered by bone in the crown

The crown is the visible part of the tooth that protrudes from the gingiva, and it's covered in enamel

Which has such a high mineral content that it's the hardest substance in the human body

When the teeth are developing enamel is made before the tooth erupts into the mouth by a group of cells called the ameloblasts

That dye wants the tooth erupts

Meaning that the teeth lose the ability to make more enamel forever

Now let's fill the tooth in from the inside out

Blood vessels and nerves come from the jaw bones and enter the center of the root through a narrow passage

Called the apical foramen

From there. They enter the soft center of the tooth called the pulp. Will they provide nutrition in sensation?

The outer wall of the pulp has Edano blasts which are cells that secrete a bone like substance called dentin

Which is filled with proteins and minerals

The Adana blasts have long processes or arms that lay within tiny tubules in the dentin

Kind of like an octopus sticking its arms through a block of cement

These tubules are important for sensory nerves as well, which use them to travel through the dentin from the pulp to the dentin enamel Junction

Finally there's saliva, which is secreted from several glands in the mouth

Saliva has bicarbonate ions, which helps to neutralize acid in the mouth as those glycoproteins like mucin that thickens the saliva

Saliva also has calcium and phosphate which serve as a replacement minerals to help remineralize the tooth surface

So when it comes to dental caries

There's a tug of war between the pathogenic factors that promote demineralization of the tooth and protective factors that promote re mineralization of the tooth

Normally, there's a layer called the pellicle that covers the tooth and bacteria in the mouth like viridans group streptococci

settle on that pellicle layer

These bacteria are called early colonizers and they attach to the surfaces using bacterial surface proteins called adhesions

because they're on the pellicle of the teeth these bacteria come into contact with sucrose which

Is a sugar found in various foods and drinks including table sugar?

Sucrose has a glucose molecule bound to a fructose molecule

so the bacteria use an enzyme called glucose sil transferase to cut the bond between them and

Use the fructose for energy and add glucose to a growing chain of glucose molecules called the glucan

Who cans allow the bacteria to attach firmly to the surface of the tooth and form dental plaque which is a sticky collection of bacterial

Proteins from saliva and dead cells from the lining of the mouth

Individual bacteria multiply and form a lot of small micro colonies that coalesce which creates a layer of dental plaque

What is the type of biofilm?

Compared to a micro colony the bacteria in a biofilm communicate with each other via chemical signaling and together

they create a complex system where some bacteria work on tunneling between the micro colonies and to the surface in order to bring in a

steady supply of food as

An analogy if bacteria were ants than a micro colony would be a tiny group of ants each doing its own thing

Whereas a biofilm would be an ant farm with complex tunnels in rooms and each ant carrying out a specialized task

So typically dental plaque can form on the surface of teeth

But if the pH of the local environment around the tooth surface remains above about 5.5

enamel will not demineralize

One factor that tips the balance towards caries progression is having less bicarbonate rich saliva, which can result from conditions like Sjogren's syndrome

radiation treatment for cancer gastric reflux or as a side effect of a medication or recreational drugs a

Key factor that contributes to tooth demineralization is sugar

some bacteria ferment sucrose and that produces lactic acid as a byproduct in

Addition acidic foods and drinks can also cause a pH in the mouth to lower

So a drink that has lots of sugar and lots of acid like soda which has a pH of around three

Can damage the teeth in two ways?

The bacterial population in the mouth is diverse and if the pH in the mouth starts to decrease it alters the balance of power

bacteria that thrive in a low PH like mutants streptococcus e in lactobacillus start to dominate

as

Dental plaque grows thicker the amount of oxygen near the enamel surface starts to fall

That makes the environment on the enamel surface favorable for facultative anaerobic bacteria

Which can metabolize sugars with and without oxygen present if?

Sucrose is metabolized anaerobically or without oxygen

Lactic acid starts to build up and it can quickly lower the pH on the enamel surface to below 5.5

Once the environment becomes that acidic

calcium and phosphate in the enamel start to dissolve into the fluid filled diffusion channels between the enamel crystals and

That starts the process of demineralization

Every time sugar enters the mouth the bacteria are able to produce more acid and this destruction in the subsurface

Continues until the surface gets so thin that it collapses like walking on thin ice

Intact enamel keeps bacteria out of the dentin because they do not fit through the enamel diffusion channels

However, if deep mineralization is allowed to continue the enamel surface will cavitate to expose the dentin which will allow bacteria to enter the dentin

once bacteria are in the dentin it's called infected dentin and usually requires a restoration or filling if

Destruction continues into the dentin layer, then the caries lesion enlarges towards the pulp

Eventually the bacteria penetrate into the pulp causing irritation and damage to the nerves

That's the stage when individuals usually experience pain

Although pain can also happen when the caries lesion involves the dentin layer since sensory nerve fibers travel through tubules in the dentin

Eventually bacteria travel down into the root canal space and fill the entire inside of the tooth

it's worth mentioning that formation of a carious lesion doesn't have to start with the enamel of the crown if

The gingiva recedes or plaque forms between the gingiva and the root

Bacteria and acids have direct access to the cementum which is much softer than enamel and dissolves more quickly

The demineralization of cementum and dentin can happen in a pH range of 6.2 to 6.8

Symptoms of dental caries include tooth pain and sensitivity

Especially when chewing or drinking something. That's or hot or sweet

If the process continues it can eventually lead to a root canal procedure or even losing a tooth

Diagnosis is usually made based on symptoms and looking for areas of discoloration or roughness

Tenderness or inflammation in the mouth as well as using dental radiographs

It's always ideal to prevent a caries lesion from forming in the first place and it starts with a risk assessment for identifying

individuals at high risk of caries

That includes individuals that have had a prior or current carries lesion have problems with saliva production

has specific abnormal levels of acid forming bacteria like mutant streptococcus II and lactobacillus in their mouths and

Those that have poor dietary habits like frequent snacking as well as a high sugar diet

so treatment of dental caries disease depends on the level of risk more specifically reducing the pathogenic risk factors like

antibacterial rinses to get rid of bacteria and

increasing protective factors like products that mimic saliva

In addition brushing and flossing are useful because they physically remove dental plaque as well as deliver fluoride to the teeth to help with

Remineralisation products that have fluoride can help remineralize spots where enamel is lost. It's hard minerals

If the enamel surface is intact, then the caries lesion can be treated without drilling a tooth and instead you can use chemical remineralisation

once the enamel surface is fully cavitating to the dentin now the bacteria have a pathway to enter the dentin and

It might be necessary to remove the infected dentinal tissue and replace it with a dental filling which allows the tooth to chew

If the infection is so large the entire top of the tooth needs to be removed a dental crown can be used to replace it

Ultimately, these restorative treatments are useful

But they alone don't resolve the underlying cause of the caries lesion and can't prevent new caries lesions from forming

Alright as a quick recap

Dental caries lesions are the end result of the dental caries disease process

Dental caries lesions typically form in an environment where there are lots of sugars in the mouth and a pH below

5.54 enamel and below 6.2 to 6.8% amande dentin that environment favors bacteria like mutant

streptococcus e in lactobacillus which

Demineralized enamel and the dentin beneath it and if untreated it can eventually result in a cavity caries lesion

Diagnosis is done by visual inspection and radiographic imaging and treatment and prevention includes stopping D mineralization and promoting

Remineralization as well as reducing levels of harmful bacteria and restoring the surface of the tooth if needed

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