Caries bacteria | Caries

Caries bacteria

In the healthy oral flora of the oral cavity there are well over three hundred different species of bacteria, of which only two are caries bacteria. These bacteria can metabolize the sugar in food, which is absorbed as a substrate, into acids (especially lactic acid) and cause lasting damage to the tooth. These bacteria primarily include Streptococcus mutans and lactobacilli.

The main caries bacterium is Streptococcus mutans, which settles in the plaque. From the sucrose ingested with food, Streptococcus mutans forms glucan molecules, with which it can also adhere to smooth surfaces such as tooth enamel. Caries bacteria can be transmitted from person to person by saliva.

The bacteria can be detected by microbial saliva tests. Both the type and number of bacteria can be determined. A high number of Streptococcus mutans and lactobacilli indicate a high caries risk, a low number indicates a low risk. However, caries only develops if the bacteria are able to utilize food residues, which means that an infection with Streptococcus mutans does not lead to caries if oral hygiene is excellent.

Recognize caries

The problem with caries is usually that it is hardly visible at first. Patients affected usually only visit a dentist when they already have toothache. In these cases, however, the caries is already very advanced and requires more extensive therapy.

For this reason, it is recommended to go twice a year for a so-called preventive examination. The dental check-up is a service provided by the health insurance company and all costs are fully covered by both private and statutory insurance. In addition, bonus points can be collected if you regularly participate in a dental check-up program.

These bonus points can significantly reduce the personal contribution of patients who have to be provided with dental prostheses (for example a crown or bridge). In addition, it is quite easy for the dentist to recognize a possibly existing caries at an early stage and to treat it in a simple way.If caries is suspected, the checkup is usually followed by an X-ray examination. The X-ray image helps to determine how deeply the carious defect has already penetrated the tooth substance.

In addition, it is also recommended that an X-ray check be carried out at regular intervals for existing fillings. This helps to detect at an early stage whether new caries has formed under the filling material or whether there are inflammatory processes in the area of the tip of the tooth root. In addition, so-called caries detectors are often used in the dental practice.

These are substances that can be applied to the tooth and change their color in case of caries. Persons who would like to check the condition of their teeth themselves at regular intervals can look for the following characteristics of a caries. In order to detect caries at an early stage, it is important to check whether the teeth: have whitish discolorations have brown spots have sticky spots

  • Show whitish discoloration
  • Show brown spots
  • Have sticky spots

To the layman, caries is usually only visible in the later stages, when the lesion already affects a large part of the tooth.

Caries can appear in different colors. An initial demineralization of the tooth enamel can be recognized as white discoloration, which corresponds to decalcification. This demineralization is the preliminary stage of caries in which the surface is still intact and the development of caries can still be stopped by specific fluoridation measures.

If an initial caries with surface collapse is present, it can take on a yellowish to brownish color. It is usually very small and hardly visible in the mirror for the person affected. Since this carious lesion grows into the depth, the hole often does not get bigger, but remains a punctiform discolored opening that only spreads like a balloon in the depth.

Patients often notice black dot-shaped discolorations, especially in hard-to-clean areas such as the fissures. These so-called “black spots” are usually inactive caries sites that do not show any tendency to spread, provided they are regularly fluoridated. About 80% of the population have these black spots.

The dentist does not notice the inactive caries when touching them with the probe, the black spots are hard. Nevertheless, these spots should be checked regularly so that the inactive carious form does not turn into an active form and spread further into the depths. Furthermore, caries lesions in the interdental space are invisible to both the person affected and the dentist by inspection alone.

In this case, the dentist can only detect the caries through X-ray diagnostics. In general, it is quite difficult for the affected person to detect caries because the disease can take on so many different forms and is difficult to detect without special diagnostics. Therefore a six-monthly check-up at the dentist should not be omitted.

The frequency of occurrence of caries can vary from person to person. There are people who rarely or never get caries and others where carious defects are more common. Why this is the case is not fully understood, it is assumed that genetic influences are responsible for these differences.

Caries is particularly common when the salivary flow is too low. This is the case, for example, after x-ray treatment of the head. Certain areas of the teeth are particularly susceptible to the onset of caries.

