Prevention and Treatment of Dental Caries

Dental caries, also known as cavities, are “a transmissible bacterial disease process

caused by acid” (Featherstone, 2008, p. 286 ). Dentists fix caries by drilling the decay away,

cleaning the area, and then fill it with a filling material. That filling material is made out of

“inorganic cements based on calcium or silicone-based mineral aggregates” (Neves, Babb,

Chandrasekaran, & Sharpe, 2017, p. 1). Everyone has a general idea of what caries are, but what

people don’t know is the way dentist treat them now isn’t the best method. By using the filling

material, the tooth’s regular mineral mass is never entirely replaced (Neves et al., 2017). This has

made researchers want to know more and look for something that doesn’t take away the tooth’s

regular mineral mass. These include glycogen synthase kinase-3 (GSK3), and photodynamic

therapy (PDT) (Hakimiha, Khoei, Bahador, & Fekrazad, 2014). They also found that saliva

benefits the tooth in many ways. I chose this topic because I want to be a dental hygienist.

Caries are more important than you think. Caries can be minor or severe, so treatment

varies. There are three main layers to the tooth. The top layer is called the enamel, which is

mostly made up of hydroxyapatite (Colgate, n.d.). Once caries breaks through the enamel it’s

inescapable. The middle layer is called the dentin. When a cavity reaches the dentin, repair to the

tooth is needed. The last basic layer is called the pulp. The pulp contains the nerves of the tooth,

also containing connective tissue, and blood vessels as well (Medical News Today, 2018).

Destroying to the pulp can result in loss of the tooth.

There are many different types of tooth filling materials you can get. Gold, silver, and

tooth-colored are the three main fillings people have heard of, but there is more than just three.

Some you might not have heard of are; ceramics, and glass ionomer (WedMD, 2017). Any filling
is a good option, but they all have their drawbacks. A gold filling is a good option because of

their ability to last a long time, their resistance to chewing, and some people think it looks more

attractive than silver (WedMD, 2017). It has all these good qualities but for a hefty price. Not

only is it expensive, but it also could take more visits to the dental office than other fillings do,

and has a minimal possibility of causing pain if placed next to a silver filling. Silver fillings are

also a good option for their ability to last a long time, and their resistance to chewing, in addition

they may not cost as much as composite fillings. The silver filling is a bit bigger than other

filling material, usually healthy parts of your tooth will have to be removed in order to fit the

silver filling. Not only that, the silver filling will most likely turn into a gray color. Drinking hot

and cold drinks could result in a cracking of the filling. Tooth-colored fillings are being used a

lot. They are closely matched to the color of your tooth with more brace for impact. In addition,

less of the healthy part of your tooth will have to be removed. Even though it’s the color of your

tooth it doesn't have as much durability as a silver filling, and they aren't exactly on the cheap

side.

Some fillings that aren't well known could also be a great option. Ceramics, which is

usually made out of porcelain, last up to fifteen years (WebMD, 2017); longer than silver and

gold. Though the price might be pretty expensive. Another filling that could be used is glass

ionomer. Being made out of acrylic and glass the common use for this filling is around the gum

line. This filling lets out fluoride that could help lessen tooth decay, but only last about five years

or so.

When people get a cavity they don’t think much of it. They schedule an appointment to

fix it, get it fixed and move on. Caries are caused by sugar, we all know that. What we don’t
know is that the healthy part of the tooth never grows back, resulting in destroyed healthy

enamel of the tooth. You can do many things to help prevent caries, before it’s to late. By eating

the right food and/or taking vitamins, some caries may be prevented. Calcium is a big part of

your overall health. You can get calcium from lots of different foods, like cheese and milk

(123Dentist, 2013). This helps benefit your overall tooth and gum health. Zinc is a very well

known treatment for the common cold, but also helps with getting rid of bacteria and growth of

plaque across the gum line. Taking in some magnesium into your body is another easy way to

halt caries. You can get magnesium from pills and food like spinach, tofu, and dark chocolate.

