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Dental damage, sequelae, and prevention.

DISEASE Caries and inflammatory periodontal disease are the most prevalent oral diseases, and both result from the activity of dental bacterial plaque. Plaque is a complex biofilm that contains various microorganisms and forms mainly on teeth and particularly between them, along the gingival margin, and in fissures and pits (figure 1). This biofilm adheres by a variety of mechanisms. If plaque is not removed regularly, the flora evolve, and plaque may calcify, forming calculus (tartar) (figure 2). Fermentation of sucrose and other nonmilk extrinsic sugars to lactic and other acids causes tooth decalcification and, with proteolysis, results in caries (decay)(figure 3). The main organism involved in this process is Streptococcus mutans. Caries is seen less commonly because of the protective effect of fluoride, but it is still prevalent in disadvantaged and deprived people, especially in preschool-aged children. Accumulation of plaque and a change in the microflora may also cause gingival inflammation (gingivitis). Gingivitis may progress to damage the periodontal membrane (chronic periodontitis) and lead to tooth loss. OTHER DAMAGE Trauma Trauma is common in sport, road accidents, violence, and epilepsy. It occurs mainly in men and boys and usually affects the maxillary incisors.