Doctors Revision

Oral & Dental Health

Dental Caries

A disease process resulting in localized destruction (demineralization and dissolution) of tooth tissues by acids produced from bacterial fermentation of dietary carbohydrates.

Also known as: Tooth Decay, Cavities

View images for Dental Caries (Google Images, opens in a new tab)
On this page

Referral and warning signs

When to refer

Refer ALL cases of dental caries to dental personnel (Dentist/Dental Officer/Dental Therapist at HC4+) for assessment and restorative treatment or extraction.

Red flags

  • Severe, persistent, spontaneous toothache (suggests pulpitis/abscess).
  • Facial swelling (suggests abscess/cellulitis).
  • Fever associated with toothache/swelling.

Signs and symptoms

  • Initially asymptomatic.
  • Tooth sensitivity to hot, cold, or sweet stimuli.
  • Localized toothache (may be intermittent initially, becomes persistent as decay progresses).
  • Visible pits or holes (cavities) in the teeth.
  • Discoloration (brown or black spots) on tooth surface.
  • Pain on biting or chewing.

Risk factors

  • Poor oral hygiene (plaque accumulation).
  • Frequent consumption of sugary foods and drinks.
  • Dry mouth (reduced saliva flow).
  • Lack of fluoride exposure.
  • Deep tooth pits and fissures.
  • Malocclusion (crowded teeth harder to clean).
  • Gingival recession (exposes root surfaces).

Diagnosis

Clinical assessment

Visual examination (detecting cavities, discoloration). Tactile examination with dental probe (detecting softened enamel/dentin, 'stickiness'). Patient symptoms.

Investigations

  • Dental examination.
  • Dental X-rays (Bitewings, Periapicals): Essential for detecting interproximal caries and assessing depth of lesion.

Diagnostic criteria

Clinical or radiographic evidence of demineralization/cavitation of tooth structure.

Differential diagnosis

  • Pulpitis (more severe, persistent pain).
  • Dentin hypersensitivity (pain brief, sharp, stimulus-provoked).
  • Cracked tooth syndrome.
  • Tooth erosion/abrasion/attrition.
  • Developmental defects of enamel.

Management

Pharmacological treatment

  • Pain Relief: Paracetamol 1g Q8H (Adult); 10-15mg/kg/dose Q8H (Child). OR Ibuprofen 400mg Q8H (Adult); 7-13mg/kg/dose Q8H (Child). (LOC: HC2)

Dental Treatment (Referral Required)

  • Restoration (Filling): Removal of decayed tissue and replacement with filling material (amalgam, composite resin, glass ionomer). (LOC: HC4+)
  • Fluoride Application: For early ('incipient') enamel lesions.
  • Root Canal Therapy (Endodontics): If decay reaches the pulp. (LOC: RR)
  • Crown: If extensive tooth structure loss.
  • Extraction: If tooth is non-restorable or patient opts for removal. (LOC: HC4+)

Monitoring

Regular dental check-ups to detect new or recurrent caries.

Complications

  • Pulpitis (inflammation of the tooth pulp).
  • Periapical abscess (dental abscess).
  • Cellulitis.
  • Osteomyelitis (rare).
  • Tooth loss.
  • Pain, difficulty eating, nutritional impact.

Prevention

  • Good oral hygiene (brushing with fluoride toothpaste, flossing).
  • Dietary modification (reduce sugar frequency).
  • Regular dental check-ups.
  • Use of fluoride (toothpaste, water, professional application).
  • Fissure sealants on susceptible teeth.

Patient education

  • Explanation of caries process (bacteria, sugar, acid).
  • Importance of oral hygiene and diet.
  • Need for dental treatment (filling/extraction).
  • Pain relief options.
  • Preventive strategies.

Uganda-specific notes

Highly prevalent. Access to restorative care limited, leading to high rates of extraction. Prevention and early detection are crucial. Provide analgesia and refer.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 23, Section 23.2.2

For learning and professional reference. Use current local guidance and clinical judgement.

Browse all conditions
Scroll to Top