Dental Caries

Progressive demineralization and destruction of enamel/dentin from bacterial acid production (Streptococcus mutans, Lactobacillus) within dental plaque, fermenting dietary carbohydrates.

Most common chronic disease globally.

• Early: asymptomatic white spot lesions (reversible with fluoride)

• Progressive: visible cavitation, discoloration, thermal/sweet sensitivity (reversible pulpitis ; resolves when stimulus removed)

• Advanced: spontaneous, severe throbbing pain (irreversible pulpitis; persists after stimulus, may worsen lying down)

Complications: periapical abscess (swelling, severe pain), risk of spreading facial cellulitis/Ludwig's angina (submandibular space, airway emergency)

Red flags: facial swelling, trismus, dysphagia/dyspnea (Ludwig's; emergency), fever with dental pain, diplopia (rare, orbital extension)

Clinical exam (visual, tactile probe), radiographs (bitewing for interproximal caries, periapical for extent/pulp involvement/abscess).

Differentials: dentine hypersensitivity, cracked tooth syndrome, sinusitis (referred to upper teeth), trigeminal neuralgia, TMJ dysfunction.

• Non-cavitated: fluoride application, dietary counseling (reduce sugar frequency), improved oral hygiene

• Cavitated: restorative filling by dentist

• Pulp involvement: root canal treatment or extraction if non-restorable

• Periapical abscess: drainage (essential), antibiotics only if spreading infection/systemic symptoms/immunocompromised (amoxicillin 500mg tds, or metronidazole if penicillin-allergic, 5 days); adjunct to drainage, not a substitute

• Analgesia: NSAIDs ± paracetamol

Ludwig's angina/spreading facial infection: EMERGENCY; urgent airway assessment, IV antibiotics, urgent maxillofacial/ENT drainage, admission

Prevention: 6-12 monthly dental review, fluoride toothpaste, dietary sugar reduction, fissure sealants (children), water fluoridation

Referral: dentist for definitive management; urgent hospital/maxillofacial for spreading infection/airway compromise.