Dental caries is tooth decay caused by bacteria that turn sugars into acid, which slowly dissolves the hard enamel and then the softer dentin below. It is the most common chronic disease of childhood and is largely preventable with fluoride, less sugar and regular dental care.
Key symptoms
- Often none early on
- Sensitivity to sweet, hot or cold food
- Toothache, worse with chewing
- Visible holes or dark spots on the teeth
- Bad breath
What you find on exam
- White chalky spots (early decay) or brown to black cavities
- Broken or missing teeth, plaque along the gum line
- Tooth tender to tapping or gum swelling nearby suggests an abscess
- Risk factors: sugary drinks, bottle at bedtime, dry mouth, poor brushing
Tests
- Dental exam with a probe and bitewing X-rays by the dentist
- History of fluoride exposure
- Look for causes of dry mouth: medicines, Sjogren syndrome
Treatment basics
- Brush twice daily with fluoride toothpaste; cut down sugary snacks and drinks
- Fluoride varnish, which primary care can apply to young children
- Dental referral: fillings, sealants, crowns
- Silver diamine fluoride to stop decay in selected cases
- Root canal or extraction if the pulp is infected
Red flags
- Facial swelling or fever (spreading infection)
- Severe tooth pain that wakes the patient at night
- Rapid, widespread decay in a toddler (early childhood caries)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.