These are the interdental spaces, the tooth surfaces and the tooth necks. Here plaque can accumulate particularly well and is more difficult to remove. Especially in the interdental spaces, the detection of a caries can be more difficult, because the first signs can be hidden by gums.

Malpositioned teeth (anomalies of the dentition) also favour the occurrence of caries. However, any area that is difficult to access for daily oral care also has a higher risk of caries. Molars and wisdom teeth are often affected by caries because of their location.

The space between the teeth represents a dirt niche, which means that caries often occurs here because the area is difficult for the patient to access. The toothbrush with its bristles does not reach the narrow spaces between the teeth and therefore these gaps must be cleaned with additional aids such as dental floss or interdental brushes.Since this cleaning method is one of the least popular and is not used by a large part of the population, food residues can remain in this space for a long period of time. The microorganisms then have a free path to use these food residues as substrate and to multiply – as a decomposition product, caries is created by acid production.

In most cases, both adjacent teeth are affected by caries. Furthermore, this caries can usually spread unnoticed and unhindered, as it is clinically invisible to the dentist. The caries in the interdental space can only be detected by X-ray diagnostics and remains hidden without it.

Therefore it is important to remove remaining food in the interdental spaces as early as possible to give the bacteria no chance to form caries in these spaces. Regular fluoridation in the interdental spaces can also provide lasting protection against the development of caries. Milk teeth are much more porous than permanent teeth and are therefore less protected against caries.

This is due to the fact that the mineral content of the dental enamel of milk teeth is much lower, which is why a caries lesion also spreads at a higher rate. Furthermore, the relations of the layer thicknesses of the milk teeth are also different. The enamel layer is much thinner, the dentin layer is thicker than in a permanent tooth.

The pulp is also much larger and is therefore reached faster and earlier than in a permanent tooth. Therefore, the risk of the dentist encountering the pulp during the removal of caries is greater than in permanent teeth. In this case, a root canal treatment of the milk tooth is necessary in order to guarantee the space maintainer function of the tooth as long as possible.

Another problem is the poor oral hygiene of many children. Due to limited motor and mental abilities (especially in small children), they brush their teeth much less well and plaque can more easily infect the teeth. Furthermore, poor nutrition due to many sweetened drinks and food also increases the risk of tooth decay.

If a tooth is affected by caries, it is treated with a filling therapy. Filling materials are variable. After this filling therapy the destroyed carious tissue is removed and replaced by filling materials.

It is quite possible that caries will reappear under the filling at the edges of the filling in the hard tooth substance. This caries is called secondary caries. This secondary caries occurs much more often under plastic fillings than under amalgam fillings.

This is because amalgam has a bactericidal effect, which protects the filling margins from caries. Plastic has no bactericidal effect whatsoever, which increases the frequency of secondary caries. It is very important to clean teeth that have been treated with a filling especially thoroughly, especially the interdental spaces.

If bacteria can adhere to the edge of the filling, it is often easy for them to reach the intact tooth under the filling and lead to secondary caries. Progressive secondary caries can be a reason why a filling breaks out or gets lost. The caries softens the hard tooth substance under the filling and loosens the bond between the filling and enamel or dentine so that the filling can come loose.

Reasons for secondary caries can be reduced oral hygiene, but also an incomplete removal of caries can leave bacteria behind, which can cause caries under the filling. A very old plastic filling may also have become leaky, as the filling edges discolor after a certain time and are not as durable as amalgam, for example. Therefore, especially the edges of plastic fillings should be checked regularly and replaced after a few years.

A crown protects the tooth from further loss of hard tooth substance, especially if the tooth is already weakened by carious lesions. As with secondary caries under a filling, caries can also develop under a crown. The reasons for the development of secondary caries are similar.

After some time, the cement used to fix a crown may wash out and open a gap. If this gap is not noticed and therefore carefully cleaned, bacteria can enter this groove under the crown unhindered and weaken the healthy tooth structure through caries.If poor oral hygiene is added to this, the bacteria can use the food leftovers as a substrate and metabolize them. Since the enamel layer has been almost completely removed by the preparation for the crown, the tooth is hardly protected if the microorganisms get under the crown.

