ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. K02ArtikelübersichtKaries
- Causes and risk factors
- Examinations and diagnosis
- Disease course and prognosis
What is tooth decay? Tooth decay is a change in hard tooth substance that protects the tooth from the outside. Most people understand caries as the proverbial "hole in the tooth". In fact, tooth decay begins much earlier. In dental caries, there is an increasing descaling (demineralization) of hard tooth substance (enamel and dentin under it). Acid-forming bacteria are responsible for this demineralization. Only when the process of descaling is not stopped, it finally comes to a hole in the tooth.
The term tooth decay is medically not completely correct. The tooth substance does not rot, it is degraded. The term "hole in the tooth" is also used more in everyday language.
Physicians distinguish between different types of caries, depending on how much tooth substance the bacteria have already destroyed: In an initial caries is still an intact surface with incipient descaling before. With established caries the surface is defective.
Depending on which layers of the tooth are affected, sub-forms are again differentiated:
- Caries superficialis: defect in the enamel (most superficial layer of the tooth)
- Caries media: defect to dentin (second layer of the tooth)
- Caries profunda: tooth decay in all layers to the Zahnpulpa, in which there are nerves
- Caries sicca: tooth decay has come to a halt
Dental caries is considered the most common dental disease worldwide. Almost every person suffers from tooth decay at least once in their lives. Milk teeth and permanent teeth can be equally affected by tooth decay. Depending on the age in which caries forms the first time, the question "What is caries?" Answered differently, since different areas of teeth are particularly affected depending on the age.
In small children, caries affects the incisor and adjacent gums first, then progresses slowly to the edge of the tooth. This caries in infants is also referred to as Nuckelflaschenkaries and arises mainly through improper diet (for example, with sugar sweetened tea) of the children.
In older children and adolescents, caries is often first on the occlusal surface. Cause is also here usually a wrong (sugar-rich) diet. In adults, on the other hand, there is predominantly caries between the teeth. The reason for this is on the one hand in the wrong or negligent dental care or also on strongly sweetened drinks such as coffee or tea.
In people over 60 years, the dental necks of caries are particularly affected. In old age, the gums often form back. This leads to the fact that the individual tooth necks are exposed. There, however, the natural protective layer is thinner, so it comes faster to the hole in the tooth. This form of tooth decay is also called root caries.
In order to explain to children the question "how caries develops", "Carius and Baktus" was developed as early as the 1950s. The story of Karius and Baktus shows children what happens to tooth decay in their teeth. Today, the bacterial couple are also on posters at the dentist, in the form of comics or in short stories that warn against deciduous tooth decay.To the table of contents
Tooth decay: symptoms
Caries describes a progressive course of tooth destruction. In this case, "only" one tooth or several teeth can be affected. In addition, different symptoms occur, depending on the stage in which the caries formation is. At the beginning, only changes to the superficial tooth layers occur. Later, the visible hole in the tooth is created.
Caries: early stage
At the beginning, tooth decay is barely visible. Doctors call this period initial stage. Cretaceous white spots (white spots) slowly appear on the teeth. There are already minerals from the teeth dissolve and the enamel becomes holey (porous). Also, dark discoloration of the teeth are an indication of tooth decay.
Actually, the mineral loss can be compensated at this stage: Regular and careful brushing removes the harmful caries bacteria. And the fluoride contained in the toothpaste ensures that minerals from the saliva replace the loss in hard tooth substance.
In case of poor oral hygiene it comes to the progression of tooth decay. Teeth that are rarely brushed become increasingly demineralized, creating a hole in the tooth. This is the first time pain can occur. However, pain occurs at the latest when the nerves of the teeth are also attacked by bacteria. At this stage, many teeth are also very sensitive to heat, cold or very sweet foods.
Caries: late stage
Without treatment, tooth decay progresses slowly. From an affected tooth, tooth decay can also spread to other teeth. With increasing degradation of the tooth substance, the pain increases. An untreated caries infection is very dangerous. The inflammation may attack the jawbone and trigger inflammation. The bloodstream also allows bacteria to enter the entire body from the mouth and infect other organs.
Secondary caries (caries under filling / caries under crown)
Once it has come to a hole in the tooth, it is drilled at the dentist and closed with a filling. This treatment does not guarantee that you are protected from decay. Teeth often develop a so-called secondary caries. Over the course of several years, small gaps form in the border area between tooth and tooth filling or crown. These are too small for the bristles of the toothbrush to reach. However, they are big enough for the microscopic bacteria to settle here. Tooth decay occurs so often in places where a hole was already filled in the tooth.To the table of contents
Caries: causes and risk factors
Tooth decay is influenced by several factors: bacteria, dental hygiene and eating habits. There are over 700 types of bacteria in our mouth. To a certain extent, these microorganisms are necessary for a healthy oral flora. However, some bacteria feed mainly on sugar. They absorb sugar that is fed into the diet, split it and excrete acid metabolites as waste products. These acids attack the enamel by removing minerals. If this process is not stopped, eventually the hole in the tooth.
