Journal of Dental Pathology and Medicine
Open Access

Dental caries; Tooth decay; Demineralization; Dental plaque; Dietary sugars; Restorative materials; Amalgam; Composite resins; Glass ionomer cements; Bioactive materials; Fluoride-releasing agents; Antimicrobial compounds; Nanomaterials; Adhesive technologies; Minimally invasive techniques; Digital dentistry; CAD/CAM; 3D printing

Introduction

Dental caries, commonly known as tooth decay, is a prevalent and significant public health issue that affects individuals across all age groups. Characterized by the demineralization of tooth enamel and dentin, dental caries results from the interplay between dental plaque, dietary sugars, and the host's oral environment [1]. The management and prevention of dental caries rely heavily on a combination of proper oral hygiene, dietary modifications, and the use of various dental materials designed to restore and protect the teeth [2]. This article delves into the etiology and progression of dental caries, as well as the various dental materials employed in their management [3]. Dental caries remains one of the most prevalent oral health issues worldwide, affecting individuals across all age groups and socioeconomic backgrounds. Characterized by the progressive destruction of the tooth structure due to acidogenic bacterial activity, dental caries can lead to pain, infection, and tooth loss if left untreated [4]. The multifactorial nature of dental caries involves a complex interplay between microbial biofilms, dietary carbohydrates, saliva composition, and host immunity. Despite significant advancements in oral health care and preventive measures, dental caries continues to pose a substantial public health challenge [5]. The understanding of dental caries has evolved considerably since its recognition as a microbial disease in the late 19th century. Early research focused on identifying the primary bacterial culprits, such as Streptococcus mutans and Lactobacillus species, and their role in acid production and enamel demineralization [6]. Subsequent studies have elucidated the dynamic processes of demineralization and remineralization, highlighting the importance of saliva, fluoride, and other protective factors in maintaining enamel integrity. Parallel to advancements in caries research, the field of dental materials has undergone transformative changes [7]. Traditional restorative materials, such as amalgam and gold, have been largely supplanted by modern composites, ceramics, and glass ionomer cements, which offer superior aesthetic properties and enhanced bonding capabilities [8]. The development of biomimetic materials and the incorporation of bioactive components have further expanded the therapeutic options available to dental professionals, enabling more conservative and effective treatments. This review will delve into the etiology and progression of dental caries, examining the latest insights into microbial ecology, biofilm dynamics, and host responses [9]. We will also explore contemporary diagnostic methods, including advanced imaging techniques and biomarker analyses, which have improved the early detection and monitoring of carious lesions. Furthermore, we will discuss the evolution of dental materials, focusing on their physicochemical properties, clinical performance, and future directions in restorative dentistry [10].

By integrating knowledge from both dental caries research and material science, we aim to provide a holistic perspective on the current state and future prospects of dental care. This interdisciplinary approach is essential for developing innovative solutions that not only address the underlying causes of dental caries but also enhance the quality and longevity of restorative treatments, ultimately contributing to better oral health and overall well-being.

Etiology and progression of dental caries

Dental caries is a multifactorial disease influenced by biological, behavioral, and environmental factors. The primary etiological factor is the presence of dental plaque, a biofilm composed of bacteria that adhere to the tooth surface. The most cariogenic bacteria within the plaque are Streptococcus mutans and Lactobacillus species, which metabolize fermentable carbohydrates (primarily sugars) to produce organic acids.

These acids lower the pH in the oral cavity, leading to the demineralization of the tooth enamel, which is composed mainly of hydroxyapatite crystals. When the pH drops below a critical threshold (approximately 5.5), the enamel begins to lose minerals, and if this process continues unchecked, it can lead to the formation of cavities. The progression of dental caries can be categorized into four stages:

Initial demineralization: The earliest stage, characterized by subsurface demineralization without cavitation. It is often visible as a white spot on the enamel.

Enamel decay: Continued demineralization leads to the breakdown of the enamel, forming a cavity.

Dentin involvement: If untreated, the decay progresses into the dentin, which is softer and more susceptible to rapid destruction.

Pulpal involvement: Advanced caries can reach the dental pulp, causing inflammation, infection, and potentially leading to abscess formation.

Prevention and management of dental caries

Preventive strategies for dental caries focus on reducing plaque accumulation, enhancing enamel resistance to demineralization, and minimizing the intake of dietary sugars. Key preventive measures include:

Oral hygiene practices: Regular brushing with fluoride toothpaste and flossing to remove plaque.

Dietary modifications: Reducing the frequency and amount of sugar intake.

Fluoride therapy: Application of topical fluoride through toothpaste, mouth rinses, and professional treatments to enhance remineralization.

Sealants: Application of resin-based sealants to occlusal surfaces of molars to prevent plaque accumulation in pits and fissures.

Dental materials for caries management

The selection of dental materials for the restoration of carious lesions depends on factors such as the extent of decay, the location of the cavity, and the patient’s individual needs. The primary dental materials used in caries management include:

Amalgam

Composition: Dental amalgam is an alloy containing mercury, silver, tin, and copper.

Advantages: Durable, strong, and relatively inexpensive.

Disadvantages: Aesthetically unappealing due to its metallic color, concerns about mercury toxicity.

Composite Resins

Composition: Made from a mixture of resin matrix and filler particles (such as silica).

Advantages: Aesthetic appeal due to tooth-colored appearance, good bonding to tooth structure.

Disadvantages: Technique-sensitive, prone to wear and staining over time.

Glass ionomer cements (GICs)

Composition: Consist of a mixture of fluoroaluminosilicate glass and polyacrylic acid.

Advantages: Releases fluoride, bonds chemically to tooth structure, good for areas with minimal occlusal load.

Disadvantages: Lower mechanical strength compared to composites and amalgam, less aesthetic.

Ceramics

Composition: Primarily made from porcelain or lithium disilicate.

Advantages: Excellent aesthetic properties, high biocompatibility, and good wear resistance.

Disadvantages: Brittle, can be expensive, requires more extensive tooth preparation.

Gold Alloys

Composition: Gold combined with other metals like platinum and palladium.

Advantages: Superior durability, excellent biocompatibility, and wear resistance.

Disadvantages: High cost, metallic color, and requires more extensive tooth preparation.

Advances in dental materials

Recent advancements in dental materials aim to enhance the properties of traditional materials while developing new options that offer improved performance and patient outcomes.

These allow for the placement of thicker increments of composite resin, reducing the time required for restorations and minimizing the risk of voids.

These materials, such as bioactive glass, not only restore teeth but also promote remineralization and have antimicrobial properties.

Incorporating nanoparticles into composite resins enhances their mechanical properties, aesthetics, and wear resistance.

Computer-aided design and manufacturing allow for the precise fabrication of ceramic restorations, improving fit and reducing chair time.

Advances in adhesive technology have improved the bond strength between restorative materials and tooth structure, leading to more durable restorations.

Conclusion

Dental caries remains a significant health concern, necessitating effective preventive and restorative strategies. The choice of dental materials plays a crucial role in the successful management of carious lesions. While traditional materials like amalgam and composite resins continue to be widely used, advancements in dental materials promise to enhance the quality and longevity of restorations. A comprehensive understanding of the properties and applications of various dental materials enables dental professionals to tailor treatment plans to meet the specific needs of their patients, ultimately improving oral health outcomes.

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