The caries then usually progresses rapidly and can quickly infect the pulp and nerves. Furthermore, a treatment error or a mistake by the dental technician can also be the reason for a leaking crown. If the marginal seal of the crown is only minimally too large, it represents an entry portal for caries, which will promptly lead to secondary caries.

The tricky thing is that the caries remains radiologically invisible, because the crown absorbs the X-rays completely and does not allow any insight into the interior. Therefore even the dentist usually notices quite late, for example at a leaking margin, that secondary caries has formed under the crown. Cervical caries is now not located on the occlusal surface as most caries is, but, as the name suggests, in the area of the neck of the tooth.

This can be, as physiologically intended, closely covered by the gums, or exposed due to external influences, such as excessive brushing or gum disease. If it is exposed, bacteria can easily get to it. The neck of the tooth represents the transition from the crown to the root.

The crown of the tooth is covered with enamel and at the neck of the tooth it turns into tooth cement, which covers the dentin in the root area. The enamel is very hard and the real protection against caries. In the area of the neck of the tooth, however, this is no longer present, so that the dentine can be attacked by bacteria unhindered.

Bacteria have it very easy in this area, as they start directly on the softer dentine and can reach the tooth pulp relatively quickly. From there it is only a small jump to the root canal. The main cause of caries in the cervical area is exposed tooth necks.

The causes of exposed tooth necks are different. The main reason is usually periodontitis. However, the consumption of nicotine can also contribute to it.

Exposed dental necks can also be caught by people who regularly brush their teeth, but exert too much pressure with a toothbrush that is possibly too hard and in addition use toothpaste with strong abrasive bodies. As a result, the gums are exposed to a great deal of stress, causing the small tissue fibers to travel and the gums to retract. The path for bacteria at the neck of the tooth is clear.

The best precaution against cervical caries is not to give the bacteria the opportunity to cause caries at all. Since the main cause is exposed tooth necks, one should prevent periodontitis or gingivitis. The most important thing is good and sufficient oral hygiene.

Brush your teeth at least 2 times a day with a fluoride toothpaste, with a not too hard toothbrush and little contact pressure. Make circular movements away from the gums towards the crown of the tooth at an angle of 45°. Electric toothbrushes remove plaque even more reliably and easily.

Tongue scrapers, mouthwashes and dental floss, for the hard-to-reach interdental spaces, should be used in addition. It is also very important to keep your check-up appointments with your dentist at least twice a year. A professional tooth cleaning can also be carried out during such a visit.

An effective caries therapy can only be guaranteed if the dentist in charge makes a correct assessment of the depth of caries and the condition of the affected tooth. For this purpose, the dentist has various diagnostic possibilities at his disposal. In some cases, special solutions, so-called caries detectors, can help to show carious defects on the tooth.

These solutions stain the defect after they are applied to the dry tooth. In addition, a suitable imaging procedure can be performed before starting the caries therapy. In dentistry, two different procedures are usually used for this purpose.

If several teeth in different quadrants show carious areas, an X-ray overview (orthopantomogram; OPG) can be made. If only one tooth has caries, a so-called tooth film should be taken. This allows an exact assessment of the depth of caries.Since the patient is always exposed to radiation when X-rays are taken, imaging procedures should only be performed in special cases.

The therapy of small carious defects can usually be carried out without imaging. Once a caries has been identified as such and the extent of the defect has been determined, the actual treatment can begin. The therapy in the presence of caries depends mainly on the exact localization and the respective caries stage.

In this context, different forms of caries must be distinguished. The so-called initial caries is considered the preliminary stage of a real caries. These are decalcification processes in the area of the tooth enamel, which appear as small white spots on the tooth surface.

The therapy of this form of caries is usually done by applying a fluoride-containing substance. In this way the affected tooth enamel can be remineralized and hardened. In addition, fluoride-containing toothpastes can help to protect the affected tooth from further damage.

When using fluoride-containing toothpastes, however, it is essential to follow the instructions of the dentist treating the tooth. An overdose can lead to unsightly fluoride deposits on the tooth surface within a very short time. Caries, which is not limited to the enamel but also affects the deeper dentin, usually requires a much more extensive treatment.

