S. R. Prabhu - Handbook of Oral Pathology and Oral Medicine

Occasionally, supernumerary roots may be detected in mandibular third molars, mandibular canines and premolars

No treatment is required

Detection is critical for endodontic treatment

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1 2.1 Definition/Description

2 2.2 Frequency

3 2.3 Aetiology/Risk Factors/Pathogenesis

4 2.4 Classification of Caries

5 2.5 Clinical Features

6 2.6 Differential Diagnosis

7 2.7 Diagnosis

8 2.8 Microscopic Features

9 2.9 Management

10 2.10 Prevention

Dental caries is an infectious, transmissible disease resulting in destruction of tooth structure by acid‐forming bacteria found in dental plaque (an intraoral biofilm) in the presence of fermentable carbohydrates

The infection results in the loss of tooth minerals that begins with the outer surface of the tooth and can progress through the dentin to the pulp, ultimately compromising the vitality of the tooth

60–90% of schoolchildren worldwide; the disease is most prevalent in Asian and Latin American countries

Biofilm acid‐producing bacteria metabolize sugars and produce acids that lower the biofilm pH creating conditions that demineralize tooth enamel and dentin

Acid‐producing bacteria are Mutans streptococci and Lactobacillus species

Acids produced include lactic, acetic, formic and propionic acids. These acids are capable of demineralizing enamel and dentin

Cycles of demineralization and remineralization continue in the mouth in the presence of cariogenic bacteria, fermentable carbohydrates and saliva

Plaque microorganisms, substrate, susceptible tooth and time are essential factors for the development of caries

Classification is based on:Rate of progression: acute and chronic cariesAffected dental hard tissues: enamel, dentin and cemental (root surface) cariesLocation on the tooth surface involved: pit and fissure caries, approximal/smooth surface caries and root surface caries ( Table 2.1) Table 2.1 American Dental Association caries classification system: Site Definitions‐OriginSource: Based on Ismail, A.I., Tellez, M., Pitts, N.B. et al. (2013). Caries management pathways preserve dental tissues and promote oral health. Community Dentistry and Oral Epidemiology 41 (1): e12–e40.SiteDefinitionPit and fissureThe anatomical pits or fissures (clefts or valleys in the tooth surface) of the teeth at the occlusal, facial or lingual surfaces of posterior teeth OR the lingual surfaces of the maxillary incisors or caninesApproximal surfaceThe contact point(s) between adjacent teethCervical and smooth surfaceThe cervical area or any other smooth enamel surface of the anatomic crown adjacent to an edentulous space (toothless space); may exist anywhere around the full circumference of the toothRootThe root surface apical to the anatomic crown

Asymptomatic in the initial stages

Mild pain, tooth sensitivity when carious lesion gets larger

Visible cavity in the tooth

Brown, black or white chalky discoloration

Oral malodour

Decay at a location that has not previously experienced decay

Appears at a location with a previous history of caries

Frequently found on the margins of fillings and other dental restorations

A lesion on a tooth that was previously demineralized but was remineralized before causing a cavitation

Severe decay on multiple surfaces of many teeth ( Figure 2.1)

Those at risk: individuals with xerostomia, poor oral hygiene, drug‐induced dry mouth, large sugar intake and radiation to the head and neck region

Treatment options include therapeutic and preventive strategies, including diet modifications Figure 2.1 Rampant caries(source: From Mary A. Aubertin. 2014. Common Benign Dental and Periodontal Lesions. In: Diagnosis and Management of Oral Lesions and Conditions: A Resource Handbook for the Clinician, ed. Cesar A. Migliorati and Fotinos S. Panagakos, IntechOpen, doi: 10.5772/57597).

Rampant dental caries in infants and toddlers; also known as baby‐bottle caries

Most likely affected teeth: maxillary anterior deciduous teeth ( Figure 2.2)

Cause: allowing children to fall asleep with sweetened liquids in their bottles or feeding children sweetened liquids multiple times during the day

Education of parents/carers to follow healthy dietary and feeding habits to prevent the development of early childhood caries is important

Rampant caries often found in methamphetamine users and is often called ‘meth mouth’

The dental symptoms of methamphetamine users include poor oral hygiene, gingival inflammation, xerostomia, rampant caries and excessive tooth wear Figure 2.2 Early childhood caries(source: by kind permission of Dr Sadashivmurthy Prashanth, JSS Dental College, Mysuru, India). Figure 2.3 Caries in a methamphetamine user(source: From Mary A. Aubertin. 2014. Common Benign Dental and Periodontal Lesions. In: Diagnosis and Management of Oral Lesions and Conditions: A Resource Handbook for the Clinician, ed. Cesar A. Migliorati and Fotinos S. Panagakos, IntechOpen, doi: 10.5772/57597).

The pattern of caries is distinctive: it tends to start near the gums and involves the buccal smooth surface of the posterior teeth and the interproximal space of the anterior teeth, and progresses to complete destruction of the coronal portion of the tooth ( Figure 2.3)

The key to successful dental treatment is cessation of methamphetamine use.

Radiation caries is a complication of head and neck cancer radiotherapy

Typical radiation caries is characterized by enamel erosion and dentin exposure ( Figure 2.4)