Saturday, 11 February 2017


Tanvir MedicalCare

                          DENTAL CARIES

 Dental caries is the infection of the teeth, bacterial in origin and generally presenting as toothache and cavitation  along with discoloration or patches on the teeth and foul odor.

  Socially, Dental caries is not a good disease to carry because of bad breath it causes, which can drive away persons during social interaction. It can be a inhibitor of kissing, because the lover in spite of being in love  might be too repulsed by the bad odor to approach the lover and be cosy. Thus it's very important that Dental caries is prevented and if it's present, is treated.

   I won’t be delving too much into technical aspects, but some background information is important.  The teeth are covered by a tough layer called enamel, specifically meant to protect the teeth and prevent Dental caries. Enamel is a hard surface covering, composed of minerals especially hydroxyapatite, which becomes soft and soluble when exposed to acidic medium.
     Dentin and Cementum are other constituents of teeth but less strong than Enamel with less mineral content.

   Saliva is a substance secreted by the salivary glands like the Parotid gland, Submandibular gland, Maxillary glands and is alkaline and helps in maintaining alkaline medium in the mouth, which protects the teeth and also helps us in swallowing (deglutition ) of food.

 Thus, for infection of the teeth to take place, its essential that Enamel is broken down or weakened, which is greatly facilitated by acidic environment in the mouth.

  The acidic medium in the mouth can be the result of low or faulty saliva formation, which decreases alkalinity of mouth and increases acidity of the mouth. The acidity of mouth can further be increased by the formation of lactic acid from carbohydrates entangled in the teeth by the action of certain bacteria like Streptococci, Lactobacilli, which are mainly responsible for the Dental caries.

   Though weakening of enamel by the action of acidic medium in the mouth is widely accepted as the basic mechanism for the formation of Dental caries but there are differing theories as regards how the actual bacterial invasion of the teeth takes place.

     My Dental caries theory is markedly different from others. I believe  that microscopic canals are first formed in the enamel due to the action of acidic medium in the mouth, which are sufficient to permit the bacteria to invade the teeth. Once inside the tooth, the bacterial action is catalyzed and the size of microscopic canals continue to increase until they become macroscopic and finally cavities are formed which are the hallmark of Dental caries.

  Once the stage has progressed from the macroscopic canals to tooth cavity, the tooth is largely Unsalvageable. But if proper treatment is started at the microscopic or even macroscopic canal level, the tooth can be salvaged and saved. Thus all efforts should be made to diagnose Dental caries early and treat it as well to prevent the formation  of macroscopic canals.

    First I will discuss preventive modalities. Prevention is simple. Never allow any carbohydrates to remain in the mouth after eating. Rinse your teeth and mouth properly with water even after the smallest feed.  After each feed big or small, take water (clean) in the mouth, rub it on the teeth with your fingers and between teeth and than throw it out. Repeat it 2 – 3 times or till such time you feel fresh in the mouth and make sure that no carbohydrate or food particles are entangled in your teeth.

   Brush your teeth at least twice a day, once in the morning and once at  bed time, with a tooth paste which produces enough detergent effect to take out the food particles from between the teeth. If the tooth paste is fluoride medicated, all the better.

     Much of the time these simple measures should be sufficient to prevent the formation of Dental caries. But due to overwhelming reasons Dental caries can develop or if it has already developed before you start practicing these preventive steps. For this I am prescribing a treatment for Dental caries which is both curative but can be taken prophylactically every 3 months or so.

           Capsule Amoxycillin 500 mg +cloxacillin   1 twice daily

           Tab. Metronidazole 400 mg 1 twice daily

                                                           X 5 days

For pain one can take Tab. Ibuprofen 400 mg 0r Tab Diclofenac 50 mg twice or thrice daily.

An alternative treatment is

    Tab. Ciprofloxacin 500 mg 1 twice daily

     Tab. Metronidazole 400 mg 1 twice daily

                                                                   X 5 days

If your weight is less than 45 kg, the Ciprofloxacin dose is halved to 250 mg twice daily for 5 days and rest as above.

There are good mouth washes available like the chlorhexidine mouth wash which can be tried for a week every 3 months as prevention and with above prescribed medication.

  Dental caries does not isolate itself to the mouth, bacteria from Dental caries foci can spread to the heart and can destroy the valves or even cause endocarditis. Thus all cases of Dental caries should be rigorously treated as prescribed above and preventive steps taken to prevent its development.

    Prevent Dental caries
     Treat Dental caries
     Prevent pain in the heart
      Enjoy a good kiss!

Copyright Tanvir Nebuchadnezar

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