Dentin Caries

As the process progresses into dentin, the tooth produces tertiary dentin in an attempt to protect the pulp. A lesion may appear white or brown and may be matte or shiny.

Frequent sugar consumption shifts the dental biofilm toward acid-producing, acid-tolerant bacteria. The acid challenge causes mineral loss in hard tooth tissue and can first appear as a white spot.

An occlusal lesion can look non-cavitated in the mouth yet extend substantially into dentin on a radiograph. Cavitated occlusal lesions visible in dentin on a bitewing radiograph need invasive treatment.

Regular exposure to fermentable carbohydrates and a cariogenic biofilm are both needed for caries to progress. Insufficient fluoride exposure is also a contributing factor in the disease process.

Visual-tactile examination, radiographs and fibreoptic illumination can be used to assess caries. Bitewing radiographs can detect lesions on contacting tooth surfaces, while ICDAS records severity across six categories.

A lesion that can be reached and cleaned may be managed without a filling through biofilm disruption, remineralisation or sealing. A non-cleansable cavitated dentin lesion requires restorative treatment to rebuild lost tooth structure.

The amount of work depends on whether the lesion is cleansable, cavitated and visible in dentin on imaging. Early management aims to preserve dental tissue and avoid unnecessary removal.

Loss of tooth structure at a moderate stage means the tooth must be filled and rebuilt. Complications of progressing caries include apical periodontitis, periapical abscess, cellulitis and osteomyelitis.

Daily brushing and flossing remove dental plaque. Fluoride limits demineralisation and supports remineralisation; it is available in toothpaste, mouth rinses and professionally applied gels or varnishes.