Brushing your teeth reduces the number of bacteria in your mouth. Not just after each meal, but immediately after each brushing on the tooth surface slowly forms again a deposit of bacteria and salivary components. Medically, this plaque is referred to as plaque or biofilm. If the teeth are brushed irregularly, this coating is getting thicker. In it, it is mainly those bacteria that cause tooth decay that multiply. People who rarely, irregularly, or carelessly brush their teeth are therefore much more likely to suffer from tooth decay than people who perform careful oral hygiene.
However, there is one exception to the rule: after consuming acidic foods, such as citrus fruits or cola, you should wait a while to brush your teeth. Because the acid roughened the enamel, so it is easier to remove when brushing. Before cleaning you should wait about 30 minutes.
The caries development is promoted by sweet food. These are mainly table sugar (sucrose), glucose (glucose) and fructose (fructose), which make good use of the bacteria and indirectly damage the teeth. Long-chain sugar compounds, ie complex carbohydrates as they are in whole-grain products, do not promote tooth decay.
If plenty of saliva is present, the minerals contained therein can replace losses in the hard tooth substance. An increased amount of saliva also serves to liquefy ingested food. This way, they can be transported away better and stay less on the teeth. Some components of the saliva also neutralize the acid. Others have antibacterial properties. If there is little saliva, caries is more likely to develop: the interdental space and the tooth crown provide optimal conditions to ensure that food that is not transported away by the saliva can adhere to it.
The nature of the immune system also determines how well the body defends itself against harmful bacteria. People with weakened immune systems often suffer from tooth decay. A weakening of the immune system occurs, for example, in chronic diseases such as HIV or diabetes mellitus. In addition, drugs such as antibiotics or corticosteroids (for example, cortisone) reduce the immune system's resistance.
Is tooth decay contagious?
Caries is a bacterial infection and, like other bacterial infections, is contagious. In everyday life, however, the risk of infection of tooth decay has little significance. The bacteria that are responsible for the development of caries, carry everyone in the mouth. It therefore definitely needs individual risk factors before it can lead to an outbreak of tooth decay. Transmission of caries-causing bacteria between two adult humans (such as by kissing or sharing cutlery) is therefore insignificant for caries development.
Contagion in infants
That tooth decay is contagious, but plays a role in infants. There are fewer bacteria and microorganisms in the mouth than in adults. In infants without teeth even none at all. Theoretically, adults who, for example, briefly take the child's pacifier for cleaning themselves, even transfer the possible caries into their children. Whether the risk of infection is really so big, is controversial with experts.
Influence of the family
Contrary to popular belief: tooth decay is not hereditary. Tooth decay can occur frequently in families. For example, hereditary factors such as deep tooth grooves (tooth fissures) are a potential risk factor for tooth decay. In addition, there are eating and hygiene habits that children learn from their parents. Families with a lot of sweet foods on the regular diet, as well as families with barely learned toothbrushing, have a much higher risk of tooth decay in children than in other families.To the table of contents
Caries: examinations and diagnosis
If you suspect caries, the dentist is the right person to contact. In a short conversation he will first raise the medical history (anamnesis). You have the opportunity to describe your complaints. Afterwards, the doctor can ask further questions, for example:
- When did you first notice these symptoms?
- Do you have relatives who often suffer from dental problems?
- Have you had any problems with your teeth in the past?
- How many times a day do you brush your teeth?
Subsequently, a detailed examination of the teeth takes place. The dentist can detect tooth decay by looking closely at the teeth with a small mirror. Tooth decay occurs first by changes in the surface of the teeth. The dentist can answer the question "tooth decay - what to do?" Only if he knows how deep the tooth decay has penetrated into the tooth. If such changes are present on the surface, he then checks with a small probe (a kind of thin rod) how far the damage has already progressed.
Caries in the initial stage is usually very difficult to recognize. In many cases, however, caries is also accidentally detected when radiographs are taken. On x-rays carious areas are very easy to recognize. Only in order to arrive at a suspected caries to a diagnosis, but rarely radiographs are made.
In addition, there are other, modern methods that can be used to diagnose tooth decay. These include, for example, the measurement of electrical resistance and various fluorescence methods.
Electrical resistance measurement: Healthy, enamel-moistened enamel conducts electrical current. In caries damage, this conductivity increases in the enamel, that is, the electrical resistance - measured using a hand electrode - decreases.
Fluorescence method: They are based on the fact that the hard tooth substance fluoresces under certain conditions. The fluorescence properties depend on the state of the tooth substance: Carious sites fluoresce differently than healthy tooth substance.