Stages of Dental Caries

After every meal consumption food debris accumulates on the surface of teeth. These remnants have to be brushed away. Otherwise, bacteria in the oral cavity transform the sugars left from food into the acids. These acids can cause breakdown of the outermost layer of the tooth and provoke tooth decay progression. Even children may suffer from caries in their early childhood. This disease may develop before all deciduous teeth erupt and find their place in the oral cavity. There and then the teeth already need proper care. Otherwise, caries of primary teeth may cause serious complications affecting permanent teeth before their eruption. That is why parents should control their children’s intake of sugars and make them brush their teeth regularly. 

Dental caries in children

Clinically the following stages of dental caries in children are distinguished:

Stages of Dental Caries - photo 1
Photo 1. Stages of Tooth Decay.

Superficial caries

The earliest form of dental caries represents itself in white, yellowish or brownish spot lesions. These spots are chalky areas of various forms and sizes. They usually appear on the upper incisors. Children have no painful feelings at this stage of tooth decay. However, the tooth may become sore and sensitive to sour, sweet, salty, cold and hot food and beverages. Cariogenic bacteria dissolve various minerals in the enamel. The formation of weak spots and cavities occurs very frequently. The spots which initially have no distinct boundaries start to expand. As the carious cavities appear, rugged surface of the affected tooth is the primary sign of carious lesion. Some patients may confuse it with dental plaque. Tooth enamel undergoes changes at this stage of tooth decay. The cariogenic bacteria act on tooth enamel softening its structure to the point when it can be removed by the dentist with the help of dental instruments. Remineralization of the tooth surface applying topical fluoride and other minerals should be administered to prevent the tooth structure from further damage. Thus, without proper treatment the decay will persist.

Stages of Dental Caries - photo 2
Photo 2. Superficial caries.

Median caries

If no treatment is administered and the initial stage of tooth decay progresses, the bacteria will break through the enamel, which is the hardest layer in the tooth structure, and cause irreversible damage. Median caries is the stage of tooth decay that affects the dentine. Carious cavities filled with softened dentine start to emerge. As the microorganisms invade this tooth layer, they undermine the enamel. As the dentine layer has pain and nerve fibers, pain may be intensified by chewing sweet, hot and cold products. However, this stage may proceed asymptomatically. The dentist will perform X-ray examination of the carious tooth to detect the decay. At this stage remineralization is no more a possible treatment option. The tooth will have to be properly cleaned and accurately filled by the pediatric dentist to stop further transmission.

Stages of Dental Caries - photo 3
Photo 3. Median caries.

Deep caries

Because of the specific structure of deciduous teeth (the dentine canals are broad and short) infection affects the pulp very quickly. This stage of tooth decay is referred to as deep caries. Progressing into the tooth, the bacteria along with their irritant products provoke inflammation of the pulp tissue. Putrefactive gases accompany the process of tooth decay. The infection becomes extremely rampant, pus formation is triggered and blood supply in the tooth is impaired. These factors combine to cause pulpal necrosis. As the nerve tissue is damaged or destroyed, pain disappears. However, if it is not too late, a dentist can prevent the nerve death applying special medications to the affected pulp and filling the carious cavity when the infection is neutralized. If destruction of the nerve tissue is irreversible, root canal treatment must be performed.

Stages of Dental Caries - photo 4
Photo 4. Deep caries.

As the cariogenic bacteria as well as their products reach the surrounding soft tissue, an abscess is formed. The infection passes out and reaches the nerve tissue and blood vessels. This process provokes emergence of persistently throbbing pain in children. The tooth itself becomes extremely sensitive: touch and pressure cause intolerable pain. Before performing any dental manipulation a dentist will prescribe painkillers to relieve soreness and antibiotics to kill the microorganisms. In the patients with deep dental caries swelling of the cheeks may be visible as the inflammation process is in prime condition.

Any stage of tooth decay can be easily prevented. Thus, as prevention is always easier and cheaper than management, everything that should be done is to keep appropriate hygiene of the oral cavity. Visiting the dentist’s office must be an annual practice. These simple preventive measures will save the children’s teeth from dental caries as well as secure them from further problems when permanent teeth erupt.

Video: Early Stage Tooth Decay

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