Fluoridation of the tooth surface can no longer stop the spread of the carious defects in the presence of such dentine caries. When treating this form of caries, the dentist must remove the carious tooth substance together with a minimal amount of healthy teeth. This is the only way to prevent the possible formation of new caries under the filling material (so-called secondary caries).

The tooth must then be completely dried out and filled with filling material. The choice of the most suitable filling material depends on the condition of the tooth as well as on the patient’s wishes. In the treatment of caries, a distinction is made between rigid and plastic filling materials.

Rigid filling materials are usually only used in case of more extensive carious defects. They have to be made outside the oral cavity, in a dental laboratory and then inserted into the tooth. For this reason, rigid filling materials are significantly more expensive than plastic ones.

In terms of stability, however, the advantage is clearly on the side of the rigid filling materials. The group of plastic filling materials includes mainly composites (synthetic materials) and amalgam. These substances can be placed directly into the cavity after preparation and drying of the tooth, where they can be shaped and hardened.

In contrast to rigid materials, they are particularly suitable for the treatment of small caries. In the meantime, plastics are mainly used in the therapy of caries. The reason for this is the fact that amalgam fillings are said to have properties that are hazardous to health.

However, a dental filling made of amalgam seems to be much more durable than a plastic filling. The therapy of caries is basically covered by both statutory and private insurance companies. However, both the production of a plastic filling and the therapy with a rigid filling material require additional payment by the patient.

The only exceptions are anterior fillings and fillings in patients who are not allowed to be treated with amalgam (for example, in case of intolerance, allergies or kidney dysfunction). In these cases, at least the costs of a plastic filling are fully covered by health insurance companies. Patients with a so-called caries profunda (deep caries), where more than 2/3 of the dentin is affected, require a much more extensive therapy.

In addition to the placement of the filling, the dental nerve (pulp) must also be protected. For this reason, the usual filling must always be preceded by a so-called underfilling. A calcium hydroxide containing medication, which is supposed to stimulate the formation of new dentine, is inserted into the depth of the cavity.

A so-called penetrating caries (caries penetrans), on the other hand, already reaches through the dentin to the pulp cavity. No other disease is as widespread worldwide as caries or tooth decay.Almost every person in the population has or has had a carious lesion that had to be treated with painful filling therapy. But can caries be cured in another way?

If a caries has not yet broken through and damaged the surface in the initial stage, the initial demineralization can be reversed by fluoridation. In this case no filling therapy is necessary. As soon as the surface is damaged (i.e. a hole) by caries, fluoridation is no longer sufficient and the tissue destroyed by caries must be removed mechanically.

With new types of lasers such as the E – YAG- laser, many people want to escape the unpopular drill, but this is not possible in particularly deep cases, as the laser cannot remove the complete caries in this case. Therefore, in the majority of cases only the conventional filling therapy brings the desired success. The laser treatment of caries is a new method to remove caries selectively.

The so-called erbium-yag laser is used, which emits light of a wavelength that is absorbed by the moisture of the tooth. The water expands in such a way that micro-explosions are created, which remove the soft caries tissue by generating energy. During the treatment the patient wears hearing protection because the application generates relatively loud blows.

However, E-Yag lasers cannot yet replace the drill because they are not efficient enough for deep caries. The cost of such treatment is about fifty to two hundred and fifty euros per carious tooth. Moreover, there is no scientific evidence for the removal of caries with laser, so the laser has not yet been able to replace the mechanical drill.

In general, home remedies can alleviate the pain symptoms of caries, but they cannot stop or even reverse the caries. Chewing on clove and turmeric has proven to be effective in alleviating the pain. Clove extract has been a proven active ingredient in dentistry for thousands of years and its calming effect is well known.

In addition, normal household salt is said to reduce the caries activity, but this is highly doubtful due to the lack of scientific evidence. If there is irreversible damage to the hard tooth substance caused by caries (i.e. a deep hole reaching into the dentin), no household remedy can replace treatment with filling therapy. In general, the use of home remedies should be discussed with the treating dentist in order not to interfere with the therapy measures against caries.