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Dental Caries in Adults

Is caries different in adults?

Adults, just as children, are at risk of developing dental caries, and the same risk factors are involved: poor hygiene and frequent intake of sugar-containing foods. Regular exposure to fluoride, from water and toothpaste, prevents dental decay in adults just as in children. In older adults, gum recession, a consequence of periodontal disease, leaves the root surfaces of teeth exposed and at risk of decay. Root surface caries is frequent among older persons, and this creates a need for treatment.

But a large part of adults' treatment need is related to earlier caries and its treatment. The mouth is a corrosive place: continually warm and moist with an electrolytic fluid, it is not surprising that all but the most noble metals deteriorate with time. No matter how good originally, many, even most, fillings and other restorations ultimately fail due to stress and corrosion. This deterioration may lead to fracture of restorations or it may lead to secondary caries, which is caries that occurs at the edge of a filling or a crown.

The illustration shows a tooth with a small filling, probably made of silver amalgam. At one margin, a leak develops. This could be from fracture of part of the filling, fracture of part of the tooth enamel, or just from a change in shape of the filling. If plaque accumulates, the products of bacterial metabolism can track down the wall of the cavity and lead to a new carious lesion underneath the filling. This progresses, first through the dentine, then the pulp tissue becomes red and inflammed, then infected and necrotic. Abscesses develop at the apices of the two roots. Disease that is allowed to progress so far can be treated only by removal of the contents of the pulp cavity and a root filling, or by extraction of the tooth.

Can caries in adults be prevented? Just as in children, dental caries in adults is a consequence of bacterial metabolism of sugars and other energy-rich foods. Prevention depends on the reduction in the numbers of bacteria (by good oral hygiene), and reduction in the availability of sugars, by improved diet. The presence of fluoride assists always. Because most adults today have fillings or other restorations as a consequence of caries in childhood, defects in these contribute frequently to adults' need for treatment for caries. A good preventive strategy consists of:

Practise good oral hygiene, brushing the teeth at least twice daily;
Have a good nutritious diet, and do not snack on sugary foods;
Use fluoride toothpaste; and,
Visit your dentist regularly, at least annually unless advised otherwise.
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