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1. Dental Caries
Introduction
Dental caries is also known as tooth decay or dental cavities. Cavities are permanently
damaged areas in the hard surface of the teeth that develop into tiny openings or holes. It is
an infection of the tooth causes by bacteria that causes demineralization and destruction of
the hard tissues of the teeth (enamel, dentin, and cementum). It is a result of the production of
acid by bacterial fermentation of food debris accumulated on the tooth surface. If
demineralization exceeds saliva and other remineralization factors such as from calcium and
fluoridated toothpastes, these once hard tissues progressively breakdown, producing dental
caries (cavities or carious lesions, that is, holes in the teeth)
Definition
According to WHO," Dental caries is defined as localized post eruptive pathological process
of external origin involving softening of the hard tooth tissue and proceeding to the formation
of cavity."
According to Sturdevant," Dental caries is a infectious microbiologic disease of the teeth that
results in localized dissolution and destruction of calcified tissues".
Incidence
Today, caries remains one of the most common health problems in children throughout the
world.
Globally, it is estimated that 2.3 billion people suffer from caries of permanent teeth and
more than 530 million children suffer from caries of primary teeth.
The Global Burden of Disease Study 2017
Prevalence:- The dental caries prevalence of 5-6-year- olds is 67% (urban 64% ; rural 78% ).
The caries prevalence of 12-13-year-olds is 41% (urban 35%; rural 54%). Comparison of data
over the last 20 years shows and increasing trend of untreated dental caries.
https://www.mohp.gov.np/downloads/National%20Oral%20Health%20Policy.pdf
Causes
Bacteria most common streptococci
Food rich in carbohydrate
Poor oral hygiene
Inadequate dental care
Sleeping with bottle in the mouth
Use of pacifiers
Faulty salivary gland functions

2. Patho-physiology
Bacteria, acid, food pieces, and saliva combine in the mouth to form a sticky substance called
plaque. Plaque adheres to the teeth. Plaque that is not removed from the teeth turns into
calculus (tartar). Plaque and tartar irritate the gums, resulting in inflammation of the gums
(gingivitis) and periodentitis.
The acids in plaque damage the enamel covering the teeth, and create holes in the tooth
(cavities). Cavities usually do not hurt, unless they grow very large and affect nerves or cause
a tooth fracture. An untreated cavity can lead to a tooth abscess. Untreated tooth decay also
destroys also destroys the inner layer of tooth (pulp), which will require more extensive
treatment, or worse case removal of the tooth.
Signs and Symptoms
A person experiencing carries may not be aware of the disease.
1. Appearance of a chalky white spot on the surface of the tooth, indicating an area of
demineralization of enamel formation of micro cavity (earliest sign).
2. Appearance of brown lesion continues to demineralize, it can turn brown but will
eventually turn into a cavitations (cavity). Once a cavity forms, the lost tooth structure
cannot be regeneration.
3. Presence of dark brown and shiny lesion: suggests dental caries were once present but
the demineralization process has stopped, leaving a stain. Active decay is lighter in
color and dull in appearance.
4. The decay passes through enamel, the dentinal tubules, which have passages to the
nerve of the tooth, become exposed, resulting in pain that can be transient,
temporarily worsening with exposure to heat, cold or sweet foods and drinks.
5. Bad and foul taste
Diagnosis
1. History taking
2. Inspection of all visible tooth surface using a good light source, dental mirror and
explorer.
3. Dental radiographs (X-ray) may show dental caries before it is otherwise visible, in
particular caries between the teeth.
4. Large dental caries are often apparent to the naked eye, but smaller lesions can be
difficult to identify.
Prevention
1. Oral hygiene
(i) Personal hygiene care consists of proper brushing at least twice a day and
flossing at least daily.
(ii) Professional hygiene care consists of regular dental examinations and
professional prophylaxis (cleaning). Sometimes, complete plaque removal is
difficult and a dentist or dental hygienist may be needed.
(iii)Use correct brushing technique

3. (iv)Regular dental checkup
2. Dietary modification
(i) Minimizing snacks because snacks create a continuous supply of nutrition
for acid-creating bacteria in the mouth.
(ii) Brushing the teeth after meals is recommended. For children, the
American dental association and the European academy of paediatric
dentistry recommended limiting the frequency of consumption of drinks
with sugar and not giving baby bottles to infants during sleep.
(iii)Mother is advice to avoid sharing utensils and cups with their infant to
prevent transferring bacteria from the mother's mouths
3. Other measures
(i) The use of dental sealants is a means of prevention. A sealant is a thin plastic-like
coating applied to the chewing surface of the molars to the chewing surface of the
molars to prevent food from beings trapped inside pits and fissures.
(ii) Calcium, as found in food such as milk and green vegetables, is often
recommended to protect against dental caries.
(iii)Fluoride helps to prevent decay of a tooth by binding to the hydroxyapatite crystals
in enamel.
(iv)Avoid sticky foods such as biscuits, chocolate. If possible, brush, the teeth or rinse
the mouth with water after eating these foods.
Management and treatment
1. No carious lesion: No treatment.
2. Inactive lesion: no treatment but regular checkup.
3. Analgesics during pain, during tooth extraction or pulpectomy.
4. Antibiotic to treat infection.
5. An amalgam used as a restorative material in a tooth.
6. Localized dental infection can be managed by extraction, pulpectomy, or root canal
treatment.
Nursing management
1. Assessment
 Assess the patient’s oral hygiene practices.
 Assess the teeth, gums, mucous membranes, and tongue for colour, moisture, texture,
irritation, and infection
 Assess the patient’s nutritional status
 Assess the fit of dental appliances.
 Assess the mouth for dryness and breathe for odour.
 Assess for any complaints of toothache
2. Diagnosis.
 Impaired dentition related to ineffective oral hygiene
 Imbalanced nutrition less than body requirements related to inability to chew
3. Intervention
 Provide a mouth care routine including tooth brushing at regular intervals with a soft-
bristle toothbrush and fluoride toothpaste.
 Brushing teeth in an up-and-down manner

4.  Brushing of teeth at least twice a day Including the gums and tongue in oral care
 Replacing the toothbrush as bristles wear down
 Encourage to avoid high-sugar foods.
 Instruct patient to obtain regular dental checkups and follow up.
 Educate the patient regarding the importance of dental checkups and follow up
Complication
1. Discomfort or pain
2. Fractured tooth : A tooth fracture is a break or crack in the hard shell of the tooth
3. Tooth abscess: An abscessed tooth is a pocket of pus that can form in different parts of a
tooth as a result of a bacterial infection. It’s sometimes called a dental abscess
4. Tooth sensitivity: Tooth sensitivity, or “dentin hypersensitivity,” is pain or discomfort in
the teeth as a response to certain stimuli, such as hot or cold temperatures.
References of dental caries
 Uprety K, Child Health Nursing, fourth Edition (2071 Bhadra), Tara Books and
Stationery, Chhetrapati, Kathmandu, page no.316-317.
 Shrestha T. Essential Child Health Nursing, first Edition2015, Medhavi Publication;
Jamal, Kathmandu Page no.485-486
 https://www.nidcr.nih.gov/health-info/tooth-decay/more-
info#:~:text=Tooth%20decay%20(dental%20caries)%20is,infection%2C%20and%20
even%20tooth%20loss.
 https://www.who.int/news-room/fact-sheets/detail/oral-health