Karies

Karies, or dental caries, is a multifactorial disease of the mineralized tissues of teeth, driven by acid production from the dental plaque biofilm. It involves demineralization and subsequent cavitation of enamel and dentin. The process is influenced by the presence of cariogenic bacteria (notably Streptococcus mutans and Lactobacillus), fermentable carbohydrates, and a susceptible tooth surface over time.

Early lesions appear as white spot areas of demineralization and often are asymptomatic. If untreated, lesions progress to cavitation, can expose dentin, cause sensitivity, and, in advanced cases, pain or infection reaching the pulp.

Diagnosis relies on clinical examination and bite-wing radiographs to detect occlusal and interproximal lesions, complemented by risk assessment considering dietary habits, fluoride exposure, saliva flow, and past caries experience.

Prevention focuses on reducing plaque, limiting fermentable sugars, and enhancing remineralization. Key measures include regular toothbrushing with fluoride toothpaste, fluoride varnish or gels, dental sealants on fissures, limiting snacking, and maintaining adequate saliva. Socioeconomic factors, limited access to care, and xerostomia increase risk.

Treatment ranges from noninvasive remineralization strategies for early lesions to restorative interventions for cavitated lesions. Restorations restore function and seal the lesion; in children and adolescents, preventive programs are particularly important. In elderly patients, root caries may require different approaches.