One study proved a natural method to enhance dentin growth in order to protect the pulp

from exposure (Neves et al., 2017). Remember dentin is the middle layer of the tooth between

the enamel and the pulp. Dentin is formed by specialized cells called, odontoblasts. In this study

three different odontoblasts like cells, called GSK-3 inhibitors are tested to form new dentin.

Unfortunately, the results only show a thin layer of dentin is formed so in more severe cases of

dental caries this is not a complete solution. But, further studies could lead to a more complete

natural solution. The researchers tested different GSK-3 inhibitors: BIO, CHIR99021, and

Tidelglusib

Each inhibitor was soaked in a sponge like material called Kolspon and placed in a rat’s

molar tooth that was drilled out (0.13mm) to expose the pulp. After the sponge was placed in the

caries it was covered by material to protect the tooth. As a control MTA was used. MTA is the

inorganic material used today to protect the pulp layer from exposure. In addition, untreated

teeth and the sponge only were used as control.

 After 4-6 weeks the teeth were removed from the rats and analyzed (Neves et al., 2017).

The results showed the inhibitor soaked in sponges showed 2 times the dentin growth compared

to the sponge alone and 1.7 time greater than MTA. In addition, the sponge material completely

degraded. The results show positive signs towards a natural restoration of detine and hopefully

may eliminate the need for MTA in the future.

As a preventative method for dental caries, research was done using photodynamic

therapy(PDT) (Hakimiha et al., 2014). PDT is the process of using photosynthesizers and light

to kill bacteria and fungal infections (Journal of Dental Research, 2007). For this study, two

different photosynthesizers were used in conjunction with two different types of light to test the

effectiveness of killing the bacteria S​ treptococcus mutans​, a​ significant contributor to tooth decay

(Hakimiha et al., 2014). The two combinations of light and photosynthesizers tested were:

Radochlorin with a 662nm laser, and Toluidine blue O (TBO) with LED light at 630nm.

The results of the test proved positive for the reduction of S​ treptococcus mutans​ bacteria

using both above combinations. In addition, neither combination proved more effective vs. the

other. As a control, the tests were performed with each of the lights alone as well as the

photosynthesizers alone. In each of those four scenarios, none were effective at killing the

Streptococcus mutans​ bacteria. Either of these methods can be effective at preventing dental

caries. Also, in a separate study, TBO proved effective in killing microorganisms within the

dental caries and may be an effective method of eliminating bacteria before dental restoration is

performed.

Saliva is a very important component to your overall oral health. It helps clear bacteria

away from the tooth, and is a safeguard from tooth decay. Two percent of saliva is composed of
different substances “including mucus, proteins, minerals, electrolytes, antibacterial compounds

and enzymes” (Delta Dental, 2019, para. 2). The rest is water. “Research shows that it protects

against gum disease, tooth decay, and other oral infections”. Vitamin A is a key component for

the function of saliva (123Dentist, 2013, para. 3). You can get vitamin A from food like spinach,

and sweet potatoes. In order for saliva to become effective on the teeth and gums it has to travel

from the salivary glands and through tubes called ducts (Winning Smiles, 2018). Saliva is very

effective at wiping away food that could cause caries. It also has minerals that can aid growth

back on the enamel.

Dental caries may not be that big of a deal to a lot of people, but their smiles are. Instead

of destroying the healthy parts of a tooth, why not try and grow it back or better yet, prevent

dental caries. Common methods of addressing dental caries today are very expensive and time

consuming. This information that I gathered help me better understand more about teeth and

caries in general. In the future, simple, non-invasive procedures may be available if studies like

these continue. Imagine if photodynamic therapy could be used as an at home treatment to

possibly prevent some caries from happening instead of making multiple trips to the dentist

office...unless you enjoy the peaceful sounds of a drill and the pleasant smell of burning enamel.
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