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Tuesday, September 9, 2008

Caries

Tooth decay (dental caries) starts with the destruction of the enamel cap by micro-organisms
present in the oral cavity and adherent to the tooth surface. This leads to exposure of the underlying dentin to the oral environment and to its destruction by bacterial proteolytic enzymes. The dental management is the way of teeth manage. Caries will not occur that somebody have a good dental management.
Enamel caries will not be visible in routinely prepared histologic sections as this tissue dissolves
completely during decalcification. In ground sections made from undecalcified teeth, microscopic
examination under transmitted light will reveal optical alterations related to decreased mineral content of a still-intact crystalline structure.
These alterations tend to occur over a coneshaped area having its base on the surface and its point towards the amelo-dentinal junction. With increasing loss of minerals from the enamel structure, this tissue will disintegrate. The dental consultant can make some suggestion about the caries.
Sometimes, this destroyed enamel will contain so much organic material that it is still present in decalcified sections where it is visible as a basophilic amorphous mass.
The initial carious lesion in dentin afflicts the tubuli that serve as a highway for bacteria to spread into the dentin. As the tubules of the carious dentin become more distended due to breakdown of their walls by the proteolytic enzymes excreted by the invading bacteria, they may fuse and form spindle-shaped cavities perpendicular to the tubules. Fusion of afflicted tubules over a longer distance may also create spindle-shaped cavities in the same direction as the tubuli run. Through the continued loss of dentin between the tubules, its inner structure crumbles away .
When caries is not halted by dental treatment, bacteria and their toxic products will reach the
soft inner part of the tooth, the dental pulp, and evoke an inflammatory response . Subsequently,
the pulp dies and toxic substances from the pulp space diffuse through the apical foramen into
the adjacent periapical part of the periodontal ligament and surrounding jaw bone. Periapical
disease will now ensue. If the root surface of a tooth is exposed due to periodontal disease, the root-covering caries may also be the victim of carious decay. At this site, the bacteria penetrate into the cementum using the collagen fibres that once anchored the tooth in its tooth socket as pathways. The dental consultants can make solution about it.